"Therapy Ready"

This post will focus on making sure your child is therapy ready before an ABA session, and what exactly that means.

When the ABA professional asks you to please have your child "therapy ready" when therapy sessions start, what do they mean?
  • If the child is ill or experiencing unusual circumstances (e.g. child slept only 2 hours the night before) the therapist should be notified before arriving to the home
  • The child has been fed, or offered food recently
  • The child's diaper is dry, or they've been taken to the bathroom recently
  • The child is awake (therapist should not have to wake a sleeping child)
  • Preferably, the child is not engaged with their most preferred items or toys

The point of these guidelines is to make sure the therapist does not arrive to the home to work with a child who is hungry, crying, wet/soiled, tired, or fixated on a specific toy or item. Any of these scenarios is likely to start off the session on a bad note.

For the therapy sessions to be most beneficial, the child should be in an attentive learning state, calm, and ready to contact reinforcement (if they are already contacting valuable reinforcement, they may be less motivated to work with the therapist). 

Throughout the session the therapist will present multiple demands and lead the child through frequent transitions, often at a quick pace. Many parents want to know what to expect of a therapy session, especially if they are new to ABA. I could walk into 1,000 homes and see ABA sessions happen in 1,000 ways. So a very general example of how a therapy session could look is detailed below:

Therapist arrival: Greet client and family, take time to set up for session
Transition: Therapist transitions client to work area, takes time to build rapport and engage with established reinforcers
Transition: Reinforcers are put away, and demands are presented/specific goals are targeted. Contingent upon performance and correct responding, breaks or reinforcement are intermittently delivered
Transition: Outside play time, or more adaptive teaching opportunities are embedded into the session such as a snack, playing basketball outside, sibling interaction/family games, or going for a short walk
Therapist departure: Therapist informs the client and family the session is complete, takes time to clean up work area, collect data, and record session note

It is easy to see from this brief session outline that if the child is sick, tired, hungry, etc., the session could quickly grind to a halt and dissolve into extended problem behavior. Most of the time (not always, but very frequently) if my staff contacts me to after a session to discuss how horrible the session went, after some digging I find out that the session started on a very bad note....and probably should have been rescheduled.
If sessions are consistently starting off on a bad note, that means goals are consistently not being targeted intensively, which means data scores are consistently dipping or decreasing, which means ultimately = the child will not progress as they should. So this issue of "therapy ready" is actually quite serious.

It's important to plan to set your child up for success before therapy sessions, so that in the long term they are regularly contacting success during sessions and progressing through treatment plan goals. I usually give my clients several tips to help them set their child up for success, I will include a few below:

  • Using language or a visual, inform the child that it is almost time for a therapy session. It may be helpful to show them a picture of which therapist is coming (e.g. "Look, Ms. Nicole will be here soon"). It should not be a shock to your child when the front door opens and the therapist is standing there.
  • Set aside the most valuable reinforcement (and let your child see you do this) and explain that they can have it when the therapist arrives. As a BCBA, I do this all the time during supervision sessions by arriving with valuable reinforcers, and then telling the child "I'm going to give this to Ms. Nicole", to increase motivation to work with the therapist.
  • Have your child engage with a neutral activity shortly before therapy starts (example: coloring, Play Dough, etc.). The activity should not be overly stimulating or too reinforcing, but should help the child get into a calm, on task, and alert state before therapy begins. It may be helpful to have them engage in this activity in the same area the therapist will work with them. Often, therapists arrive for a session and the child is having free play, or unstructured time spent running, jumping, climbing things, etc. In a situation like that, the child is very unlikely to be motivated to come over to the therapist and sit and work. 
  • If problem behavior begins to happen right before the therapist arrives, this can be an amazing opportunity for learning. Don't feel the need to quickly calm or soothe your child, but instead use the therapist's arrival as an opportunity to ask for help. Example: "He fell out on the floor right as you were pulling up, now in this situation what should I do??"

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