Since Graham started therapy the question I’m most commonly asked is what they actually DO. He’s not even two years old, what kind of therapy is possible? So today I thought I’d give you a little insight into what I’ve seen of ABA (Applied Behavior Analysis) so far. If you saw my last update on Graham’s progress, you know that I am very convinced that ABA can work even in toddlers.
Disclaimer: I am not trained or certified or anything when it comes to child development, autism or ABA. This is just to give you a basic idea of what you’d see if you observed Graham’s ABA sessions. You should definitely consult some qualified therapists for more info.
Graham’s therapy is divided into two parts: Work and Play. The play part isn’t actually work-free, there’s lots of sneaky little ways that techniques to increase his communication and interaction come into the play. But today I’ll focus mostly on work.
For work Graham has to sit in his little green chair. Preferably he sits still with his feet down and his hands folded. I know it sounds hard to believe, but it happens. Of course, much of the time he’s so excited to be sitting in his chair that he is wiggly and throwing his arms around.
When ABA first started one of the main exercises Graham had to do was simple: responding to his name. At the time we started, the Bug’s name response at home was around 5-10%. It’s now up to around 80%. Here’s a basic outline with this simple exercise.
The therapist sits across from Graham. He is asked to choose a toy from two options. Once he chooses his toy, he plays with it for a little while and then is asked to give it back. (Or it’s taken away.) At this point Graham is “working” for that toy and it may be used as a visual incentive at some points.
Once Graham is ready, the therapist will give a command, in this case, saying his name. If Graham makes eye contact he gets vocal affirmation and celebration as well as receiving the toy. (Aka, we all clap and tell him he did a good job, there may be some tickles involved as well.)
This exercise will be repeated a few times. Sometimes it’ll go back and forth between one task and another. Maybe between calling his name and having him raise his arms in the air or bang on the table like a drum.
If Graham fails at the task, sometimes they try again. Often it means that some extra help will be given. One example with making eye contact after is name is that they’ll bring their fingers to their eyes to make him look. Or they may hold the toy in their hand while they make that sweep to their eyes.
The therapists keep a log of how he’s doing and seem to adjust what they try depending on how well he’s responding. After a few minutes of “work” it’s back to playtime again.
Recently he’s had more complex tasks. He has to identify a body part (right now we’re on belly) or point at one specific object from a group of three.
I can really see how it’s affected Graham. Somehow ABA seems to have flipped a switch in his brain where he realizes that when we talk we’re trying to communicate with him. Gestures and words have meaning. Not only does he take that in, he’s also taking part himself by talking and pointing.
Another thing we’ve used lately is PECS (picture exchange communication system). The Bug has certain pictures, perhaps some like these:
I found these here, you can find PECS pictures all over the web. When Graham wants something from one of these pictures he hands it to you. It sounds simple, but PECS does create actual communication. It’s particularly helpful when Graham doesn’t always have the word associated with the thing yet. We plan on using PECS to create a “menu,” since one of Graham’s most common reasons for meltdowns is food.
It’s my understanding that ABA can be a little tricky since toys or food are used as rewards. But I don’t see a problem. Graham gets so excited about positive reinforcement that he’s cheering for himself. In fact that is our recent problem. When we are trying to communicate something and he knows what he’s supposed to do, sometimes he cheers instead of doing it.
But, as Eric says, it’s happy screaming and we’ve dealt with much worse.
Oh, and if you were wondering about the little Bug, we took him out to dinner (successfully!) yesterday. He ate a whole bowl of pasta, watched boats go by in the harbor, and enjoyed pointing and yelling at all the lights. His coloring skills are also getting pretty impressive. He is working hard on holding a crayon in each hand.
It took him a good 5 minutes to notice the lobster right in front of him. Once he did, he got pretty excited. Note, the pointing. This kid, he’s learning.
No, seriously, he’s learning. He just visited my office and was identifying and saying “red” and “yellow.” Holy cow.