Incentives

Yesterday, my daughter, S, had a difficult time at the end of the day and would not get off the van after day program once she arrived to her destination. She cried loudly all the way home - very loudly - and she rides about 25 miles with other people on the van. 

Periodically, during very emotional moments, S freezes when she has something on her mind. So she froze yesterday. They called me to help her get off the van. Usually once she sees me, she gets right off, knowing that I'll talk with her about what's on her mind. She would not get right off when I arrived so I just gave her some space and time to process.

Remembering that all behavior is really communicating a need or is purposeful for the person in some way,  I knew that S lost emotional control over something and then had shut down until she could talk about it. She needed to have some quiet in order to regain composure.

Her well-meaning substitute van driver, trying to be helpful, asked me if there is some incentive I could give to S to get her off the van. Something like a food item, she said. I nicely said, no, that's not the way to go in this situation, and left it at that. But what I was feeling was a twinge of humiliation for S, even though she didn't hear our conversation (I don't think).

There are so many reasons why S, or anyone with cognitive disabilities, should not be offered an 'incentive' in many situations. The clinical term for the food incentive the van driver was proposing is called 'positive reinforcement.' The layperson's terms are 'reward' or 'motivator'. The definition of positive reinforcement is that when presented, it increases the behavior that immediately preceded it.

Here are some of the reasons why S should not have been offered an incentive to get off the van:

1.   The incentive had nothing to do with the behavior. By offering it instead of trying to figure out the reason for the behavior, you are being dismissive about their need at that moment. 

2.  Incentives are often given to people with less power and status by people with more power and status in order to control them.

3.  If the incentive (or positive reinforcer) was given in this case, would S have been rewarded for getting off the van or rewarded for crying for 2 hours and refusing to get off the van? You have to be very careful what you are offering incentives for.

4.  Incentives can be undignified. I, like S, have a tendency to withdraw and shut down if I have something very emotional on my mind. (My husband fondly calls them 'nuclear winters'). Picture how it would be if he told me, "Honey, if you will come out and talk to me, you can have some pizza."

5.  The incentive in this case would have been more for our convenience than for S's needs.

This is how it turned out....I told S that we would be able to talk about what was on her mind once she got off the van. We left her alone and stood outside the van waiting. She stayed on for about 15 more minutes. I  re-approached her and suggested that we go home where it was cool and comfortable and she can relax and tell me what is bothering her.  She nodded and came off a few seconds later. Then later at home when she had calmed, she approached me and said she was ready to talk. She told me that she was upset because she was expecting a different van driver that day and got overwhelmed when she saw he was not the driver.