I heard on a radio show the other day that the vast majority of people do not want to hear the truth. They only want to hear the things that support their beliefs. I recognize that I resemble that remark. Much as I like to be challenged, I tend to look for and enjoy finding writings that validate my own beliefs and people who agree with me.
A significant hot button topic for me is the use of rewards when working with people with cognitive disabilities. Rewards I have seen used are soda, coffee, stars, certificates, pencils, special outings, and the most ubiquitous one - praise. The way I observe rewards being used seems manipulative and controlling. A common example is giving out rewards for things you want someone else to do. What about what they want to do? If they wanted to do it, they would find intrinsic reward in the activity so no extrinsic reward from staff or parents would be necessary.
Another thing staff do is to give out rewards too frequently and for insignificant tasks, thereby weakening the value of the reward over time for that person, assuming they did enjoy the reward to begin with. We use verbal praise as a reward in this way. We say, "Good job" for the most mundane tasks. If they put their lunch away - "good job." Greet with handshake- "good job." Dishes to sink with less than three prompts - "good job." Flush the toilet - "good job."
Something that most bothers me about rewards is that when I have seen them used, the person loses interest in the activity and gains interest primarily in the reward. If a person is encouraged to read more and gets rewarded by pizza (a real incentive used for kids through a famous pizza chain), the person doesn't read because they love to read anymore. They read because they want to earn pizza. They then lose interest in reading and the reward had the opposite effect in the long-term.
There are many other reasons I really dislike using rewards in my work. They make anxious people more anxious as now they are worried if they are going to earn their reward. They are used despite the person's protests that they don't want to learn or do what the staff want them to. If they are used to improve behavior, rewards don't target the reason why the person is not doing something or doing something. Rewards promote competition in others around them who might not be earning their rewards successfully. They don't teach people to be proud of their own accomplishments because once the rewards are used, people become conditioned to look for the approval of others in the form of rewards.You have to take an item away to make it rewarding. So, you can't let a person have soda if you are trying to get them to do something for soda.
There is another side to this topic, though, and that is why you have to be very careful to seek the truth, not just what you want to hear. While I dislike rewards in the way they are implemented, I have seen them be effective at improving someone's life when nothing else was working. Someone might be rewarded with a trip to the store and the purchase of a new dress for losing 20 lbs. Rewards often provide motivation to get someone over a hump in their life. One of the people with intellectual disability whom I know has great anxiety over having medical and dental treatments. This is very common, actually. We tried giving him sedating medications, using desensitization techniques, and holding him down. Nothing worked until a behavior specialist brought out chocolate on one appointment. That seems the most benign of all the techniques we tried with him and it provided him the incentive he needed to be successful. He sat quietly for his entire exam. Rewards can also provide motivation for someone who is not intrinsically motivated to be able to learn a new skill.
And I am embarrassed to say that as much as I protest their use, I have used rewards with my own daughter and successfully. Once, a while back when she was in her early 20's, she was on three psychotropic medications for outbursts and anxiety. As time went on and the medicines weren't working, higher doses were added. Eventually, the medications that she was using to combat anxiety were causing abject anxiety in her. She became afraid of noises and the anticipation that a noise might occur. She got very afraid at night listening to all the noises outside her window. She was so afraid, that in the middle of the night, she started making a bed for herself at the foot of our bed. She would bring her blankets and pillow and sleep on the wooden floor and we would find her there in the morning. This evolved into refusals to sleep alone and sleeping in our bedroom every night. We tried many things to get her to sleep in her own bed such as making a soothing nighttime ritual, staying in her bedroom until she was asleep, nightlights, bedtime stories. Nothing worked until I put a shaping plan in place where she would earn small rewards each day like DVD's, then weekly awards of going out to dinner at fast food places, then a final reward once she was back in her bed of going out to her restaurant of choice. It took about one month to get her back in bed, moving her pile of blankets and pillows inch-by-inch from our bedroom each night until she was back in her own room. To this day, much as I rail against rewards, I am happy I used them and it was worth it in this case.
I guess that's my point. Rewards can be a good thing if used respectfully, carefully, and with a plan to fade their use out once the person has accomplished what they wanted. So I have learned a valuable lesson. That I want to be conscious of seeking the truth, even if it goes against what I believe is true.
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