On 20th March 2011, I bought a lined exercise book and every day we sat down ‘on neutral territory’ and discussed what Ben had eaten (in brief), how many calories he’d had, what challenges he’d overcome and whether he’d managed to keep to his agreed exercise list.
It was also a good time to share any thoughts or any difficulties, or for either of us to ask any questions, without biting each other’s heads off. The key is to keep calm and for this ‘meeting’ to be equal, in ‘No Man’s Land’ (but of course ED is banned!)
As the parent / carer, you have overall control. The idea is for this to appear as a joint effort in which they can participate and have views / opinions. It’s also a fantastic opportunity to really talk about what’s going on.
“Let’s do points”, I’d say, when we had a quiet 5 or 10 minutes in a day – or even every other day.
The Contract has been a very positive thing, full of encouragement and low on penalties. We compiled the contract together (although, in reality, I engineered it to go the way I wanted…)
Any part of the contract can be adjusted at any time depending on progress, but it needs to be mutually agreed (i.e. not appear to be mum inflicting her will on child).
The first part of the contract (#1 - #3) sets out the parameters. #4 lists the rewards / points.
- Here I note down the agreed daily calorie amount. (Not everyone deals in calories, so it needs to be something where you both agree how much will be eaten in any one day.)
- I also note any agreed adjustments if, on weighing weekly or fortnightly, he’s lost, maintained or put on weight. (Usually we’d agree to increase by 100 a day if he’d lost weight and 100 every other day if he’d maintained – until we got back on track to a gradual weight increase or reached an agreed Weight Restored.)
#2: Weight Gain
- How much weight you expect him to gain each week or fortnight (in our case although we aimed at 0.5kg a week it actually worked out at nearer 0.26kg per week)
- When he will be weighed and where (e.g. every Friday morning at CAMHS)
#3: Agreed Exercise – to be reviewed as necessary
- Out of control compulsive exercise used to be a big problem with Ben. He didn’t know where to stop and was doing a ridiculous amount. So we wrote down a list of ‘agreed exercise’ over and above which he was not allowed to do.
- He wasn’t allowed to carry forward ‘un-used’ exercise to another day.
- Penalties for going over the agreed weekly list.
#4: Rewards – Points system
“Points win prizes!” was Ben’s mantra. 3 points = £1 and we’d keep a running total based on the points system below. Occasionally he’d withdraw ‘points money’ to spend on stuff (like his models or whatever).
This is what attracted Ben most to the idea of the Contract – a great way to save up for stuff! Also, at a time when he was feeling unable to control things like eating and exercise, or go into school, points gave him the encouragement and boundaries he needed.
Yes it was a bit expensive at first, but it was worth it! As things improved, some challenges were removed because they were no longer challenges. These days all he gets points for are new challenges only (not calories, exercise or anything because that’s been under control for a while). But again all this was mutually agreed.
We also wrote down the number of points that can be deducted for dishonesty and how many get deducted for what. (Note: we rarely had to deduct points.)
- 1 point per day Ben keeps to current calorie total
- 2 points for every day Ben exceeds current calorie total by a min of 200
- Points deducted for cheating, etc
Challenges are a fantastic way to get them to face their fears e.g. fear foods, etc – and give them a go.
1 point for each challenge. These might be: fear foods, socializing, a challenging meal, eating between meals, ‘condense calories’ (as Ben calls it), eating out successfully, ‘sitting around doing nothing’ (as Ben calls it) followed by a big meal, etc etc.
It’s not just a case of asking them to list the challenges but to talk about why they were a challenge, how he felt about overcoming them and how brilliant it is that he overcame them.
And of course, new challenges gradually become old challenges, then phased out altogether.
As Ben discovered that doing challenges didn’t mean massive weight gain, indeed sometimes he didn’t put on any weight after a challenging week, the challenges stopped being something he was afraid of.
- 3 points for every full day
- 2 points for every full morning
- 1 point for every part morning or full afternoon
- 1 point per day Ben keeps to exercise part of contract
- 3 points for any non-exercise day
- 3 points deducted for dishonesty
- 2 points deducted when DON’T have 200 calories on extra exercise days
Weight gain (serious points here!!!!):
• 20 points for every fortnightly weigh-in session Ben incs by 1kg
• 18 points for every fortnightly weigh-in session Ben incs by 0.9kg
• 17 points for every fortnightly weigh-in session Ben incs by 0.8kg
• 16 points for every fortnightly weigh-in session Ben incs by 0.7kg
• Less than 0.7kg = zero points
• Don’t deduct points for losing weight – keep this a positive contract
The above contract to be adjusted accordingly subject to regular parental monitoring of progress.
Signed ______________________________ (Ben)
Signed ______________________________ (Mum)