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July 1, 2015

Run and drop

Q: I work with a student who is a runner and has low cognition. I find it hard to keep him safe. He seems too cognitively impaired for picture exchange and he can run very quickly and will drop to the floor where you can't pick him up, he is too heavy. I am trying to keep everyone safe. Do you have any ideas?

A: I suggest you revisit your use of the visual schedule. Regardless of his perceived ability level, the team should begin by focusing on creating a system to teach him the order of events (what do I have to do, how much do I have to do and what comes next) thereby decreasing his stress over not truly understanding expectations. Teach him to be confident and comfortable with transitions by using the schedule system to communicate these basic expectations.

When thinking about your student falling to the ground during a transition, think about the whole fight or flight response. Now add a "fort" or escape response (fight, flight or escape). If someone is frustrated or stressed out by a situation and does not have effective communication skills to negotiate it, that person is likely to re-gain control by hitting out, running away or shutting down. Dropping to the floor is often a form of shutting down and if you think about it, it is more adaptive and preferable than hitting you or running away, so I would work positively with the falling to the floor. Take the fall as a communication effort and validate it. Avoid pushing through his resistance because you can actually push him to use a fight response.

One way to begin teaching the schedule is to have a schedule posted (using pictures and words) of the main transition events during the day (circle time, recess, snack time, work time, music, etc. anything that requires him to move). Using Velcro, have a picture representing each event next to its' mention on the schedule and a blank piece of Velcro next to the picture. Walk the child to the schedule saying "check schedule" while putting a laminated ? in his hand (with Velcro on the back). Guide him to the posted schedule with the least amount of physical guidance and with no words (except the initial "check schedule"). When you get to the schedule, hand over hand guide him silently towards to first picture on the schedule; help him put his ? next to the picture and then take the picture off. You can then say, "time for circle" and slowly guide him (and his picture) to the area of the room used for circle time. Have a receptacle (a strip of Velcro, a bucket, etc) for him to put the picture in prior to taking his seat.

After the group is over, hand him another ? and guide him to his posted schedule (with only a "check your schedule"). Repeat the same routine using the second picture on the schedule. Eventually, you will be able to give him a ? and he will independently go to his posted schedule to see what is next. This type of schedule has been used successfully with non-verbal 2 and 3 year olds, as well as older students who do not know how to follow a schedule.

If you use a visual schedule, and you clearly teach what is coming next, and he is still falling to the floor, think about the other reasons for the response. Obviously he does not want to go any further. Is he responding to panic? Are you going to the restroom and that last time a toilet flushed automatically and it scared him? Are you going to the library and the last visit the fire alarm went off? Are you going to the cafeteria and he either doesn't know what is on the menu or he doesn't like the choices? Assume there is a reason and the person needs more support to make the transition successfully.


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