Monday, April 29, 2013

Homework Completion




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 may be 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 may or may 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 17th president of the United States was. ABA therapists are not tutors. If therapy is funded by insurance, depending on plan coverage academic goals may not be covered.   Insurance is paying for behavioral interventions, not academic tutoring. 
What I will usually do is complete the homework with the child for a specified amount of time, 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/pleading 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 ____ activity, 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. Reinforcement can be tangible, an edible, short breaks,  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”.
  • 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.  Stick to your original demand 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. Break the homework 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?”.
  • 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.









Sunday, April 21, 2013

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.


Tuesday, April 9, 2013

Program: 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. Understanding emotions is a pivotal skill that opens pathways to 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 common emotions
Expressively identify common emotions
Identify/Label own emotional state
Label/discuss social scenarios ("playing, fighting", etc)
Discuss emotional regulation strategies ("I feel angry, so I should take 5 deep breaths")



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 1st 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:




 


 





Thursday, April 4, 2013

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!