Intensive ABA Services
Alex's mom had only one good picture of her son from his third birthday. Looking at it she painfully remembered how he had shied away from his guests and isolated himself in his bedroom, refusing to come out and join the party.
Shortly after his birthday Alex started behavioral treatment and had learned a number of new skills over the past year. At school he had learned to tolerate the closeness of other children, and was learning interactive play skills with his peers.
Now that his fourth birthday was approaching Alex's mom and dad were hopeful that Alex would enjoy his party this year. Starting about a month before his birthday, Alex's therapy team and his parents planned some typical birthday behaviors and activities which they practiced with Alex.
Here are the birthday activities Alex learned:
Instructors gift wrapped a box and taught Alex to open it. First Alex was given the box without wrapping paper and ribbon and learned to remove the lid. Inside the box he found either a favorite toy that was used exclusively for teaching this task, or something eatable that he favored. The reward varied from box to box in order to avoid satiation over time and was always accompanied with encouraging praise. Once Alex could remove the lid by himself, the box was wrapped loosely with tissue paper held together with a ribbon. Alex learned to cut and remove the ribbon and was rewarded for this. Once Alex could cut the ribbon, remove the tissue paper and remove the lid to find his gift (reward), real wrapping paper and tape was introduced. It did not take Alex many days to open his gifts without help.
Over the next days Alex learned to say "Thank you!" upon receiving the gift-wrapped box. Initially the instructors prompted (helped) for example, by saying: "Say – Thank you!" while extending the gift but not letting go of it until Alex had uttered "Thank you." His reward varied such that some times he would open the box and find favorite things inside, and other times he would exchange the box with the reward extended by the instructor and some times there would be encouraging praise only. Gradually the instructors withdrew their help to "Thank........", then to "Th........" and finally to an expectant look only. Eventually extending the box was sufficient for Alex to say "Thank you," as he accepted it. At the party, Alex's mom would stay close to Alex ready to help him remember in case he should forget what to say.
Alex's parents chose two party games that Alex practiced before the party. The games were short and simple and without complicated rules. The first game "Pin the Tail on the Donkey" was changed to "Pin the Wheel on Thomas" since Alex was very interested in Thomas trains and train wheels. A big picture of Thomas was glued on to a large piece of cardboard and a strip of Velcro (the hook side) attached where the wheels belonged. Pictures of wheels were glued to cardboard and cut out then provided with bush-side pieces of Velcro on the back.
Alex is afraid of the dark and does not like to be blindfolded so parents and team decided that he should not practice this part of the game. Many four-year old kids are scared of the dark and would have nothing but sympathy with Alex.
During practice Alex lined up to take turns with two of his instructors. Alex's mom blindfolded the instructors and helped guide the participants toward the Thomas train. (In his regular program Alex had learned to wait and to take turns, two important programs that were unspoken prerequisite skills for entering preschool). As Alex practiced the game, he was rewarded for attaching wheels to the right spot on Thomas that is, he got to play with a new Thomas train that was put away afterwards and used exclusively for practicing "Pin a wheel on Thomas"
The second game was a slightly modified version of "Musical chairs" with chairs enough for everyone who participated. The trick was to be the first one to sit down. Alex loves music and two of his favorite songs were chosen for the game. During practice Skittles and encouragement were used to praise Alex for sitting down every time the music stopped. Skittle is easy to hand out and therefore a perfect reward in a situation with so much motion.
"Musical chairs" was practiced when Alex's mom and his older sibling were present. The practice started with four chairs back to back on the floor and with Alex and one other person marching around them to the music. The other person followed right behind Alex and physically helped him to sit down when the music stopped. Gradually, as Alex understood what to do, the help was faded and a couple of additional chairs added. During practice, as Alex learned to sit down without help when the music stopped, Skittles was given less frequently and reduced from one every time Alex sat down, to one every other time he sat down and finally to 4-5 Skittles once the game was over. At the party all the children would get a handful of Skittles when the game was over.
When the following activities were practiced, party hats and a play-dough birthday cake with 4 candles were displayed on the counter, while Alex's mom, an instructor and Alex were seated at the table. The instructor had a bag with balloons in his lap, rewards for Alex who loved to see balloons whiz away. The instructor said, "Let's play birthday party!" followed by the instructor and Alex's mom saying in unison, "Happy birthday, Alex!" Alex's mom continued: "Go get the hats, Alex!" Alex needed help fetching the stack of hats the first time but as soon as he got his reward which was a balloon sent whizzing out over the table, Alex was eager to fetch them. Alex's mom put a hat on everyone's head and Alex was rewarded for keeping it on with another balloon whizzing through the room and loud encouragement. The amount of time Alex was required to keep his hat on was incrementally extended and accomplished by waiting a few seconds before the instructor let the balloon go. After a while, Alex kept his hat on while the instructor blew up the balloon, waited and then sent it off, a total of about one minute after which Alex took his hat off. About one minute with the hat on would be good for now.
Then Alex's mom said, "Time for cake!" went to the counter and brought back the "cake" which she placed on the table. She lit the candles and they sang the Happy Birthday song. Alex was helped by his mom who told him, "You have to wait, Alex" when he became antsy during the singing, and Alex waited. Finally his mom gave the signal he had been waiting for, "Alex, blow out the candles!" and Alex blew.
Do you have other ideas of skills to incorporate during birthdays? Share them with us here
The names of all children in this newsletter have been changed in respect for family confidentiality.
Thanks to all of those who have written to us in the past few months. This newsletter has been a constant balancing act. On one hand, we want to provide a newsletter that's accessible enough to those with only a little understanding of behavioral treatment. On the other hand, we want the information to be clinically and professionally rigorous.
Wake Up! Fall asleep and snore loudly on the child's lap. Then wake up suddenly for the school bell — "ding ding ding!"
Keep My Arms Down! Put one of your arms out and when the child pushes it down, make a cranking sound, and raise the opposite one up. When the child tries to hold both down, raise a foot.
Because of Bronwyn's participation in behavioral treatment, her family has found many milestones to celebrate. Her mother states, "Of course the amount of talking she is doing is one milestone we've celebrated. We hang on every word she says."