Challenging Behaviors
What do you do when your client protests "no" throughout session?
-Follow the client's lead
-Limit demands
-Use motivating reinforcers to increase engagement (First, then)
-Teach them to say something else (e.g., "okay!")
-If the “no” is primarily to escape, do not give in immediately and follow through with the task in a fun way
-Utilize demand fading
-Reinforce participation and engagement (differential reinforcement)
What do you do when caregivers are in denial about red flags for ASD?
It can be a lot for families to take in and it's totally normal to have doubts. Your role is to support your client's development, not to convince the family of a diagnosis. Meet families where they are at and provide support!
During session, siblings are present and try to take over, grab toys, or get your attention, what do you do?
-Teach turn-taking and peer play
-If siblings are present, encourage caregivers to join to help support interactions
How do you run task completion when the presentation of a shape sorter or puzzle is aversive?
Task Modification: Model fun ways to play/engage
Demand fading: Only require the child to do 1-2 pieces instead of the whole activity
-Identify reinforcers: "Puzzle piece in, then bubbles!"
-Pair non preferred with preferred
What do you do when the client cannot tolerate the parent leaving the room and are often waiting outside of the door for them or engage in challenging behaviors?
-Redirection, but don't offer them choices. Instead, present something in a super fun and exciting way ON YOUR OWN. They will likely join in!
What do you do when your client gets upset when instructions to clean up are given and they throw themselves on the floor and try to escape?
-Teach functional communication for more time with toys
-Have something preferred ready to transition to after cleaning up
-Demand fading
-Errorless learning
-Make clean up a game
During session, the parent tells the child, “Say you’re all done,” but doesn’t speak directly to you. They start giving the child the iPad or having them help clean up, without acknowledging you. What do you do?
Collaborate with the parent and let them know that you are still working on (specific skill/lesson). Kindly ask if they can wait until the end of session to give your client the iPad.
-Use it is a reinforcer
What are some ways that you recharge after a tough session? How to prevent burnout?
-Talk to a coworker and share your challenges and/or wins
-Treat yo self
-Play lofi music to decompress
-Don't be afraid to ask for support if something is burning you out
What are ways to get a child to engage with a toy for longer periods?
-Make the toy "come alive" by using sound effects, movement, exaggeration and enthusiasm!
-Find novel ways to play with the toy
What do you do when it feels like your client doesn't have any reinforcers?
Think beyond toys... social, sensory, movement/activity based (e.g., tickles, blanket swings, chase, spinning, water play)
How do you decrease elopement during sessions?
If escape maintained...
-Use environmental arrangements
-Keep activities highly motivating
-Pair preferred items with non preferred activities
-Demand fading
-Functional communication
-Block elopement
What do you do when parents do not participate in session?
Encourage families to participate using respectful language!
-"Would you like to try this activity with (child's name)?"
-Model the activity/skill first and then prompt caregivers to imitate
-Explain the rationale behind lessons/programs to increase buy in
-Provide reinforcement for caregivers!
What do you do when your client is indecisive about toys/activities? For example, they will mand for an item, but once I give them access to that item, they begin to engage in crying and vocal protest.
-Teach functional communication if escape maintained
-Avoid giving choices and instead just present the item, prompt them to mand and then begin playing with it
-Capture opportunities to mand for items that they are already gravitating toward and allow them to individually play with it before joining
-Parallel play next to them?
What do you do when your client has a hard time transitioning between activities?
-Priming
-Have alternate preferred activity ready to go
-Make the transition fun
-Functional communication for "more time"
Your client is having a day with low energy and doesn’t want bubbles or any reinforcer that they usually like. How do you get them motivated?
-Incorporate movement/sensory activities!
What do you do when the child engages in aggressive behaviors toward EI or parent throughout session?
-Teach functional replacement behaviors depending on the function
-If access maintained, offer other choices of items that are available
-Remain neutral and calm
-Simply saying "no hitting", "no throwing" or "don't do that" is not enough. You have to teach them a replacement skill. Teach them what TO do instead.
-Teach replacement skill outside of aggressive episode. Be proactive!
-Remember that behavior is strengthened by attention
What are some ways to encourage your client in both English and native language so their communication grows in both?
-Respect the client's home language
-Incorporate and model English words and the child's native language
-Reinforce attempts in either language
What do you do when the child has no interest in anything you bring out to play with during session?
-Follow THEIR lead and play with what they gravitate toward
-Become the reinforcer! Pair yourself with positive experiences. Build that connection!
What do you do if your client is "rigid" in their play routines?
-Join in on their play without interrupting it. For example, if they're lining up cars, line up cars with them
-Narrate through their play
How do you keep sessions productive and run multiple programs when a child becomes fixated on one toy?
-Embed multiple teaching opportunities into that one toy/activity
-If they are fixated on cars, you can label numbers, colors, pretend play, prepositions
-Use the toy as the reinforcer
What do you do if tantrum last 10+ minutes over consecutive sessions?
-Ask yourself "what's the function?"
-Pair! Connection > compliance
If your client only mands during session and caregivers report that they don't mand outside of session, what do you do? Can you give tips/strategies to support minding outside of session?
Yes! Model and explain how to capture and contrive manding opportunities outside of session. Explain the importance of generalization.
-Choices, putting preferred/motivating items out of reach, echoic prompts, narrating
Your client is bored of your toys. What can you do?
-Present toys in new ways
-Rotate toys
-Combine toys (e.g., drive car through a tunnel made from blocks, blocks and animals, play food and dolls)
There are no toys in the client's home. What do you do?
-Talk to your supervisor
-Make yourself the reinforcer and try new things!
How do you help children regulate emotions when parents step away during session?
-Model and prompt coping strategies (e.g., deep breaths, sing a song)
-Redirection