Quote of The Day

Ahhh, the timeless wisdom of Dr. Seuss.
Fantasy, sillyness, and whimsy are necessary ingredients when caring for children in any capacity, especially as a therapist. In some ways working with my kiddos can be like stepping into a Dr Seuss book, where up is down and fish can fly.

If you haven't lately, try to change your perspective about the "odd things" your clients do, and see things from their perspective. Similar to reading a Dr Seuss book, it could be an out of this world experience.

“Fantasy is a necessary ingredient in living, it's a way of looking at life through the wrong end of a telescope.” 

Dr Seuss, Writer/Cartoonist, March 1904 - September 1991

Pairing

“Pairing” – The process of creating (or re-creating) an enjoyable, reinforcing, and pleasurable relationship between therapist and child, where the child comes to view the therapist as not just the giver of reinforcement, but as actual reinforcement. 

I have mentioned pairing before on my blog, but this is the first full post all about pairing. Pairing is one of those ABA activities that some therapists just LOVE to do, and some therapists dread. I think this is because so much of pairing is unstructured and “loose” and for left-brain type therapists (like myself), we like structure and order.

I have worked with ABA therapists who are a-MAZ-ing at pairing, and some who definitely needed help and training on successful pairing skills. The good news is that this is a skill that can definitely be improved upon no matter how long you have been working in this field. Pairing in its simplest terms is just being the embodiment of a toy. When I am successfully paired with a child, I feel like a gigantic toy. The child is pushing and pulling on me to get me to engage with them, ordering me around (“No, sit right here!”), excited to see me arrive and sad to see me leave, and any activity is more exciting if Ms. Tameika does it too.

 If you are one of the pros at pairing, feel free to leave tips in the comment section about what helps you be so successful with pairing. If you could use some pairing assistance, then keep reading!

The therapeutic relationship should begin with pairing and rapport building. Even if you already know the child, you shouldn’t immediately jump into giving demands. Pairing is how therapists establish instructional control, build trust, connect themselves to reinforcement (eventually becoming a reinforcer), and get to know the child’s interests. Skipping the pairing process can cause problem behaviors to increase, kill instructional control, and impair the therapist-child relationship. If I am not properly paired with a new client and I just walk in and start giving orders, what is motivating the child to do what I say? What is motivating the child to want to come and play with me? 

What you could unintentionally do is create a situation where the child is doing things you ask to get away from you. So you place a demand, the child answers, you provide reinforcement, and the child walks away/leaves the room/elopes. That is definitely NOT a situation you want. It’s no fun for you or the child to have to chase them around the home. 

You will know pairing has been successful (and you can begin to fade in instruction) when the child is consistently coming toward you, not walking away from you, or when the child chooses to follow you around the home vs. staying up under mom and dad or engaging in solitary play. The whole "Im-going-to-play-alone-with-my-back-turned-to-you" thing is like a red flag that you have more pairing to do. When you can enter the home and start pulling out materials and the child sits down by you and shows interest in working with you, then pairing has been successful.

Pairing is all about social reinforcement and play, which many kiddos with Autism are not motivated by, or will not work for. You are teaching the child to work for non tangibles such as approval or praise, which will also benefit the child away from the therapy session. Teachers don’t usually pass out bits of cookie for correct responding. They are far more likely to give a thumbs up or a smile. Children with Autism may need to learn that non-tangibles can be reinforcing too, and the pairing process is bursting with varied types of social reinforcers.   

Also, even for  kiddos who don’t enjoy play they probably enjoy attention. A therapist showing up at the home 2-3 times each week strictly to play and provide undivided attention is pretty awesome. This can pave the way for instructional control, by implicitly sending the message to the child that you WILL keep showing up and that every time you do the child must interact with you.

Pairing is not something you do for a few days with a new client and then never do again. Pairing should be re-introduced anytime the therapist-child relationship has weakened, or diminished. This could be after a long vacation or long illness, when a new therapist joins the team, if the child has had a recent resurgence of problem behaviors, etc.

These kiddos will not be overjoyed to see you arrive for a session every single day; that’s normal. However, if you reach a point where the child is regularly expressing disapproval at your arrival (“No!”), eloping from your sessions, or having difficulty transitioning into work (mom or dad have to physically bring the child to you to start therapy) then something is definitely wrong with the therapist-child relationship, and its time to go back to pairing.

Instructional control is the process of establishing authority as the therapist, and pairing is the process of establishing yourself as the giver of all good things. Does it sound like these 2 concepts are in opposition to each other? Actually, when done properly pairing will help you gain instructional control. The reason why is because if I am restricting access to the child’s most reinforcing items then that means I control them and some type of interaction with me is required to get the items back.

 If I skipped the pairing process with a new client and just walked up to the child and started giving demands, I would probably get problem behaviors or elopement. The child would simply walk away from me or maybe even run away from me. How are you going to have an ABA session with a child who doesn’t want to be in the same room as you??

There is one last benefit of the pairing process that I feel is sometimes overlooked. Successful pairing teaches the child that I am fun, I am a friend, and when I show up at the house good things happen. So in the future if we have a bad session or the child hates a program I am trying to teach, they can separate the task I am asking them to do from who I am. In other words, they can dislike what I want them to do and still like me.

Here is an example of the first few days of pairing with a new client, and what that progression might look like:

PAIRING PROGRESSION

Day 1: Introduce myself to child. Observe the flow of the day and how the child spends their day. Act more as an observer than an active participant. Shadow the parents as they engage with the child so I am connected to reinforcing people (the parents). Place 0 demands on the child.

Day 2: Greet the child. Begin to connect myself to known reinforcers. If child loves to swing, push the child on a swing. If child loves going to the park, take the child to the park. Praise appropriate independent behaviors, such as eye contact or sharing (“Thanks for sharing with me!”), and have lots of playful interactions doing what the child wants to do. Do lots of narrating or mimicking (if the child is verbal) during the play. Follow the child’s lead.

Day 3: Greet the child and begin to prompt a response. Restrict access to reinforcers by being the one in control of reinforcing items. Deliver these items to the child with no demand required throughout the session. Begin to incorporate social reinforcers into play such as having a babydoll give the child kisses. Praise appropriate independent behaviors, such as eye contact or sharing (“Thanks for sharing with me!”), and have lots of playful interactions doing what the child wants to do. Do lots of narrating or mimicking (if the child is verbal) during the play. E.g. “We’re coloring a picture”. Continue to follow the child’s lead.

Day 4: Greet the child and wait for them to respond. Arrive to the home with a Grab Bag of reinforcing items to introduce during the session. Restrict access to the reinforcers by placing minimal demands on the items. For example if the child wants a pinwheel out of your Grab Bag require them to spin the pinwheel once (prompt if you need to), then immediately praise the spinning and give the pinwheel to the child. If the child is verbal begin to require they label reinforcers to get them (hand the child a ball but dont release it until they say “Ball”). Increase amount of social reinforcers used during the session to a few each hour; label the name of the activities as you do them. For example, as you lift the child into the air say “You’re an airplane!” Begin to have the child follow your lead, e.g. As you are playing with the child on the floor stand up and yell “Come chase me!” and then run into another room. Reward the child following your lead with tickles.

*Quick Tip: Here’s a link to a massive variety of social reinforcers. Try to mix in 5-7 different ideas into each ABA pairing session. Good luck!

Great Pairing Video via Youtube

“It’s Time to Do Your Homework”

This is one of those topics that really transcends Autism or special needs. The majority of my clients who are in school have behavioral difficulties around homework: escape behaviors, noncompliance, aggression, tantrums, etc.

But guess what??—So do neuro-typical kiddos!

It isn’t uncommon that I go into homes and my client needs help completing homework successfully, and so do their older brother and younger sister. So definitely feel free to apply this information to any child you know of who has difficulty with independent and correct completion of age appropriate homework activities (that is the ultimate goal for homework).

Homework is such a common behavioral issue for families because it tends to combine multiple non-preferred tasks into one: completing academic tasks that may be very difficult, working on a task for an extended period of time, following multiple step instructions, working on a task independently, and working for delayed reinforcement. Add to that a situation that (usually) is JUST as frustrating and non-preferred for the parent, and homework time tends to be bursting with problem behaviors.

So how can ABA therapy help with the bloody battle which is often homework time?

ABA therapists approach the task of homework behaviorally. We focus on improving concrete behaviors that will allow the child to be more successful when completing homework, such as listening, attending, reading directions, sitting appropriately in the chair, tuning out noise or stimuli, writing, etc. We will work on homework by targeting the problem behaviors the child is exhibiting to get out of, delay/avoid, or reduce homework expectations.

ABA therapists typically do not approach the task of homework academically. That means that the ABA therapist isn’t trying to teach the child how to do long division, their multiplication tables, or who the 17^th president of the United States was. ABA therapists are not tutors. If the child is an insurance client (the therapy is paid for via insurance) then it actually could be considered insurance fraud for the ABA therapist to spend hours and hours teaching the child what a noun is. Insurance is paying for behavioral interventions, not academic tutoring. This may mean that the ABA therapist helps your child with homework, and all the questions don’t get answered. Or all the problems aren’t done correctly. 

What I will usually do is complete the homework with the child for a specified amount of time (otherwise it could eat up an entire session), and direct the child to give the homework to mom or dad to check while the child and I finish our session.

Common Homework Mistakes

Here are some of the most common mistakes I see parents commit when trying to get a child with an ASD to complete homework. This isn’t about shaming parents; it’s about learning more effective strategies and better ways to tackle the problem of homework completion.

• Arguing with the child: Example – “Is that supposed to be a 3? Erase that and do it again that looks like a 8.....Yes it does……Yes it does…….Yes it does” Endless power struggles and arguments with the child are really just intended to distract you from what you are trying to do and delay the completion of homework. Arguing with a child is never necessary because as the adult, you are the final word. If your child is trying to pull you into an argument, don’t respond. Restate the demand and use prompting to help the child respond correctly.
• Lack of transitions and priming: Example – Parent abruptly walks up to child “Okay, time to do your homework. Come on” Priming basically means you are stating expectations of behavior before the task. This could look like reminding the child to stay on task, that they can ask for help, and what reinforcement they can earn (we’ll talk about reinforcement next). Successful transitions would include telling the child at specific intervals that it is almost time to do homework, such as “it will be homework time in 5 minutes”. Successful transitions could also include making a visual schedule where homework is set for a specific time of day and the child knows that after ____, its time for them to do homework.
• NO reinforcement: Example – Parent has child working on academic tasks for 40 minutes to an hour with no reinforcement given and no praise. In an ABA session I would never have a child work for 40 minutes without delivering some type of reinforcement or praise. That would be a quick way for me to see a lot of problem behaviors start happening. Reinforcement can be tangible, an activity (after homework the child can play video games), or even short breaks in between homework activities, such as: spelling assignment, break, math assignment, break, etc. With children who are very noncompliant or struggle with completing homework correctly it might be hard to praise or reinforce the child. If you can’t praise the child’s successful completion of homework, you can praise their effort, or their behaviors, such as “You are sitting so nice!” or “I love how you are trying even though this is hard”.
• Begging/Pleading with child: Example – “C’mon, lets just finish this okay? Dylan, I’m tired. Please? Lets get this over with” Similar to arguing with a child, it isn’t necessary to beg or plead with a child to exhibit the behaviors you want to see. State your expectations, remind the child what they can earn (see why reinforcement is so important?), and use prompting to help the child be successful. Begging and pleading only puts the child in control and robs you of your power as the parent.
• Making endless, empty threats: Example – “We will sit at this table all day until you write your name on the paper!” Making empty, endless threats sends a clear message to your child: I am frustrated, and I don’t mean what I say. I highly doubt you want to actually sit at the dining room table for 5 hours because your child refuses to write their name on their homework. Choose your words carefully so you don’t end up making nonsensical statements. Stick to your original demand (“Its time to do your homework”) and avoid unnecessary language, which is a HUGE amount of attention to a child who is not doing what you want them to do.
• Doing way too much homework at once: Example – Parent gives child 2 pages of spelling homework, 3 pages of math problems, and 10 sentences to diagram in one sitting. I don’t really know what happened to homework, but there seems to be a lot more of it since I was a child. Some of my older clients come home with pages and pages of homework to complete. I wouldn’t give a child 50 tasks at once during a therapy session, and I wouldn’t suggest a parent do that during homework time. Just imagine how defeating and discouraging that would feel if your boss gave you an assignment that you aren’t very good at and dislike, and it was 50 pages long? That’s how these kiddos feel when their homework assignments are not broken down into sections, with easy tasks interspersed with difficult tasks.
•  “Helicopter” mom or dad: Example – Parent hovers over the child as they complete homework, erases the child’s wrong answers, tells the child where to sit, reads the directions for the child, etc. The ultimate goal of homework is that the child will be able to complete it independently. So to work towards that goal it’s important not to use excessive prompting. If your child has the fine motor abilities to use an eraser, then they should erase their own wrong answers. Try sitting across from them instead of next to them. Offer the child choices so they feel more in control. Say to them “Do you want to sit in this chair or that chair?”, “Which pencil do you want to use?”, or “What do you think: spelling or math first?”.
• Environment isn’t properly arranged: Example – Homework happens all over the house, no designated space, TV is blaring in background, siblings are sitting at same table playing as child is trying to focus on homework, etc. Homework should happen at a specific time of day, in a specific place. The area should be free of distractions and excessive noise, and siblings should be redirected to another area so the child can focus. A child with an ASD might not be able to focus on math homework while their younger brother paints a picture directly next to them. I typically do homework with a client at the dining room table where there is plenty of lighting, and we are far away from video games or TVs.
• Time Out is used during homework time (Nooooooooooo! Please don’t do that): Example – “I told you 3 times to get out your history book! Go to time out until you can listen and pay attention” Time Out as a behavioral intervention will only be effective if the “Time In” environment is reinforcing. If the child is doing homework (which is typically highly non-preferred) then sending them to Time Out is like sending them to Disneyland. What you will likely see is its very hard to get the child to come back to homework after you send them to Time Out, and the problem behaviors keep increasing and getting worse. Instead, set a time limit on homework and choose a very powerful reinforcer. Tell the child if they finish their homework before the timer goes off, they get the reinforcer. This way if the child refuses to comply, you can still use prompting to ensure compliance and now the child has lost a desired reinforcer.

*Resources for Homework Completion:

 http://www.autismlearningfelt.com/2011/04/tips-for-happier-homework-time.html

 http://www.myaspergerschild.com/2012/04/resolving-homework-battles-with.html

http://www.child-autism-parent-cafe.com/homework.html 

 http://www.psychologytoday.com/blog/pride-and-joy/201209/battles-over-homework-advice-parents

Using Token Boards

Token boards are a way to visually track the reinforcement for a given task, and its also a type of delayed reinforcement. A goal in any ABA program should always be to fade from continuous, tangible reinforcement to more social reinforcers that are delivered intermittently, such as praise, or privileges. Otherwise our clients will be at a disadvantage when they are in a middle school classroom and expect to receive a bite of cookie every time they answer a question correctly. In the real world, we tend to be motivated by intrinsic reinforcement, and the reinforcement we contact through our environment is usually intermittent. 

Engaging in non-preferred activities during the day can be a challenge for our kiddos. Disruptive and challenging behaviors usually take place during these types of tasks or activities, and I have often observed that the least preferred activities also have the least amount of reinforcement for successful completion. 

Using a token board system provides children with visual information about “how and when” to earn their reinforcer and allows them to see the consequence of low effort, disruptive behaviors..... what I like to call "stalling" behaviors ("I need a pencil...this one is too small.......can we sit in the kitchen.......I'm thirsty!"). The child cannot earn the desired reward while engaging in any of these behaviors, so instead of delivering threats or stating your SD over and over you can just point to the token board and tell the child "As soon as you do 2 math problems, we can go to the park". The child will quickly learn that delaying the task also delays the reinforcement!

Token boards are not difficult to make, and definitely dont need to be purchased. They can even be made quickly on the fly, in the middle of a session. That is something I have done before with kiddos who were having an off day, displaying lots of escape behaviors, or just needed multiple reminders about their reinforcement. Typically, a token board system would be written into the behavior plan so you would already have one ready to for that individual child. However, some days these kiddos just need a little bit more help to be successful and a huge part of ABA is thinking on your feet :-)

Token boards should have (at a minimum) the following three sections:

•The reward section

•The ‘tokens to earn’ section

•The ‘tokens earned’ section

The child needs to understand what they are working to earn, what they must do to earn that item, what will NOT earn the item (this step is often skipped over), and the duration/amount of work you will require before they can access the reward.

Here is an example: You are working with a 6 year old on a Block Design program. The target is the child will build a 4 block structure. You are using a token board system where for every 2 independently correct responses the child earns 1 check. After 2 checks, the child can play 10 minutes of Wii. If the child needs prompting to build the 4 block structure, refuses to comply, builds a 1, 2, or 3 block structure, or exhibits behaviors, they do not earn a check. Only correctly and independently performing the target behavior gains a check. Particularly for older children, they enjoy getting to check off or add the token to the board themselves. Have a mini -celebration each time the child earns a token, and remind them how much further they have to go: "Great working, Evan! You earned 1 token! Just one more, and we can go play Wii!"

 

There are all kinds of ways to create a token board, and the age of the child as well as their interests/personality should guide you. If the child is younger and loves Barbie, then you could have a token board where the child colors in a photo of a Barbie, and when they have colored in 3 Barbie's, they earn the reward. This way earning the reward is fun and the reward itself is fun.

Remember to keep the child motivated. Learning to work for delayed reinforcement is tough. You are essentially thinning the child's schedule of reinforcement and if you move too quickly, you will get behaviors.

Making a Token Board:

Supplies: The actual tokens, spaces to place tokens onto or inside of, and a photo/label/image of what the child is working to earn (if possible you can also place the actual item onto the token board). I highly suggest you laminate both the token pieces and the board, otherwise after a bad session the lovely token board you created could be ripped up in pieces on the floor.

Teaching Strategy: Create firm, concrete rules for the token board and stick to them. It is completely unfair to change the rules of the token board minute by minute, or when you feel like it. I usually use a token board for seriously non-preferred tasks, such as homework. So for homework, my expectations might be that the child needs to do homework independently without needing me or a parent to help them with every problem. So for that child I might create a token board where for every homework problem they complete independently they earn 1 token. They can still ask me for help, they just dont earn a token if I had to help them complete the problem. When homework is all done we will count up their tokens and each token equals 5 minutes of riding their bike outside. If those are the rules then I need to stick to them and allow the child time to learn them. If you change your token board too rapidly, the child will be confused about how it works. If they dont know how it works, then how can the token board benefit them?

Behaviors: It is quite common that once these kiddos learn the rules of the token board the next response is to see just how far those rules can bend. This could mean the child completes a task, but does it incorrectly. Or the child exhibits problem behaviors such as crying or demanding the reinforcer before they have completed the task. This is why its so important to select clear, firm rules before implementing a token board. Everyone on the therapy team needs to be clear on how the token board works, what earns a token, and what does not earn a token. The child cannot access the desired reward until they earn the required number of tokens. If you find that you are having difficulty getting the child to work for the tokens, try reducing the amount of tokens required to earn the reward. Especially for a young child, the child could be required to do 1 difficult task, and 2 simple tasks to earn a token. 

The Reward: The reward used should be powerful, and the more tokens necessary the bigger the reward should be. A child shouldn't have to earn 15 tokens to get a high-five. That would be pretty ridiculous. Providing praise for each token earned (not just the final reward) will also help keep the child motivated. I find that my kiddos get excited to see a token added to their chart, or to add a check to their token board. If you praise their earning a token, then they will start to get excited about progress and not just the ultimate goal. The reward should be delivered immediately upon the child earning the required number of tokens, and don't allow the child to access the reward if they dont have enough tokens. Doing so will simply undermine the effectiveness of the token board.

Token Economy Video

Recognizing & Labeling Emotions

There is SO much I could say about teaching emotions, the complexities of nonverbal communication, facial scanning, emotional self-regulation, perspective taking and “mind reading” that this post could go on for pages and pages. So to keep things concise, I will focus on specifically teaching a child to recognize and label the emotions of others.

This really isn’t even a topic specific to Autism. Many young children struggle with identifying the emotions of others, and being able to respond appropriately. Many of us know of that emotionally immature 3, 4, or even 7 year old who struggles to make and keep friends, due to annoying and outrageous behavior. They play silly, rude, or mean jokes on their friends that no one else finds funny. They don’t seem to notice when their friends are upset, sad, or embarrassed. They are uncomfortable with their friends crying around them, and instead of asking “What’s wrong?” they just walk away.

Although typically thought of as a social skill, learning to identify emotions can also influence communication, play skills, academic success, and even the ability to get and keep a job. Just think about a 17 year old with Aspergers who tells inappropriate sex jokes at work because he can’t tell when other people are annoyed. Or a 7 year old with Autism who can’t maintain friendships because he never looks at his friends faces.

I love teaching emotions because it is a life skill that is vital to meaningful interaction with society, but a specific reason I love emotion programs is because my kiddos have to look at faces in order to learn the skill. Many children with Autism will go to great lengths to avoid looking at someone’s face, or especially into someone’s eyes. Yet most nonverbal communication happens in the face, and in the eyes. So whether I’m holding up a flashcard or making exaggerated facial expressions, beyond teaching the child to label an emotion I am also teaching them that a key to understanding other people is their face. 

The sooner you can start teaching emotions, the better. There really isn’t a prerequisite for teaching emotions; it’s more of a pivotal skill that opens pathways to teach a variety of other skills.  Always be sure to model appropriate facial expression, voice tone, and affect when demonstrating a behavior. If you are modeling “happy” then talk in a louder tone of voice, smile, widen your eyes, and clap your hands or shout “Hooray”. Do more than just make a face. When teaching a child with Autism the skill of recognizing emotions, it is helpful to exaggerate. Many of these kiddos don’t want to look at someone’s face, so give them a reason to want to study your face. Put your inner actor/actress to the test and really give it your all. If you are modeling sad, pretend to cry, talk in a quivering voice, and lower your head. Demonstrate the depth of emotion you want the child to mimic.

Emotion programs can become quite complex, or can be taught in a very simple way, just depending on the age and functioning level of the child. A toddler with PDD can be taught to touch the “happy” doll and the “sad” doll. Or a teenager with Autism can be taught to watch a short video clip of a couple breaking up, and then discuss how each person felt (yes, that could be a way to teach emotions. I told you emotion programs are fun!).

Depending on how the child communicates, you can begin teaching emotions receptively or expressively. Unless the kiddo is a strong vocal communicator, I usually will start a program receptively (“Touch sad”) and then move to expressive (“How does she/he feel?”). There are 9 main emotions that you want to be sure to teach, and beyond these 9 I usually consult with the primary caregivers to see how complex they want to get:

Happy, Sad, Angry, Surprised, Scared, Confused, Sleepy, Bored, Shy

Here is a sample hierarchy of teaching basic emotions:

Receptively identify emotions using object (e.g. doll) -SD: “Give me the sleepy doll”

Receptively identify emotions using picture card (large color photos are preferred) -SD: “Touch happy”

Expressively identify emotions using picture card -SD: “How does he feel?”

Expressively identify emotions as another person makes a face -SD: “How do I feel?”

Child makes a face to demonstrate an emotion -SD: “Show me scared”

Child labels an emotion using image of a scenario -SD: (Child looks at a photo of a little girl crying who just dropped an ice cream cone) “How does she feel?”

Child acts out a scenario or brief scene featuring an emotion -SD: Therapist tells child to pretend he is at a birthday party and is opening presents. “Show me excited!”

Once a child can understand emotions, you will find that its often much easier to prompt appropriate social interactions (“You hurt your friends feelings, look, she’s crying”), generalize those skills to self regulation (“You look like you’re upset, lets go take a walk”), help children communicate better (“When you yell and make that face it makes me think you’re angry. I need you to ask me nicely with a calm face”), etc. The importance of teaching children with Autism to understand emotions cannot be overstated.

**Quick Tip: Parents, as your child’s 1^st teacher be sure to model a wide range of emotions for your child with Autism. I often find that children with Autism are strongest on two emotions: mad and happy. Often the reason why is those are the emotions they see the most on the faces of their parents…super happy with a big smile, or very angry with a raised voice. What about fear? Embarrassment? Pride? Excitement? When was the last time you let your child see you afraid? It may sound like an odd thing to model, but for a child with Autism your face may be the only face they are comfortable looking up into. As a parent of a special needs child, you go through a rollercoaster of emotions on a regular basis! Don’t be afraid to let your child see your vulnerability, and a range of emotions.

Resources on teaching Emotions:

  Mind Reading Software

 

  Teaching Materials

 

  Teaching children to mind read (a manual)

Quote of The Day

 

Teaching is at its best when it is done with P-A-S-S-I-O-N, creativity, and captures the motivation of the child. Great ABA therapists know how to strike a balance between work and play, without having to sacrifice effectiveness.

If you cant remember the last time you laughed or made the child laugh during a therapy session, its time to inject more creativity into what you're doing!

The Art of Redirection

Redirection – An ABA behavior reduction technique used to distract the child from a problem behavior, or lead them to engage in a more appropriate behavior than the one they are currently engaging in. Redirection isn’t intended to replace the need for a FBA  and Behavior Plan to extinguish a problem behavior.

I have stated previously on my blog that ABA therapists are not magicians and we don’t carry magic wands, but there is one thing that ABA therapists have in common with magicians: When we are doing our REALLY well, an onlooker has no idea what we just did. :-)

Redirection is a technique that most educators, therapists, and caregivers know all about. Great teachers and great ABA therapists are masters at the art of redirection. When done correctly, to the naked eye it isn’t clear that the therapist is using redirection and it sometimes might not be clear what the inappropriate behavior was.  Particularly if the therapist has known the child for some time, they are already aware of triggers or cues that precede problem behaviors and they move with precision timing to get the child engaged in something else that is more appropriate.

 It’s always easier to prevent a problem behavior than to react to one. So many times, parents will ask me “What do I do when my son/daughter does (problem behavior)?”, and my response to that is why wait until they are already engaged in the behavior?? Change your mindset about problem behaviors, and start focusing on how to prevent them before they even kick off.

Let’s make this more everyday and less clinical: You have been waiting all day for an important phone call, so you decide to relax a bit in the meantime. You have a steaming bubble bath ready to go in your candle lit bathroom. Which of the following scenarios would be more frustrating and/or annoying:

1) You step into the nice, warm bubble bath and sigh happily. Then the phone rings, and you have to get out of the tub to go answer it.

2) Before you can step into the nice, warm bubble bath the phone rings. You head towards the living room to answer the phone.

See the difference? It is more difficult to stop a problem behavior and redirect a child to a new behavior, because the behavior is already happening. From the child’s point of view, the problem behavior could be just as enjoyable (if not more enjoyable) than a warm bubble bath, and our therapist voice saying “Do NOT climb that!” is like the shrill, ringing telephone making them get out of the bathtub.

When done artfully, redirection is a way to distract the child from the problem behavior they want to engage in, remind the child they can make better choices, or present alternative ways to meet the same function of the problem behavior. I have seen some really creative ways to redirect, both in homes and in classrooms. Successful redirection requires consistently being 1 step ahead of the child. It requires putting on the eagle “therapist” eyes, scanning the environment for any behavioral triggers, and keeping a close eye on the child’s affect and mood particularly in new social situations, during transitions, and during downtimes.

I have also seen redirection done poorly. That usually looks something like a teacher or therapist who notices the child is engaged in a problem behavior, and then may say something like “Get down” or “Stop running”. The first issue is the therapist wasn’t attending to the child properly, and allowed the child to begin engaging in the problem behavior. The second issue is the therapist gives a “Stop” statement instead of a “Go” statement, so now the child is given the power to decide what replacement behavior to use. Most of the time, it wont be anything appropriate. I’m sure many teachers can relate to telling a child running down the hallway to “stop running” so then the child begins to skip…..or walk quickly…….or gallop. This is why “Go” statements are preferred, where the therapist or teacher tells the child what the replacement behavior should be (e.g. “Show me walking feet please”).

 The better you know the child, the easier it will be to redirect them successfully because you will know their interests and likes/dislikes. When I see the masters of redirection at work, there are certain things they do and don’t do that cause their redirection technique to be so successful. 

Wishing I would tell you what those things are?

Your wish is granted!

• It’s good use of ABA methodology to always reinforce the redirection. The redirected item or activity is always something more appropriate than what the child was currently doing, or was about to do, so we would like the child to engage in the redirected behavior again in the future. Lets say a child is inappropriate when meeting new adults and just lunges into peoples personal space because it gets a big attention response. Redirect that problem behavior into a cool dance move. Teach the child to greet a new adult and then show off their cool dance move. Then be sure to reinforce the redirected behavior (the dance move) with applause and tons of praise (tell the new adult to clap with you!) so that the more appropriate behavior will be reinforced and continue to happen.
• Try to redirect to something similar. I like to explain this by saying don’t take away an orange, and give a shoe. If you need to take an orange, give an apple. If your client enjoys visually stimming with mirrors by staring at mirrors and laughing hysterically, or putting his face directly against the glass, don’t take that behavior away by saying “Let’s go play with some blocks”. You just took away an orange, and handed the child a shoe. Pick a redirection behavior that is similar to the problem behavior, but more appropriate. In this example you could stand between the child and the mirror and hold out a pinwheel and a kaleidoscope. Tell the child to choose one to play with, and then reinforce their choice. Prompt the child to hold the toy close to their eyes, stare at the toy, and show them how to move the toy to make it visually exciting.
• If you are trying to redirect the child to an activity, try hopping into the activity with the child. This is something I see many parents do who are amazing at redirection. If their child is being crabby and aggressive with their siblings while playing a board game, the parent will join the game and change the way it is being played.  Instead of the parent stopping the play, they will join the children and suggest a new game, or make up crazy rules that get everyone laughing and competing to think up the silliest way to play the game. Remember, redirection can sometimes be as simple as distracting the child out of the problem behavior.
• Be quick on the draw! I dare any cowboy from an old black and white western to be quicker on the draw than an excellent ABA therapist. When redirection is an art, it happens so quickly that if you blink you might miss it. I have observed therapists prevent a child from aggressing at a peer with songs, one step instructions, or by asking questions. I have observed therapists redirect a tantrum into a silly dance, or an imitation game. Arrived to a home for a session and the child is clinging to Mom and wants no part of you or your therapy? Tell the child to race you to the therapy room, and have Mom give the countdown (Ready…Set…Go!). Let the child win, and then give them a reward for winning 1st place in the race, as you walk them to the therapy table.

Quote of The Day

Today's QOTD isn't a quote, its more of a "Did You Know"......

 

When teaching a child with Autism, so many painstaking baby steps of progress can happen when teaching language that its easy to forget what language looks like with a "normal" (that dreaded word) child.

When teaching language to a child with Autism, the child may initially just have a handful of words. Then they can say 15 words....then 30.....then 42! The progress is so exciting and therapists and parents are so happy to be able to communicate with the child that everyone can forget that typically developing children have vocabularies that are large, varied, and complex.

When I spend time with typically developing young children, it amazes me sometimes to watch things they can do that my much older clients still cannot do. Spent time with a 2 year old lately? They will talk your head off! :-)

 It is important as therapists and parents to remember to set high goals. Don't compare your child or your client to other kids with Autism. Set high goals, and work diligently to help the child meet the goals.

I found the above photo on Pinterest (do you know about Pinterest?? Its awesome!), and I immediately thought of Manding trials and pulling language out of my clients, often over weeks or months.

 Does your verbal child with Autism chatter as much as a typical child of the same age? If not, I challenge you to set higher goals for that child. Can your child engage in conversation, answer novel questions, or describe things? Or does their language consist only of mands ("I want juice") or tacts (child points to car driving by, "Car") ?

 I challenge you to spend some time with a typical child the same age as your child, and then go back and take an honest look at your child's ABA progress and language goals.

Generalization: Teaching Loosely

Teaching loosely is a term that most educators are probably familiar with, but it’s a concept that can also be very helpful to ABA therapists. Teaching loosely is a way of intentionally teaching content to promote generalization for the learner. Instead of the typical way of teaching where a child learns a skill and then learns to generalize the skill and maintain it across environments, with teaching loosely generalization is an integral part of the lesson right from the start. Teaching loosely is about randomly and intentionally varying parts of your teaching, including materials, tone of voice, words, facial expressions, seating, room/location, time of day, etc.

Generalization is so important! If you can teach a child or student to say “Hi” to you, but they never greet peers or unknown adults then what is the point of that? How does the skill of saying “Hi” benefit that child? Teaching children with Autism should never happen within a vacuum. The skills learned should be intentionally applied across settings and individuals, to help the child interact meaningfully with their environment.

 There are many ways to generalize, including across time, across settings, and across stimuli.

• Time- Michael learned to read 15 sight words last October. Today he can still easily read those 15 sight words.
• Settings- Michael learned to read 15 sight words off index cards in Mrs. McDougal’s 1^st grade classroom. Michael can still read those 15 sight words off an index card regardless of the environment (at home, on the playground, during an ABA therapy session, etc.).
• Behaviors- Michael learned to read 15 three letter sight words. Now Michael is easily reading other sight words that have three and sometimes four letters, and he has started showing an interest in storybooks.

When initially teaching a skill using DTT or VB methodology, it is important to remove unnecessary stimuli, use a clear and simple SD, provide strong reinforcement quickly, and minimize error. What can happen in an ABA program is the instructor or therapist doesn’t fade this intensive teaching style, and doesn’t remember to plan for generalization.  When teaching students with Autism, it is imperative to help the child generalize the material they have learned. If a child is taught to say the word “Mommy” because a therapist holds up a photo of his mother, that doesn’t mean the child will say “Mommy” when his mother walks into the room. Parents often ask me why their child doesn’t display skills outside of the therapy room, or why will they only do XYZ skill with the therapist. The reason why is usually a failure to teach for generalization.

Teaching loosely takes work and planning, and forethought. It would be pretty difficult to properly plan for generalization without a clear terminal goal. Teachers or ABA therapists often make long term and short term goals, but not a terminal goal. A terminal goal answers the question “What do I want it to ultimately look like when the student has mastered this skill”. A long term goal might be to get a child to sit quietly at their desk during transitions, instead of bothering peers, walking around the classroom, or engaging in stims. A terminal goal would be much broader than that, such as expecting the child to choose an appropriate activity to engage in during down time or transitions that doesn’t require adult help. For example, writing sentences in a journal book, reading quietly, or drawing a picture. 

As a professional, any skill that you teach to a child with Autism should be done with a terminal goal in mind. Think bigger than teaching a child to talk, potty training a child, or reducing a behavior. Aim for helping that child become as independent, successful, and productive as they can in a variety of real-world environments.

If you are wondering if your student or client may need more generalization intentionally embedded into instruction, ask yourself: If you removed yourself and someone else taught the student, would learning suffer? If you change the reinforcement, does learning suffer? If you move to a new classroom/setting, does learning suffer? If you change your wording (“Come here” vs. “Hey, stand by me”) does learning suffer? If you find yourself answering yes to these questions, it’s likely there isn’t enough generalization of skills happening.

Cooper, Heron, & Heward have some amazing tips and recommendations for teaching loosely. These strategies would be helpful in a classroom setting, as well as in any quality ABA program (I have implemented many of these strategies over the years, and they are great at promoting generalization):

Choose behaviors to change that will contact reinforcement in the natural environment (such as praise, positive feedback or attention, social approval, etc).	When writing programs or creating goals, think of all situations/settings where the behavior should and should NOT occur.	Teach sufficient examples (don’t just use one photo of “bird”. Use multiple photos, a video clip, and a bird stuffed animal).	Use 1 or more teachers (this is why most ABA programs use 2-3 therapists per case).	Teach from a variety of positions (do you always sit next to the child?? Switch it up!).
Regularly and consistently do “maintenance checks”, where you bring out old material and make sure the child can still perform the skill.	Use an intermittent schedule of reinforcement (start to thin the reinforcement schedule so the student isn’t sure exactly when reinforcement will be delivered).	Ask other people to help you reinforce the targeted behavior(s).	Vary the smells, sounds, and decorations in the training environment (for a child with Autism, they are absolutely learning not just you but also the environment).	Teach at various times of day.

*Recommended Resources:

Lots of specific tips about generalizing skills and concepts- From A to Z: Teaching Skills to Children with Autism by Tameika Meadows

The “White” Book- Applied Behavior Analysis by Cooper, Heron, & Heward