Little Steps using The Science of ABA: November 2012

Doctor and dentist visits are never easy for a child. I remember when I was young, I used to be so petrified of going to the dentist (even though the dentist was my dad!). The smell and the look of the office made me shudder. I think the thing about doctors and dentists are that even though it's a routine yearly check up, what happens in the office is unexpected, because sometimes you do get sick unexpectedly or sometimes the dentist finds a cavity and you have to co-operate with the dentist/doctor in that situation at that very moment. A child with autism or any typical developing child may have a hard time understanding this concept of sometimes things happen unexpectedly and now we have to adjust our behavior to make this visit successful. So how do we teach our children this?

One of the first things we can do especially if a child has receptive and expressive language is reading a social story. This usually should be paired some behavioral contract or a rule. For example, "Remember when you let the dentist check your teeth nicely, we get to go get Mcdonalds after !". Remind your child throughout the dentist/doctor that he/she is earning something he/she really likes. Throughout the visit, tell your child that they are doing a really nice job and it's okay to be specific. For example: "I love how you are letting the doctor check your heartbeat" etc. In addition to this, something else you could do is to role play at home with some doctor/dentist tools to prepare your child for the visit.

If your child does not possess enough receptive or expressive language or does not understand contingencies well, you can try a procedure that is used widely in our field. It is called Shaping.

Shaping is "—Process of systematically and differentially reinforcing successive approximations to a terminal behavior". (Heward et. al, 2000) In other words, shaping is the process of breaking things down in little steps and reinforcing those little steps leading up to the end goal.

Therefor during a dentist visit and depending on the child's needs, one of the first things we teach is merely opening their mouth for 10 seconds when given the directions "say ah" or "open your mouth so I can take a look". When the child opens his/her mouth for ten seconds, reinforcement is provided. Once the child has mastered that, the next step would be to increase the time and maybe use our fingers to touch the teeth for a specified amount of time. Another thing to consider is some children cringe at the sight of gloves. Therefore, maybe starting the shaping process by introducing gloves. For example, the child sits down and the parent/teacher puts on the gloves in front of the child. Once this is mastered, then we can teach the child to open their mouth.

When conducting a shaping procedure, a task analysis is used. A task analysis is a list of behaviors that we have shape. Below is the task analysis for cooperating with the dentist. Task analysis are going to vary depending on each child. Some child may master something more quicker than the other. Also, each step in the task analysis has to be broken down further.

Walk in
Sits down
Dentist puts on gloves	This can be broken down even further. For example some children need to be taught to tolerate gloves for only couple of seconds and build up that time.
Dentist puts on dental bib	The breaking down of this skill may be required as well. For example, some children need to be taught to tolerate the bib for a couple of seconds and slowly build up to tolerating it the entire dentist visit.
Dentist turns on light
Dentist tilts head back
Dentist prompts mouth open	This may need further breaking down same as above.
Dentist uses fingers to count teeth	This may need further breaking down same as above.
Dentist uses mirror	This may need further breaking down same as above.
Dentist uses pick	This may need further breaking down same as above.
Dentist uses tool to polish	This may need further breaking down same as above. Since we at home do not have the polishing tool, we can use an electric toothbrush to simulate dentist tool.
Dentist provides water to spit
Dentist turns off light
Dentist takes off bib
Dentist gives instruction to leave

The above is just an example of what a task analysis should look like for a child visiting a dentist. Remember, when the dentist visit is successfully shaped at home, it does not mean your child will be successful at the dentist. Further programming for generalization maybe required. For example bringing your child to the dentist just to sit and wait in the office, then bringing your child to the dentist again and practicing laying on the dentist chair. For these purposes, it might be helpful to find dentists that are willing to cooperate with you and allow for training to occur at their office. Choosing a practice with several dentist will also help programming for generalization.

Last but not least, before beginning any shaping procedure an important aspect to think about is the motivational system. What motivates your child? Does your child use a token board, if so he/she would have a visual when reinforcement is available. Choose a reinforcer that is portable and immediate so when your child is appropriate, reinforcement is available immediately. Some parents and teachers have used non-contingent reinforcement. This means that if your child likes a movie, the movie is played the entire time your child is at the dentist. Depending on your child, this can be faded out as your child becomes more successful.

Below are some simple guidelines for shaping :

Pryor's Ten Laws for Shaping

Raise criteria in increments small enough so that the subject always has a realistic chance of reinforcement.
Train one aspect of any particular behavior at a time. Don’t try to shape for two criteria simultaneously.
During shaping, put the current level of responses on a variable ratio schedule of reinforcement before adding or raising the criteria.

When introducing a new criterion, or aspect of the behavioral skill, temporarily relax the old ones.

Stay ahead of your learner: plan your shaping program completely so that if the learner makes progress, you are aware of what to reinforce next

Don’t switch teachers midstream. You can have several teachers per student, but stick to one shaper per behavior.
If one shaping procedure is not eliciting progress, find another.
Don’t interrupt a training session.

If behavior deteriorates, “go back to to kindergarten.” Quickly review the whole shaping process with a series of easily earned reinforces.
End each session on a positive note

More guidelines for Shaping

— Select the terminal behavior
Determine the criterion for success
— Analyze the response class
— Identify the first behavior to reinforce
Eliminate interfering or extraneous stimuli
Proceed in gradual stages
Limit the number of approximations at each level
Continue to reinforce when the terminal behavior is achieved

Shaping is a procedure that takes careful planning and consistency. If not thought out or planned thoroughly one might be shaping an undesirable behavior. Therefore, take the extra time to plan out what exactly you want to shape and how you are going to shape it. Any behavior that is observable or measurable can be shaped. Any behavior can be shaped, as long as it is done systematically using little steps at a time.

Here is an excellent video of a shaping procedure:

http://www.youtube.com/watch?v=cZORgZh4qK8

As usual, please email me with any questions.

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Monday 26 November 2012

Shaping workshop in December in full gear !

Shaping Workshop

Tuesday 20 November 2012

Teaching your child how to co-operate during dentist and doctor visits