Waiting can be a hard skill for a child with Autism to learn. Individuals with Autism often have difficulty with abstract thought, and don't understand the concept of time. The words "Just 5 more minutes", or "We'll do that later", may mean nothing to these children. Children with Autism also have a rigidity of interests and a need to follow an internal schedule, which makes the child want their needs/wants met now...now...NOW.
I was inspired to do this post after seeing a meltdown this morning. It wasn't at the grocery store this time, it was inside a shoe store. As I was deciding between two pairs of shoes, I saw this adorable little boy who had clearly reached his internal time limit for shoe shopping. First he began to whine, whining escalated to crying, and then crying escalated to throwing shoes across the store. I kid you not....pumps began to fly across the store. I'm sure for many people witnessing this, it just looked like a bratty child having a tantrum. What I saw was a child who didn't know how to wait.
Many aggressive and challenging behaviors can stem from a child's inability to wait. You might be wondering why is it so important to teach a child with Autism to wait. The reason why this is such an important skill is because its a pivotal skill, meaning it impacts the success of learning more advanced skills. Children have to wait, because adults have to wait. As a child matures and starts interacting with society they will have to wait in the classroom, at the park, at the grocery store, inside the home, at the airport, etc. Here's a few examples of what difficulty with waiting can look like:
- Whenever the teacher tells the class to line up to go outside, Doug gets very excited. Doug loves playing outside. Doug gets so excited and impatient while waiting in line that he regularly pushes other kids down, and steps on their feet.
- Iyanna is at the mall with her dad. Iyanna makes the sign "eat" to her dad to signify she is hungry. Her dad tells her they are leaving the mall in 15 minutes, and and she can eat then. Iyanna begins to cry, and a few minutes later bolts away from her dad and runs to the food court where she starts eating leftover food off of tables.
- Tyrone's daycare teacher just bought a new trampoline for all the children to play with. Tyrone has fun all morning jumping on the trampoline by himself. After lunch, another child tries to climb onto the trampoline with Tyrone. The daycare teacher says only 1 child can jump at a time and tells Tyrone to get down. Tyrone watches the other child jump for a few seconds, and then he screams and pushes the other child off the trampoline.
When teaching a child with Autism to wait you can work on this issue incidentally or you can write up a program and teach it in a structured way. I tend to do both. I write up a Waiting program and I also show the adults in the child's life how to work on this skill away from the table. The more the child gets to practice waiting, the better.
So lets look at both approaches:
Teaching a Child to Wait: Program-
For a step by step explanation of how to write ABA programs see my Writing ABA Programs post. For a Waiting program you will need activities or objects the child enjoys. You will also need a timer. Before writing the program you need to determine the child s current ability to wait appropriately. Appropriate just means the child doesn't try to reach for or grab at the item they are waiting for, and if the child is vocal they don't whine or plead for the item. If its an activity, the child doesn't try to run past you to access the item. If you determine the child can wait about 20 seconds before they grab at the item, set your first target at 10 seconds. You always want to start a little below what the child can currently do to ensure they contact reinforcement. Slowly build up the amount of time using small increments. Select a simple SD. Typically "Wait" is the SD used. Allow the child to access the preferred item for a few seconds. For example, give them a highly preferred doll to play with for a few seconds. Then take the doll away, say "Wait" and set your timer. Place the doll where the child can clearly see it but slightly out of their reach. Once the timer goes off praise the child for waiting and give them the doll back. If the child does not wait appropriately use physical prompting to get compliance and ignore any inappropriate behaviors such as crying. Do not provide praise or reinforcement if the child didn't wait appropriately. Lastly, be careful about allowing the child to almost touch the item. The child should wait to access the item calmly, without exhibiting problem behavior. Repeat, repeat, repeat.
Teaching a Child to Wait: Incidental-
Create opportunities during the day for the child to wait for something. At breakfast, start to hand the child the orange juice and then stop and say "Wait". When getting the child out of the car, reach to unbuckle their car seat and then stop and say "Wait". Use varied opportunities and various items. Have the child wait for toys, to leave a location, to enter a location, and to start an activity. Be sure to always provide quick praise and reinforcement for good waiting. Everyone who interacts with the child should give the child opportunities to practice this skill. If you are in public and don't want to use a timer you can do a finger countdown. Hold up 2-10 fingers and do a countdown to zero. The child should calmly wait without trying to touch the item until you are done counting. If the child does not wait appropriately use HOH prompting to get Quiet Hands compliance and continue counting. Ignore any inappropriate behaviors. Do not provide praise or reinforcement if the child didn't wait appropriately. Repeat, repeat, repeat.
**Quick Tip: Visuals can be a great way to help teach waiting. For children who don't understand the passage of time using a visual makes time much more tangible and real. What kind of visual you use will depend on the age and cognitive ability of the child. For a young child I may use the stoplight colors of green-yellow-red. I hold up a red card which means "wait". I then hold up a yellow card which means "almost". Finally I hold up a green card which means "go", or access the item. You can use these cards for an object or activity. For an older child I may use number cards. This is great if you are having a conversation with another adult or on the phone and need the child to wait before speaking to you. Flip through the cards starting at number 10 working down to 0. Once you get to 0 give the child your full attention and praise them for good waiting. This gives the child a much more concrete understanding of time rather than you saying "Hold on" over and over. When using visuals always pair language with the visual so you can eventually just use language and fade out the visual.