Most ABA therapists
(myself included) start out in this field doing intensive skill acquisition
with young children, using DTT methodology. I love DTT because it is so
structured, and it is a way to boil teaching down to its most simple state. 1:1
DTT at a worktable has minimal distractions, is instructor led, and teaches
broken down skills in high repetition. Many of the reasons I like DTT are the
same reasons why it often isn’t appropriate for older or higher functioning
clients, as one of my higher functioning kiddos used to demonstrate when he
would say “You already asked me that”. :-)
Older/ higher
functioning kiddos can require a bit of a different teaching approach in an ABA
session, and may become bored if traditional DTT is used.
I have talked about
ABA with older kids on my blog before in a general sense, but I haven't worked with many older kiddos. My preference and most of my experience has been
in an early intervention capacity (under 5). However, there are some really
cool aspects to working with adults and older clients. I remember
the first adult I ever worked with, he would stand in his front yard every
Tuesday (I saw him on Tuesdays) and wait to see my car turn down his street. As
soon as he saw my car, he would begin to smile and vigorously wave. That was a
really new experience for me, to have a client be that excited for me to
arrive! He was a sweetheart, and I learned a lot from working with him.
When working with
an older client, or a client who is higher functioning, instead of DTT a more
naturalistic methodology is typically used. This can include the use of task
analyses, intrinsic reinforcement, written schedules, community based
instruction, and functional living skills, aka daily living skills. Here is an
example of how I might structure a session with an older client:
Independent Work,
Chores, Community Instruction, Sensory Activity, Board Games,
Hygiene/Personal Care, Self-Help Skills, & Homework
I might start the
session by creating the schedule of what we will do that day. Particularly for older clients, I let them give a lot of input on what we will do.
There are certain things we must do (the programs), things the parents want
done, and then client choice. If the client can read, we can write out the
schedule together. If not, then a visual schedule is fine. Reinforcement is
embedded by alternating between preferred and non-preferred tasks, such as
completing homework before we go on a community outing.
Functional or daily
living skills, such as completing chores, bathing,
grooming, or meal preparation, are interspersed throughout each session. This
will vary from client to client depending on what is important to the family. For example, a 10 year
old who cannot independently take a shower. Or a 22 year old who cannot
independently answer the phone and take a message. Programs can be written for
those skills and they can be taught using a combination of ABA strategies, such
as chaining and visual modeling.
With older clients,
I am more of a facilitator and less of a “teacher”. I help the individual work
through their daily schedule of activities, being sure to provide the least
amount of prompting necessary. I find the biggest issue I have to tackle right
away with older clients is explaining to the family that they are prompting way too much. Independence is key. So if the client can
wash hands, but only if mom or dad keep the soap locked up (because the client
uses way too much), then I will quickly select using 1 pump of soap as a goal. True
independence can’t be obtained if the individual needs someone else present to
get the soap for them.
A community outing
with an older client would gradually increase in complexity and difficulty, from being
able to be appropriate in a store, to placing preferred items in the cart, to
placing both preferred and non- preferred items in the cart, to participating in
checkout, until we can enter a store and I can silently follow behind my client
as they independently shop and checkout. Again, independence is key.
That means I am not holding my clients hand, they carry their own money, and
they create and carry their own grocery list.
A better way to explain a big
difference when using naturalistic teaching, is that the client is more in
control of the session. I don’t walk into the grocery store and say “Go
here….do this……put that in the cart, etc”. I let the client determine the
store, what we will buy, etc., and I am there as a facilitator to make sure
they have the supports they need. Those supports may include visuals,
prompting, timers, modeling, transition cues, etc.
Here is another
look at a sample session breakdown, with a bit more detail:
Homework
Completion: Must complete 3 problems independently before using a “help card”
Independent Work:
Task Completion program
Sensory Activity:
Play Wii baseball game together
Chores: Laundry,
Pick out clothes to wear next day, Ironing
Community
Instruction: Create grocery list, count out money needed, go to store
Sensory Activity:
Painting to music, Yoga stretches, 15 minute walk around neighborhood
Social Interaction:
Play Apples to Apples board game, Play Uno
Hygiene/Personal
Care: Shower, Shave face, Cut/trim nails
Sensory Activity:
20 minutes with Sensory Box
Self-Help Skills:
Prepare dinner using a visual recipe, Set table, Serve meal
Chore Completion: Clear
table, Wash dishes
Here are some
resources for naturalistic teaching with older or higher functioning clients:
*Related Posts: Natural Environment Teaching, Older Kids & ABA, Community Based Instruction, and Backward and Forward Chaining
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