Please Don’t Suggest a Sticker Chart

By Rosie and Jo’s mum.

Those words seem so innocent yet they can feel so loaded.

This is the kind of advice parents generally pick up at toddler groups when dealing with the terrible twos. We see it on TV, in parenting magazines and on parenting forums. There can’t be many parents out there who haven’t tried some sort of reward system at some point. We also all pretty much understand the principle behind using sanctions/withdrawing privileges/natural consequences and there are varied opinions on their effectiveness.

So, when you have been through years of watching other people’s children doing things your child can’t do, been through every sleep training method out there but are still kept awake for several hours of every night or have reached the end of your tether, trying to manage the physical outbursts which result from your child’s emotional distress, it is pretty much guaranteed that you have followed every bit of parenting advice you’ve ever come across and they have all failed miserably, often compounding your child’s distress in the process. Once you have exhausted every strategy, you end up having to swallow your pride and start asking the professionals for help. This never feels like a good place to be.

I completely understand that there are some basics to be covered. There is no point in referring a child to CAMHS if the problem is that the they are allowed to stay up all night and live on sweets because their parents don’t have the first idea of how to implement boundaries. There has to be a conversation somewhere along the line that includes “What is Charlie’s bedtime routine?” “Have you withdrawn Mollie’s access to the internet?” and “Have you tried rewarding the good behaviour you want to see more of?” The problem was that I had tried all sorts of strategies to help my children to sleep, organise themselves and cope with challenging environments. The dreaded sticker charts had been the first to fall by the wayside, along with sleep training and just leaving them to sink or swim.

It had become clear that I wasn’t dealing with bad behaviour. Rewards and sanctions don’t change your ability to fall asleep, your executive function or your sensory processing and the only way they change your anxiety is to increase it. No sticker, bar of chocolate or trip to Legoland is going to prevent a meltdown from social/sensory overload or make a child whose system is flooded with adrenaline feel able to walk into school. By suggesting I use these very basic strategies repeatedly, it felt like these professionals were minimising my children’s very real and disabling distress and seeing me as the most inept of parents whose lack of basic parenting skills was the root of the problem.

I went through the bedtime routine/rewards and sanctions conversation with Rosie’s head of year when she first became unable to attend school. I did it again at her first CAMHS appointment. Then I had it again with her form tutor. My patience was beginning to wear thin. Then the SENCo. By the end of her statutory assessment, we had also covered this ground with one CAMHS psychologist, an educational psychologist, a community paediatrician, a specialist teacher, an occupational therapist and numerous TAs and teachers. Every one of them seemingly unable to imagine either that I could be capable of working out these basic principles for myself or that the multitude of professionals who came before them might have already had this bright idea. Some pushed it repeatedly and very hard, convinced that, if the sanctions and rewards weren’t enough to get her into school every day, I simply wasn’t committed enough to imposing them.

Long after her diagnosis of autism was confirmed and her statement of SEN was issued, I was still being questioned about my basic parenting skills and told that I just needed to be firmer, impose boundaries and take charge of my child. Every new professional we came across seemed to need to start from basics all over again. After years of these appointments it was becoming very hard to tolerate. I was regularly pressured to try some strategy that was a variation on the sticker chart principle. I was also painfully aware that parents who reject these repeated suggestions are opening themselves up to accusations of refusing to engage with professionals’ advice; a dangerous position for the parent of a child with additional needs.

Just to be clear, when the problem wasn’t a difficulty resulting from her disability, our behaviour management at home was highly effective and Rosie was an extremely well-behaved and compliant child, as was her sister.

On a more positive note, while her diagnosis was being considered and Rosie’s level of distress was causing serious concern, a brilliant CAMHS psychologist pointed out to me that she needed some positive emotions to support her mental well-being. He said I absolutely should not put pressure on her, impose any sanctions or withdraw the one activity she lived for as a punishment, just because she was unable to attend school. It was the best piece of advice I was ever given by CAMHS. I felt empowered to ignore the pursed lips from school staff after that.

During this time, it was becoming harder to persuade her younger sister, Jo, to attend school too. Her anxiety was climbing and she was non-verbal and highly distressed at the end of every school day. The school asked me to attend a parenting course and, keen to learn new strategies to help my distressed children, I went.

The first things we talked about were bedtime routine and reward charts. I soon realised that this was the sum-total of the advice they had to offer.

Jo was referred to CAMHS. At the first appointment I was asked about reward charts. I was well versed in this conversation by now. I covered every point in a few sentences and we moved swiftly on.

A few months later, the therapeutic appointments started. The therapist didn’t ask me about reward charts – phew! He went straight in and set up a reward based transaction. If Jo was in school on time every day for the next week, she could have a very attractive reward at the next appointment. I sat back and bit my tongue. I gave the idea my full support but, on Monday morning, instead of a child standing by the door, ready to leave on time, I was faced with broken glass and Jo in such distress that she missed the next two days of school. For some children, reward charts are the worst thing you can use.

Months later, in the middle of an appeal to the SEND tribunal for residential school because no school in our county could meet her needs, a social care assessment was carried out to determine funding responsibilities. The social worker sat and listened to our story of failed school placements, abusive support staff and escalating mental health needs, disregarded my assertions that Jo was frustrated and upset about being unable to attend school and guess what she asked me…….

“Have you tried offering her a reward for every day she goes to school and making staying at home boring?”

Seriously? You honestly think that the independent school placement with one to one TA support failed because I am not making home boring enough? You think CAMHS would see my child every week for over two years because I haven’t thought of rewarding her for going to school? You genuinely believe there is a possibility that this whole sorry, horrifyingly expensive, soul destroying mess could be sorted out by me using a reward chart? Do you honestly believe that you can force a child to overcome their crippling anxiety by imposing sanctions? Will you ever stop assuming that the parent is to blame?

There really needs to be a point at which professionals are prepared to credit parents with a reasonable level of intelligence and skill. Once someone knows that your child has been seen by multiple professionals over a period of months or years, they should feel able to take it as read that the basic parenting strategies have been tried and probably failed for a very good reason. It is also important that professionals start to discriminate more clearly between a disability and badly managed behaviour. Poor behaviour management does not need to be screened for at every appointment and in every conversation.

It is now clearly recorded in Jo’s statement of SEN and in all the private reports we had for the SEND tribunal that rewards and sanctions are counter-productive for Jo, as they are for many children on the autism spectrum and they should not ever be attempted.

I’m quite sure it’s only a matter of time before someone asks me again whether I have tried a sticker chart.

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14 thoughts on “Please Don’t Suggest a Sticker Chart

    1. Fiona thank you for that feedback. Honestly? Putting crazy incomprehensible stuff that we all experience into words is one of the key things we strive to do. For three reasons – firstly we think that it does help others to explain their own mad situations to the people around them, secondly, for those who haven’t had our experiences but work with us as professionals, or are family or friends – we want them to be able to understand a little better. Lastly of course it does help us to process what on earth has happened! So your comment means a lot. 🙂

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    2. I get, but she dosnt do that when she’s here, or but she’s fine at school, maybe your not being strict enough, accused of bad parenting by my ex, IE not strict enough, or a classic it’s just a phase, or she will grow out of it, or its her age
      Arrrggghhh

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  1. add on to the last comment, our childs paediatrition even told us that he was too old to be seen by paediatrics (he was 10) and that there were needier children that needed to be seen! needless to say I was not happy!!! several complaints and angry letters, phone calls etc later I received an apology and a magical joint camhs paediatrics appointment where when I presented them with an extensive list of issues/events we have been dealing with the psychologist prescribed meds, finally we are getting somewhere beyond the stupid useless sticker charts!!!! I wonder if the hand book for caring for sen kids advises the promotion of sticker charts, maybe sponsored by the manufacturers of stickers?? sally-ann

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  2. I have to tell a little story of our experience yesterday with my 13 year olds new psychologist a young lady and an intern. A kindly pair, keen, respectful but totaly new to PDA. Good that PDA is being treated as a real thing, but of course, no training at all in PDA, so going in blind and banking on my new found expertise. You see, we are back in the inadequate system, government run token for mental health. I had filled them in as much as I could about what triggers to avoid and how to speak, that she will avoid and say no to everything you try if you don’t use the right language. They had a bout 3 weeks of learning before the first ‘therapy’ session was to begin, which was yesterday here in NZ. The first thing they tried was a chart on the board, aiming to put good and bad things into boxes. The Doc with the white board and pen lasted about 30 seconds before my daughter tore her off a strip with such accuracy I couldn’t not help but laugh. It was one of those cringe and high five moments both at the same time. I did feel sorry for the Doc but she took it well and moved on to the next idea. Linking my daughters love of TV shows with anxiety to teach her and find a space of interest to tackle her ocd. Nice try but… way too direct, they used the word homework… out came the fire extinguisher as she tore through their efforts. They sat, out of spontaneous ideas, confused and deflated that their university training hadn’t covered kids who are way ahead of the game. Again I stifled a laugh and said I did warn you she will keep you awake at night.My daughter said to them, I can see exactly what you are trying to do and it wont work, go away and think of some better ideas. We did manage to pull it round and found some relaxed happy space, and ended up laughing together as my daughter amused us with her every impressive quoting of films relevant to what we were trying to talk about. I explained that the best thing to do was get the trust, use humor but it must be natural. We must all be equal and there will be ways to help. Instead of us going home with ‘homework’ (shudders at the word) we left them with a long list of shows to watch, PDA information to look up and rather itchy heads that needed scratching. Lets hope we can teach them and they can pass on some ideas that are much needed in the wolrd of professionals and PDA. Mums, we must write the books. If it doesn’t work, don’t do it, sod authority, its time for us to rise up and tell them whats what. lovepda. xx

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      1. A great big packet of stickers, maybe? After all, to be an effective incentive it should be something related to their greatest interests…

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  3. Just found this blog & so many of the posts resonate deeply with me. We too have been through the ‘have you tried a reward chart?’ so many times; we too were sent on a parenting course where the leaders actually queried why on earth we were there. “This course was never designed for anyone dealing with the problems your child has.” Yet CAMHS insisted that we jump through their hoops before they even started to consider that our excellent GP might have been right over five years ago when she first referred our child for a psychotherapy assessment. We’re still waiting, even though it’s been marked down as ‘urgent priority’ since last year. My child is also able to run rings around the professionals and their suggestions. The local MP is involved, PALS is involved. the local council is involved. We’re stuck in a horrific land of limbo & if one more professional dares to suggest a sticker chart, I’m not sure I can be held completely responsible for my actions. (Although I have now started playing ‘psychobabble bingo’ at appointments & meetings … at least I get through them without saying anything too sarcastic now.) Thank you so much for sharing your experiences; it makes me feel a little better that we’re not alone in banging our heads against the brick walls of ‘the system’.

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    1. Thank you Judie, we will keep writing and hopefully our posts and other help, along with your obvious tenacity will help you to fast track through the crazy stuff to get what your daughter needs. thank you for reading, feeding back comments and adding to the conversation too. 🙂

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