Learning to Wait

Waiting can be a hard skill to learn. Individuals with Autism may have difficulty with abstract thought, and the concept of time. The words "Just 5 more minutes", or "We'll do that later", may mean nothing. Autistic clients can also have a rigidity of interests and a need to follow a schedule, which makes the child want their needs/wants met now...now...NOW.

I was inspired to do this post after seeing a child meltdown this morning inside a shoe store. As I was deciding between two pairs of shoes,  I saw this adorable little boy who had clearly reached his internal time limit for shoe shopping. First he began to whine, whining escalated to crying, and then crying escalated to throwing shoes across the store. I kid you not....pumps began to fly across the store.  I'm sure for many people witnessing this, it just looked like a bratty child having a tantrum. What I saw was a child who didn't know how to wait.

Many aggressive and challenging behaviors can stem from a child's inability to wait.  You might be wondering why is it so important to teach waiting skills. 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.  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 other kids down, and steps on their feet.
• 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.
• Tyrone's daycare teacher just bought a new trampoline for all the children to play with. Tyrone has fun all morning jumping on the trampoline by himself. After lunch, another child tries to climb onto the trampoline with Tyrone. The daycare teacher says only 1 child can jump at a time and tells Tyrone to get down. Tyrone watches the other child jump for a few seconds, and then he screams and pushes the other child off the trampoline. 

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. Don't be the type of professional or parent who sticks band-aids on problems. Eventually that band-aid will stop working and the wound will be worse than before.

When teaching waiting you can work on this skill incidentally or you can write up a program and teach it in a structured way. I tend to do both. I write up a Waiting program and I also show the adults in the child's life how to work on this skill outside of therapy. The more the child gets to practice waiting, the better.

So lets look at both approaches:

Teaching a Child to Wait: Program-

For a step by step explanation of how to write ABA programs see my Writing ABA Programs post. For a Waiting program you will need  activities or objects the child enjoys. You may also need a timer (but it's not required). Before writing the program 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 vocal 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, such as "Wait/Hold On/Just A Minute". 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". Place the doll where the child can clearly see it but not reach/touch it. Once the designated time of waiting has ended, give the child the item. It's important to also practice waiting for activities, not just tangible items. So waiting to go outside, waiting to access mom's attention, or waiting to watch a favorite TV show.  Practice daily.

Teaching a Child to Wait: Incidental-

Create opportunities during the day for the child to wait for something. At breakfast, start to hand the child the orange juice and then stop and say hold on, wait a minute, or some other natural wording. When getting the child out of the car, reach to unbuckle their car seat and then stop and pretend to be busy with something so the child has to wait. Use varied opportunities and various items. Have the child wait for toys, to leave a location, to enter a location, and to start an activity. Be sure to always provide quick praise and reinforcement for good waiting. Everyone who interacts with the child should give the child opportunities to practice this skill. If you are in public and don't want to use a timer you can do a finger countdown. Hold up 2-10 fingers and do a countdown to zero. Not all children will need timers or finger countdowns, but they can make waiting much easier for those who do.

**Quick Tip: Visuals can 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. For a young child maybe a stoplight visual colored green-yellow-red. The red card could mean "wait",   yellow could mean "almost", and the green card could mean "go", or access the item. For an older child maybe number cards. This is great if you are having a conversation with another adult or on the phone and need the child to wait before speaking to you. 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.