How to Engage for ABA.

As many who read this blog will know, the first 6 months post diagnosis I did much of Harri's therapy, based on ABA principles, at home with additional therapy provided by several trained ABA therapists. Since that time Harri has transitioned to a new service where I have had the oppotunity to observe the application of ABA in a different setting and manner.

This post is based on some of my observations about engagement of  Harri during his therapy sessions. What worked, what did  not, and what tools were most useful in terms of motivation and positive reinforcement. (Hat tip to Brian and Christy at http://bothsidesofthecoin1.blogspot.com/ for this post idea)

The first and I think most important aspect to engagement is relationship. If you are working with your own child then you have that advantage immediately. If utilising external therapists they have to be the 'right fit' for your child. I think this concept is important in any area of therapy, but in working with children with ASD it is crucial. We are trying to teach our kids that both interacting with people and learning are positive experiences. If this is not the case then our kids are adept at retreating into their own world, which is the opposite of what's required to teach and form bonds with others. From my own perspecive I want to see a therapist approach my son as Harri first, person with ASD second. They will want to know and understand what makes him tick as an individual, rather than assuming their professional knowledge of Autism overrides the need to understand his unique personality. Also, as I said in the post A Tale of Two ABA's, I found the idea of forced compliance questionable, and with Harri it led to stubborn refusal to participate and even ocassional distressing tantrums. I prefer a therapist who works strongly on positive reinforcement as outlined below.

Following on from getting to know the child, is then understanding what motivates them. Harri is a sensory seeker so finding toys to attract him is quite easy. Any type of cause and effect, interactive toy usually does the trick for him.The challenge for his therapists is maintaining novelty as once he has mastered something he tends to lose interest. This means having access to a wide range of resources to ultilise. Both of the women he works with are constantly trying new and stimulating toys and games to keep him interested. Some children may be more motivated to work for food rather than play. Can I add though, witholding of food is to me abhorrent. If a child is hungry it is unrealistic to expect them to be able to focus. When I think of food, I think treats, like chocolate, M&Ms, or Tiny Teddies. Harri was always happier with social rewards, but the point is finding what each individual child is most keen on. When we worked at home I had a box full of reinforcers that Harri only had access to during therapy. Things like little wind up and blow up toys, bubbles etc. One of the best shops I have found for the types of toys that suit is National Geographic Stores. But given the need for a wide array of toy options a local op shop or toy library may be more financially kind.

Either way the reward must be either immediate or clearly established in order for the child to know what they are working towards and to generate a positive association with doing work. When we did home based therapy Harri had a visual schedule. So if he wanted to, for example,  feed the fish in our pond during his break, the therapist would draw three aspects of work he would be required to do, and as each one was mastered he could stamp or tick it off in order to understand he was working towards his desired goal. With the current service provider we use a token system, where Harri has three tokens which symbolise the work he has to do  in order to play. Once all tokens are on the token board he is free to play with whatever it was he chose prior to the work starting. Both systems are easy and if practiced with consistency kids seem to grasp reasonably soon. In my observations what works best with small children like Harri is small bursts of work followed by a decent amount of play time. Over time the aim is to increase the capacity to sit and focus, but at least in Harri's case that is a slow process. Personally I think it's more important that the child feels positive about the time they are working which will then lead to longer ability to attend to task rather than forcing young children who like Harri may become easily frustrated. Another way to maintain engagement for longer is to allow work to take place where the child is comfortable. So you might start at a table and then move the floor, then maybe outside. This is good for teaching generalisation too.

Harri is not a big stimmer. I'm not sure, but I imagine this can make a difference in terms of what engages a child. If all a kid wants to do is stim, then perhaps that becomes the initial way to motivate work. So you explain, you do some work, then you get to stim. This might also have the added benefit of preparing a young child for school where he or she can develop the capacity to focus in class and then in break time can engage in self soothing behaviours. I suspect this is one issue, to allow stimming or not, where therapists may diverge and in that case I suppose it's up to parents to determine how they wish to proceed. It might take trial and error but I reckon most parents could tell a therapist immediately what their child likes best.Toys, food, stimming, jumping on a trampoline and so on. If the child is not prepared to work that usually means you have not found the best motivator yet. Of course on some days nothing will work. If Harri is coming down with a cold, or had a bad night or is just in a mood he is withdrawn and resistant to work. I am OK with that, and I expect his therapists to be so too.

For Harri visual and physical access to all the toys and games is a distraction so his therapists put them all in a clear large container so he can see them but cant gain access. This might be helpful for other kids too. Harri also needs to be reminded from time to time what it is he is working towards. And whatever that may be, the therapist has allowed him to choose just before the work session commenced. If he goes a bit wobbly and stops paying attention to the task at hand they give a reminder of what it is he wanted to play with. If that doesn't seem to work then they might try playing with it to see if that perks his interest. If he comes ambling over to see what they are doing the therapist then says something like 'oh' you want to play with the toy? OK, you have one more token to get then you can play'. So its a continual process of engagement, reminding, working, reinforcing, and lots of enouragement. The child ideally has a clear sense of being in control. They may not understand the benefits of what they are learning, but they enjoy the process enough to go along with the requests.

Something else to be mindful about if, like Harri your child is echolalic or echopraxic. To be hyperconscious about use of language and actions to teach. For example when Harri's first therapist starting holding a toy he wanted and waiting for some eye contact before he could  have access to it, she pointed to her face. After that for several months he always pointed to his face when making eye contact. This has faded now thankfully and the new service provider does not require eye contact in the same way. The current sticking point is when naming things he says for example, "no that's a bed", instead of simply 'that's a bed'. He does this because a couple of times he was corrected with a 'no, that's a ..' response when he named something incorrectly. Now we are having to teach him to name without the no added.  As I say this is just another issue to have awareness of if you are doing the therapy yourself. With Harri, and I reckon most of our kids, habits are easy to create and more challenging to undo if they prove unhelpful.

I know there are heaps of other tips and ideas I have left out and am hoping some of the more experienced parents reading this will add their advice and support here. Feel free to ask any questions. Hope this helps some of you who are starting out on the therapeutic journey with their little ones.