Wait! Don’t Prompt Just Yet…Try Modeling/Request Imitation First

Prompting/fading procedures are used extremely often when implementing ABA interventions with individuals with ASD.  When used correctly, and the fading procedures are systematic, this strategy is quite effective.  However, it should not be the first plan of action in many instances.  Here’s why:

Think about how you learn most of the things you know.  It can be through reading and through experiences.  Many people say, “I need to see it first.”  Well, we know that children with ASD are visual learners.  Don’t you think it makes sense that they would need to see it first as well?  Thus, instead of making a request and then prompt if the child does not respond, first model the expectation.  Immediately following the model, provide an opportunity for the child to imitate the model.  This strategy is called modeling/request imitation (Buffington, Krantz, McClannahan, & Poulson, 1998). If you can show the child exactly what you want him/her to do, you will be surprised how often the child can imitate the response without any prompts.  Of course, if the child does not imitate the model, prompting/fading procedures can be used at that time. 

Another reason why it is important to use modeling/request imitation is to increase the child’s independence.  If the child can see what is expected, and imitate the model without any prompts, independence is achieved much quicker than using prompts and having to systematically fade them out.  Using modeling/request imitation is a great way to prevent prompt dependency. 

One more reason to use modeling/request imitation before prompting/fading procedures is to build the child’s self-esteem.  If the child can see what you want and imitate without any prompts, the child is likely to have a sense of accomplishment and feel good about his/her performance.  Once prompts have to be initiated, you are saying, “Let me help you.” Depending on how those prompts are delivered, the child can quickly begin to feel like a failure.  I am not saying that using prompting/fading procedures is bad because I use them all of the time.  I am saying it is best to first try modeling/request imitation. Initiate prompting/fading procedures only if the child cannot respond to the model.  Below are some examples for using modeling/request imitation:

1.  Early Childhood:  A caregiver wants to teach a child how to use a fork.  The caregiver first models sticking the fork into a piece of food, then takes the fork out, gives it to the child and says, “Now, you try!”  The child takes the fork and attempts to stick it into the food.  Although the fork didn’t go all the way in, the caregiver positively reinforces the child with specific praise and quickly puts the fork in the food and gives it to the child to eat.  With each successive trial, the caregiver models and offers an opportunity for the child to imitate.  After just a few trials, the child is able to independently stick a fork into the food.

2.  Elementary:  A teacher wants to teach a child how to add with regrouping.  The teacher sits next to the child and writes two of the same problem on a piece of paper.  One problem is on the child’s side; the other is on the teacher’s side.  The teacher first models adding the numbers in the ones column, and provides an opportunity for the student to imitate that step with the same problem.  Next, the teacher models how to add the tens column with the number that was carried over, and provides an opportunity for the student to imitate that step as well using the same problem.  Several problems are done this way until the student is able to complete the problem without any modeling.

3.  Middle/High School:  A teacher wants to teach a student how to measure materials for a science experiment using measuring cups and measuring spoons.  The teacher decides to use peer-mediated intervention by having a peer use modeling/request imitation to show the child how to measure with the cups and the spoons.  For each item that needs to be measured, the peer first shows the child how to fill up the measuring cup/spoon, then dumps it out and gives the student an opportunity to imitate the model.  The peer continues to use modeling/request imitation until the student can measure independently without the model.

4.  Community-Based Instruction:  An employer wants to teach an individual how to file away folders in alphabetical order.  The employer models how to do so, removes the folder, and provides an opportunity of the individual to imitate.  This is repeated with several different folders until the individuals can file alphabetically without a model.

Quiet Hands???

Emily Shamash, Ed.D.

Deb Leach, Ed.D., BCBA

Many teachers and parents use the term "quiet hands” with children with ASD to teach them to refrain from flapping their hands or engaging in other self-stimulatory behavior with their hands.  We would like to encourage readers to rethink that approach. 

From our perspective, there are a host of issues with using the "quiet hands" phrase.  First, some kids may flap their hands because they are excited about something.  Who are we to suggest that this is an inappropriate way for them to show their excitement?  Some kids flap their hands or rock back and forth because their bodies need movement in order for them to feel “centered.”  As long as the movement is not preventing them from engaging in learning or social activities and it is not preventing others from engaging, then we should probably allow them the freedom to regulate themselves.  If we don’t, we often end up playing a game of whack-a-mole: You stop the hand flapping and something else (that may be much more inappropriate or disruptive) will pop up to replace the need for self-regulation.  

In some cases, the function of hand flapping may not be to show excitement or for self-regulation due to movement needs, it may be to communicate another function such as lack of engagement, inability to engage in a task because it is too difficult, disinterest, frustration, anxiety, etc.  In these instances we need to conduct a functional behavior assessment (formally or informally) to determine the function of the hand flapping so that we can: 1) Make any changes to the environment, adult behavior, or peer behavior to prevent the need for hand flapping 2) Teach more appropriate and effective replacement behaviors that serve the same function. 

Telling students to have “quiet hands” is a very surface level solution to what some consider a problem.  It is similar to telling students to stay in their seats throughout a lesson. Instead, we need to look at their engagement level in the lesson and/or what purpose leaving their seat may serve.  This way we can focus on increasing engagement which would likely result in children staying in their seats.  If we determine that a child is leaving his/her seat to get attention from another adult, we then need to ensure that adult refrains from giving the child attention for out of seat behavior and increases attention and positive reinforcement for in seat behavior. 

Generally speaking, we should not focus on behavior reduction.  Instead, we need to first determine if the behavior is enough of a problem to warrant an intervention.  If so, then we need to determine the function for the behavior, make necessary changes to the environment and the behavior of others to potentially prevent the behavior from occurring, and teach replacement behaviors that serve the same function in a more desirable way. 

“Let’s Go Potty!” A Three-Phase Teaching Procedure for the Initial Stages of Toilet Training

“Let’s Go Potty!”

A Three-Phase Teaching Procedure for the Initial Stages of Toilet Training

Jennifer Rodecki, M.Ed.

Deb Leach, Ed.D., BCBA

Caregivers and teachers of children with ASD and other disabilities are always looking for helpful hints on toilet training. Truthfully, there are multiple skills that must be taught to fully toilet train a child. This reading will provide a description of how to introduce a child to the beginning steps of toilet training.

Phase 1:  When first beginning toilet training, you will simply be working on getting the child comfortable with sitting on the toilet several times throughout the day.  During this phase of the training, the child will continue to wear diapers or pull-ups.  It is important to do your best to avoid making the toilet training aversive for the child.  Do not force the child to sit for a certain length of time during Phase 1. You should provide large amounts of positive reinforcement while the child is in the bathroom, on the toilet, and after the child sits on the toilet during this initial phase.  This can be through the use of social reinforcement, activity reinforcement, or tangible reinforcement. The purpose of providing positive reinforcement is to pair toilet training with things the child finds enjoyable to increase the child’s willingness to participate in toilet training.  When telling the child it is time to use the bathroom, use a consistent phrase each time, such as “Let’s go potty.” Take the child into the bathroom. If the child will not sit on the toilet, start by giving the child the reinforcer while he or she is standing in the bathroom. After 2 – 3 times of receiving the reinforcer while standing in the bathroom, withhold the reinforcement until the child sits on the toilet. While the main goal during Phase 1 is not to get the child to actually eliminate while sitting, if the child happens to do so, be sure to provide meaningful positive reinforcement.

Phase 2:  Once the child is sitting on the toilet for seconds at a time, you should begin increasing the length of time you expect the child to sit on the toilet before providing the reinforcer. You should start with thirty seconds of sitting before getting the reinforcement. After the child is able to sit for thirty seconds for 2 – 3 times, increase the time requirement to one minute.  Once the child has sat on the toilet for one minute, give the reinforcer. Continue this for 2 – 3 successful trials and then increase the time requirement to two minutes. Continue this procedure until you reach five minutes. Some children may not be able to sit for five consecutive minutes. In this case, 2-3 minutes should be their time limit. If the child eliminates in the toilet give verbal praise and a highly preferred reinforcer.

Phase 3:  Once the child is comfortable with sitting on the toilet a few times each day, it is time to begin potty training without diapers.  Bring the child to the potty on a fixed schedule.  The fixed schedule can be every 20 minutes, 30 minutes, 40 minutes, etc.  It depends on your child’s frequency of elimination.  During this phase, be sure to record the times that the child is having accidents. This recording should last 3-5 days. While recording accidents, it is also important to note when the child has had any food or drink. It is likely that you will notice a correlation between the child’s consumption of food and drinks and the accidents. After 3-5 days, you should start to notice a pattern developing of when your child is having accidents.  Once you notice a pattern, begin taking the child into the bathroom about 5-10 minutes before you are expecting the accident.  Do not provide any negative consequences if/when your child has an accident.  Accidents are part of the learning process.  React unemotionally, bring the child to the bathroom, say something such as, “You pee on the potty,” and clean up the mess without making an issue out of it.  During this phase, give verbal praise and a highly preferred reinforcer when the child eliminates in the toilet.  The reinforcers can be gradually faded out once using the toilet becomes more of a regular pattern for the child.

These steps provide the child with an introduction to toilet training.  Keep in mind that these procedures should be implemented consistently, and that it may take a couple of weeks to several months for accidents to cease depending on the child.  It’s important to continue with the steps outlined even when accidents are occurring.  These procedures are not only designed for young children.  Jennifer (first author) used these procedures with middle school students with moderate-severe autism who were not potty trained.  She was able to get all students potty trained at school within several months.  While there are additional procedures for getting to the point where the child is completely independent with using the toilet, being able to use the toilet on a schedule without accidents is the first step to independently using the bathroom.   

5 Tips for Successful Play Dates

5 Tips for Successful Play Dates

Jennifer Rodecki, M.Ed.

Deb Leach, Ed.D., BCBA

Play dates are a “normal” part of childhood for most children. However, it can difficult to plan play dates if your child has ASD or other disabilities. Parents of children with disabilities may shy away from the idea of hosting a play date because their child has meltdowns, or they don’t want other children to bully their child. However, play dates can be an excellent way to teach your child socially appropriate behaviors in a natural environment. Below are five tips for setting up a successful play date.
1. Plan Ahead: Having a variety of interest-based activities planned can help make play dates more successful for your child. It is best to plan activities that are interesting to both the child with ASD and the peer(s) whenever possible.  A visual schedule of activities can help reduce the anxiety of your child with ASD.  It is best to prepare the schedule of activities using pictures and/or words, review the schedule with the child before the play date, and use the schedule during the play date.  This allows the child to know exactly what to expect and what comes first, next, and last.  
2. Teach the Expectations: Once you have developed a plan of interest-based activities, teach your child the behavioral and social expectations for the play date.   This can be done with a literacy based behavioral intervention such as a Social Story©.   These stories should be written from the child’s perspective and explain what will or may happen during the play date and the behaviors the child is expected to display.
3. Use Peer-Mediated Interventions. Once you’ve planned the activities for the play date and prepared your child, it is time to ensure your child is supported throughout the play date to increase the likelihood of success.  Even with adequate preparation, without the necessary support, your child may end up “doing his/her own thing” instead of actively engaging with the peer(s).  Instead of jumping right in and telling your child what to do, try to utilize the peer(s) to bring your child into the activity.  This is called peer-mediated interventions.  Simply put, when you use peer-mediated interventions you encourage the typically developing peer(s) to use strategies to encourage the child with ASD to interact.  You can teach peers strategies such as following the child’s lead, prompting/fading procedures, positive reinforcement, and modeling/request imitation.  Consider this example: John came over to play with Scott, a young boy with autism. The parents set up Moon Sand for them to play with.  John begins building a fortress, while Scott is burying his hands in the sand. Instead of forcing Scott to build a castle, you could say, “Wow! John that’s a great castle you’re building! When you’re finished, do you want to let Scott bury your hands in the sand?” In this example, you are teaching the peer to follow the child’s lead.  You may need to facilitate to get the interaction going, but you can fade out once the children are engaged in the interaction.
4. Avoid Disaster. In the beginning, you may find that starting with shorter play dates (15-30 minutes) is better for your child. You can then work up to longer play dates. While it is important that you are not overbearing during your child’s play date, you want to make sure you are keeping a close enough eye on your child to prevent a possible meltdown. If you notice your child’s warning signs for a meltdown, it is best to intervene to prevent an outburst. He/she may just need a short five minute break from the situation to regroup. Sometimes a favorite snack will help, and the friend will likely be ecstatic to eat a snack as well. Changing from an intensive hands-on activity to a more calming activity such as swinging, listening to music, or coloring may also help you avoid disaster. Of course this does depend on each individual child’s interests and sensory needs.  It is also best to start with just one peer at a time for play dates and include more children once your child has success. 
5.  Manage Meltdowns. No matter how hard we work to be proactive, sometimes meltdowns still occur. Make sure you have a back-up plan in case this happens. Pop in a movie for the friend or ask the peer’s parents to pack a favorite toy just in case. Explain to the peer that your child sometimes gets overwhelmed and needs a few minutes to relax. Take your child into a setting where he/she feels the most comfortable (bedroom, play room, etc.). Try not to put any added pressure on your child. Give your child as much time as needed to feel comfortable returning to the play date. Once your child is composed, have the child choose an activity that he/she enjoys and invite the friend to participate. 

         

Yes, When Pigs Fly! Helping Kids with ASD Deal with Hearing the Word "No"

Many kids with ASD have a difficult time hearing the word "no."  In my experience, it's not necessarily that they can't deal with getting what they want.  They simply get very upset when they hear someone say "no."  This may be because they think the "no" means "no forever."  Here's an example:  One of my former students called me one day to ask for advice with her student with autism.  He would have a meltdown everyday that chicken nuggets weren't an option for lunch.  She would ask him what he wanted for lunch each day, and he would say chicken nuggets.  If the cafeteria was not serving nuggets that day, she would say, "No, you can't have nuggets today," then give him the choices.  He would proceed to scream and tantrum for quite a while.  When I was speaking to her I said, "I wonder if he just thinks you're being a big witch and YOU won't let him have chicken nuggets." I suggested creating a lunch calendar that showed the days that chicken nuggets would be served. This way, when he asked for chicken nuggets, instead of saying "no," she could show him the next day that he could get chicken nuggets.  Happy to report: It worked!  Not always so easy, but in this case, it was.  This reminds me of a workshop I went to when I was still an undergraduate preparing to be a teacher back in the day.  It was called, "Yes, When Pigs Fly!"  The premise of the workshop was teaching educators to say "yes" as much as possible, and when the answer is "no," say, "Yes, when..." letting the child know when they can get what was requested (you don't really say, "when pigs fly" :)  It's a great approach for teachers and for parents.  For kids with ASD it helps avoid excessive amounts of anxiety and feelings of being powerless.