Saturday, May 26, 2012

Autism & Functional Skill Training

Photo source: www.theautismhelper.com



Functional-
1. Of or having a special activity, purpose, or task.
2. Designed to be practical and useful.


In my Social Skills post I talked about how its important to remember to include social skills training in any ABA program. Providing instruction to a child with Autism isn't  complete until the child can successfully navigate through social situations. In addition to social skill development, another instruction area that can be overlooked is Functional Skill Training. 


Functional skills are skills you teach to the child that are intended to be practical, useful, and helpful in a variety of settings. Children with autism may need to be specifically taught functional  skills that other children readily learn from their environment. Functional skills should be age appropriate goals that are relevant to the people in the child's life. 
You may have worked with children with minimal or no functional life skills. These children can be bright and friendly, but outside of an instructional environment they are unsure of the "rules of life". The child may stand and stare at children in the cafeteria, because they dont know how to ask if they can sit down. The child may tantrum and scream when snack time is over, because they dont know how to ask for more food. The child may hug strangers in public places, because they dont know what inappropriate touch is. Its easy to see how a lack of appropriate functional skills can place children with Autism at a disadvantage in the home, school, and community.

Functional skill goals are going to be very specific to the particular individual. The child’s cognitive ability, environment, and lifestyle will determine what goals you select. Its also important to consult with the child’s family to see what functional goals are important to them and of high value.
 Without careful consideration of  the persons age, the values of the family, or respecting the dignity of the individual, functional skills can be taught incorrectly. Here are a few examples of how functional skill goals can go wrong:

 -Functional goal: Teach an early learner toddler to properly use utensils. I once worked with a Hispanic toddler who was being taught in school to use a fork. The teachers spent week after week teaching this child to use a fork because an assessment revealed that he didn’t have the skill. However in the home environment this child rarely used utensils as the family mostly ate finger foods, like tortillas. Communication between home and school was poor, so the teachers didn’t know this until I brought it to their attention. This skill goal was not truly functional for this child.
-Functional goal: Teach a pre-pubsecent girl to use feminine hygiene products. Many parents or caregivers begin teaching this skill to girls with Autism right before puberty, not fully understanding how difficult this skill can be to teach. Inevitably the teaching process is difficult and frustrating for everyone involved. In a communication style the child can understand, the child should be advised about upcoming body changes years before they need to learn what to do.
-Functional goal: Teach leisure skills to an adult with cognitive impairments. I spent some time recently with a 42 year old woman with moderate cognitive impairments, and her favorite hobby was watching Nickelodeon cartoons such as Spongebob, or Dora the Explorer. Due to an extensive behavior plan created by staff members,  this woman who used to spend her free time harming herself can now enjoy a variety of shows--however they are all cartoons. It isn't age appropriate, or respecting the dignity of the individual, to only teach this woman to watch TV all day. Much more appropriate  functional goals could include baking, painting, reading simple books, or gardening. 




When correctly implemented into an ABA program, functional skill training of age appropriate goals can benefit the individual in several ways:


Reduce social stigma
Can counteract bullying/teasing
Leads to better quality of life, happiness, self -esteem
Makes social interaction easier with same age (not younger) peers
Reduces burden placed on parents or caregivers as individual becomes more self-sufficient
Makes community outings easier
Makes it easier to function in a variety of environments
Can encourage appropriate interests, diminish inappropriate interests
Behavior approximation of peers leads to increased social opportunities
Sense of belonging due to shared peer interests
Can lead to hobbies and leisure activities
Can reveal skills and strengths
Can eventually lead to post secondary education or job placement


If you do not currently have any functional goals in your ABA program, I encourage you to think of a few to start teaching. Individuals of all ages need appropriate functional skill training; this isn’t just for children. Functional skills are skills or behaviors that are either done by the individual or will need to be done FOR the individual. For example: brushing teeth. I can either brush my own teeth, or someone will have to do that for me. There is no "just skip it" option.


Here are a few functional skill goal ideas:

  • Purchasing items at a store
  • What an emergency is, and what 911 is
  • Using a public restroom
  • Toileting skills, particularly wiping (this skill is sometimes skipped)
  • How to do laundry
  • What is sexually appropriate behavior, and what is not
  • Crossing a street
  • How to rotate between topics during a conversation
  • What is personal space, and how to respect it
  • Hygiene skills, such as applying deodorant
Tuesday, May 22, 2012

Adventures in Early Intervention



Early intervention is key…… Early intervention is key…… Early intervention is key…

How many times have you heard that? Parents of children newly diagnosed with Autism are immediately told to get their child into intensive treatment. There is a sense of urgency to this recommendation, and if you are lucky you are handed a list of agencies to contact. If you’re not so lucky you get to research, locate, and narrow down agencies on your own.

But what if you dont know who to contact? Or you dont know which treatment to select? Or you contact several agencies and none of them have openings?

The process of locating and then enrolling your child into early intervention services isn’t as simple as it sounds. The idea that you can get a diagnosis, enter into early and intensive treatment, and voila...everything works out great is more fantasy than reality for some families. 
The early intervention process can be a chaotic and frustrating series of misadventures that include  false starts, mounds and mounds of paperwork, a parade of professionals and therapists coming into your home, funding issues, and waiting lists. In addition to being a complicated process its also very stressful due to pressure parents feel to pick the best treatment at the best time, and the stakes are high.




Below is some information about what to expect from the early intervention process, based on what parents have told me about their experiences. Early intervention services will vary greatly from state to state, so some of this information might not be applicable for your area:

-          Document Everything: From the time you get a diagnosis for your child (or from the time you begin to have suspicions about your child) start keeping a record of all doctors visits, evaluations, medications, etc. Keep a journal of behavioral notes about your child including a brief summary of pre or post-natal abnormalities. Your journal should include information about the pregnancy experience, birth, and developmental milestones leading up to the actual diagnosis. If you can include actual dates with your notes, that’s even better. This is helpful for a few reasons- - As you start seeing various doctors and professionals you will notice that many ask the same questions over and over. If you have a journal of your child’s history, then its a much easier process to give background information about your child to each professional.. Keeping documentation is also helpful because it gives you a record to refer back to later. When your child ages out of early intervention and enters school, the school system will find a record of your child’s development and therapy history very helpful.
-          Require Documentation from Professionals: As you start the early intervention process you will talk to or receive services from many different individuals. ST’s, OT’s, pediatricians, doctors, psychologists, behavior specialists, etc. Each new professional may tell you they need to do an assessment and evaluation of your child. What they might not tell you is that sometimes they can use prior assessments instead of doing a brand new assessment. In other words, instead of paying 4 people to assess your child you can use 1 assessment 4 times. Every professional who observes, assesses, or evaluates your child should be able to provide a written report of their findings. Keep these reports, as you will need them later.
-          Ask Questions!: This one is so important. In order to get the most out of early intervention services you need to understand what's going on. If a professional tells you that your child has “Global Receptive Language Deficits”, do you know what that means? If the doctor recommends a biomedical protocol, do you know what that is? If your insurance company denies ABA coverage because they state Autism is an educational diagnosis, do you understand what they are saying? Ask questions until you understand what a professional is saying, and if they make you feel stupid or uncomfortable for asking questions then find a new professional immediately. The professional should explain their services, their findings, and their recommendations in clear and simple terms that are easily understood.
-          Be Prepared for Service Transitions: Children with special needs have access to free early intervention services from birth to age 3, at which point the school system is responsible for providing services. That means if you don’t receive a diagnosis of Autism for your child until they are 2 years old, then you will only receive 1 year of early intervention services. Or if your child received a diagnosis at 15 months old and then sat on a waiting list for 13 months, the cut off is still age 3. Even as you begin using early intervention services, it’s important to plan ahead for what the next step is once the services end. Will you place your child in a preschool environment? If yes, an Autism school or a typical school? Will your child receive therapy services in the home? If yes, what kind of therapy and how will you fund services?
-          Quality May Vary: I have heard many stories from parents about rude, unreliable, or unprofessional early intervention specialists who worked with their child. The therapist might show up late for each session and then leave early. Or the therapist never returns your phone calls. Or maybe the therapist has been promising to get that evaluation report to you for over 5 months. Just because a service is free does not mean poor quality is acceptable. Speak up about rude and unprofessional treatment, and contact management of the organization to resolve the issue. Parents sometimes say things to me like “Well, my child only sees this person once a month. I don’t want to make a big deal about it”.  The point of early intervention is to get your child school ready and to address as many deficits as possible in a limited amount of time. In order for that to happen the quality of treatment is very important.
-          Beware of Ridiculous Waiting Lists: 6 months, 9 months, 1 year, even 3 years. These are all pretty standard amounts of time to be placed on a waiting list to receive Autism services. The reality is the number of children needing treatment is exploding, and the number of professionals in the field isn’t keeping up. So rather than being surprised by severe waiting lists, you should expect it.
 I'm not saying you shouldn’t place your child on a waiting list to receive an evaluation or treatment from a reputable agency or professional. My question is, while you are on this waiting list what are you doing in the meantime? If you can afford to, hire a private therapist while you are waiting for a spot to open up for a free early intervention agency. Enroll your child in a playgroup or social skills program until that ST becomes available. At the very least you can read books, do some research, and start working with your child yourself. What’s most important is that you take advantage of the time you spend on waiting lists, because you cant get that time back.


Research and best practices consistently recommend early intervention services for children with Autism. However, for many different reasons it wont always be possible to secure quality early intervention for your child. Some parents don’t get an official diagnosis until their child enters the school system, and is way past the cutoff age for early intervention services. Or you might live in an area where there are no early intervention agencies or services. Don’t think of early intervention as only meaning “Birth to age 3”. Once you become aware that your child has Autism or some type of developmental delay, as early as you can begin intervening with quality treatments or therapies. 




Wednesday, May 16, 2012

QOTD




Most people think what I do is about using rewards and incentive to get children to stop inappropriate behaviors. That's not really what ABA is about.

I like to describe what I do as manipulating the environment in such a way that the child has no reason to maintain challenging, aggressive behaviors and every reason to adapt appropriate social behaviors.
Or put another way:

"If you wish to modify your child's behavior, you have to change yours".

Your behavior is what will ultimately determine the success of your child's ABA program.
Friday, May 11, 2012

Teaching Communication to "Non- Verbal" Children



* Highly recommended book (I love this book): Teaching Language to Children with Autism

 Many individuals with Autism can have impairments or difficulties with true functional communication. Sometimes this is due to medical conditions, such as tongue abnormalities or Apraxia. More often this is due to severe deficits in the areas of motivation, typical language development, and social interaction skills. Speech delays can also be linked with excessive ear infections, which can lead to hearing loss or impair speech processing during times of critical brain development.

 The majority of the children I have worked with were non- vocal when I first met them. This means they did not consistently communicate vocally. Maybe they had some babble, or would say a few word approximations, but they were unable to reliably communicate their wants and needs to others.
 I intentionally used the word "non- verbal" in the title of this post, because communication is not just words. A child can be "verbal" and communicate using PECS, sign language, an iPad device, etc. But if I say a child is "vocal", I am specifically saying they can communicate with words.
Confused yet? I hope not :-)

Non- verbal individuals often communicate by pointing, leading, or the majority of the time: through their behavior. I have observed quite a few clients who without saying a word had an entire household catering to their every desire. The parents knew that 2 screams meant “turn the TV on”, a crying fit meant “pick me up”, pushing a sibling meant “I don’t want to play”, and so on.

The goal when working with individuals who have communication difficulties should be broader than just expressive language.....the child may never gain vocal speech. That doesn't mean they can't ever learn to Communicate.
The goal should be teaching the child a functional, effective, system of communication. If I teach a 5 year old to label colors and body parts but she can't tell me when she is hungry, that's a good example of a child who can talk but isn't using language to communicate.

 From my experiences, positive indicators for developing vocal communication include vocal sterotypy (particularly with various intonations and pitches), frequent babble or echolalia, and demonstrating social awareness or alertness (e.g. child stares intently at your face when you sing to them). A young child who will echo, sing wordless songs, or babble, often can be quite successful with intensive language intervention.
The behavioral piece of communication is HUGE. It can't be stated enough: Children who cannot communicate have some of the most persistent and challenging problem behaviors. Why? Well, just imagine that you are placed in an environment where no one speaks your language. If you speak English, everyone else speaks French.  Now imagine that you are hungry and must convince these people to feed you. How long would you try pointing and gesturing, before you started pushing people and throwing things?

If a child lacks motivation to communicate, and isn’t externally required to communicate, then from the child’s perspective its much easier to engage in behaviors. A child who is allowed to fling their plate to the floor during dinner to signify “I'm done” has zero incentive to think up words, form them with their lips, and then speak.
Reinforcement is also huge. For a child with Autism to learn to communicate, reinforcement must be present. You might be wondering, “Why do I have to reinforce my child to talk? My other children just started talking, they didn’t require M&M’s to do so”. A characteristic of Autistic Disorder is qualitative impairments in communication. This can mean the child has no language, exhibits speech delays, or has no motivation to use the language they do have.


There are  many options for teaching functional communication (and often a BCBA/Consultant will recommend multiple options at once, I know I often do). Remember, communication is far broader than just the ability to talk:

Various Communication Methods

  •      Verbal Behavior Approach (ABA) – There are many different ways to do ABA, and VB is a branch on the ABA therapy tree. VB has a functional language focus. VB captures and builds upon motivation, and uses rewards to reinforce communication across verbal operants (requesting, labeling, echoics, etc). Language is taught as a behavior and each component is broken down. If the child likes ice cream, one of the first things they learn to say is “ice cream”. This way, the child’s motivation to get a desired item is used to pull language out of the child: You say ice cream, you get ice cream. The VB approach also uses repetition, prompting, and shaping to get desired responses. Initially, “buh” is acceptable to request the ball. Over time (and with careful data analysis), the criteria become more demanding until the child can say “BALL”. For a detailed description of VB, see my Verbal Behavior post. 

  •    Speech Therapy- For every 10 clients I see, probably 6 are also receiving speech therapy. Many parents think that ST is the only way to get a non-vocal child talking. SLP's often work with conditions such as stuttering, language impairment, feeding/swallowing, etc. (for more information see www.asha.org). I have worked with kids who made huge gains from ST, and I have also worked with kids who did not, even after months and months of ST.  Its important as a consumer to pursue speech and language professionals who have experience with Autism and behavior management. I have certain clients who lost their speech services due to behavior issues. Its also important to look at the intensity of services being offered. Many of my clients who get speech therapy only receive 15-45 minute therapy sessions once per week. For a child with Autism presenting with significant behaviors and no consistent means to communicate, that may not be enough therapy. If your child is currently receiving speech therapy and experiencing success and making great progress, I highly suggest encouraging collaboration between the ABA team and the SLP. Its so important that we all collaborate with each other and train the parents/caregivers on what we are doing!

  •  Sign Language- Always combine labeling with sign language so the child hears the correct word, as well as learns the sign. When considering sign language you want to think about the child’s age and fine motor skills. If a child has poor fine motor abilities and cannot make multiple, intricate signs to communicate then sign language may not be a good choice (although you can always teach approximations to signs). Age is important because you want to think about how big that child’s world is. If the child is only 2 and spends all day at home with Mom or Dad, then sign language is probably a good choice. However if the child is 11 and goes to school, after school care, karate practice, and then home, then all of the people the child has regular contact with must know the child’s signs. If the child walks up to a teacher on the playground and signs for her “red notebook”, will the teacher understand? If the child doesn’t get a prompt response to their sign language, they may stop signing. Also a very common error I see with clients who have learned ASL is getting stuck on the sign "more". Many professionals and parents teach the child to sign "more", and unfortunately the sign then gets generalized. The child will randomly walk up to people and sign for more, and no one knows what they want. More of what?? Imagine how frustrating this must be to the child. Its best to begin teaching signs with simple, clear mands that are highly preferred by the child ("book", "chips", "juice", etc), also be sure to avoid teaching signs that are very topographically similar when first starting out.
 
  •  Picture Communication Systems- This would include the PECS system, touching or pointing to photos to communicate, or use of an electronic picture system such as the iPad app Proloquo2Go. The child learns to communicate by exchanging, touching, or pointing to photos of items, activities, individuals, etc. Systems such as these can be ideal for an individual who can match picture to sample, or demonstrates the ability to scan and select. Other advantages to these systems is that they are simple to use (and for others to understand), can be transported across environments, and can eventually be very elaborate.  Disadvantages of picture systems can include: difficult to keep up with all the various photos/pictures, and the child's interests change so frequently it may require changing the cards very often. There are also assisted communication devices that will create speech for the individual by speaking in a simulated voice (which is often programmable). The learner inserts a card, or types/pushes a button and the machine speaks for them. Since these are technological devices the cognitive level of the learner should be considered (do they have the muscle control to push or swipe? do they understand the 2D photo connects to a 3D item or activity?).

  •  Language Immersion- This is a method typically seen in preschools or daycares that accept very young children with special needs. The classroom immerses the children in language throughout the day with the intention of creating a stimulating environment conducive to speech. Items are clearly labeled with photos and words, children are engaged in conversation even if they cant talk (“David, is my coat blue? Nod if my coat is blue”), and the teachers spend time working 1:1 with each child on turntaking, eye contact, and joint attention. To me, these classrooms look similar to the Koegel method, or Pivotal Response Training. Often these types of techniques are implemented by early childhood education teachers, or parents. An advantage of language immersion, or focusing on pivotal skills to enhance communication, is this method can be easy for a parent to implement with their own child. These types of techniques focus on developmental milestones leading to first words, such as babbling, recognizing distinct sounds, imitating actions, responding to receptive commands, and communicating using gestures. Working with the child 1:1 will include lots of intrinsic rewards, and naturally occurring interactions. For example: treat the child’s babble as if they are words, and carry on a conversation with them. Narrate your actions and the child's actions, even if the child doesn't respond to you ("We're walking upstairs now. Lets count the stairs: 1,2,3,4....."). While you are narrating try to make eye contact with the child, build upon shared interests, have an animated facial expression, and make learning fun.

 
The wide array of programs, books, resources, and clinics out there that promise to get children with Autism to talk can be very intimidating and confusing for consumers. Be a critical consumer and look for research proven methods that clearly explain how the treatment works, and what is involved.
Ask lots of questions! If you have to buy the treatment or purchase a book before anyone will explain exactly how it works, be suspicious.

 No matter which option you select to teach communication, in order for it to be effective and consistent across settings and people you will likely need to incorporate behavior management. The child must learn that anything less than the communication system will no longer be accepted. That means if you are teaching the child to use sign language to request a cookie, then they are no longer allowed to climb up onto the kitchen counter and get the box of cookies off the top of the refrigerator. Make communicating with you a requirement, or the child wont do it.
The child must also learn that communicating with people leads to good things. If the child just learned to request “juice”, then initially every time the child says juice they should get a sip of juice. The child needs to see that communicating with people promptly gets needs and wants met.
 If you have implemented a system of communication for a child with Autism and the results are inconsistent, ask yourself: “Is this communication system the only way he/she can get this need or want met?” If the answer is no, that may be why you aren't seeing progress.



**Quick Tip: Early intervention is critical when it comes to targeting speech production and development. You want to start working with the child from a very young age to ensure the best results. However, research shows that all hope is not lost for older individuals with Autism who have no consistent system of communication. It will be more challenging for an older child to learn to talk, but it is not impossible. The most promising methods for children over the age of 5 include speech generating devices (which do not inhibit language) and developmental approaches that facilitate joint attention.

References:

Kaiser, A. P., Hancock, T. B., & Nietfeld, J. P. (2000). The effects of parent-implemented enhanced milieu teaching on the social communication of children who have autism. Journal of Early Education and Development [Special Issue], 11(4), 423-446.

Kasari, C., Paparella, T, Freeman, S.N., & Jahromi, L (2008).  Language outcome in autism: Randomized comparison of joint attention and play interventions.  Journal of Consulting and Clinical Psychology, 76, 125-137.

Murphy SA. (2005) An Experimental Design for the Development of Adaptive Treatment Strategies. Statistics in Medicine. 24:1455-1481.

Pickett, E., Pullara, O, O’Grady, J., & Gordon, B. (2009).  Speech acquisition in older nonverbal individuals with autism: A review of features, methods and prognosis. Cognitive Behavior Neurology, 22 1-21.

Schlosser, RW, & Wendt O (2008).  Effects of augmentative and alternative communication intervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology • Vol. 17 • 212–230.




Saturday, May 5, 2012

Learning to Wait









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. 
A child who doesn't know how to wait may become aggressive, defiant, and may eventually have a meltdown. Most people just see the behavior as the problem and try things such as blocking the aggression, telling the child to stop pushing, or putting the child in Time Out for throwing chairs. The problem with that approach is that in all of these situations the behavior was the by-product of a skill deficit. These children did not know how to wait. When put in situations where they didn't get a desired item or activity "right now" they engaged in problem behaviors. In order to effectively terminate these problem behaviors you have to target the skill deficit, not just the outcome behavior. Don't be the type of professional or parent who sticks band-aids on problems. Eventually that band-aid will stop working and the wound will be worse than before.

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.
Thursday, May 3, 2012

Quote of the Day


“An ounce of prevention is worth a pound of cure.”

~ Benjamin Franklin, 1706-1790


I like to think of this quote as directly referencing early intervention; The foundation that you build today will impact your future results.