Wednesday, August 28, 2013

“Look At Me!”: Gaining Attention



Photo source: www.johnrobison.com


*Recommended Reading: The Off Task Learner


For anyone providing ABA instruction to a child (teacher, parent, therapist) knowing how to get, and then keep, learner attention will be critical. Just because you start a session with a compliant and attentive child does not mean the session will end that way.  Much of ABA instruction can involve quickly delivering specific demands, and if the child is not properly attending then it can be difficult to truly assess learning.

Even outside of an ABA therapy session, getting and keeping the attention of a child with Autism can be challenging. I find that when I observe non-ABA professionals interacting with kiddos with Autism, they end up “throwing away” lots of demands. They may give a demand to a child who is engrossed in a DVD, has his back turned, or is engaging in vocal stims. When this happens, I really can’t blame the child for not complying with the demand. How can the child comply with a demand to “Come eat dinner” when all he heard was “-inner”?

What most adults determine to be indicators of paying attention (sustained eye contact, immediate responding) can actually be pretty difficult behaviors for a child with Autism. Self-stimulatory behaviors can make paying attention difficult, as can auditory processing issues. For example, if I am at a kids play center with a client and I am trying to give him a demand, I may have to compete with the sounds of kids laughing and screaming, the whoosh of the air conditioner, and the dings coming from a nearby video game. My client might have difficulty tuning all of that out to focus on what I am saying.  
Socialization deficits can also make paying attention difficult for a child with Autism. Looking directly into my eyes may be very aversive to the child, so if forced to “Look at me” they may now be so uncomfortable they can’t really focus on what I’m saying. Or standing in close proximity to me could be a very uncomfortable situation, which makes attending to what I am saying more difficult. All of these factors must be considered when trying to get and keep the attention of a child with Autism.

 I think this is common knowledge, but if not let me share: Just because an individual with Autism is not looking into your eyes, does not mean they’re not listening. I know especially for teachers it can come off like disrespect if a child stares at the floor while you are talking to them, but for a child with Autism they may look away in order to put all their focus into listening.

Here are some suggestions for gaining attention:


Avoid:
  • Using the child’s name – I mention this briefly in my Stimming  post, but you really want to avoid using a child’s name to get their attention in an ABA session. You could end up saying the child’s name literally hundreds of times in a 2 hour session, and you are also teaching the child to pair their name with a demand. I will give a very clear example of how unpleasant this is from the child’s point of view. Lets say that every time you are at work, your boss calls out your name (“Tameika!”) and then follows it by giving you more work to do. How long would it take you to start feeling dread and annoyance when your boss says your name? Not very long. So it’s really important not to pair the child’s name with work (“Aidan, touch cup”…..”Aidan, give me yellow”…..”Aidan, how old are you”).
  • Touching/moving the child’s face – Beyond not being a true indicator of attention (the child may orient their face to you, but not their eyes), this can also be pretty aversive. Would you want me to yank your chin towards me because you aren’t paying attention to my story about my vacation? I doubt it. The child may have temporarily forgotten about your presence while they are engaging in stimming, so to abruptly touch their face or chin can be very jarring.
  • “Look at me!” –  Understand that saying “look at me” is not the same as asking the child to pay attention. Also, ple-e-ease do not shout at the child "Look at me!". That is not the way you want to gain attention. Use a natural tone of voice and an interesting facial expression, and say something like "Are you looking?" or (while gesturing to materials) "Look right here".
  • Using rigid reminders or cues – I have used visual cues to get the attention of a child at the table, particularly very young children. However, it can sometimes be hard to generalize or fade these cues. This could be something like a sign that says “Hands quiet, Feet still, Mouth closed, Ready to Learn”. What I would suggest is not relying on cues or reminders such as these so much that the child isn’t actually learning to attend, they are really just learning to be prompt dependent.

Try:

  • Use behavioral momentum – Behavioral momentum basically means to allow the individual to contact success first before presenting a demand or task. So if you are conducting an ABA session and the child is not paying attention, give them a few mastered tasks such as “Clap hands……stand up”. Then put out your cards/materials and start teaching. Be sure to reinforce the mastered tasks. This way the child has a behavioral cycle of {easy(reinforcer)+easy(reinforcer)} before you move to harder tasks, which can make it more likely they will attend.
  • Be fun and engaging – The best ways to gain attention will always be child specific. However I can say that for past clients, we would have goofy things we did at the start of a session such as countdowns, arm/hand squeezes, racing to the work table, etc. For older or more high functioning children, you can offer choices (“Should we do Matching or play the Numbers Game first?”). This way the child is involved in the structure of the session, and you now have their attention.
  • Capture or Contrive M.O. – Capturing the motivation of the child will always lead you into gaining their attention. If I want $5, and you walk up to me holding $5, I’m probably going to pay attention to what you’re saying to me. Wouldn’t you? So start the session by conducting a Reinforcer Preference Assessment, to see what will motivate the individual/client. Gaining and keeping attention should always be a byproduct of consistent Differential Reinforcement, capturing motivation, and approaching the individual with powerful reinforcers.

*Quick Tip:

Attending should not be a skill that is assumed upon. Maybe the individual/client does not know how to attend. In that case, you can use ABA strategies to teach the skill. Here are a few suggested skill acquisition programs to target attending:

Imitation
Receptive Language
Responding to Name
Attend to an Object  (track object with eye gaze)


6 comments:

  1. Fantastic! I've been an ABA student in grad school for nearly 3 years and I've caught myself doing some of the no-no's on your list. Thanks so much for helpful tips that I can add to my arsenal!

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    1. Im glad the blog is helpful for you! Good luck in grad school :-)

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  2. I've been scanning your archives devouring all of the helpful tips and techniques that you are posting on your blog. Thank you thank you thank you!!!!! I've been doing ABA for about 4 months and unfortunately I feel very incompetent because I still feel that I have SO MUCH to learn. I really want to help these children as much as I can and recently I've felt very stuck.

    Thank you again for all the help! One of your books that I just purchased should be arriving soon and I can't wait to get my hands on it!

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    1. Hello,

      Thank you, thats so wonderful to hear :-)
      ABA is a vast field, and there is SO much to learn but here's the good news: You dont have to learn it all at once!

      Please let me know your feedback and thoughts after reading the book, I love hearing from the readers. I hope you enjoy it,

      Tameika

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  3. Hi!

    I’m a big fan of your wonderful blog and I consider it the most useful blog about ABA ever. But there is something about this post that I consider somewhat incorrect, so I would like to draw your attention, pardon the pun, to it.

    The whole post is excellent and very helpful – I recommended it to a number of people. What I have problem with is this concrete phrase:

    “Self-stimulatory behaviors can make paying attention difficult”

    Now I must say, that I’m Autistic person, and in my experience and from what I heard from other people with ASD – no, it is not necessary so. It can be true in some cases but in other cases appearance of the stims _signifies_ attention.

    Now I have a number of stims myself and some of them, like rocking and fidgeting with items, really help me to concentrate, especially when paying attention is hard. It may not be true for every person or even for every stim in one person, like myself, but it can be true.

    All my childhood I had bad experience with other people ridiculing and stopping my stims but one thing was especially odd to me – the insistence that my “attention stims” distract me. It was absurd statements when I was a child, but adults generally do not listen to feedback from children with communication differences.

    Now I work as an ABA technician and I see the same attitude among all professionals regardless of their views on self-stimulatory behaviors in general. When I try to speak about it, it’s like I’m talking nonsense.

    As far as I know there is no research on the function of stimming in regards of attention, maybe I’m wrong though. Either way this assertion is more intuitive than evidence-based, and does not deserve to be treated as some kind of axiom. The possibility of stims HELPING to concentrate one’s attention is very real, and each case should be regarded individually… like everything in ABA.

    Also what I’m trying to convey is that attention patterns in autistic children are usually unconventional and so are outward signs of the attention. One must be very careful to judge when child is paying attention or not, so thank you for writing about this issue.

    PS English is not my native language and I never lived in English-speaking country, so please excuse any errors I’ve made.

    PPS Full disclosure – I totally stimmed while writing this.

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    1. Hi Mira,

      I LOVE your comment.

      Many of my supervisors and mentors over the years have ranged in their perspective on how best to handle self-stimulatory behaviors. Personally, I do not belong to the school of thought that "stims" should always be eliminated. I think with any behavior change, the 1st question that should be asked is "WHY am I intervening on this behavior?"....is it because teachers find the behavior annoying? Parents find it frustrating? Is it harming anyone?

      I can see your point that sometimes stims may actually promote attending/concentration, and I think of some of my older clients where we may be working at their kitchen table on homework completion and they need to tap a pencil, rub a koosh ball, or kick their feet back and forth in order to stay focused throughout the task.
      Then I think of some of my younger, nonverbal clients who are still "learning how to learn". If a young girl is screeching and flapping her hands, she won't hear me say "match fish". Or if a young boy is staring up at the ceiling fan and humming, how can he stack Legos with me? The behavior of staring up at the ceiling fan is incompatible with the behavior of building a Lego tower, and usually at that point my client stops responding.

      The attitude you speak of amongst ABA professionals when you talk about this is just inexcusable, and I can't say I haven't seen some of that myself.

      Thank you for sharing your own experiences and unique perspective, this conversation will be in my head the next time I am in a session with a client, believe me! :-)

      Thanks for commenting!
      Tameika

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