Behavior Management Plan for FASD

Written for:
10-year-old boy
Fetal alcohol effects
Self-contained special-education class
One-on-one aide
By Terri Mauro


Overview of Behavioral Issues Associated with Fetal Alcohol Effects

Specific Behavior Plan for [child]
I. Create rules that target specific behaviors.
II. Provide constant positive feedback when rules are not being broken.
III. Provide immediate, unemotional time-outs when a rule is broken.
IV. Adjust the environment to make it easy to follow rules.
V. Assess effectiveness of plan on a regular basis and make adjustments.

Overview of Behavioral Issues Associated with Fetal Alcohol Effects

In working with [child] and managing his behavior, it will be helpful to understand a few things about fetal alcohol affected brains:

• For most of us, the part of the brain that has impulses and the part that knows the rules are in constant easy communication. So we have an impulse to do something, we check it against what we know to be acceptable rules of behavior, and we make a conscious choice whether or not to break a rule. But in fetal alcohol affected brains, the connection between those two areas is faulty or missing. So the child has an impulse to do something, and by the time the part of the brain that knows the rules is even aware of the impulse, the action has already taken place, and most likely somebody is already yelling at the child about it. So you can have a kid who knows the rules, wants to follow the rules, is upset about breaking the rules, yet still breaks them. At the moment of action, he’s working purely on impulse.

• And since impulsive behavior is almost by definition without reason, asking a fetal alcohol affected child why he did something and not taking "I don't know" for an answer is pretty much insisting that he lie. They don't know why they do it. They may not even know what they did. So you'll either get gobs of denial and defensiveness, or you'll get a spontaneous excuse that defies credulity. Imagination and creativity are some of the positive attributes of people with FAE, but when they're used in service of getting out of trouble, they usually result in a tall tale that makes matters worse.

• Social and emotional development lags way, way, way behind in people with FAE. Teens and young adults with FAE often have an emotional developmental age of about 6. So with an elementary-school-aged child, you have to figure they may be working at a toddler stage at best. You have to adjust everything to that level -- expectations, supervision, privileges, rules, discipline. People with FAE tend to be verbal well beyond their level of understanding, and it may be tempting to assume that that clever and talkative child is able to understand social rules at a much more sophisticated level. It's a mistake.

• Stress makes things worse. A confusing thing with FAE kids is that sometimes they seem to be able to do things and sometimes they don't, and it's natural to assume that that indicates willfulness. But in fact their ability to control their behavior declines in proportion to the amount of stress they are experiencing. This can be obvious stress -- a noisy place, difficult schoolwork, disruptions of routine -- or less obvious, particularly in kids with sensory integration problems who react to things in the environment the rest of us wouldn't even notice. Sometimes the loss of control happens well after a stressful event -- if a child uses up a lot of resources getting through something hard early in the day, he may run out of control late in the day.

Because of these relatively unchangeable facts of an FAE child’s life, strategies that rely on self-control and presume willfulness; that require an advanced level of maturity and responsibility; or that increase the level of stress will be ineffective at best and may in fact escalate bad behavior. These may include:

• Negative consequences.
• Big positive consequences.
• Escalating consequences.
• Nagging to stop behavior.
• Pressure not to break rules.
• Abstract rules like “Be respectful.”
• A choice offered between compliance and negative consequence.
• Behavior modification

On the other hand, strategies that do not presume control; that don’t put undue weight on behavioral slip-ups; that are suited to the child’s level of emotional maturity; and that decrease the level of stress will be more effective, and at the least will not escalate bad behavior. These may include:

• Positive consequences, on a modest scale, delivered immediately.
• Distraction from misbehavior.
• Brief time-outs, delivered consistently and matter-of-factly.
• Changing of environment to make success more likely.
• Behavior analysis to assist in changing of environment.
• Constant positive feedback and encouragement.
• Specific rules like “No hitting.”
• Choices in which both options are acceptable to adult.
• Behavior management

Specific Behavior Plan for [Child]

I. Create rules that target specific behaviors.

• Translate abstract classroom rules into five or six specific directives targeted to [child]’s particular needs. For example:

NO pushing, poking, hitting, or grabbing.
NO hugging or kissing in school.
NO interrupting the teacher.
NO leaving desk without permission.
NO using mean words like “stupid” or “shut-up.”

• Post the rules where [child] can see them, possibly taping them to his desk.

• Only include items in rules that you will be willing to reinforce with a time-out whenever the rule is broken. Avoid things that are likely to recur with such frequency that he would be in time-out constantly, such as finger-sucking, jumping, messy writing or standing up at desk.

• You may want to include at least one rule that [child] has little trouble keeping, so that he has a constant experience of success and control.

II. Provide constant positive feedback when rules are not being broken.

• Using the rules above: If he passes anywhere near another student without touching them inappropriately, comment on how well he followed the rule. If he goes five minutes without interrupting, comment on it. If he stays seated for even a few minutes, announce that you like the way he’s sitting. Tell him you like the way he’s talking when he chooses words thoughtfully.

• If you see him about to break a rule, jump in and distract him with a positive comment like: “It’s really hard to sit still, isn’t it? I see that you’re really trying. It’s great that you’re trying your best.”

• Augment the positive feedback with neutral statements indicating that he’s being noticed in a non-negative way any time he is following the rules. Comment on the pencil he’s using, the clothes he’s wearing, the story he’s writing, the number of problems he’s done.

• Do not expect or require a verbal response from him for the positive statements. Improved behavior will be his response.

III. Provide immediate, unemotional time-outs when a rule is broken.

• Say something along the lines of, “Oops, you interrupted. Go sit, please.”

• No nagging before and no discussion after the time-out. He does his time and emerges with a clean slate.

• Keep the time-outs brief to reduce resistance. At home, as little as 20 seconds has been successful in changing behavior. In the classroom, a minute should be sufficient. It’s not a punishment so much as an acknowledgment that a rule has been broken, and a break in the action to get himself together.

IV. Adjust the environment to make it easy to follow rules.

• Children with FAE need an “external brain” to help them with judgments and adjustments they cannot make on their own. It is the job of adults who are working with [child] to constantly monitor his reactions and his environment and arrange ways for him to be successful and unstressed.

If inappropriate physical contact is a problem:

• Put [child] at the front or end of any line.
• Give him tasks to do in the classroom as other students are leaving (e.g., turning out lights) so that he will naturally be last in line.
• Try to steer him to areas of the classroom or other room that are not crowded.
• Provide physical barrier between him and other students if he seems to be struggling to keep his hands to himself.
• Offer distraction if he seems to be struggling to keep his hands to himself.

If staying in his seat is a problem:

• Allow him to stand up while doing work.
• Provide frequent movement breaks.
• Provide lots of distractions and motivations to keep him on task.
• Consider providing him with a larger working space at the back of the room so that he can move around without distracting other students.
• Consider alternative seating options such as an exercise ball.
• Consider allowing him to work on projects in a more hands-on way, with less seat work required.
• Use movement as a reward for completing small amounts of work.

If interrupting the teacher is a problem:

• Give him written information about what will be happening on a particular day so he can follow it without questioning.
• Allow him one question every five minutes, or when he’s completed an allotted portion of work.
• Have him write questions in his notebook and present them at an appropriate time.
• Provide distractions when he seems about to interrupt.
• If he’s compelled to interrupt in the disciplining of another student, use distractions or removal to another part of the room or school to keep him from noticing or becoming involved.

If completing work in a cooperative manner is a problem:

• Give him a checklist of work he must complete so that he can keep track visually.
• Consider putting all worksheets to be done that day in a folder and allow him to choose what to do.
• Provide motivating rewards for small increments of work completed.
• If work is completed quickly, allow him to move on to a more enjoyable activity like computer work, reading, even looking out the window.
• If the appearance of a worksheet is overwhelming, fold it or use a piece of paper to block out all but one or two questions. Give a reward after these are completed.
• Allow verbal answers instead of written if that keeps him going.
• Allow him to pick a new writing utensil before starting a new worksheet.
• Send home uncompleted work as homework rather than making an issue of it at school.

If misbehavior appears to be escalating:

• Do behavior analysis to try to determine what might be causing stress. Possibilities include: disruption of routine; substitute or absence of adult in classroom; assemblies or periods in mainstream classroom (Spanish, art, music); difficult work; lots of fine motor work; overstimulation at recess; noisiness; boredom; lack of movement.
• If the circumstance that is causing the stress can’t be changed, strengthen all other supports, increase the number of positive or neutral statements, break work into smaller units for rewards, and lower academic and behavioral expectations for the day.
• Keep track of what seems to cause problems and prepare in advance for future occurrences. If possible, send word home in advance of schedule changes or absences so that [child] can be prepared.
• Talk to [child] about what you think may be causing him to lose control. “You seem to be having a hard time this afternoon. I think maybe you used up all your control sitting still at the assembly this morning. Let’s try to pull you back together.”

Maintain a “bag of tricks” to be used as motivation, reward, or distraction from misbehavior.

• Have as many high interest or highly distracting items or ideas as possible so you can keep trying until something works. Some things that can be used to motivate and/or distract [child] when necessary are:
Car magazines (freebies from supermarket)
Shopping cards
Writing or drawing in notebook
Toy cars
Hard candy
Game where you join dots to make squares
Different pens
Looking out window
Asking a question
A surprising or silly statement
Whispering a secret in his ear
Taking a walk
Getting a drink
Pushing hard against his hands
Reading a book
Choosing what to do next

• Keep adding ideas to the list as you find things that work (or as [child] asks to do things -- use those as rewards/distractions).

V. Work with parents to assess effectiveness of plan on a regular basis and make adjustments.

• Send daily behavior report home (parent will provide form).

• Parents will include school behavior in daily “credit review,” in which [child] can earn points for privileges.

• Share with parents what seems to be working, and seek advice for what doesn’t.

• Include on report any stress-inducing occurrences that may have affected behavior.

• Meet with parent regularly to discuss behavior that is causing a problem in the classroom and develop management strategies.

• Re-evaluate the rules from time to time and adjust them to reflect [child]’s changing behavioral challenges and triumphs.

• Take advantage of materials on Fetal Alcohol Effects and other behavioral resources available from the parents. These include:

Fetal Alcohol Syndrome, Fetal Alcohol Effects: Strategies for Professionals by Diane Malbin

Fetal Alcohol Syndrome by Anne Streissguth

“Teaching Students with Fetal Alcohol Syndrome/Effects” from the British Columbia Ministry of Education

Transforming the Difficult Child: The Nurtured Heart Approach by Howard Glasser and Jennifer Easley

Steps to Independence by Bruce L. Baker and Alan J. Brightman

The Challenging Child by Stanley Greenspan

Regarding "Baby Picture" Assignment

Written for:
Child in kindergarten
Adopted from Russian orphanage at age 27 mo.
Reader Submission

I received the note you sent home with [Child] this morning regarding your teaching the children about families and how they grow and change. I must admit that I am disheartened by the fact that such an assignment would be requested and that you are asking the children to bring in baby pictures. I have had two children already attend [school] and I was grateful this type of assignment was never issued. I had hoped the educational guidelines regarding family photos or family tree assignments had already been addressed. I assumed incorrectly and hope to enlighten you a little on this topic.

The problem with all of these types of assignments is that there are many children who simply cannot complete them, for any number of reasons, not just adopted kids without baby pictures, as is our situation. Kids in foster care, kids with parents in crisis, kids whose families can't afford to take pictures, etc. all may be unable to provide pictures or say "where" they came from, or simply may not want to share that information. To ask some families to do this type of assignment is cruel and insensitive, and as an adoptive parent, I try do everything I can to educate others about that perspective. For example:

What do you say to a kid who is in foster care, who has been going from house to house for several years? How does that child furnish baby pictures, or tell about his/her parents?

What do you say to an immigrant family who has come to America with very little, who is surviving right now on the help of strangers?

What do you say to a family who has multiple parents or to a family on welfare who has never taken pictures, or to a family going through a bitter divorce or custody case?

What to you say to a kid whose family can't afford food or sufficient housing, let alone a baby picture? Pictures are a luxury. So are magazines to even cut out a "pretend" picture.

The basic problem is that insensitive assignments put children in a situation of providing information that is (a) private and/or (b) potentially impossible to have. Yes, you could always make up stuff, or fake a picture, or whatever -- but then you are the odd one out. When a teacher (or anyone) makes a child feel "different" that way, "different" is usually a negative.

I ask you to consider a different methodology of teaching this unit. For example, I have copied the below from the website

The assignment: Bring in a photo of yourself as a baby

The bias: This excludes children who might not have a baby photo -- foster or adopted, immigrant children or children whose families have no camera. If the object is to match a baby photo with a child today, children who are a visible minority are eliminated early from the fun.

Achieving the goal: To illustrate growth and change, bring in a picture when the child was younger or smaller. To describe a child, bring in something else to tell us more about her -- a book, a trophy, a pet. To test reasoning ability, bring in a picture of someone we all know, or describe yourself with three clues, adding one a time until someone guesses correctly.
I will be able to provide a picture of [Child] at the age of approximately 27 months, and I am sure the other children will never notice that this is not a baby picture. But if this assignment had been given to my other children, both adopted at age 7 years, they would not have been able to bring any pictures. I am bringing this to your attention as I am sure you have probably not thought of this angle.

I know of many other websites full of information on this very subject. Please feel free to contact me for any other information. In the meantime, if you could submit a change in this assignment to the parents, it would be greatly appreciated.

copyright (c) 2003 by Kelly Trainor

Recommended Modifications

Written for:
12-year-old girl
Adopted from Russian orphanage at age 4.5
Learning/language delays
Mainstream class two years behind age group
Instructional aide
Preparing IEP for middle school
By Terri Mauro

• Reduce number of choices on multiple-choice tests. Skip or rewrite questions with ambiguous wording or trick answers.

• Allow essay tests to be either started (outlined/organized) or finished at home.

• Provide set of textbooks for home study.

• Furnish a weekly list of vocabulary words in appropriate subjects. These can be in the form of flashcards or a list. Share vocabulary list with speech therapist.

• Provide photocopied version of textbook pages with important material highlighted.

• Provide an outline of the main ideas and vocabulary words for each unit.

• Offer supplementary materials that coincide with the text at an easier readability level.

• Help student organize her ideas before writing with graphic organizer or outline.

• When working on classroom reports, allow student to use a fill-in-the-blank form.

• When writing research papers, assist student in the formulation of topic sentences.

• Send home detailed information on assignments so parents and tutor can provide appropriate assistance.

• Consider using techniques and materials appropriate for ESL students.

Observations on How [Child] Learns

Written for:
11-year-old girl
Adopted from Russian orphanage at age 4.5
Learning/language delays
Mainstream class two years behind age group
Instructional aide
Start of school year
By Terri Mauro

Four Observations About How [Child] Has Learned

1. She has learned at pretty much the same pace whether she’s had a lot of help or a little help. She has always made forward progress in whatever program she was in, and that progress has been remarkably steady. There were no great leaps forward when she was in a self-contained class with intensive help for her learning problems, and no great falls back when she was in a mainstream class with little individualized assistance. Programs we have pursued to try to accelerate her abilities in reading comprehension and language acquisition have also had very minor effect. She learns at the rate she learns, and considering her background and challenges, I’d say she’s doing a pretty good job for herself. All things being equal, then, I’d prefer she get as little help as possible.

2. She is motivated — but not necessarily to learn. She is motivated to please grown-ups. She is motivated to keep up with what her classmates are doing. I do not believe she is motivated to learn a specific lesson specifically for the sake of learning it. It may seem that way sometimes, but I think it is more a case of her reflecting the enthusiasm and excitement of the person who is working with her. It may take a while of working with her to realize this. But it is absolutely essential to understand this about her, because it means that she will only work as hard as we expect her too. If we are willing to settle for less, she will be only too happy to provide it. On the other hand, if we challenge her, she will make an effort. She may not be able to consistently succeed at it, but she will be willing to try.

3. She has some very marked strengths which can provide her with positive classroom experiences. These include spelling, penmanship, math facts, rote memorization, and organization. Last year, her teacher mentioned that [child]'s classmates were impressed by her ability to come up with multiplication facts quickly. Many children have remarked on her good handwriting, and more than once we have had phone calls from kids wanting to know about the homework because they know [child] always has it written down and has it done. I believe it has helped her socially to be able to show mastery in some areas, and it also helps her self-confidence to be reminded, when struggling with tasks that are hard for her, that there are indeed things she does very well (and other kids don’t). We talk a lot about everybody having strengths and weaknesses.

4. Her weaknesses are very clearly tied to language. Anything having to do with getting knowledge out of language or showing knowledge through language will be difficult for her, and that includes reading comprehension in all subjects, math story problems, writing, and anything abstract. It is important to note that although she has very obvious and consistent struggles in these areas, she is making progress. She is doing more difficult work in all these areas than she was able to do a year ago. She can, from time to time, do quite decently in them. When she does most poorly, I think, is when there is a double degree of difficulty: She has to not only get the meaning from the lesson, but then must also get the meaning from an obscurely worded question. This will, of course, happen more frequently as she goes forward in school; however, I have hopes that her abilities will follow along, always somewhat behind but allowing for consistent improvement.

Five Things to Keep in Mind About [Child]

1. She likes to know what to do. And she is at her most insecure when she does not. I believe this is a legacy of her 4.5 years in an orphanage, when she never had to make a single decision on her own. Adults always made it clear what she was to do in any situation. She loves routine. She will be the child in any classroom who always knows what specials come on which days, who’s getting pulled out for what when, what book to have out for what subject, and what the usual way of doing things is. She will know these things better than anybody else, and yet she will still ask, just to make sure, just to tap that touchstone. And the same thing is true of her schoolwork. She will want to know exactly what to do. She will not want to make any mistakes. If there is an adult available to tell her what to do, she will seek to get as many details and as much help as possible. She may in fact know exactly what to do, but if she can get someone to tell her, she will. We can help her by directing her to trust her own interpretation of things; when she asks, “What should I do?” say, “What do you think?”

2. Her self-esteem is fine, thanks. Unlike many children in special education or with learning disabilities, [child] has not had the experience of failure. She started right in with self-contained special-ed in preschool, rather than failing in a mainstream program and being placed in self-contained. Her experience in mainstream classrooms has been positive. The children have been accepting, the teachers have liked her, and while she has sometimes described the work to me as hard or boring, she has never seemed to feel overwhelmed by it. Consequently, I think we need to interpret her periodic expressions of frustration or reactions to stress not as potential crises of self-esteem but as, well, expressions of frustration or reactions to stress. She may, on occasion, pretend to bop her head, roll her eyes, sigh, call herself stupid, or even tear up. I have been known to do these things when confronted by a hard problem or a poor response of my own. I’ll bet most of the people working with [child] have, too. I honestly do not think, in [child]’s case, it is anything more than that. She does not hold things in, and that is good. Reassure her, point out her strengths, reaffirm your patience, and move on. It is not a signal to back off, or make things easy, or head off any possibility of failure.

3. Always watch your language. It is impossible to overstate the degree to which [child]’s language delays impact on her learning abilities. There’s a phenomenon observed in language acquisition called subtractive bilingualism, by which a child learning a second language completely loses her first language before gaining any mastery in the second. This is what generally happens with children adopted from foreign countries, and it’s what happened with [child]. Instead of building a second language on top of the firm foundation of a first language still being spoken in the home, which is the case with most ESL kids, foreign adoptees generally lose that foundation altogether, and often, because of early deprivation, didn’t have much of a foundation to begin with. As a result, these kids are showing major delays in the acquisition of language as a basic communication tool, and an even more extended delay in the ability to use language as a tool of academic learning. It will likely take well more than seven years for her to achieve full mastery in this, although I believe that one day she may be able to do it. Until then, if [child] doesn’t understand something, it is not necessarily because she does not understand the underlying concept, but because she does not understand the language being used to convey that information, or to elicit it from her. I've had some success with rephrasing things; using examples out of her own experience; or drawing a diagram or chart to make abstract things more concrete. I have had no luck with hammering the same language home again and again.

4. She already has one enormous modification in place. If we were trying to help [child] survive in a sixth-grade classroom with children her own age, I would be writing a very different letter. But she is in a fourth-grade classroom, two years back, and this should to some degree compensate for her delays. Testing has shown her to be in the general vicinity of this age level in most areas. I have no desire for her ever to work at her own age level, but I do think that she can work at this one, with passing if not spectacular grades, without further modifications. There are certainly things that can be done to increase her strengths and mitigate her weaknesses, but I want to know that when she gets a grade, she has earned it herself, and that she has had as much exposure to and opportunity to learn every element of the fourth-grade curriculum as any other student. I would like us to think of her as a fourth-grade student who is keeping her head above water, and not as a sixth-grade student who can barely do fourth-grade work.

5. She is a tough kid. And a sweetheart, absolutely, and a child you want to keep happy so you can keep seeing that smile. It may seem at times that she needs to be protected or else she will fall apart. But please, if you remember nothing else, remember this about her: This is a child who at age 4.5, left everything that was familiar to her and went with strangers, in three vehicles she had never ridden in before (car, train, plane), to a place she had never seen, to live in something called a family which was completely foreign to her, to cope with a language she could not understand, food she’d never eaten, sights and sounds and experiences that were more unfamiliar to her than we can possibly imagine. And she did all this with a smile on her face, and never looked back. She has adjusted remarkably well. She and I talk often about how strong she is: how everyone thought she was going to die when she was a baby, but she made it through and grew into this beautiful, tall, strong, healthy girl; how she survived a transition more severe than any her classmates have even imagined going through, and has gone on to do so well for herself. In light of what she has already thrived through, I don’t believe that any amount of challenge in the classroom is going to “destroy” her, as one child-study-team member put it in the past. She is much, much tougher than she looks. Use that.

Four Concerns About How Much Help Is Too Much

1. It is absolutely possible to make things harder for [child] by trying to make them easier. It all goes back to that language thing: If she can’t make sense of the language you’re using to explain something, you are adding degrees of difficulty. I notice this all the time in the math homework, when the text tries to teach “tricks” to do math more easily. [Child] will be able to do the math just fine without the trick, but the language used to explain the trick gets her so tied up in knots she will not have the first clue how to proceed. I thought of this when [the aide] worried about [child]’s ability to divide because she didn’t know how to put 2 into 4. Now, I can guarantee that if you wrote 4 divided by 2 with the standard symbols, [child] could do that problem. But the language of asking for that result distracted her. Sometimes this difficulty with the language of help makes her appear to be more needy than she actually is. And then more help, more layers of language, will be piled on. And the estimation of [child]’s ability will go down with each layer. I have seen this cycle before. I do not want to see it again.

2. Help shifts [child]’s focus. When someone sits down to help [child] answer a question, her focus may shift from finding the answer to the question to finding the answer the grown-up wants her to find. She wants to please, and so she starts throwing out answers. These are often wildly, obviously wrong. Again, this does not necessarily mean she doesn’t know the answer or cannot do the work; it means she is no longer trying to solve a problem with a specific answer that can be figured out, but is trying to read your mind. The best method I have found is to let her do the work, and then go back and discuss specific wrong answers with her. Working with her from the start often results in guesswork or helplessness.

3. Help gives too much away. I have no problem with [child] getting help that strengthens her skills and overall ability so that she can do the same work as everyone else. I also feel that that kind of help is very hard to give. It is much easier to give help that gets her through particular assignments and tests by essentially giving her the answers. I freely admit that when helping her with her homework, I am more than likely to give the second kind of help. That help is not useless; she doesn’t learn anything by getting answers wrong. But it’s not what she really needs, and I would like to hope that educators will know better ways to help than I. At any rate, I would rather she have a level playing field, with normal expectations, at school, and have us adjust our expectations at home. At this point, what I expect is an A on spelling tests; C or better on concrete math and vocabulary tests; D or better on things that involve reading comprehension and writing. I expect her to do better with multiple choice and math facts than with written answers. By the time we go through her test folder, I have a pretty good idea of what she knows, and if she doesn’t show that on the test we talk about it. But [child] generally knows what I’m expecting, and has her feelings of success and failure based on that. If at the same time less is being expected of her in the classroom, if the aide is helping her to get an A when she would have gotten a C on her own, then I have to inflate my grade expectations. But I’m not sure how that helps her.

4. At some point, there will be no help. We have to foster independence in [child] if she is going to have any sort of normal life. She is happy to have help, and will take as much of it as she can get, and will swear she needs it. But fostering her dependence does not help her in the long run. Everything we do, every step of the way, has to be with the goal of letting her do it herself. She will always have to deal with confusion and things she doesn’t understand; I want her to have an arsenal of ways to deal with that that do not all involve somebody helping her.

Accommodations Requested

Written for:
Boy age 14
Freshmen in high school
Mainstream classroom
Reader Submission

[Child] has documented problems in the following areas that impact his learning:

• Difficulty in reading and writing comprehension
• Learning disabilities in expressive language skills (written and verbal)
• Short-term memory deficits
• Learning disabilities in organizational skills
• Delayed language processing times
• BiPolar Disorder and Central Auditory Processing Deficits

We therefore request the following accommodations be made:

1) [Child] should be strongly encouraged to use his Assignment Notebook. Actively and continuously teach [Child] note taking, organizational, and study skills. This should include test dates, specific assignments or class work, extra or additional classes, labs, lessons, tutoring sessions, etc. Any missing work or assignments should be noted in his assignment notebook.

2) Provide study sheets or study guides at the beginning of each class period (such as a copy of any overheads to be used), because [Child] has difficulty taking notes and processing information while listening. A photocopy of the teacher's lecture notes may be all that is needed. In some situations a note taker may need to be provided. Study guides for final exams need to be given to him at least a week in advance (2 weeks preferred).

3) All assignments are to be in clear written form, on an assignment sheet he can take home. The only exception would be a short assignment written out in clear form, with time allowed to copy it accurately and verified by the teacher or study-buddy.

4) Assign [Child] preferential seating, near good role models, preferably second row, center. Allow him to move to a study corral, or to move his desk away from distracting areas and kids. Assign [Child] to group projects with good role models, or allow him to work on a modified version on his own.

5) Do not surprise [Child] with questions that require an immediate response. No pop quizzes. He does not process thoughts (expressive language) well when surprised.

6) Allow [Child] the use of a computer for any assignment, test, or project of more than a few written sentences. Allow him the use of a calculator for all math problems.

7) [Child] will be allowed untimed testing and to take tests in a distraction free setting. Allow [Child] to use scratch paper or to work directly in test booklets. (I leave this to you and [Child] to decide when it is necessary.)

8) Grade [Child]'s tests on subject area only. Tests should be typed, clear and easy to read. Do not mark down his grades for grammar, spelling, neatness, etc. unless the testing is specifically for that subject area. For example: grammar counts on a grammar test. (Correcting these areas are fine, and very helpful, just don't reduce his grade.)

9) Provide a duplicate set of books for use at home.

10) If [Child] is missing materials for class allow him to gather what he needs without penalty.

[Child] has trouble with social immaturity and "cluelessness," and may respond inappropriately at times. It is best to intervene early, when trouble first appears. Please be careful not to embarrass or humiliate him, especially in public.

Any staff member who has ongoing contact with [Child] needs to be made aware of these disabilities and accommodations, as well as others who may impact his behavior or grades.

If you need further information on BiPolar, CAPD or any of [Child]'s disabilities, we have plenty of information we would be glad to share, including web resources, book lists and handouts.

A weekly update of both behavioral and academic status should be emailed to parents.

copyright (c) 2003 by Kelly Trainor

Helping [Child] Behave

Written for:
8-year-old boy
Fetal alcohol effects
Special needs summer camp
Suggestions at start of session
By Terri Mauro

There are three key factors to keep in mind when considering how best to manage [child]'s sometimes disruptive behavior. Since [child] will have an individual aide, I'm hoping that some of this information can be incorporated into his camp experience without taking attention away from other campers. I think it will help everybody have a better time.

Fetal alcohol effect: By the very nature of this disorder, [child] is not able to consistently control his impulses, use cause-and-effect thinking, or consider consequences. When he is calm and not stressed, he may be able to do these things with varying degrees of success, but as his stress level increases -- due to the other factors listed below, due to transitions, due to disruptive behavior of other children, due to discomfort with what he is being asked to do, due to rising disapproval of adults -- his ability to control himself will very predictably decrease. If a stress-causing factor is unavoidable, then you MUST expect and be prepared to deal with increased impulsiveness and decreased regard for consequences from [child]. It is not willful disobedience on his part. It is brain wiring.

It's been helpful for us to realize that fetal alcohol exposure damages the Corpus Callosum, which normally connects the left and right sides of the brain and allows instantaneous communication between the two. If that part of the brain is damaged, as it is in people with FAS/E, that communication is slow, faulty, or nonexistent. Rules are stored in the left brain, and any behavior modification that focuses on rules and consequences will only reinforce that left-brain storehouse. Unfortunately, however, impulses come from the right brain. Ordinarily, we are able to have an impulse, instantly check to see if it's alright to follow it, and act accordingly. We can make a split-second decision whether the pleasure is worth the risk. But a person who does not have that ability to communicate between the two sides of the brain can know the rules, desperately want to follow the rules, want to please and avoid negative consequences, and yet still break the rules, because when the impulse comes there is no way to access the information that would stop it. By the time a child like [child] remembers he didn't mean to do something, he's already done it, and people are already angry.

That anger, and branding impulsive behavior as "bad behavior," can start a child on a cycle of low self-esteem, and push them to the point of really not caring one way or another. When you screw up whether you mean to or not, there's not a lot of incentive to want rewards or fear consequences. It must seem to them like what's going to happen is going to happen whether they want it to or not. This, in turn, is thought to be responsible for the high rate of delinquency, drug abuse, criminal activity, and mental-health issues that plague FAS/E victims as they get older. The secret to avoiding these "secondary disabilities" is understanding that the child has brain damage which causes him to be unable to control his behavior, and not blame, shame or punish. What seems to work better is to prepare for better control before the behavior occurs, by changing the circumstances in which the behavior is most likely to occur, and then provide positive consequences for positive outcomes while ignoring negative ones.

Sensory integration disorder: [Child] receives inadequate stimulation and input from his proprioceptive and vestibular systems. Briefly, the proprioceptive involves the awareness of the body's position in space, and vestibular involves a sense of balance and gravity. In order to increase his inadequate information in these areas, [child] needs to move. This is what all the jumping, stomping, bending, rocking, finger-sucking, head-swinging, crashing, and banging are about. He needs extra-hard input, and he needs it constantly. If he doesn't get it, he cannot remain alert to what is going on around him. With the movement, he is able to pay attention, even if it looks like he isn't (ask him a question and you'll see). This is a child who literally cannot "sit still and pay attention." He may be able to do one or the other, but not both.

Think of it in terms of the way you feel when your foot's asleep. Imagine the worst, most painful, most tingly sleeping foot you've ever had. Now imagine that you have been forbidden to stomp on it or do anything to ease those pins and needles. Could you sit for a prolonged period of time and never slip, never stomp? And if you did, would you be able to concentrate on anything other than the pain in your foot and your overwhelming desire to move it? If the forbidding of foot-stomping continued, would you at some point decide that no punishment and no reward were more important than your overwhelming need to ease the tingling? That, I think, is what it feels like to be [child].

As much as you possibly can, within the context of these two months of camp, I think you will do best to allow [child] his movement. If it distracts the other campers, perhaps he and his aide can move into a position a bit off from the group where it will be less disruptive. At the very least, give him movement breaks every ten or fifteen minutes. And during stressful periods -- such as transitions, crowded places, noisy surroundings -- be particularly expectant, tolerant and facilitating of his need for hard input. Some of that need may be reduced by massages, hand-squeezing, foot-squeezing, palm scratching, pushing against someone's hands, and similar sorts of input.

Low muscle tone: This also figures in to [child]'s need to move, and the sometimes wild and uncontrolled nature of his movements. Muscle tone involves the ability of the muscles to hold the joints in place. It is not the same as muscle strength; if you've ever struggled to make [child] do something, you'll know that he's plenty strong. But he's very loosely strung, like one of those puppets where you press the button on the bottom and the whole thing goes limp. Because of this looseness, it is hard for him to keep his body upright without momentum. This accounts for his often headlong pace when walking. It also contributes to his need for movement, because it is physically difficult for him to be still. You'll notice that even if he does put forth the effort to be still (and this detracts from his concentration on anything else, as above), he may sway somewhat, and if he has to sit without support, he will usually flop onto the ground. It is a great deal of work for him to be still and upright, and putting forth that effort will adversely affect his levels of concentration and stress.

The low muscle tone also hinders fine motor skills (can't get a tight grip on a pencil or fork) and gross motor skills (can't balance on one foot, which is a part of many, many more complex movements). This and the sensory-integration problems also cause a problem with motor planning -- with poor information coming in to his brain and poor performance of his muscles, it may seem impossibly hard for him to figure out how to sequence a series of movements. Because he can't articulate the problem, he will try to avoid the action, whether by going limp and complaining of fatigue, or trying to talk his way out of it, or misbehaving so as to be removed from the activity. This is another situation where it can help to stop and analyze what he might be trying to accomplish by the behavior, and perhaps stop the activity that is causing him trouble, modify it, or break it into smaller pieces.

None of this means that you have to let [child] run wild, just that things will go easier if you do the thinking when his brain gets stuck on something. We are certainly trying to move [child] to a point where he will be able to do some of this himself, but he is not there yet. Talking through our thought processes -- as in, "I can see by the way you're acting that this is hard for you. Do you want to try this instead?" -- will help in the long run, I think, although he may not always respond appropriately at the time. He needs to know that somebody understands and knows what to do. He tries very hard to cope by himself, but his coping mechanisms are immature, disruptive, and sometimes just make people mad at him. We can offer him other options.

In addition to the ideas above and in the enclosures, here are some specific suggestions:

• If you need to keep [child] from misbehaving before the fact, or break him out of a stuck behavior, some things to try are: distraction (perhaps by talking about cars), humor (saying something silly or acting silly will usually get his attention), or physically taking his hand or touching his shoulder and guiding him where you want him to go.

• The absolute best, nearly always effective positive reward for [child] is letting him play with keys. I realize that there is some concern that keys are not a productive plaything for him, but I do not believe that is so -- and, more importantly, camp is a "whatever works" situation and I am less concerned with breaking what may seem a bad habit than in getting him through these weeks in a positive, nondisruptive way. If the people working with [child] don't want to share their keys, we will send some in; but he will always be more interested in keys that belong to people and have specific vehicles or purposes behind them. Besides being a motivator, keys are also a very calming object for [child] and may help him sit still when necessary. If you refuse to use the keys with [child], you are throwing away the one invariably powerful motivator for a child who will suffer almost any consequence to keep what he sees as control. Please don't.

• Related to the keys, cars are also a useful object of interest and motivation for [child]. If you need him to do something particularly difficult, and will be walking by the parking lot in the next transition, offering to let him look at somebody's car may be a sufficiently motivating reward.

• As much as possible, ignore [child]'s poor coping mechanisms while suggesting better ones. For example, he has a habit of declaring his desire for negative consequences: If you say, "[child], stop that or you'll have to leave the room," he'll say, "I want to leave the room" -- even though it may be clear that he wants no such thing. He can't control his behavior, but he can control the spin. Calling his bluff in these situations does not seem to change the behavior the next time, and can often escalate him into tears and hysteria. I think it will be more helpful to say "I don't think that's true" and offer a better explanation or solution, and a positive consequence.

• Break things into the smallest steps possible, and give positive consequences -- whether a look at some keys, a break from the action, or just a word of praise -- in the shortest time increments possible.

• If the locker-door slamming is a problem again this year, and if there is no way he can be re-routed so he does not pass them, I'd suggest trying this: Before you get to the area with the lockers, do something to distract him -- talk about cars, give him keys to look at, encourage him to join you in a silly walk or a silly noise. Walk with him on the opposite side from the lockers (if I'm recalling correctly that they're only on one side of the hallway) and do what you can to block the sight of them with your body. Walk through the area as quickly as possible. Then, when he's passed them successfully, make a big to-do about it, with praise, maybe a sticker, maybe some keys if you haven't used that to get him through the gauntlet. After using distraction for a while, you might be able to start warning him before you get to the lockers, and reminding him that he'll get a positive consequence for not touching them, and making a big deal about steeling himself to move quickly through and not slam. Eventually, when you get close to the spot, you can say, "What do you need to remember?" and let him supply the information. And then, we hope, eventually he will do it all without prompting, or maybe just lose interest. If he fails at any time, make a big deal of "Oh, no, you forgot!" and point out that he doesn't get the positive consequence. He will say he didn't want it, and you will say that's not true, but it's hard to resist the lockers, and you'll try harder next time. The better you can do in distracting him so that he doesn't have to remember at first, the better this will be.

• [Child] is generally a good-natured guy, so if he has a particularly antagonistic or belligerent reaction to something, that is a clear signal to back up and look at what might be really going on with him. For example: [child] has always been relatively cooperative around the house. So we were surprised when he suddenly started refusing to put on his slippers. It wouldn't happen every time, but when it did, he would scream his refusal. The more we yelled at him to go put on his slippers already, the more he would cry and scream, demanding whatever consequence we offered. It was so uncharacteristic and so over the top that we finally stopped to see what else might be going on. And it turned out that, when he did this, what was really happening was that he couldn't find his slippers. In his mind, inability to find slippers = inability to put them on. It never occurred to him to say, "Hey, folks, I'd love to do what you say, but could you help me find them?" He just rigidly popped into "No Can Do!" mode, and got stuck there. [Child] can't unstick himself, but we can avoid getting stuck ourselves.

• [Child] still has a hard time with eye contact, and it may be that, especially when he's feeling stressed, he's not able to deal with visual and auditory stimuli at the same time. Rather than forcing eye contact, you can usually get good attention by saying, "[Child], listen to me." He may not look, but he will listen.

• "Time outs" are often helpful for [child], especially if explained as "I can see by your behavior that you need to take a break." Given his motor problems, sitting in a chair for time out can be unnecessarily hard; going out into the hall or away from the group in some way will be better. This can be a good way to deal with overstimulation.

• If you'd like to send home a simple behavior chart for [child]'s day -- at school they do one happy, straight or frowning face for the morning and one for the afternoon, with occasional notes about particular trouble spots -- we will try to discuss his behavior with him. Consequences delivered at home are not effective, being so far removed from the actual behavior and antecedent, and discussion is not always productive because [child] usually doesn't know why he does what he does at the time, much less hours later -- but we do like to be aware and will follow through as best we can.

And finally, a metaphor that I hope the younger staff members will not be able to appreciate but the older ones may be. I have recently read of FAS/E behavior as being similar to drunken behavior, and I think that's right on the mark for [child]. Think of how being drunk affects your impulse control -- how it disengages the "rules" brain from the "impulse" brain and allows you to do things you never would sober (that may indeed be part of alcohol's charm for many of us). Think of how it affects your vestibular and proprioceptive senses -- how hard it can become to keep your balance, control your movements, remain upright, walk straight; and how easy it can be to misjudge distances or the amount of force needed. Think of how it impairs your perception of events and your reaction to them; your perception of other people's feelings and your level of concern for that. Think of how much effort it takes to pretend to be unimpaired, and how easy it is to slip into a sort of silly, funny, uncaring-of-consequences mode. Think of how you react if someone criticizes your behavior: Do you analytically say, "Why yes, I can see that alcohol has impaired my abilities somewhat, and I am behaving inappropriately"? Or do you say, "Hey, I meant to do that!"

In our cases, the choice to drink belongs to us, and the consequences are deserved. In [child]'s case, the choice to drink belonged to his birthmother, and he is suffering the consequences undeservedly. We can help him best by understanding that, and being his designated drivers.

Handling [Child]'s Behavior

Written for:
8-year-old boy
Fetal alcohol effects
Self-contained special-ed class
One-on-one aide
Response to teacher's discipline choice
By Terri Mauro

Professing to be pleased with a punishment has been in [Child]'s repertoire of behavioral responses for a long, long time without any sign of changing. My theory is that it is his attempt to be in control of a situation -- he can't control his behavior, but he can control the spin. It's sort of like when we do something clumsy and then say, "I meant to do that!" Many times at home he has insisted that he wants us to do something we've threatened, even when he clearly does not want it and is nearly in tears at the prospect (as when we threaten to take away one of his beloved cars). I think, by this time, it is a knee-jerk reaction on his part, and while on some level it gains him control, on another level it continues him in a spiral of getting reactions he doesn't want for things that he doesn't know why he's doing.

For that reason, I think it's best to ignore what he says, even though it can be terribly annoying. I'll usually say, "I don't think that's true," and keep on as though he does not in fact want the punishment. I would like to reinforce for him that it makes more sense to tell the truth -- which might be "I'm sorry" or "I didn't mean to" or "I don't know why" -- than to reflexively give these untrue answers. I don't know if he's ready to understand this yet. He still seems to have little awareness of his inner state, or at least no vocabulary to express it. Maybe when he says he likes something we know he doesn't, we can use that as an opportunity to model some more appropriate things to say.

With all due respect, I'm not sure it's helpful to ask him to write about why he made one of these answers, first because it implies that he has done it defiantly or deliberately and I don't think that's the case; second because it hopes that a consequence given at home is going to influence an impulse had at school and I think that's unlikely; and third because I don't think he has an idea in the world why he said that or what he feels, as the mess he wrote last night will evidence. I don't object to having him write sentences, because he could certainly use the fine-motor practice, but maybe an apology would be more appropriate. It may not change his behavior the next time, but it will give him a moment's reflection on the fact that the things he does can make other people feel bad or mad, and that's something he's at least starting to come to grips with.

As to the silliness: Have you noticed any pattern as to when it's a particular problem? We notice it at home around bedtime, especially when we've let him stay up a little too late. Also, less consistently, when he wants to avoid doing something he perceives as hard. Would there be any use in charting the times and situations he does this at school and seeing if there are any changes that could be made to help the situation?

I'm enclosing some pages form a book called "Steps to Independence," which was recommended at a seminar the special-ed department had for parents a while back. The A-B-C method they mention -- changing behavior by changing antecedents or consequences -- is pretty close to what we've found works best with [Child]. The material here may be pretty old hat for you, but maybe there's an idea in it somewhere that could help with these sillness outbreaks.

Then again, his behavior always takes a nosedive when he's having a physical or developmental growth spurt, and that may be what's happening here. In which case, if experience serves, we just have to wait it out.

Introduction to [Child]

Written for:
9-year-old boy
Fetal alcohol effects
Self-contained special-ed class
One-on-one aide
Start of school year
By Terri Mauro

[Child] has been diagnosed with Fetal Alcohol Effect (FAE). Since he spent the first 21 months of his life in a Russian orphanage with very little therapy or stimulation, his development in many areas is particularly delayed. FAE may look in many ways like ADHD -- hyperactivity, distractibility and impulsivity are the most common effects -- but behavior modification that works with ADHD kids is generally ineffective for children with FAE, since the brain damage caused by prenatal alcohol exposure can keep them from being able to learn, adjust, and change their behavior. What is recommended for children with FAE is to focus on changing the environment rather than the behavior. This sometimes involves changing our attitudes and expectations as well. Here are a few specific things to be aware of when working with [child]:

[Child] may appear high-functioning in many areas, but there are others in which he is significantly delayed. Although his expressive language is close to age-appropriate and he is good at his academic work, his emotional development is closer to a four- or five-year-old level. You may not be able to expect more of him in terms of sitting-and-being-quiet, taking turns, and interacting with other children than you would of a kindergartner. We can talk to him all we want about being a "big boy," but his coping mechanisms are not anywhere near "big boy" level, and there's nothing he can do about it. We need to adjust our expectations accordingly.

Fine motor work is particularly trying. Because [child] has low muscle tone, he has trouble holding a pencil and controlling its movements, and becomes easily fatigued. It is very hard for him to maintain focus when doing something frustrating and difficult (as, indeed, it is for all of us), and as indicated above, his capacity for tolerating frustration is that of a much younger child. Please be sensitive to this. You can sometimes keep his mind on the work if you remove the fine-motor component; at the very least, break fine-motor work into small segments and give him breaks and rewards in between.

[Child] needs movement to stay alert. Because of sensory integration problems related to his reception of vestibular and proprioceptive input, [child] needs a certain amount of movement to be able to pay attention. If you can get him to sit still and be quiet, you may notice that he becomes sleepy and inattentive. Conversely, many have noted that [child] can be moving around the room and seeming not to be listening, but still be able to tell you exactly what you said. Movement helps him stay alert. While you may not be able to let him roam around, *please* plan many movement breaks for him throughout the day, and don't be to stern about fidgeting. If you don't plan movement breaks, he may request them himself by asking to go to the bathroom. A lot.

Rewards work better than punishments. He can't remember either when he's feeling impulsive, but the less stress in the environment, the more he's able to control himself, and rewards create less stress than punishments. Things that work well as rewards/motivators for him are: looking at someone's keys; car magazines (the freebies from the supermarket); getting to take a walk; jumping; looking out the window; going to the therapy room and putting his hands in rice; and basically anything he's asked to do that you've had to say no to. Time-outs can be effective with him, but you might try phrasing it as a positive: "I can see by the way you're acting that you need a time out."

Introduction to "The Nurtured Heart Approach"

Written for:
10-year-old boy
Fetal alcohol effects
Self-contained special-education class
One-on-one aide
By Terri Mauro

[Editor's note: "The Nurtured Heart Approach" is from the book "Transforming the Difficult Child" by Howard Glasser, MA, and Jennifer Easley, MA, and is copyrighted by them. You can learn more about their methods from their Web site at This is an attempt to distill a little of this wonderful, very helpful book into brief readable form for teachers.]

[Child] had a SPECTACULAR day on Sunday. He was quiet in church, said "Amen" when he received the Host (he's been tending toward either "thank you" or "excuse me" in recent weeks), was very helpful all day, self-corrected nicely when he was near a slip-up, and only ended up in the time-out chair once, right before bed, when the fatigue sillies were setting in. I hope that's the same kid you see today, because he was pretty awesome.

We've seen a lot of that kid over the past few weeks, and whether it's really a product of the new behavior management scheme we're using -- and not aftereffects of a cold, or a maturity growth spurt, or the aftereffects of a developmental growth spurt (which usually leaves him pretty disorganized while it's going on) -- I wanted to tell you some of the things we've been doing, in case they're really what's making the difference.

One simple change has been phrasing requests with the words "I need." The presumption of the book ("Transforming the Difficult Child: The Nurtured Heart Approach" by Howard Glasser and Jennifer Easley) is that any request worded more softly than that -- with words like "please" and "why don't you" and "can't you" and "I'd like you to," as I've been prone to do -- give the child the impression that there's an option to just say no. This seems impossibly simplistic, but I can't deny that since we've started saying "I need you to ...," his compliance has increased to almost 100%. Sometimes we have to add a NOW at the end, but it works. Amazing.

Another big element of this approach is an avalanche of positive statements through the day. The theory here is that intense kids get a bigger emotional payoff for negative behavior, and though they may not like it or do it consciously, they become addicted to that energy. I would not have thought that true for [child], but he does often seem to want to get the worst reaction out of the way when he feels he can't control himself anyway. And again, I can't deny that the endless positivity has made a difference -- in him, and maybe in me, too, charged with constantly finding good or neutral behavior to promote. The statements fall into three categories:

Video moments: Just observe what the child is doing, in a neutral way, when he's not breaking the rules. Some examples from the book: "I notice that you're working hard on your drawing. It looks like a fancy car with green stripes and a red top." "I saw you dribbling the ball up to the hoop. You looked disappointed when your shot bounced off the rim." The idea is that even a rule-breaking child spends much more time not breaking the rules than breaking them, but tends to receive our notice and energy much more dramatically when the behavior is negative. I know I've been guilty of fending [child] off when I'm busy with something, but then, when he misbehaves, being 100% present and on the problem. Wrong strategy.

Proactive recognition: Provide an energetic verbal response when rules are NOT broken, instead of when they are. Any time [child] gets anywhere near another child without pushing, praise him enthusiastically for not pushing. If he goes five minutes without saying words you don't like, make a big deal about how he's controlling his words. Pull successes out of neutral behavior. If you see he's getting fidgety at his desk, praise him for staying at his desk so long. I would have thought that, with [child], these comments would have put the thing we don't want him to do in his mental loop and he would immediately do it, but this has not been the case at home, and I think it's because they're presented in a positive way. Some examples from the book: "Brandon, I appreciate that you have not used foul language all morning long. Thank you for following the rules." "Frankie, I like how you are using your power to control your strong feelings. You did not take your frustration out by breaking anything or hitting anybody. Keep up the good work."

Creative recognition: Use simple, clear and specific requests to "create" successes. Pick ones the child is likely to do anyway. Provide specific information about what you see him doing. This is where the "I need you to" wording above comes in. Praise even partial compliance ("I see you were really trying to...").

This is what we've been trying to do for positive or neutral behavior. Negative behavior gets a quick consequence -- a brief time-out -- but no energy at all. At times when he's seemed ready to slip out of control, I've told him "I'm not going to give you any energy when you're like this," and he's pulled himself back from the edge. He's been extremely cooperative about going to the time-out chair, and incidences of rule-breaking behaviors have decreased dramatically. NO ENERGY for bad behavior. No berating or blaming, but also no cajoling, no pleading, no bribing, no talking it over, no active attempts to turn the behavior around (and I know I've been guilty of all those). Just a quick trip to the time-out chair, and move on. No conversation after -- he's done his time, and he's a free man.

This is all accompanied by a credit system that allows us, at the end of the day, to give him tangible rewards for not breaking the rules, and additional rewards for specific chores, responsibilities and nice things he does. (More importantly, it's an additional opportunity to make a big deal over all the times he did good and didn't do bad). I don't know how motivating this is for him at the moment, but he's participating, which I didn't think he would. He bought a car over the weekend with credits he earned, and was very keen to do so. So I have my hopes.

Thank you for all your help and understanding.