“Pairing” is a common term that ABA professionals often use to describe the process of building or maintaining rapport with a client. Therapy often begins with intentional and thorough pairing, where its ALL about what the client loves or enjoys and making that available to them on a non-contingent basis (jargon defined: for FREE). Basically, the therapeutic relationship should start off with low demand, and high reward.


 When done correctly, the client will see the ABA professional walk through the door and connect that to receiving good things/having fun.

I have mentioned pairing before on my blog, but this is the first full post all about pairing. Pairing is one of those ABA activities that some therapists just LOVE to do, and some therapists find challenging. I can't tell you how many times a therapist has said to me "...But, I don't know how to pair with him".
 I think this is because so much of pairing can be unstructured, client-led, and loose, that for some individuals it feels like doing nothing. Or it feels like wasted time. I have even had parents complain to me that the staff is "just playing" with their child and need to get to work already. 

I have also worked with ABA therapists who are amazing at pairing and building rapport. One of my previous staff referred to herself as "Mary Poppins on crack". :-) Correctly so, I would say.

Pairing in its simplest terms is just being the embodiment of a toy. When I am successfully paired with a child, I feel like a gigantic toy. The child is pushing and pulling on me to get me to engage with them, ordering me around (“No, sit with me over here!”), excited to see me arrive and bummed to see me leave, responsive and cooperative during work tasks, and and any activity is more exciting if I engage with it too.

The therapeutic process should begin with intentional pairing. By begin, I mean when initially meeting the child or at the start of each therapy session.
 Pairing is how therapists establish instructional control and connect themselves to reinforcement (eventually becoming a reinforcer). Skipping the pairing process can cause problem behaviors to increase, kill instructional control, and impair the therapist-child relationship. If I am not properly paired with a new client and I just walk in and start giving orders, what is motivating the child to do what I say? What is motivating the child to want to come and play with me? 

What you could unintentionally do is create a situation where the child is doing things you ask to get away from you. So you place a demand, the child answers, you provide reinforcement, and the child walks away/leaves the room/elopes. That is definitely NOT a situation you want. It’s no fun for you or the child to have to chase them around the home. 

You will know pairing has been successful when the child is consistently coming toward you, or approaching, and not walking away from you, or escaping. The whole "Im-going-to-play-alone-with-my-back-turned-to-you" thing is like a red flag that you have more pairing to do.

Pairing is all about social reinforcement and enthusiastic engagement, which is often hard for the children I work with. They just don't find social interaction all that interesting. Pairing is not something you do for a few days/hours/weeks ( I have heard all kinds of pairing formulas) and then never do again. I've worked places that taught us pairing rules like: pair for the first 5 sessions, or the first 2 weeks, and then transition to placing demands. Research does not support these kind of blanket rules. 

Think of pairing as something to be implemented prior to task demands, not just when starting with a new client. I  teach my staff to briefly pair at the top of all therapy sessions, and to continually conduct brief reinforcer preference assessments to make sure they are approaching the client with what that client wants, in that moment. This is a far more effective way to think about pairing......it is not something to check off a list and then never do again. Its a way of embedding client interest and just good ol' FUN into your sessions, so that work is gradually embedded into play, rather than being a jarring transition.

There is one last benefit of the pairing process that I feel is sometimes overlooked. Successful pairing teaches the child that I am fun and when I show up at the house good things happen. So in the future if we have a bad session or the child hates a program I am trying to teach, they can separate the task I am asking them to do from who I am. In other words, they can dislike what I want them to do and still like working with me.

Here is a simple mock up of the first few days of pairing with a new client, and what that progression could look like. 

This is not a template that has to be followed, remember pairing is NOT a dry recipe or a blanket rule! Rather this is one sample of how task demands can be gradually increased over time:

PAIRING PROGRESSION

Day 1: Introduce myself to child. Observe the flow of the day and how the child spends their day. Act more as an observer than an active participant. Shadow the parents as they engage with the child so I am connected to reinforcing people (the parents). Place 0 demands on the child.

Day 2: Greet the child. Begin to connect myself to known reinforcers. If child loves to swing, push the child on a swing. If child loves going to the park, take the child to the park. Praise appropriate independent behaviors, such as eye contact or sharing (“Thanks for sharing with me!”), and have lots of playful interactions doing what the child wants to do. Do lots of narrating or mimicking during the play. Follow the child’s lead. Introduce some task demands in the work area.

Day 3: Greet the child and begin to prompt a response. Restrict access to reinforcers by being the one in control of reinforcing items. Spend more time in the work area, or increase ratio of demands to breaks. Begin to incorporate social reinforcers into play such as having a babydoll give the child kisses. Praise appropriate independent behaviors, such as eye contact or sharing, and have lots of playful interactions doing what the child wants to do.

Day 4: Greet the child and wait for them to respond. Arrive to the home with a Grab Bag of reinforcing items to introduce during the session. Restrict access to the reinforcers by placing demands on the items. For example if the child wants a pinwheel out of the Grab Bag require them to spin the pinwheel once (prompt if needed), then immediately praise the spinning and give the pinwheel to the child. If the child is vocal begin to require they label reinforcers to get them (hand the child a ball but don't release it until they say “Ball”). Increase amount of social reinforcers used during the session to a few each hour; label the name of the activities as you do them. For example, lift the child into the air and say “You’re an airplane!” Begin to have the child follow your lead, e.g. As you are playing with the child on the floor stand up and yell “Chase me!” and then run into another room. Reward the child following your lead with tickles.

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Tameika Meadows, BCBA, Blog Author

I get emails pretty frequently from people who are new to the field of ABA. If you are making the switch to being an ABA Therapist then its pretty normal to have lots of questions about what to expect and how to approach the job. Especially if you work directly for a family, you probably wont get much information about the first day and what you should/shouldn't do. Many families believe that the ABA professional will show up on day 1 knowing exactly what to do. However, the truth may be that you're nervous or a bit unsure about what you should be doing.

There are SO many settings an ABA therapist can work in, from the classroom, to an agency, to directly for a family. I will try to be all-inclusive, but some of this information may not apply to certain settings. For example, if you start a new job with an ABA agency then typically your first day will be some type of training or orientation, and it can be anywhere from a few days to a couple of weeks before you actually start working directly with clients.

I will mainly talk about new ABA therapists who are going to work with a client in the home setting.

Below is a general list of tips. This is information that I wish someone would have shared with me when I first entered the field of ABA. I hope its helpful!

• Do Your Research- If at all possible, observe the client during 2-5 therapy sessions (across multiple staff) before you start working with the client by yourself. This is sometimes called Shadowing, and its when you are paired up with another therapist and follow them around as they go into the field to work. Despite what some agencies/companies may think, Shadowing is not the same as Training. Simply shadowing someone for a few days does not mean you will necessarily be ready to work with the client by yourself. During your first few days, ask TONS of questions, review the program binder and Treatment Plan, and pay attention to how the client interacts with current therapists. As the new kid on the block you can pretty much expect to have all sorts of testing behaviors thrown at you, so its always helpful to know what the client looks like on a good day. You also want to observe transitions and down times during the therapy session. If the current therapist starts every session by playing a DVD and giving the client grapes, there's a good chance the client will expect you to do that too. The current therapist is a valuable source of information to you, as they already know the client very well. Its one thing to sit and observe a session, but when you are responsible for running an entire ABA therapy session all of a sudden ABA doesn't look quite so easy. Be patient with yourself, and understand that there is a learning curve.
• Establish rapport- Pairing is taking the time to establish rapport with the client, and to approach them with the items/objects they find highly enjoyable. This process should occur prior to formal instruction. I typically tell new therapists to spend their initial sessions pairing, and running mastered programs. You want to build a positive relationship with the client and take time to learn their personality and strengths. Pairing is essential because it makes the child want to be around you, and it makes escaping from you less desirable. Ask caregivers or current therapists what the client LOVES to do, and then do those things with the client. One of my very first clients used to love to go to a neighborhood park. He rarely got to go because all the other therapists came at night. Well, as the only mid-morning therapist I took that child to the park every single day. Over time this child associated me arriving to his house with his favorite activity, and we had a great paired relationship. You can use activities, tangibles, or edibles to pair with the client. You could also use people, such as playing with the child while he sits on Mom's lap. Be careful when using people though, because it can be hard to separate the client away from Mom when its time to start working. 
• Meet The Parents/Caregivers- When you initially start working with a new family, use that time to familiarize yourself with the household routine, rules, and get clear answers about the family's expectations of you. Ask the simple questions (Where does the family want you to park? Where are reinforcers stored? Does the family have pets?) as well as the bigger questions (What other therapies does the client get? Is the client aggressive at all?). On day 1, its a good idea to ask for a tour of the home. It is helpful to know where the closest bathroom is located, where the child's bedroom is, where favorite goodies are stored, etc. Familiarize yourself with the therapy materials, and ask the parents how they want things organized. I have had families ask me not to park in their driveway, to remove my shoes in certain rooms, or inform me about a loose back door the client may try to bolt out of. All good information to have!

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Tameika Meadows, BCBA, Blog Author

Which of the items pictured above would be reinforcing to you?
It would probably depend on what I asked you to do, the time of day, if you were hungry, sleepy, tired, sad, etc. You probably wouldn’t wash my car if I offered to give you $1. But you might wash my car if I offered to give you $100 (…or maybe not, if you really hate washing cars).

ABA therapists use reinforcers to get the learner to comply, to sit, to attend, to transition, and many more various behaviors. It took me a while to learn that just because child A will work for something that doesn’t mean child B will. It seems like such an obvious thing to know, but as therapists we do tend to make sweeping generalizations about the kiddos we work with. Such as:

"All kids will work for candy… All kids will work to avoid a reprimand.....All kids like attention… All kids know who Dora or Spongebob is... All kids like tickles" 

Every one of those statements is wrong, because they assume all kids are the same.

Choosing, selecting, and testing reinforcers takes skill and patience but the payoff is huge. Instead of being in a session with a child who is bored or defiant,  you now are approaching the child with the knowledge of what they like and what they will work for…..because there is a difference.

 I really like chocolate cupcakes, but I will not paint your house to get paid in chocolate cupcakes. There is a difference between your client liking something, and your client working for something. If you have been working with a client on a skill or set of skills for a long time without seeing progress, try changing your reinforcement. The child may have gotten bored with the reinforcement. Or maybe they like the item but not enough to do a difficult skill for it. They could have become satiated on the reinforcement (this happens very often with edible reinforcers).

A big issue I see happen frequently is someone else in the child’s life is giving them a similar reinforcer and the therapist doesn’t know. For example, the teacher at school keeps a candy dish full of Skittles in the room that the children have free access to. Its highly unlikely that you will be able to get your client to do challenging tasks to earn a Skittle, if they spent all day freely munching on Skittles. In behavior analytic terms this is called Bootleg Reinforcement. This can happen pretty often, so its important to make sure the reinforcement you are using is unique and the child doesn't have free access to it.

 If you had just finished a big seafood platter and I offered you a hamburger, the hamburger probably wouldn’t seem too appetizing. Even if you love hamburgers I have to offer it to you at the right moment. To understand effective reinforcement, you have to understand how to manipulate M.O. (Motivating Operations). Once you can do that you are on your way to being an awesome therapist!

Here are a few procedures to select powerful, effective reinforcers:

• Start by observing the child in a variety of settings- When I say “observe the child”, most therapists think I mean follow the child around the house. Observation is much bigger than that. Observe the child at the park, the grocery store, grandma’s house, in the classroom, at a birthday party, etc. Notice what the child gravitates to, what they touch, what they stare at, what they smile at, and what objects they pick up. Over time you will likely start to see patterns emerge that tell you what that child likes. A favorite observation tool of mine is to take a client to a toy store like Toys R Us. I just let them wander freely and I pay attention to what they look at, touch, or engage with. That gives me a great source of ideas as to what kind of items/toys that child likes.
• Talk to caregivers and others- Talk to the child’s parents, teachers, other therapists, siblings, etc. Ask questions about what kind of toys/items your client likes. Try to use open ended questions, such as “What kind of movies does Tanisha like” versus a closed ended question like “Does Tanisha like movies”. Make sure you ask sensory related questions so you can learn what the child likes to see/hear/smell/touch. If appropriate, you can also just interview the child.
• Test your ideas- Once you have an idea of what the child likes gather a few reinforcers together. Present the reinforcers to the child and pay attention to what they engage with longest. I am basically describing a Preference Assessment.
• The only constant is change- This is probably the most important thing to remember: Your client’s interests and likes will change over time. Don't your interests change with time?? With some of my clients I change the toys in my goodie bag every few days because I know those children get bored quickly. On the other hand, I have one client I have been seeing over 2 years on a consultative basis. Every time I visit, she immediately requests that I play Hide & Seek with her which is a game she finds highly reinforcing. She never gets tired of it. Let the child indicate to you when its time to change your reinforcers. If they want to work for the trampoline every day, that’s great. However if one day they don’t want the trampoline you need to be ready to use another reinforcer. Keep a supply of reinforcing items with you that are interesting and vary in size, texture, color, etc. Don’t just show up to a session and grab what is in the home, and try and use that as a reinforcer. The items in the home are things that child sees everyday. You may be able to get the child to do easy tasks for the teddy bear you grab off their bed. But once you move to more difficult tasks, or once that child has a bad day, that teddy bear just isn’t going to cut it.
• Have a stash of 24 Karat Gold reinforcers- That is just my own nickname for my super powerful reinforcers. I call them my “24 Karats”. As you spend time with your clients you get to know their personalities, and what they like. You learn what items they go insane over. Instead of mixing those items in with your other reinforcers, put them aside. Save them for really difficult sessions, like if the child is getting over a cold, didn’t get enough sleep, or you are teaching a very hard skill. Bring these items out sparingly. You want to keep the interest in these items high so when you bring them out the child is really excited. How do you know if a reinforcer is a “24 Karat”? Here are a few signs to look for:
1. You bring the item out of your goodie bag or your car, and the child immediately makes a beeline over to you and tries to take the item.
2. The child mands for the item when it is out of sight.
3. Watch facial expression: the child smiles, their eyes widen, or they give intense eye contact to the item. Here is a very simple trick: Place the reinforcer/random goodie on your palm so the child can see, and then close your palm tightly. If the child comes over to you and tries prying your hand open you are holding a 24 Karat!
4. When its time to put the reinforcer away the child resists giving the item up, cries, tantrums, or may even become aggressive. Therapists, be happy when you see this reaction because it tells you that the child really wants that item.
5. The child will drop an item they really like, in order to approach you when you are holding the 24 Karat.

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Tameika Meadows, BCBA, Blog Author