Friday, February 15. 2008

Building Relationships During Bedtime Generalization

Posted under: Family

By Vince LaMarca, M.A., BCBA, Editor
Lovaas Institute - Indianapolis

Part of the family's role in behavioral treatment is to help a child apply skills he has learned in therapy to everyday life. Some parents question whether they can do this when the day is already so hectic. However, many parents are pleasantly surprised at the benefits of consistently focusing on generalization.

Dorothy, the mother of a four-year-old son with autism put it this way, "Generalization gives me a chance to connect with my child in really positive ways. Bedtime used to just be a routine, but when we started gradually moving things from therapy, it became more of an interaction. My son's so familiar with the games we play at bedtime and he's always been so successful with them that now it's become a time of the day we both really look forward to."

Below is a list of skills that were initially taught in therapy and then generalized to bedtime routines. The generalization ideas were developed by parents, like Dorothy, and consultants from the Lovaas Institute.

Matching:

Our son learned to match identical objects and then non-identical objects (for example, he would put different cars together, different apples together, etc.). At bedtime, we put 5 different pajama bottoms around the room. Then, we hand him a pajama shirt and say, "Find your pants!" He really gets into looking around the room to find the matching pajama bottoms.

Asking Where:

As our son progressed in therapy and started asking "Where...?", we added a slight variation to our game of finding the pajama bottoms. Sometimes, we wouldn't put out the matching pair of pants. After our son looked around the room for a little bit, he would ask, "Where's the pants?" We'd go over to where we had hidden them and pull them out and say, "Surprise!" What we hadn't expected is that he loves the game so much that he always turns and looks at us when asking the question. We're planning on increasing his language soon by having him call the pajamas by name or color ("Where's the blue pants?"). I think this kind of routine could even work well with a nonverbal child who uses an augmentative communication device.

Labeling Objects/Making Choices/Requesting:

We spent a lot of time looking for ways to get Kevin to request more frequently. We remembered seeing lots of toothbrushes with characters in the grocery store. In therapy, we taught him to identify the different characters on the toothbrushes (e.g., "Touch Thomas (the tank engine)/ Elmo/etc."). We also worked on making choices ("Do you want Thomas or Elmo?"). At night, we would hold up two toothbrushes and ask which one he wanted to use (e.g., "Thomas" or "Blues Clues"). Now we just ask him, "Which toothbrush do you want to use?" and he looks in the toothbrush holder and names the one he wants.

Labeling Pictures:

I find that a lot of families read a story to their son or daughter at night. This has always been one of the easiest places to generalize labeling pictures. I remind parents that story time should remain a quiet, calm, and fun activity. You don't want to ask a child to label so many pictures that it's just more work time. But when only a few questions are interspersed in the story, and parents stick to the easier pictures to identify, it can help a child to be more involved in story time. Some parents find taking turns labeling pictures is another way to make story time more interactive.

Listening to Stories:

I also find that many families who do not have a story time would like to have one, but their son or daughter will not sit still. There are a couple of different areas we can work on in therapy to help a child with story time: finding what types of books a child gravitates toward, learning to identify pictures in books, and increasing the length of time a child will remain while looking through a book. When parents generalize these skills to bedtime, I always explain that it's important to go slowly. They may just start with flipping through a couple pages while their son or daughter lies in bed. Then, they may make one or two comments about each picture. For some children, using the right books (ones the child finds interesting) and gradually increasing the length of the story time has helped. For others, including a preferred activity after the book (for example, always getting to turn off the light once the book is closed) has made story time possible.

Self-Help:

Our son likes to put things in piles, but doesn't like to clean up. In therapy, we've been working on putting toys away, but he still takes a long time to do it. The best success we've had is at night. After he puts on his pajamas, I hand him his clothes and say, "Put these in the laundry." He always hurries to the basket and throws them in...probably because the clothes in the basket look like a great big pile!

Sequencing:

It's easy to teach a variety of three-part sequences quickly in therapy using pictures. For example, in response to "How do you get ready for bed?", a child will say, "First I brush my teeth, then I wash my face, then I put on my pajamas." But it's when parents use these routines in everyday life that interesting things can happen. For example, I had a family who would ask their daughter "How do you get ready for bed?" at bedtime. Initially, they prompted her to stop after the first part of the answer and then complete that part of the routine (e.g., "First I brush my teeth" – she does it, "then I wash my face" – she does it, "then I put on my pajamas" – she does it). Once she learned to do that, they started prompting "then..." after the answers she had learned or in between them, and they started getting some interesting, novel responses. Sentences weren't always grammatically correct, but she would mention things like drying with a towel, drinking water, and a kiss from mommy.

Receptive People:

My son is nonverbal and sometimes it takes a lot of creativity to figure out a way to do the things we take for granted with our other children. Prayer time at night is something I had always wanted my son to be more a part of. When he finished learning the names of familiar people in therapy, we decided to try and generalize the skill during prayers. We created a small board with wallet-sized pictures of family members, teachers, and instructors at the bottom. After the other children say who they want to pray for, I choose two people to pray for and my son moves their pictures to the top of the board when I say the person's name. There are three spaces remaining, and my son gets to choose which pictures to put in those spaces. I say their names as he puts them up with the pictures I choose. Not only does the activity give us a chance to practice people's names, but both my children and I always wonder which pictures my son will choose to put at the top of the board for the day.

Do you have an interesting story about your child?

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