After a new client’s assessment is complete, it is time to start teaching him/her the skills that were identified as lacking. However, many of these children have never been in instructional settings and may not be used to sitting at a table and doing work. Additionally, the child may not be used to receiving instruction from anyone other than his or her parents. For these children, it is likely that immediately requiring them to sit at the table and work for 10-15 minutes may result in problem behavior such as screaming, crying, or aggression and noncompliance with demands. We have many techniques for gaining compliance in this intensive teaching situation.
The first session or two with a new client is spent “pairing” ourselves with reinforcement. During this time, the therapist places few, if any, demands on the child and provides as much social (praise, tickles, etc.) and tangible (toys, food, etc.) reinforcement as possible. Reinforcement is anything the child enjoys which he or she would be willing to work to obtain. Pairing establishes the therapist as someone who provides good things and who the child enjoys being around. This process makes it more likely that the child will comply with the therapist’s instructions. It also allows the therapist time to determine what activities and toys the child enjoys and will be most motivated to work to obtain. Pairing may take less time with children who are more advanced and have attended school or been in other instructional settings.
Once the child comes to the therapist to gain reinforcement without engaging in problem behavior, “pairing” has been completed. At this time, demands are slowly introduced. Initially the therapist may begin incorporating demands into play activities away from the table. For instance, the therapist may require the child to say or sign “ball” before throwing it to the child. The next step might be to instruct the child to sit at the table for a short time while he or she watches a movie or eats a preferred food. Ideally, many different reinforcers should be provided at the table to establish the table initially as a place where good things happen, rather than work. Next, the therapist would instruct the child to sit at the table and complete only one demand before providing a tangible reinforcer or allowing the child to leave the table. When the child consistently does this without any problem behavior, the therapist may start to place two demands before providing reinforcement, and so on.
Gradually increasing the amount of work the child is required to do before reinforcement is provided ensures that the therapist and/or the table does not become unpleasant (aversive) for the child because of their association with demands. This might be seen in everyday life when a child has a tantrum when he or she is told to sit at the table for dinner. Usually this behavior occurs if the child finds eating difficult or unpleasant and the table is then associated with eating. The techniques described above could be used in this situation by playing with the child at the table and gradually increasing the amount of food he or she is required to eat. Another example might be a child who will scream or cry if told to take a bath because he or she finds washing or being washed aversive. In situations such as these, you can try pairing and gradually fading in demands at home to make everyday routines more enjoyable.
