Environmental Modifications in the Home

When trying to decrease problematic behaviors exhibited by children with developmental disabilities, the team should not only focus on teaching the child skills to adapt to his/her environment, but also work towards shaping the environment in a way that will help the child be more successful. Shaping a child’s environment can help to calm, stimulate, and provide order for the child. It can also help the parents to regain control of situations that have gotten out of hand. This guide is intended to give parents, family members, staff, and case managers ideas on how to make changes to things in the environment that they can control. Information is given on specific products and materials; and in most cases, we have given names and links to websites and stores that they can be obtained from, as well as the estimated costs.

* The Metro Crisis Coordination Program does not endorse any product, vendor, or approach; rather is listing possible options. Some modifications may require DHS and/or Department of Health approval, especially if to be used in a licensed facility. Please consult with licensing statutes or a licensing personnel before implementing.

Home Safety

Kitchens
One of the issues that parents often face is how they can keep their child out of the refrigerator and the food cabinets. Some children are constantly sneaking food out of the refrigerator, often resulting in the child gaining large amounts of weight and the parents spending large amounts of money on food. This can be a serious situation, especially for children with disorders like Prader-Willi Syndrome. Some children may also attempt to consume foods that are raw or improperly cooked.

It is important to secure dangerous chemicals such as detergents, cleaning supplies, and pesticides. It is also important that parents have the means to lock up kitchen knives, matches, lighters, scissors, and razor blades.

The Prader-Willi Syndrome Association has a website that offers good ideas for securing the kitchen.

Kitchens can be secured by a few methods. Some kitchens can be structured so that the doors can be locked. This obviously takes care of all of the contents of the kitchen with one lock. However, this may not be practical in many homes. In this case, individual cabinets and refrigerators would need locks. It is often most efficient to put all of the food in one spot. Some parents choose to put most of the food in an area to be locked up, and keep healthier items separate so that the child has full access to them. Some kitchens are equipped with pantries with doors that can be locked. Some parents have bought armoires and storage cabinets so that all of the non-perishable foods can be stored in one area. Some parents have chosen to store the food in hallway closets that could be locked.

Locking the refrigerator depends on the type that the family has. For the models that have the side-by-side doors, bicycle locks are often the most effective. The chain lock or the large padlock can be put around both handles to prevent the doors from opening. For refrigerators that open from the side, parents can easily screw on a hasp (a two-piece latch system) and secure it with a padlock. The hasps can be found in Home Depot or other hardware stores for about $8.00. The hasps are nice because they cannot be unscrewed unless the lock is undone.

Locking cabinets and drawers can be done through a couple of different methods. The most inexpensive way is to drill a small hole in the cabinet door and install a mailbox lock, cabinet lock, or drawer lock. These can be found in a hardware store for about $5.00. Another interesting option is to use a security lock that is opened by a magnetic key. This option is the most aesthetically pleasing, because the lock and all of its parts are totally concealed on the outside. The cost for two locks with a key is $18.00, or five locks and two keys for $38.50. They can be ordered on www.cabinetparts.com

For children at risk of elopement
The first challenge is to keep the child from leaving the house. Many parents often put locks on the doors to prevent them from leaving. The kind of lock used will depend on the child’s ability to manipulate locks. Hook & eye latches and slide bolts are among the most common, simple locks for a door. If they are too easy to unlock, consider finding ones that have a spring-loaded catch that makes it more complicated to unlock. If anything, it will stall the child and give you time to catch up.

Dead bolts are among the most secure locks. Some are operated by knobs, and some are operated by keys on the inside and out. The drawback of the ones operated by keys is that it is another key to carry around, and lose. Many parents are also very weary of not being able to get their children and themselves out of the house in the case of a fire. All of these locks can all be bought at the local hardware store.

Keyless locks:
Keyless locks provide the adult with the benefit of locking doors to prevent wandering from the house or to prevent the child from entering certain rooms—without having to keep track of keys. There are several options that can be used for locks:

• Digital keypad deadlocks and handle latches,
• Mechanical keypad deadlocks and handle latches,
• Card-swipe systems,
• Proximity systems, (you hold a fob close to the pad)
• Biometric systems (finger-print detection)—cheaper than you think. There is a system for under $200 available on www.homesecuritystore.com.

The least expensive of these options is the digital keypad deadlocks. They run for as low as $85. These systems can be found on websites such as:

• www.keylesspro.com
• www.nokey.com
• www.keylessentrylocks.com
• www.homedepot.com

Alarms:
For those who prefer to not keep the doors locked at all times, there are alarms available to alert the caregiver that the child has left the house or a specific area. Firstly, since some houses are equipped with security systems, the parents are often able to simply set the alarms for the doors. Be careful to make sure that the alarm would not be sent to the alarm company.

For those without security systems, there are inexpensive alarms that can be attached to doors and windows. There is a small, inexpensive ($10) alarm called SlideAway that will emit a very loud, piercing alarm when a door or window is open. This alarm is turned on and off with a switch. The drawback is that the alarm would need to be shut off every time that someone would want to go through the door without setting it off. It is perfect for windows or doors that are not used often.

The drawback with the SlideAway alarm is that it can be easily switched off with a switch. For those with children who are clever enough to figure that out, Radio Shack sells similar alarms that can only be switched off by a key or a keypad. They are, however, a little more expensive ($21.99 and $29.99). They can be found on www.Radioshack.com.

Another option is to use a motion alarm ($18). When used by the door, the alarm will detect movement and alert the caregiver that the child is going out the door. The motion alarms are also nice to use in the child’s bedroom or in the hallway to alert the parents when the child is wondering in the house during the middle of the night. The alarm can be set to sound a loud 110-decibel alarm, or a pleasant door chime. Home Depot sells a similar device made by Heath/Zenith for about $40. This device detects motion, and sends a signal to a separate receiving device that is plugged into a nearby outlet. Whatever is plugged into the outlet (lamp, radio) will then turn on.

There are alarms that can be put on the child to alert the caregiver when he/she leaves the area. There is one made by Child Guard ($25). The child carries a small transmitter that looks like a cartoon animal. The transmitter sends a constant signal to the receiver, which is held by the adult. The signal is adjustable- from a distance of 6 to 30 feet. When the child goes beyond the set distance, the adult’s receiver starts to beep, letting them know that the child is starting to wander off. This device is nice because it can be used both at home and out in the community.

The SlideAway, motion alarms, and Child Guard can all be found on web sites that sell personal protection and safety products, including:

• www.yourfamilydefense.com
• www.radioshack.com

Wrist Alarms— For children who have a very persistent problem and/or live in areas where they would be in serious danger if they ran away, the parents can spend more money and buy advanced alarms that are worn on the wrist. These are often worn by people with Alzheimer’s. There are few different products with several different options. Some of them have a gps locator in them to help track the individual. Some are monitored by a monitoring company. The websites for these are:

• www.projectlifesaver.org
• www.scorpion-security.com

ID bracelets
Children who tend to run away should wear an ID bracelet or necklace. They can be found at many drug stores or on the Internet at www.americanmedical-id.com or www.medicid.com. The price of these starts at about $20. Many children do not like to wear jewelry, so another option is to place iron-on labels into each garment. These can be found at most craft stores. You can also get nice iron-on cotton labels at www.conntext.com. Some children might be able to learn to carry and produce an ID card.

Fences
Here are the names and numbers of companies in the Twin Cities area that will build fences:

• Town and Country Fence 763-425-5050(north) 952-895-5656(south)
• Minnesota Vinyl & Aluminum Systems Inc. 763-755-3845(north) 952-881-0045(south) 952-470-0918(west)
• Midwest Fence 952-894-2060(Mpls) 763-572-9285(subs) 651-451-2221(St.Paul)
• Hansen Bros. Fence 800-416-9694
• Security Fence and Construction Inc. 763-574-1893 or 612-788-4729

Surveillance Cameras
Surveillance cameras can be used to monitor the child when the adult is not able to be in the same room. The adult may want to watch the child while he is doing an activity in another room, or while the child is in the backyard. The adult may need to observe the child while he/she is sleeping. The adult may also wish to observe the child for safety while he is having his “cool down” in his room, but does not want to give him the attention. Wireless cameras tend to be the most efficient for these applications. There are several models out there, ranging from simple baby monitors to highly sophisticated cameras. The costs vary. Online sources include:

• www.radioshack.com
• www.homesecuritystore.com
• www.X10.com
• www.wirelessvideocameras.com

Stuffing toilets/sinks
Many children with disabilities are fascinated with playing with water. For some, there is a strange fascination with flushing things down the toilet or clogging the sink. Such behaviors can cause water to overflow and create a lot of hassles, not to mention water damage. There are alarms that are attached to the intake pipes of a toilet or sink. When the alarm senses a leak or overflow, it will automatically shut the water off. These can be found at: www.safehomeproducts.com

Cool-down Room
For parents with aggressive children, it is often helpful for them to have a room where the child can go to be alone and “cool down” before or during an explosive episode. This should be seen as a tool to help the child to regain control, and not as a punishment. The child’s bedroom may be an option. The one drawback that parents should look for is that the child may associate the room with the behaviors and the bad feelings, and may not want to go to it on his/her own for leisure, relaxation, or sleeping. If this happens, try to use another room. Here are some considerations for a cool-down room:

• There should be a minimal number of objects to throw around and break.
• Any objects that are in the room should be soft.
• Consider putting Plexiglas over the windows. There is also a film that can be put on windows to make them more resistant to breaking. Dupont makes a similar product.
• Bolt or screw any furniture to the floor or walls that you do not want tipped over.
• Have a big beanbag, soft mats, big cushions and pillows, or a soft bed for the child to relax on.
• Use drapes or curtains instead of blinds. They can be hung with Velcro instead of curtain rods.
• Have soft sensory items that the child can use for calming.
• Have a CD player that can be used to play calming music.
• Have a dimmer switch for the lights.
• Experiment with calming lights such as Christmas lights, fiber-optic lights, lava lamps, and aquariums.

Safety in the Community 

Before going somewhere with a child with behavior problems, try to go to the site to do some preplanning. Learn the expected rules of conduct, how the child might interact, and how to prevent problems or how problems might be handled. There is an article that describes this in more detail if needed. Brown, L. et al. (1984). Ecological inventory of strategies for students with severe handicaps. (Manuscript written in cooperation with University of Wisconsin-Madison and Madison Metropolitan School District).

Light Issues
Many children have sensitivity to bright lights, and may need some modifications at home. The first consideration is the type of lights that are used in the home. People with autism, ADHD, and similar disorders tend to be bothered by fluorescent lights. They often tend to be too bright. They also flicker with 60-cycle electricity, which can be distracting or annoying to those with autism. If the child does find these lights aversive, try to replace them with incandescent lights. It is also beneficial to have dimmer switches for the lights so that you can control the brightness of the room. These can be easily installed to replace any regular switch for incandescent lights. This is useful for when the parent wants to calm or excite a child. They are also helpful for children who have difficulties with sleep patterns. The blinds should be open, and the lights should be bright during the day. The blinds should be closed and the lights should be dim in the evening. This will help to establish the pattern of day and night.

Rough duty lighting can often be found in forms of LED(light emitting diode). Several very small, but bright, lights combine to produce a large amount of light. They come in forms such as flashlights, lamps, and ceiling fixtures. Check out www.theledlight.com.

Another consideration for lighting is the paint. For children with sensitivity to light, consider the colors and the tones of the colors that are used in the rooms. Avoid yellows, reds, and bright whites. Try to use softer tones of colors. Also avoid paint sheens that reflect a lot of light, such as semi-gloss and high gloss. Instead, opt for flat or eggshell.

Organization
The need for organization goes beyond the desire to have a neat and clean house. It is important for many kids, especially those with Autism, to have a sense of order and structure. The more organization, order, and structure in the individual’s environment, the more likely it will reduce the frustration level of the child, and thus the undesirable behaviors. Having things off of the tables and countertops will also prevent them from being swept off by a child in the middle of a rage. Organize functional items in see-through plastic bins/boxes with visual labels (symbols, photos, words, textures) so the child can see and use the receptacles. Place things on shelves or in places that the child can easily see and access. Many of the storage boxes and shelves can be found in Target and Sam’s Club. There are more elaborate and functionally decorative systems that can be purchased rather inexpensively at Ikea.

If there are video games, movies, etc. that are locked up, make a catalog of the names or covers so that the child can chose from it instead of standing in front of them and trying to decide in a hurried fashion. You can make a picture catalog list of the movie/ video games by going on www.Google.com, clicking on “images”, and then typing in the name of the movie in the search box. Once you find a picture you want, simply copy and paste.

Homework
Consider the following environmental modifications to help minimize distractions and increase attention to the homework:

• Have a set time or routine that the child does the homework to establish structure and predictability.
• Establish a specific area where the child does the homework every day—away from noisy siblings and other people who may distract him.
• The area should be free from desired toys, the television, or other things that the child may find distracting or more desirable.
• Provide sufficient, uncluttered desktop space and storage space.
• Have plenty of sharp pencils, pens, erasers, and paper available in organized containers that the child would have easy access to.
• Consider the temperature of the child’s workspace.
• Provide sufficient lighting with an incandescent lamp. Avoid fluorescent lighting.
• Be sensitive to the fact that the child may have his own learning style when it comes to desks, tables, and chairs. A child may find it more comfortable to sit on the carpet or a mat and write on a clipboard or lap desk.
• For a child who tends to fidget or has poor posture, consider using an inflatable wedge seat, called Movin’ Sit. They can be found at Autism resource stores like www.autism-products.com
• If the child becomes easily frustrated with homework, remove hard objects that can be easily thrown.

Controlling time spent on electronic components/phone
Video games, TV, and phone are often times a big attraction for kids, especially those with disabilities. For some, they are almost a source of obsession. Trying to limit their time using these items can often prove very difficult. As many parents find out, trying to turn them off can often lead to big power struggles and a lot of agitation. Sometimes the amount of time that they use it may need to be limited as a reinforcement. The best way to place these limits is to take the role of the parents out of it. There is a terrific website at www.familysafemedia.com which sells devices that can control how much time that a child is able to use the telephone, television, and computers. These devices hook up to the phone jack, television, video games and computer; and they allow the parents to program how much time the child can spend on the electronic component. When the time runs up, it simply shuts off.

Other Considerations

• If the child has a tendency to put holes in the walls, consider wainscoting or paneling.
• It may be necessary to put locks on entertainment centers to keep the child from overusing or damaging the electronics components. Chose a cabinet with doors. You can easily install a cabinet lock by drilling the hole and installing a barrel lock.
• If there are a large number of items that the parents want to keep under their control, consolidate the items in a locked closet.
• Be sensitive to the fact that children may find the odors of some foods to be aversive when being cooked.
• Children can also have aversions, sensitivities, or allergies to certain perfumes. If so, avoid using laundry soaps, shampoos, and lotions that are scented.
• For children with sensitivity to sound, use carpeting instead of hardwood floors.
• Adjust the water temperature on the hot water heater so that the child cannot burn himself by turning the hot water on.
• Replace the open-lip bottles of shampoo for ones with pumps on them to make it more difficult to ingest large amounts.
• Use STOP signs on doors, drawers, furniture, and appliances to help children understand that these item/areas are off limits.
• Experiment with playing a variety of music in the home. The music can affect the child’s moods. It can also be used to stimulate or calm the child.
• If possible, design an area of the house with furniture (or lack of), where rambunctious behavior is tolerated.

The staff at MCCP are available for individualized consultations on environmental modifications and other behavioral strategies. To make a referral, consult your county case manager or call MCCP at 612-869-6811.

You can also contact me with any questions or recommendations at Jasonh@metrocrisis.org