Wednesday, August 22, 2012

Learning to Wait

Many aggressive and challenging behaviors can stem from a child's inability to wait. You might wonder why is it so important to teach a child with Autism to wait. The reason why this is such an important skill is because its a pivotal skill, meaning it impacts the success of learning more advanced skills. Children have to wait, because adults have to wait. As a child matures and starts interacting with society they will have to wait in the classroom, at the park, at the grocery store, inside the home, at the airport, etc. If your child or client is regularly engaging in problem behaviors it may be stemming from an issue around waiting.
Here's a few examples of what difficulty with waiting can look like:
-Whenever the teacher tells the class to line up to go outside, Doug gets very excited. Doug loves playing outside. Doug gets so excited and impatient while waiting in line that he regularly pushes, bumps into, and steps on the feet of children near him in line.
- Iyanna is at the mall with her dad. Iyanna makes the sign "eat" to her dad to signify she is hungry. Her dad tells her they are leaving the mall in 15 minutes, and and she can eat then. Iyanna begins to cry, and a few minutes later bolts away from her dad and runs to the food court where she starts eating leftover food off of tables.
A child who doesn't know how to wait may become aggressive, defiant, and may eventually have a meltdown. Most people just see the behavior as the problem and try things such as blocking the aggression, telling the child to stop pushing, or putting the child in Time Out for throwing chairs. The problem with that approach is that in all of these situations the behavior was the by-product of a skill deficit. These children did not know how to wait. When put in situations where they didn't get a desired item or activity "right now" they engaged in problem behaviors. In order to effectively terminate these problem behaviors you have to target the skill deficit, not just the outcome behavior.
Teaching a Child to Wait: ABA Approach-
For a Waiting program you will need activities or objects the child enjoys. You will also need a timer. Before beginning to teach the skill you need to determine the child s current ability to wait appropriately. Appropriate just means the child doesn't try to reach for or grab at the item they are waiting for, and if the child is verbal they don't whine or plead for the item. If its an activity, the child doesn't try to run past you to access the item. If you determine the child can wait about 20 seconds before they grab at the item, set your first target at 10 seconds. You always want to start a little below what the child can currently do to ensure they contact reinforcement. Slowly build up the amount of time using small increments. Select a simple SD. Typically "Wait" is the SD used. Allow the child to access the preferred item for a few seconds. For example, give them a highly preferred doll to play with for a few seconds. Then take the doll away, say "Wait" and set your timer. Place the doll where the child can clearly see it but slightly out of their reach. Once the timer goes off praise the child for waiting and give them the doll back. If the child does not wait appropriately use prompting to get compliance and ignore any inappropriate behaviors, such as crying. Do not provide praise or reinforcement if the child didn't wait appropriately.
Lastly, be careful about allowing the child to almost touch the item. Many kids like to play the "I'm almost touching it, but not quite" game. If you reinforce or allow the child to put their hand above or close to the item before they are done waiting then over time that behavior will get engrained and will be hard to get rid of. The child should wait to access the item with Quiet Hands.
Visuals can also be a great way to help teach waiting. For children who don't understand the passage of time using a visual makes time much more tangible and real. What kind of visual you use will depend on the age and cognitive ability of the child. You could use a stoplight sign where red means "wait", yellow means "almost", and green means the child can access the item. For an older child try number cards. Flip through the cards starting at number 10 working down to 0. Once you get to 0 give the child your full attention and praise them for good waiting. This gives the child a much more concrete understanding of time rather than you saying "Hold on" over and over. When using visuals always pair language with the visual so you can eventually just use language and fade out the visual.
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