Advice wanted about tolerating a cast for a broken bone

[Guest guest]

Hi everyone,

I have a question about a situation a family I am working with is having.

Yesterday, the son, a 10 year old, nonverbal boy with ASD, broke his leg. He is

wearing a temporary cast until he goes to the Orthopedic doctor today. However,

like many other children with autism, he rarely tolerates even a band-aid, and

he is very concerned with removing the cast.

My initial recommendations to the family were to make sure he has many

reinforcers that he can actively manipulate with his hands available and then

reinforce manipulating those items with edible and social reinforcers (tickles,

etc) that he enjoys. I also told them, that every time he focuses on removing

the cast, to remove the manipulative reinforcer, give him an object-manipulation

instruction, such as putting clothespins on a container, matching items, etc and

requiring completion of the instruction before giving him the manipulative

reinforcers back, while constantly varying the manipulative reinforcement. At

first I said to start with reinforcing immediate engagement with the

manipulative reinforcer, but as the cast removal behavior decreases, to

gradually increase the amount of time before reinforcing the manipulative

reinforcer behavior with edible reinforcement.

Not only is he having a difficult time tolerating the cast, but he is a

typically hyperactive child and the doctor has recommended staying off his leg

for the time being. We are looking into additional activities that can be

introduced as potential reinforcement during this time.

However, any tips from professionals and/or families with experience with broken

bones with children with autism would be greatly appreciated!

Thank you!

Kane