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What are positive reinforcement ideas to use with children with autism?

Tara Warwick, MS, OTR/L

September 2, 2014

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Question

What are positive reinforcement ideas to use with children with autism?

Answer

Initially you want to give the positive reinforcement to them immediately after they do the expected behavior.  Every time they do it in the beginning, you want to give them the positive reinforcement.  Gradually you will increase the time.  If I am working on a child, identifying their body parts, for example, and every time I say “Touch your nose,” and they touch their nose, I am going to give them a reinforcer.  Gradually then, after they are more comfortable with that skill, I am going to spread that out more to where they are not getting it every time they do something.  It is also like toilet training.  Initially I am going to start by giving them their positive reinforcement every time they do whatever it is you are expecting, for example, every time they walk into the bathroom.  For whatever level they are at with toilet training, I am going to give them their positive reinforcement.  After a certain period of time when they are more comfortable with that, I am going to make it more intermittent to where they will only get it every once in a while.  Be specific with the behavior you are reinforcing.  “I like the way you are sitting in a chair,” as you are giving them their tangible reinforcement.  You are being specific on what they are doing in order to get their reinforcement.

One tip is called the 50% rule for time between reinforcers, because many people will say, “How long should I go before I give them their reinforcer?”  Think about how much time there is in between a behavior.  When you take an 18-month-old that you are trying to teach how to sit in a chair, they might sit in a chair for 10 seconds.  I want to divide that time in half.  I know about every 10 seconds they get up and wander around.  So every 5 seconds, I have to give them a reinforcer.  For one of our little girls, she really liked this ball toy.  She was in her chair for 10 seconds and then she was up wandering around.  I knew every 5 seconds I had to give her a ball.  This increased the duration that she was in her chair.  I really like this 50% rule.  It makes it clearer to me on when and how often I need to give reinforcers.

Also make sure you have a variety of reinforcers.   If you only have one thing that the child likes, you could be in trouble someday, especially for children with autism.  They can wake up one day and not want anything to do that and then you are stuck.  The more reinforcers you have, the better.  If they only like the iPad, think of other things that we could use as reinforcers to vary them.  Limit access to reinforcers at other times of the day.  We have to work with parents a lot on this one, because the iPad can be so easy.  We have to tell parents if we are going to use this as a reinforcer during therapy or during school, we need to try limiting how much they are getting it at home.  If they get the iPad at home all the time, why would they want to do use it when they are at school or when therapy is taking place. 

It is better to reinforce in smaller quantities or lengths, than it is to get a big chunk at the end of the day.  I had a school the other day that said if a child was good all day, he got 30 minutes of computer at the end of the day.   I said, “I don’t think I can be good all day.  So let’s make this a little bit more achievable for this child.”  If 30 minutes is what you are okay with him being on the computer, every hour let him work for 5 minutes on the computer.  I would rather see him get 5 minutes of computer every hour for 6 hours than 30 minutes at the end of the day.  It is going to be more effective for him and you are going to see less challenging behaviors.  The other thing it does is it gives you a lot of time to practice transitioning away from the computer.  Often the reason children have trouble transitioning away from these big items, like the computer or the iPad, is that they think they are never going to get it again.  If I only got to be on my phone one time a day for 10 minutes, then when I had to give that up, I would be really anxious about that.  However if I knew I get it throughout the day in smaller chunks of time, I would be less anxious and I would be able to give it up a lot easier. 

One of the common pitfalls I see with reinforcement is that the reinforcer loses its power.  People will say reinforcement does not work.  Yes it does.  It is how we are doing it that is not working.  Reinforcement works.  Reinforcement is the way the world goes round.  If it is not working, it might be that this particular reinforcer that you are using is just not powerful anymore.  Maybe we need to look at something different, or like I said earlier, limiting access for that child with the reinforcement at different times during the day.  Maybe we do not give the child the reinforcer frequently enough.  Maybe it is a situation where we are expecting them to go too long without the reinforcer.  We may need to give it more often or maybe we are expecting too much from the child.  

Someone could tell me they would give me $1 million if I could dunk the basketball.   I would love $1 million dollars, but it is not physically possible for me to dunk the ball.  I will never get that.  It is not that I do not want $1 million and it is not that I will not try, but I am 5 feet 2 inches.  That expectation is even too high for me.  Think about this in your children with autism.  Are we setting this expectation really too high for them?  Do we need to start at a level where they are successful and gradually add to that for them to get their reinforcement, instead of saying the only time you are going to get this M&M is when you urinate on the toilet?   Maybe you should start with giving them an M&M if they touch the bathroom wall.  Then you get it by tapping on the wall and sitting on the toilet for 2 seconds.  How can we gradually make this happen?  Simplify it and then make it harder as we go on. 

Editor’s note: This Ask the Expert was adapted from the article "Effective Strategies for Decreasing Challenging Behavior in Individuals with Autism Spectrum Disorders".  The complete article can be accessed here.


tara warwick

Tara Warwick, MS, OTR/L

Tara Warwick is an occupational therapist who graduated from the University of Oklahoma Health Sciences Center in 2006 with her Master of Science in Rehab Sciences. She received a Bachelor of Science in Occupational Therapy in 2000 also from the University of Oklahoma Health Sciences Center. She has spent her entire career focusing on improving the quality of services for children, primarily targeting children with autism. She currently owns an Oklahoma pediatric therapy practice called Today’s Therapy Solutions and is a consultant for Project PEAK through the University of Oklahoma Health Sciences Center – Child Study Center. She practices as an occupational therapist in home settings, clinic settings, and school settings. Her specialty includes working with children with autism and challenging behavior.


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