Tuesday, September 20, 2016

Choosing ABA Therapy Stimuli



Photo Source: www.toysrus.com, www.terapeak.com


...“Get some flashcards”

Most everyone involved with an ABA program has heard that sentence from someone, at some point, while starting up services. While the goals for treatment will vary, the intensity of treatment will vary, and the duration of treatment will definitely vary, its common that the materials needed for ABA therapy are pretty similar from one client to the next.

Here’s the problem with that though: how much information did you receive about how to select therapy materials? Not how to organize them or what materials to use, but how to tell the difference between appropriate stimuli and inappropriate stimuli. What I often see is this is an area that gets skipped over or quickly mentioned, and many therapists are using inappropriate materials to teach skills….and then wondering why the child is making no progress. Or as I refer to it, the child has a data sheet full of eggs (that’s a score of “0”).

Yes, accurate and precise teaching is important. Quality clinical supervision and oversight is important. Evidence based methodology is important. I am not minimizing any of these treatment components, I am just shining a light on an area I often see lacking: the selection of appropriate therapy stimuli.

Hopefully this will help you make some changes in how you teach, and improve the materials you use regularly. I suspect that if you take the time to review the materials you are using you may find large room for improvement…. which will only benefit your clients.

And look, I even made you a lovely table :-)

STIMULI/MATERIAL
AVOID THIS
CHOOSE THIS
Flashcards/Pictures
Overly distracting (too colorful, oversized, tiny, busy background, etc.)
Use PEC images or purchased cards only
Word + image flashcards (unless you are intentionally targeting this)
Present stimuli in the same array across trials/Always put the correct response in the same spot
Glance at or hover your hand over the correct response

Cards should be simple and only contain what you are teaching (if teaching the client to tact “apple”, the card should not be an apple tree, a basket full of apples, or a photo of Mickey Mouse holding an apple)
Generalization is key: use multiple examples
Making your own materials is always helpful to be able to use real-life examples (if teaching “bed”, the photo is of the client’s actual bed)
Avoid inadvertent prompting!
Laminate everything (rough sessions happen)
3D Toys/Manipulatives
Not fully controllable /too distracting (example: if using a toy bus to teach the tact “bus”, you pick a bus that sings songs, has multiple buttons that make the bus talk, etc.)
Select manipulatives that are too fun to touch or feel
Using known reinforcers to teach skills (unless you are intentionally targeting this)
Present stimuli in the same array across trials/Always put the correct response in the same spot
Glance at or hover your hand over the correct response

Pick objects that YOU can control during teaching/that are minimally distracting
Avoid objects that blink, vibrate, buzz, are scented, etc.
Be aware that using 3D items found in the home can pair that object to demand situations
Generalization is key: use multiple examples
Avoid inadvertent prompting!
Maintain control of your materials (client cannot pause mid-trial to play with the materials)
Reinforcers
Look around and grab whatever is near you to reinforce appropriate responding
Each session bring out the same tired item/toy that the client worked for once, and assume they will always want to earn that
Silently hand the client a reinforcer and ignore them as they interact with it (silently collect your data)
Conduct frequent Reinforcer Preference Assessments
Pair novel reinforcers with known reinforcers to gradually expand what the client finds reinforcing
Avoid satiation on a reinforcer (switch ‘em up!)
Always pair tangible reinforcement with social praise, so praise can be shaped into a reinforcer on its own
Pair yourself with reinforcement breaks by talking to the client, giving tickles, or joining their play
Magical-Mary-Poppins-Good-Time-Happiness Bag
Show up to sessions empty handed
Expect the parents/family to provide a wide array of materials and reinforcers
Assume the client wants to work to earn things that are always at their house

Put together your own therapist “goodie bag” and bring it to sessions
Include a mix of reinforcers, sensory items/toys, and other fun things (crayons, glitter glue, etc.)
Be aware that some families/households don’t have toys, don’t own an iPad, etc.
Understand that you now control access to things the client can only earn when you are present
Regularly change the content of your goodie bag


*Free Staff Resource/Handout



*Source: (this is an amazing article)
 


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