Tips on How to Deal With Severe Cases of Low Tolerance to Frustration
I had the chance to work with a 14 year old teenager.
He was born with cocaine withdrawal symptoms, has a mental age of approximately 6 years and severe behavioral issues.
Something noteworthy was his extremely low tolerance to frustration.
In other words, the word "NO".
Every denial of a request would trigger a self injurious behavior (SIB) such as head banging, scratching, biting or eye poking.
So, my first goal was to reduce the intensity and frequency of these episodes.
Not an easy task since they were hard wired on him and were almost instant and automatic most of the time.
The problem was where to start.
Since this SIBs were anger misdirected (instead of going outward it turned to himself) what I first started doing was re-channeling the frustration to the outside.
For example, everyday he wanted to take a walk outside to "talk" to bugs and collect "treasure" (mostly objects thrown away in the campus´s woods).
If one day it wasn't possible to go outside, instead of telling him "no, you can´t go outside", I told him "going outside won´t be possible because the weather wouldn't let us).
The behavior change was immediate.
Instead of starting the SIB he looked through a window and started cursing at God and the weather.
I guess God wouldn't mind him cursing him instead of having one of his siblings hurting himself (I mean no heresy).
In other occasions, when the SIBs were unavoidable, what i did was ignore the SIB.
Even when he stood in front of me intentionally showing me he was hurting himself i stared at him with an inexpressive look, or sometimes even turned away from him.
This would stop the behavior.
I have been working with him for the past 6 months, and since this conduct hasn't disappeared, he seldom hurts himself badly.
I have been reducing the frequency of the re-channeling and he has responded positively to NOs.
Sometimes he carefully slaps his face, a reminiscense of the heavy slapping of the past, or puts his nails against his skin, showing me he wants to hurt himself.
But he doesn't go through with it.
This time, it´s not an SIB or an automatic response.
It´s symbolized.
It´s now a message, that says "I don't like it".
My next goal will be to put these gestures into words.
He was born with cocaine withdrawal symptoms, has a mental age of approximately 6 years and severe behavioral issues.
Something noteworthy was his extremely low tolerance to frustration.
In other words, the word "NO".
Every denial of a request would trigger a self injurious behavior (SIB) such as head banging, scratching, biting or eye poking.
So, my first goal was to reduce the intensity and frequency of these episodes.
Not an easy task since they were hard wired on him and were almost instant and automatic most of the time.
The problem was where to start.
Since this SIBs were anger misdirected (instead of going outward it turned to himself) what I first started doing was re-channeling the frustration to the outside.
For example, everyday he wanted to take a walk outside to "talk" to bugs and collect "treasure" (mostly objects thrown away in the campus´s woods).
If one day it wasn't possible to go outside, instead of telling him "no, you can´t go outside", I told him "going outside won´t be possible because the weather wouldn't let us).
The behavior change was immediate.
Instead of starting the SIB he looked through a window and started cursing at God and the weather.
I guess God wouldn't mind him cursing him instead of having one of his siblings hurting himself (I mean no heresy).
In other occasions, when the SIBs were unavoidable, what i did was ignore the SIB.
Even when he stood in front of me intentionally showing me he was hurting himself i stared at him with an inexpressive look, or sometimes even turned away from him.
This would stop the behavior.
I have been working with him for the past 6 months, and since this conduct hasn't disappeared, he seldom hurts himself badly.
I have been reducing the frequency of the re-channeling and he has responded positively to NOs.
Sometimes he carefully slaps his face, a reminiscense of the heavy slapping of the past, or puts his nails against his skin, showing me he wants to hurt himself.
But he doesn't go through with it.
This time, it´s not an SIB or an automatic response.
It´s symbolized.
It´s now a message, that says "I don't like it".
My next goal will be to put these gestures into words.
