Step 1 Deciding where to start
1)Archie sits very close to the TV
2)Archie is obssessed with his computer games, he screams and lashes out when it’s time to turn off the computer games
3)He is uninterested in people except sometimes his mum and sister
The priority was to try to limit his screen time as this was having the most impact on his life, and this was felt to be easier to change than number 3).
2) was also important in the longer term but not in the short term.
No 1 and 2 were selected as the most important behaviours to focus on
Specifically: (this goes in the tip of the iceberg)
Archie screams and lashes out at his mum when it’s time to turn off his computer games
When home from school he goes straight on his games, and he won’t play with any other toys now
Setting- home, arrives home from school, hungry? A bit tired. Living room, lots of toys out overwhelming?
Triggers- seeing the TV/games console always available when he comes home
Results – when mum tries to interest him in toys, he pushes her away; if she takes the remote away from him he screams and lashes out, she gives up. The demand is avoided.
Step 5: Why? What is the meaning of Archie’s behaviour from his point of view?
Archie is tired and hungry; this makes him more irritable and less tolerant
Archie is anxious about people as he cannot predict them; there are no social demands in computer games. He prefers to be in control to reduce anxiety, and the computer games are predictable
His behaviours (screaming and lashing out) are rewarded with getting to play on the games, so the social demand is avoided. He does not understand hitting hurts other people, he cannot put himself in their shoes
Because of his inflexible thinking, he has difficulty choosing- and there were too many toys out to be able to choose what to play with
Having the toys out all the time made them boring, not exciting enough
Step 6. Prevention for Archie
Give Archie something to eat or drink as soon as he gets in
Change the environment- remove the computer games from sight in the living room and organise all toys away into boxes, enabling his mum to take only one thing out at a time and make the focus of the interaction.
Step 7: Replacing Archie’s behaviour with new skills (What do we want him to do instead?)
Archie was allowed his computer games but only at a set special time, for set amounts of time (using a timer). At the same time Archie was taught to sit on a coloured carpet square a certain distance from the screen.
His mum got out one toy at a time. She selected things to do which could involve a routine of taking turns, to make it predictable, eg. turn taking building with bricks. This was put away at the end before getting another toy out.
Eventually Archie chose out of 2 alternatives using visual supports to aid his choice. His mum also bought him a trampoline for the garden and Archie spent more time outside with his sister.
Step 8: Change the results for Archie, and encourage behaviours we want to see.
His mum completely ignored the tantrums and protests about the computer games ending. Archie’s play skills and communication skills improved a lot as his screen time reduced, and he got more enjoyment from the interactive games with people which brought its own rewards. Archie's mum gave lots of praise and hugs for joining in games