Intensive ABA Services News and advice on Autism treatments - The Lovaas Institute

Meeting Point: Latest From Lovaas

Fall 2009

Meeting Point: Latest From Lovaas

Q & A: Tying Shoes

With Contributions from: Luis Cruz, Sarah Greenstein, Amanda Huish, Mary Kutch, Vincent LaMarca, Kali Thomas, and Linda Wright.

A hallmark of applied behavior analysis programs is the ability to conduct a task analysis, breaking down complex skills into a set of simpler behaviors. Emphasis is first placed on teaching these simpler behaviors. Teaching includes a variety of prompts to keep a child successful. Then, by gradually combining the simpler behaviors together, a child learns the complex skill. Below is an example of the way in which task analysis and prompting strategies can play a role in teaching children to tie shoes. The initial question and responses to the question come from an email discussion group hosted by the Lovaas Institute. The discussion group was created to keep the Lovaas Institute's behavior consultants throughout the nation in contact with each other as well as gain insight from other behavior analysts throughout the world.

Initial Question

I was wondering if anyone had any suggestions on how to teach a non-verbal child how to tie his shoes. My seven-year-old client is able to perform basic fine motor tasks (e.g., stringing beads, opening bottle caps, picking up objects with tweezers, etc.). Currently, we're practicing tying shoes using full hand over hand prompts for the entire sequence, and observing whether he picks up on the nuances of performing the actions on his own. We thought about breaking it down into steps, but everyone in his team, including his parents, seems to have a slightly different way of tying shoes. We wouldn't be opposed to teaching it in steps, but I'm interested if others have found what they consider the most effective way to do this. Does anyone have any suggestions?

Response One

I have had success teaching this skill using forward chaining, and it has been effective with children with varying levels of receptive language comprehension. I have found that it is important that the team and parents agree upon the steps in the chain, so that there is a consistent prompting strategy and response criteria. On my teams, everyone had a different way of tying shoes, but we decided to pick one way to ensure consistency (we did not use the "bunny ears" method). Once we had done the task analysis, we presented the instruction "Tie your shoes" (this instruction could be modified to be non-verbal or written) and then we prompted the first step in the chain. We did not require the child to finish the rest of the chain and worked on fading our prompts. We also decided not to have the child learn this skill while the shoe was on his feet initially, but rather placed one shoe on the table so that it was easier to manipulate.

Once the first step was completed independently we added on the second part and worked towards independence. We followed this procedure, adding on one step at a time until the child was able to complete the entire chain independently. Once the entire sequence was independent, we then generalized to having the child wearing the shoe as he tied it and then required the child to tie both shoes on his feet. Hope this helps.

Response Two

I agree with the suggestions for forward chaining this skill. I've also received good suggestions from some OT's over the years, so you may want to consult with your client's OT if he has one. There are a variety of prompts that can be used, such as coloring one half of the lace a different color (to distinguish left from right), and providing verbal cues (which can be simplified if needed). You can also maximize motivation by practicing this by the front/back door and reinforcing his responses by letting him go outside to play upon completing the task. I agree that it is very important that everyone uses the exact same sequence, down to every detail (which side to loop first, what direction to move the laces, where to hold the laces, etc.). This is a hard enough skill to learn, so you don't want to make it harder by prompting different variations of shoe tying. It's a motor sequence, so the more opportunities he has to experience the same sequence, the more quickly he's likely to learn it.

Response Three

I have had success teaching this skill to several children by teaching it as a picture sequence first. I have had the client learn to receptively put the pictures in order, then expressively state the "label" we came up with for the pictures so it becomes kind of like a rehearsal strategy (I realize this will not pertain to your client). The pictures just may help him cue in to the nuances that are hard to see with hand-over-hand prompting. These were the labels we used:

  1. stand tall
  2. make an X
  3. push lace under
  4. pull tight
  5. make a loop
  6. wrap it around
  7. peek and push through

Response Four

I have broken the sequence down even further and taught the knot alone in steps. This may make the next steps easier because, whether you use one loop or two, the final step is another knot.

Response Five

Here are some techniques that I used to teach a nonverbal child to tie her shoes:

  • Teach with the shoe placed on the table (heel to the child) with instructor and child positioned next to each other.
  • Make each side of the lace a different color (either color it with marker or buy two sets of shoe laces and tie them together and then lace the shoe).
  • Provide VERY clear, incremental instructions and a task analysis (find out from the parents what method they use when tying shoes as they will be the ones to help maintain and generalize the skill). For example:
    • Step 1: lift yellow lace (left lace) with left hand and red lace (right lace) with right hand
    • Step 2: bring red lace across shoe and drop
    • Step 3: bring yellow lace across shoe and let go
    • Step 4: place end of yellow lace under red lace to cross
    • Step 6: pull laces tight . . . (it helps to have a shoe as you write out the sequence)
  • Forward-chain the skill, not requiring she complete the entire sequence.
  • Develop a prompting hierarchy: verbal, point/gesture, model, physical assistance, hand-over-hand (for my client we paired it initially with the "Do this" instruction).

Response Six

Here are a few insights I've learned over the years when teaching children to tie shoes. First, while forward chaining has worked well for some children, some parts of tying shoes are easier or harder for different kids. Therefore, I've gone to fading prompts in the order of easiest to hardest finger manipulations for each child. For example, some kids have a lot of difficulty with holding the loop in place while circling the other lace around. In these cases, I've had the instructors help the child hold the loop (or even initially had the instructors alone hold the loop) while the child focuses on the easier task of circling the other lace around. Second, the "bunny ear" method may seem intellectually easier to learn (because you make the first knot, make two loops and then make the first knot again with those two loops), but the fine motor skills needed to hold both loops and make a second knot are much more difficult to prompt and fade than the fine motor skills needed to hold one loop while circling the other lace around. Third, some ingenious prompts that teams have thought up to help with particular parts of tying shoes include:

a) using a pencil or pen at the end of shoe tying to help pull through the second lace/create the second loop; the child was more attentive to grabbing where the pencil was located (rather than where the instructor pointed) since the instructor's hands were already so involved in helping the child,

b) placing a safety pin in the location of where the second lace had to be pulled through to make a second loop; the child grabbed on to that part of the lace, and

c) instructors tied the initial knot and used tape to hold the loop up on a practice shoe; the child then could practice on the table just holding the tape/loop while circling the other lace around and then pulling it through to complete tying the shoe; once the child was successful, instructors faded the tape on the loop.

Finally, this program and any strategies used need to be practiced in front of everyone. They are very difficult to explain in notes, as this post shows!

Would you like more information on applied behavior analysis? Let us know here

The names of all children in this newsletter have been changed in respect for family confidentiality.

Motor Cycle Racer! Put the child on your lap, facing away from you, for a motorcycle ride. Use your fists as handlebars and rev up. Go around curves by leaning the child left or right with all important motorcycle sounds. Then crash!

Media Player! Work with the computer on, and Microsoft Media Player turned on. Set it to a song or punch line that the child likes to hear, and click start to play it while the child watches the light show.

Happy New Year! Blow and shake New Years Eve noise makers.

Tower Disaster! Set up a tower ten feet away and let the child run at it.

I've Got a Secret! Tell the child, "I have a secret," and when they listen up close, blow quiet raspberries to the ear.

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