Establishing Cooperation and Tantrum Reduction

A considerable amount of background material is covered in the preceding chapters. It may be helpful to start the first hours of treatment at this time to gain some practical experience, which will help make the abstract concepts presented earlier more understandable.

The concepts presented in this chapter (instructions, responses, response prompting, and reinforcement) are discussed more extensively in subsequent chapters. This chapter uses these concepts to help the teacher establish cooperation and reduce tantrums in the teaching situation. These initial steps are crucial to teaching the skills presented in the following chapters. Some members of the student's team should become familiar with the material presented later in this manual to be able to give constructive feedback during the first hours of treatment. Regardless, we advise all team members to read this entire chapter before beginning to teach.

The first hours are perhaps the most important hours and the most stressful hours in the student's treatment. These first hours are important because the student's success gives you the encouragement to continue teaching and gives the student confidence, trust in you, and a willingness to cooperate, all of which are critical to future educational efforts. These first hours are stressful in that most students tantrum and resist the situation, and you will most likely be scared for yourself and the student. Even 3- or 4-year-old children can be quite tantrumous and cause a large amount of fright in the adults who try to teach them.

Keep in mind two important observations we made earlier in this manual: First, the student's tantrum is a response to frustration over not understanding what you want to teach her. Second, through her tantrums, the student succeeds in resisting demands she does not understand. Her tantrums make you anxious and perhaps cause you to back down, removing your demands. You and the student have adapted to a very difficult situation: The student is reinforced for tantruming by the removal of your demands, and you are reinforced for withdrawing your demands because doing so leads to a reduction in your anxiety over the student's tantrums. After a year or more of such daily occurrences, there is reason to believe that this interaction becomes well established and difficult to change.

Remember, you can love the student and still place demands on her. Perhaps the love an adult gives to a student should be defined in terms of its effects on the student. If what you do helps the student live a fuller and more meaningful life, then that is love. Providing attention and love contingent on maladaptive behaviours worsens those behaviours. Such interventions should not be labelled love.

Because proper completion of the first hours of treatment is critical to getting off to a good start, it is important to plan them carefully. One piece of advice seems particularly important: View the student's displays of frustration as healthful. The student's past failures bother her, and you can use that motivation to help her succeed. You can say to yourself, 'Look at all the energy she has that I can help her use for constructive purposes.'

Organizing the Teaching Environment

In Chapter 4, guidance was given for locating persons who can help you provide the student with a large number of one-on-one teaching hours, managing a treatment team, and realizing the importance of a team in helping to solve teaching problems. In Chapter 36, Ronald Huff provides advice on how to organize a parent group so as to obtain emotional support and technical information for the efforts that lie ahead. Many of the parents and teachers in such a group may have already experienced the stress and success of the first hours; their advice to your team may be significant and should be sought.

Before beginning the first hours of treatment, arrange for a teaching room in your house. This could be any room that has a holding capacity of five to eight persons and contains a small table and two chairs (child sized, if appropriate). At weekly meetings, teachers should sit in a circle around the table so that each has a clear view of the student.

In the beginning of treatment, you do not need many materials; some wooden building blocks, a plastic bucket, and reinforcing items such as favourite toys and snacks should suffice. As the student progresses, the teaching materials become extensive, necessitating a large container full of stimulus cards and objects. There should be a log book in which to write down the programs that have been introduced and the extent to which items within the programs have been mastered (see Chapter 33). The log book will eventually contain hundreds of pages, becoming the student's record of progress through treatment.

If a behavioural consultant is hired to conduct a workshop, set aside 3 days for that consultation (see Chapter 34). It is important that you and all of your team members are present for the training. If you have to start the treatment without a consultant, it may be helpful to role-play the first hours before the student becomes involved. Choose one person from the team to play the student. This person should know the student well and have some familiarity with how the student is likely to behave when asked to comply.

Remember to give praise and reassurance to the team members who are being trained and let them express their apprehensions. Facing a common difficulty builds cohesiveness. Remember, each member should take turns practicing treatment and receive feedback on his or her performance. If you have hired a consultant, ask that person to begin the one-on-one treatment and demonstrate to you the actual and concrete steps involved. This will give you some impression of that person's competence (it is easy to talk and role-play, but it is much more difficult to actually treat the student). Such a demonstration is typically more productive and efficient than role playing.

Reinforcers

Chapter 7 provides detailed descriptions of the many reinforcers that can be used during treatment; thus, only a short recap of reinforcers is provided in this chapter. Of all the aspects involved in behavioural teaching, the types of reinforcers and use of reinforcers are the most important. Identify as many reinforcers as you can prior to beginning treatment. Have them readily available and within your reach, but not within the student's reach.

To help prevent satiation, make sure that all food reinforcement is given in small quantities. For example, reinforce by using pieces of toast the size of sugar cubes or one piece of cereal, such as Frosted Flakes, at a time. Although food is often a powerful reinforcer, some students may be too upset to take solid food during the first hours of treatment. However, the same students may accept sips of a favourite beverage. As with food, only small quantities of drink should be provided to the student. You may want to have beverages prepared into small cups. Later, when you are more confident, you can provide sips from a full glass.

Do not feed the student a large breakfast or lunch prior to the teaching session. A person who is satiated by food will not find food to be reinforcing. Whenever possible, use healthful foods and stay away from candy and other sweets except as special treats. Choose food reinforcers that can be consumed quickly; avoid chewy snacks, which delay the interval between trials. Most reinforcer consumption should not last longer than 10 seconds; for the most part, 3 to 5 seconds make an ideal time limit. The more reinforced trials given, the more learning opportunities there are available to the student.

Some students may be rewarded by holding their favourite object for 5 seconds or placing a puzzle piece into a puzzle. Most students are rewarded by being allowed to leave the teaching situation and run over to their parents for comfort. Later, the student may also accept comfort from other adults. Additional reinforcers described in Chapter 7 include loud praise ('What a great kid!') and ample clapping by all adults present. Clapping is often a powerful reinforcer for students. Some reinforcers, such as playful jostling, can be used only after the student has settled down a few hours into treatment. Some students love to be tossed in the air; others thrive on having their feet rubbed. Some love to be mildly scared and surprised. Remember that the student must become comfortable with you to accept such play, and there are large individual differences in what each particular student finds rewarding. It is the discovery of new and often idiosyncratic reinforcers that makes you a better teacher and keeps the student motivated to learn.

Some students may not accept a favourite food or object when it is used as a reward. This may happen because they are too upset or because they may sense that you want to teach them and thereby change their routines. Changing a routine is often the last thing students will let you do during the early stages of treatment. They want to be in control. There are ways around such refusals, although you may need to be inventive in discovering them. We worked with one student who was resisting all commonly used rewards until we found that he was greatly reinforced by a 5-second playing of the Disney song 'It's a Small World.' With another student, we were at a complete loss in discovering effective reinforcers until we stumbled upon pouring water from one glass to another, one of his favourite self-stimulatory rituals. As reinforcement, we placed glasses and pitchers of water on the table and allowed the student to pour the water after he had done what the teacher wanted him to do. The reinforcing effects of pouring water lasted for hundreds of trials and, once the student worked for that reinforcer, other reinforcers were readily accepted and effectively used.

If you isolate an effective reward and use it correctly, you make the first step toward teaching the student. You achieve reinforcement control over the student's behaviours, which is the most important sign that you will aid in the student's development. In everyday language, you have been able to select rewards (reinforcers) and use these rewards in such a manner as to help the student learn. Before achieving such control, you are not very effective at helping the student. Consider the gaining of reinforcement control to be a major victory, no matter how trivial the student's achievements may appear to certain casual observers.

Once effective reinforcers are identified, place the reinforcers out of the student's reach; otherwise there will be a continual struggle to keep the student from getting to them without working for them. If the student is allowed free access to reinforcers, these reinforcers are likely to lose their effectiveness in the teaching environment. If possible, hold the reinforcers in your hand so you can deliver them immediately after the student performs correctly. As the student progresses through treatment, you may be able to place the reinforcers on the student's table within arm's reach because the student will, over time, learn to bridge the delay between her response and the desired reinforcement with your verbal reinforcer. Eventually, a verbalization such as 'Good!' is likely to become a secondary, or learned, reinforcer after repeatedly being paired with a primary reinforcer such as food.

Sitting in the Chair

The main advantage of starting with an easy task such as sitting is that the student will likely be successful learning it and can thus be reinforced. Sitting in a chair is commonly taught first because sitting is a relatively simple behaviour that is easy to prompt. Sitting in a chair is also discriminable to the student (as it involves gross motor behaviours) and a clear response, making it easy for the teacher to decide whether to reinforce it. In addition, sitting is a behaviour that the student must eventually learn to do.

Most students are able to learn sitting as the first response taught. For other students, however, this task elicits so much emotional upheaval and is resisted with so much tantrumous behaviour that it interferes with reinforcement delivery. We shall address potential solutions to this problem later in this chapter, noting for now that any reinforce-able socially appropriate behaviour is adequate as a first behaviour. Examples of such behaviours also are provided later in this chapter. Given individual differences, it is best to keep three or four alternate behaviours in mind.

To teach sitting, arrange two chairs (child sized, if appropriate) such that they face each other and are 1 to 2 feet apart. The student should be placed in a standing position between your legs and facing you with her chair directly behind her so that sitting down (the correct response) is easy to perform. Place your legs behind the legs of the student's chair so the student cannot tip the chair back, get hurt, or run away. If the student is allowed to run away, she will have to be chased, which is likely to be a reinforcing event. If such a chase occurs, the behaviour of running away may be reinforced and strengthened.

Instructions, Prompts, and Reinforcers for Teaching Sitting

It is important to practice the following steps with another adult playing the role of the student before you begin the actual treatment. After seating yourself and placing the student in front of her chair facing you, say, 'Sit,' in a clear and loud voice. It is important to present instructions in a succinct, definite, and audible manner. Do not show hesitation and do not use elaborate speech; the word 'Sit' will suffice. Ideally, the student will sit and you can reinforce her for sitting. Most likely, however, the student will not sit when asked to do so and you will have to prompt her.

Prompt sitting by placing your hands on the student's shoulders and moving her backward into a sitting position onto the chair. Remember to place your legs behind the legs of the student's chair so that the chair does not move backward. Ideally, prompting should occur concurrently with the instruction. Different degrees in intensity of the prompt will be necessary depending on the student. Some students sit down just by being tapped on the shoulders, whereas others need to be more firmly placed in the chair.

As soon as the student is seated (and before the student gets up), she should be provided with all the reinforcement you can give her. When you reinforce the student, act as if she accomplished a most difficult task. What you want to do is build the student's trust and confidence in you as well as in her. This may be done by providing the student with a rich schedule of reinforcement and a favourite drink, food, object to hold, or anything the student will accept and be comforted by at that time. In addition, everyone present should clap, smile, and provide a large amount of verbal praise.

As further reinforcement, the teacher should let the student go to her mother or father for comfort after she sits correctly. You may have to prompt the student to go to her parents. This may be done by placing the student in such a fashion that she can see her mother or father who, with outstretched arms, says, 'Come here.' Gently guide the student over to a parent's lap, where she is comforted. Even if the student did not seek her parent's company before this time, she will likely do so now that she is apprehensive.

This procedure, starting with the instruction and ending with the reinforcement, is one trial. Once the student is reinforced by sitting on her parent's lap for half a minute or so, repeat the process by again placing the student near the chair and present the second trial, following the exact steps used in the first trial; that is, give the instruction ('Sit'), prompt, and reinforce as done previously.

When first teaching the student to sit upon your request, you may be able to conduct one to two trials per minute. To maximize the student's learning, however, the length of time the student spends with her parent should, over time, be shortened to 10 to 15 seconds so that the task of sitting can be more frequently reinforced and strengthened. At the same time, the length of time the student spends sitting in the chair should be gradually increased from 3 or 4 seconds to 10 seconds or more.

No student can get more love than that provided in a well-run behavioural program. Once a student catches on to the task you are trying to teach (demonstrated by less fussing, needing fewer prompts, or both), it is not surprising to see the student glance at the aides in the room, anticipating and recognizing approval. Such an occurrence provides ample evidence that you are on the right track. At such a time your own anxiety level may also reduce, leaving room for relief and happiness. When this point is reached, treatment becomes a mutually reinforcing affair.

Prompt Fading

The main advantage of prompts is that they help the student correctly perform target behaviours. If you do not prompt, the student may never respond correctly to your instructions. The main disadvantage of prompts is that the student does not perform the behaviour on her own when prompts are used; thus, she is not reinforced for responding to your request but rather for responding to the prompt. Because of this, the student may become prompt dependent. To avoid prompt dependency, you must fade the prompt. Prompt fading is accomplished by gradually using weaker and weaker prompts while keeping the instructions at full strength. To fade the prompt for the task of sitting, present the instruction ('Sit') while simultaneously lessening the physical prompt, providing just enough strength to occasion the correct response. For example, shift from fully placing the student into the chair to only placing your hands on the student's shoulders, then to touching her lightly with one finger, then to just gesturing to her with your hands while nodding your head, then to just nodding your head while looking at and pointing to the seat, and then to just looking at the seat. The instruction 'Sit' should eventually be presented without any prompt.

If the student fails to respond correctly after the prompt is reduced or removed, reinstate the least amount of prompt necessary to re-establish correct responding. Remember that the verbal instructions should be expressed at full strength while the prompt is faded. Shifting control over the response from the prompt to the verbal instruction should be considered a major achievement; it is a sign that the student is learning.

In technical terms, fading out a prompt stimulus while fading in a verbal stimulus (in this case, the instruction 'Sit') is known as a shift in stimulus control. Control over the student's behaviour is shifted from the prompt stimulus to your verbal stimulus. As your verbal instruction gains strength as a reliable predictor of reinforcement, the prompt becomes increasingly less reliable. If you are very skilful at teaching, this transition is accomplished smoothly with the student making minimal or no errors. That is, the student receives almost continuous reinforcement and is less likely to respond to the loss of a reinforcer with a tantrum. Technically this is known as errorless learning. For those of us who made many errors in our past educational history, it may seem a dream to consider a teaching situation in which one almost always succeeds (and thus rarely fails). In an ideal teaching environment, successes should outnumber failures by a ratio of 4:1 to keep the student involved and learning. For your sake and for the student's sake, be sure to start simple so both of you can learn the basic steps and be reinforced.

Occasionally you may probe for mastery of a response by suddenly removing the prompt, thus testing whether the student correctly responds to your request to sit down without further prompt fading. If the student does not, reinstate the minimal amount of prompt needed to occasion the correct response, and then fade the prompt gradually. The rate of fading must be determined on an individual basis for each student. The guiding principle is to use the least amount of prompt necessary to help the correct response occur.

Shaping

Shaping is a term used to describe reinforcing progressively closer approximations to the desired behaviour. As with all other technical terms, shaping is discussed in greater detail throughout this manual. In the first hours of teaching, this procedure may be carried out as follows: As soon as the student reliably sits when asked to do so, reinforce. Then gradually increase the amount of time the student sits from 1 or 2 seconds to 5 seconds and then to 10 to 15 seconds or more before providing reinforcement. Through this procedure, the amount of time the student sits in the chair is shaped by delivering reinforcement contingent on increasing lengths of time spent in the chair. One helpful way for you to monitor the time interval for sitting is to count silently to yourself, keeping track of the number of seconds required before delivery of reinforcement. A student who learns to sit in a chair for 15 seconds is likely to be more productive in future teaching sessions than one who learns to sit for only 2 seconds. Further increases in the length of time follow naturally as new programs are introduced.

Acquiring the Skill of Sitting

Learning to sit down as a first lesson may take anywhere from 1 to 10 hours to accomplish. There should be a gradual increase in the ease and rate with which the student sits as the session progresses. This increase in the rate of sitting achieved through reinforcement is referred to as acquitting. The concept of acquisition was first introduced in Chapter 5 on tantrumous and self-injurious behaviours. Self-injury, just like sitting in a chair, is behaviour; hence, it responds to reinforcement. Socially appropriate behaviours, such as sitting in a chair, gradually replace socially inappropriate behaviours, such as tantrums and self-injury, when appropriate behaviours are reinforced and inappropriate behaviours are not reinforced. In behavioural treatment, socially appropriate behaviours gain access to the same or similar reinforcers that tantrums and self-injury achieve, lessening the need for the student to engage in the latter. Some students sit with minimal guidance and do not demonstrate any major disruptive behaviour from the very beginning of teaching. Other students tantrum a great deal, but as long as they remain seated for the required period of time, they should be rewarded by, for example, being allowed to briefly leave the teaching situation. Our experience has been that the repeated success sitting down and being reinforced for doing so is sufficient to reduce tantrums when first learning to sit given the instruction to do so. However, if tantruming does not subside at least somewhat within the first 2 hours of teaching, then go on to the next section on teaching the student not to tantrum.

Teaching the Student Not To Tantrum

For a student who continues to tantrum while sitting, it may be helpful to select not tantruming as the second response taught. Begin by having the student sit in the chair long enough to be quiet for 1 or 2 seconds. As soon as the tantrums and screams subside, the student should be amply reinforced (e.g., by getting out of the chair, receiving a favourite snack and verbal praises, or going to a parent). Gradually increase (shape) the length of time the student is to remain quiet.

As the student tantrums, nobody should look at him. Instead, all persons present should look down at the floor while the tantrum occurs. Even a short glance from a parent or team member can serve to reinforce the student's tantrums, even if a glance has never been effective in reinforcing any other of the student's behaviours. Perhaps an anxious glance is a sign to the student that someone will compromise and let him leave the situation. To avoid such glances, it may be helpful to have the student sit with his back to his parents in the early stages, because the parents are likely to be the most important persons to the student and the ones who are most anxious and uncertain about what to do. It is perhaps also the parents, being the ones who are most vulnerable, who are the most likely to give in and attend to the student during the tantrum.

Once a student learns to sit without tantruming, alternate teachers (including the parents) are introduced. This is referred to as generalizing treatment gains. Usually the student starts tantruming again when the second teacher is introduced, testing the new teacher. Testing occurs again and again, not only when new teachers are introduced, but also when teaching is introduced in new situations, as when the teaching sessions are moved from the original teaching room to other rooms of the house or outside environments (e.g., stores, restaurants, schools). The student must learn with each new adult and in each new situation that he cannot get away with tantrums. The student's tantrums and uncooperative behaviours will decrease over time with new teachers and across new environments providing that consequences of the student's actions remain constant and interfering behaviours are not reinforced but instead are placed on extinction (i.e., the inappropriate behaviours are not provided with the reinforcement that previously maintained the behaviour).

Completing a Puzzle

Although most students learn to sit in a chair and reduce their tantrums during the first hours of treatment, some students experience this task as too upsetting or difficult. Not tantruming may also be difficult for some students to learn. Given the large individual differences among students, it is important to be flexible and change tasks if no progress is noted during the first hours (see Chapter 33, which deals with methods for recording progress).

The task of completing a puzzle can be taught on the floor or at the table. Begin by placing a puzzle with three pieces (e.g., square, circle, and triangle) on the floor or table. Remove one of the pieces (e.g., the circle). Next, bring the student over to the puzzle and hand her the circle while instructing, 'Put in.' Prompt the correct placement and reinforce the behaviour with food and praise. Note that matching the shapes, such as the circle to the circle, may constitute its own reinforcer. Repeat the trial while gradually fading the prompt. Over successive trials, gradually increase the number of pieces removed from the puzzle and given to the student from one piece to three pieces at a time. What the student learns in this situation is to complete a task when you ask her to do so. (Technically speaking, you bring her behaviour under instructional control.)

Note that even if the student cooperates and gives signs of enjoying herself during this session, it is quite likely that tantrums will occur when she returns for the second session of learning to sit in a chair. Giving up control is not easy for most persons, whether or not they are developmentally delayed. The goal, however, is to teach the student better and more efficient ways of controlling others than by throwing tantrums.

Dropping Blocks into a Bucket

Dropping blocks into a bucket has been found to be helpful in establishing cooperation during the early hours of treatment. Nonetheless, shifting to the teaching of a new response in these early stages of treatment is likely to reinstate or increase tantruming. If you ignore tantrums while continuing with the new task, however, the tantrums will most likely decrease in strength and duration with the introduction of subsequent tasks.

Before teaching the student to drop a block into a bucket, select blocks the student can hold easily in his hand. Place one block on the table within easy reach of both you and the student. Choose a large-mouthed bucket and place it close to and slightly under the table or between your legs so the student does not miss placing the block into the bucket. It also helps to use a bucket made of a material (e.g., metal or plastic) that produces to a distinct noise when the block falls into it. Similar to the tactile feedback provided by the task of sitting in the chair, the block-in-bucket task gives auditory feedback that facilitates the student's forming an association between his behaviour and the reinforcing reward.

To begin teaching this new task, instruct in a loud and clear voice, 'Drop block,' while prompting the dropping response. Prompt by taking the student's hand, placing it over the block, and helping him grasp it. Guide the student's hand to the top of the bucket and release the student's grip on the block. Once the block is dropped, provide massive reinforcement. Over the next few trials, slowly fade the prompt. Fade the prompt by gradually decreasing the physical grip of your hand, guiding the student's hand to the block for him to grip onto it by himself, then slowly fade to just tapping the student's hand, then to gesturing toward the block with your hand, and finally to just looking toward the block when you instruct, 'Drop block.' Eventually fade all prompts completely such that the verbal request to drop the block (while looking at the student and not toward the block or bucket) is sufficient for the student to succeed. If the physical act of holding the block is difficult for the student, simply prompt the student to shove a block from the table into a bucket placed partly underneath the table. Repeat the instruction while fading the prompt over subsequent trials.

Once the student drops the block into the bucket upon your unprompted request, gradually increase the difficulty of the task by requiring the student to drop more than one block in order to be reinforced. This may be done by giving the instruction 'Drop block' and withholding reinforcement contingent on the student dropping into the bucket not only one block, but two, then three, and then up to five or six blocks. The task can also be made more difficult by slowly increasing the distance between the blocks on the table and the bucket. As the number of trials conducted grows, some students spontaneously use both hands to place more blocks into the bucket and more forcefully drop the blocks into the bucket. Perhaps these students gain additional reinforcement from the noise generated from the blocks' hitting the bucket. In any case, such appropriate extra behaviours should be amply reinforced.

'Come Here'

Once the student learns any two of the skills presented previously, you may introduce the task of coming to the parent when a parent says to the student, 'Come here.' It is unlikely that the student will master this task within the first few hours of treatment given that many students tantrum so severely in these first hours that prompting 'Come here' is made difficult. In addition, out-of-the-chair behaviours, such as coming to a parent upon request, may instigate other interfering behaviours, such as running away. For most students, it may be optimal to postpone this task until 3 to 4 hours into treatment. If the 'Come here' task turns out to be too difficult for the student, go on to the Matching and Sorting Program (Chapter 12), the Nonverbal Imitation Program (Chapter 13), or both. Return to teaching the 'Come here' task after some progress is made in one or both of those programs.

To teach the 'Come here' task, one of the student's parents (or teachers) should sit in a chair or sofa 5 to 7 feet away from the student. Upon completion of a task at the table (e.g., dropping blocks into a bucket), turn the student to face the parent who, with outstretched arms, says in a loud and clear voice, 'Come here.' Prompt the student to go to the parent by having a second adult physically move the student to the parent. The behaviour of going to the parent allows the student to leave the teaching situation contingent on completing a task (e.g., sitting in the chair or dropping blocks into a bucket), thereby reinforcing and strengthening these tasks. As soon as the student reaches her parent, the student receives immediate and abundant reinforcement both by leaving an initially unpleasant teaching situation and by gaining the opportunity to be cuddled by her parent. The student may also receive reinforcement by being able to hold her favourite book or toy while sitting on her parent's lap.

Note that the instruction ('Come here') must be loud and succinct to gain the student's attention. Also note that the parent should maximize the likelihood of the student's success by facing the student and reaching for her, adding a visual prompt to the verbal instruction. The physical prompt provided by the second adult further serves to maximize the student's success. Remember that all prompts must be gradually faded over time. If prompts are faded too quickly, the student may not respond correctly because the student is not as of yet 'hearing' and understanding the parent. As prompts are faded over trials, trials involving less prompting should receive more reinforcement than trials requiring more prompting.

As the student gains familiarity with the teaching situation, the reward value of coming to the parent may decrease. Therefore, the student may choose not to come to the parent. Such behaviour is acceptable at this time. In the future and in other situations, however, the student must learn to reliably come to the parent when doing so is necessary. In addition, the student must learn to come to you upon request in the teaching situation.

The following procedure is designed to help generalize the 'Come here' instruction to other adults and other situations by teaching the student to approach the person who gives her the instruction regardless of the location of the person. Teaching the student to respond to the instruction 'Come here' in this manner is most easily accomplished with the assistance of two adults who are referred to here as Teacher 1 and Teacher 2. The two teachers alternate roles of prompting and presenting instructions.

► Step 1

Teacher 1 stands or sits behind the student with his or her hands around the student's waist. Teacher 2 stands approximately 3 feet away, facing the student. Teacher 2 should have a rein-forcer (e.g., a bite of food, a sip of juice, a favourite toy) in hand and in the student's plain view. Teacher 2 presents the instruction ('Come here') and prompts the response by stretching out his or her arms toward the student. At the same time, Teacher 1 physically prompts the student to walk to Teacher 2 by gently nudging the student forward. Teacher 2 may also prompt by showing the student the food reinforcer. Once the student reaches Teacher 2, she should be reinforced for coming over. The student should remain with Teacher 2 for approximately 5 seconds. Repeat the trial and fade the prompts over subsequent trials. Place mastery at 9 out of 10 or 19 out of 20 consecutive unprompted correct responses.

► Step 2

Reverse teaching roles: Teacher 2 turns the student to face Teacher 1, and Teacher 1 presents the instruction ('Come here') and stretches out his or her arms to prompt the student. Teacher 2 prompts the student to walk to Teacher 1 by gently nudging the student forward. Immediately reinforce the student after she meets Teacher 1. Set mastery at 9 out of 10 or 19 out of 20 unprompted correct responses.

► Step 3

Continue switching between Teachers 1 and 2, fading the prompts over trials. For example, each teacher begins hiding the food (if that was used as a prompt), stretching out his or her arms to the student for shorter time intervals, and providing less manual prompting (nudging the student forward) on each subsequent trial. With the alternation between teachers, the number of unprompted correct trials required should systematically decrease until the student is able to independently come to either teacher upon his or her first request.

► Step 4

When the student responds to the instruction ('Come here') to both teachers without prompting, increase the distance between teachers to approximately 5 feet and then gradually up to 9 or 10 feet or across the room. Reintroduce the prompt of outstretched arms each time the distance is increased and fade the prompt over subsequent trials.

► Step 5

This step is introduced to teach the student to come to the chair upon the teacher's request. This step is important for learning to perform the various programs in this manual which are, for the most part, taught to the student while sitting in a chair. To begin, place the student 4 to 6 feet away from a chair positioned directly across from Teacher 1. As Teacher 1 presents the instruction ('Come here'), Teacher 2 prompts the student to come to the chair by gently nudging her toward the chair. Provide reinforcement immediately upon completion of the response. Continue to present trials of 'Come here,' gradually fading the prompt on each successive trial. The prompt may be faded by, for example, progressing from nudging the student less and less on each trial to patting the chair. When the student responds to the instruction without prompting, increase her distance from the chair to 6 to 10 feet. Prompt if necessary when the new distance is introduced, and fade the prompt over subsequent trials until the student comes to the chair upon hearing the verbal instruction only ('Come here'). Gradually generalize this skill into other areas of the house (e.g., first into the hallway adjacent to the original room, then into other rooms). Once the student masters the instruction, the teacher does not need to physically bring the student to the chair, which makes the job of teaching a little easier.

The presence of toys or other objects in the room that invite self-stimulatory behaviour may interfere with the student's response to 'Come here' and other instructions. To maximize the student's early success, remove these objects. As the student's behaviour of coming to the teacher increases in strength and the teaching environment acquires positive reinforcing properties, gradually introduce such objects into the room.

Up to this point, some 3 to 10 hours into instruction for most students, the student has learned to sit down, to perform a task such as dropping a block into a bucket, and to come to a parent and other adults upon request. Avoid teaching any two of these behaviours at the same time; for example, do not teach 'Sit' and 'Drop block' concurrently. Instead, simplify the response requirement by teaching each task separately to mastery, and then combine them. The combination of the separate responses constitutes a chain of behaviours which flows naturally such that the instruction 'Sit' comes to cue sitting, which then cues dropping blocks, followed by coming to a parent or a teacher. The last response serves as a reinforcer for the preceding responses (techniques for forming chains are provided later in this manual). From a behavioural psychology point of view, the world is full of such chains, such as when you get up in the morning, shower, and dress, eat breakfast, and then go to work or school. Rudimentary forms of these complex chains can be established during the first hours of treatment.

In the remainder of this chapter, certain additional behaviours that will help the student take full advantage of the teaching opportunities offered in this manual are introduced. These behaviours are presented at this point because they can be taught without the use of discrimination learning procedures (see Chapter 16), a relatively complex set of steps necessary to teaching most of the other programs. The student need not master the following tasks before moving on to programs such as Matching and Nonverbal Imitation (Chapters 12 and 13, respectively), both of which may be taught concurrently with one another and with the tasks described below.

Increasing Cooperative Behaviours

Younger students generally have a difficult time sitting still, especially in a teaching situation. You may have to help the student remain seated while instructions are given, not talk out loud to others, not fidget, and in general pay attention to what you are saying. At other times during learning situations, the student is encouraged to move around, be spontaneous, be explorative, and interacts with others. The reader will note that we use the term attention in a somewhat loose and general manner. It is perfectly possible for a student to sit quietly in a chair and visually fixate on your face without attending to any part of what you are saying or doing. Looking is not the same as seeing. The psychological process of attention is described in some detail in the chapter on discrimination learning (Chapter 16). Certain precursors to attention are presented here.

Many individuals with developmental delays are less compliant than typical individuals. Some present major problems when asked to sit in a chair, even for short periods of time. As demonstrated earlier in this chapter, the first hours of treatment are devoted mainly to teaching the student to sit quietly in a chair. Although the student may master sitting in a chair and the programs in this manual do not require the student to sit in the chair for prolonged periods of time, you may notice that the student fidgets with or flaps her hands excessively, moves her legs back and forth, or rocks her body while sitting in the chair. Such self-stimulatory behaviour is often the cause of a student not paying attention to you. In technical terms, the student is under the control of self-generated sensory reinforcers rather than your socially mediated reinforcers.

The student has already made some progress attending to you by mastering tasks such as responding to the requests 'Sit,' 'Put in,' 'Drop block,' and 'Come here.' Next we illustrate the instructions 'Hands quiet' and 'Sit nice.' The behaviours performed in response to these instructions are intended to further help you gain the student's attention in order to facilitate the student's progress in future programs.

'Hands Quiet'

Teaching the student to respond to the request 'Hands quiet' helps focus his attention on the task being taught and reduces the impact of stimuli generated by his self-stimulatory behaviours. The student's response to the request to keep his hands quiet can be composed of (1) keeping his arms down by his sides while his hands remain still, (2) placing his hands flat with his palms down on the top of his thighs, or (3) folding his hands in his lap. Choose the position that is the most natural for the student and the most helpful to you. Children who fidget with their thumb and forefinger should be taught Position 2 because, with their palms down and fingers spread on their legs, the temptation to fidget is minimized. Position 1 or 3 may be appropriate for students who flap their hands or arms.

When the student fidgets in the chair, present the instruction 'Hands quiet' and prompt the student to respond correctly by manually guiding his hands to the desired position. Immediately reinforce the student for following your instruction. On subsequent occasions of the student's fidgeting in the chair, repeat the instruction and prompt the response. Gradually fade the amount of prompting provided. For example, after several fully prompted trials of placing the student's hands in her lap, fade the prompt to guiding the student's hands halfway up to his lap, then one quarter of the way to his lap, and so on until the student performs the response without any assistance whatsoever.

Criterion for mastery is difficult to establish for the instruction 'Hands quiet' and similar attempts to reduce self-stimulatory behaviours. Therefore, be prepared for many trials over several weeks or months before the student reaches mastery of this task. The slow acquisition of this response may be due to the strong reinforcing effects of the student's self-stimulatory behaviour and his extensive experience in developing and strengthening such behaviour. It is possible that self-stimulatory behaviour is strengthened not only by the (positive) sensory reinforcement it provides but also by the (negative) reinforcement it provides through avoidance of your instructional demands.

The best strategy for reducing self-stimulatory behaviour is to gradually build socially appropriate behaviours to replace the inappropriate self-stimulatory ones. Such a strategy, however, requires a good deal of time before the desired results are realized. When forms of self-stimulatory behaviour appear to be triggered by easily identifiable stimulus sources (e.g., the playing of a favourite video triggers obsessive preoccupation with that video; particular patterns of light trigger gazing), we advise that such sources be removed from the teaching environment in the initial stages of teaching.

Sitting Nice

Even after a student learns to respond to the instruction 'Sit,' she may slump over or slide down in the chair. In this section, the student is taught to sit properly in the chair when asked to do so. When the student does not sit properly, she is probably not attending to the teacher but rather attending to the sensory feedback arising from a particular body position. The instruction 'Sit nice' helps to minimize the student's reinforcement from squirming and sliding in the chair and thus helps the student attend to the task at hand.

When the student slouches or slides down in the chair, give the instruction 'Sit nice' in a loud, clear voice. Immediately prompt the student to respond correctly by physically guiding her to sit properly. This may require gently nudging her shoulders back, raising her up in the chair, or turning her legs to a forward position. Immediately reward the student for sitting properly. After several trials of the instruction 'Sit nice' with full prompting, fade your prompt over subsequent trials. For example, if the student slouches in the chair, place your hands on the student's waist and see if she lifts herself in the chair rather than you having to raise her yourself. Continue to provide less assistance on each trial until the student responds correctly on her own.

In response to both the instruction 'Hands quiet' and the instruction 'Sit nice,' it is enough for the student to suppress self-stimulatory behaviours long enough (e.g., 2 to 4 seconds) for you to present the instruction in the next trial. If the student does not self-stimulate as you present the instruction, it is more likely that the student will attend to your instructions.

Areas of Difficulty

Tantrums displayed by students during the first hours of treatment can be unnerving, to say the least. Even though students eventually need to learn not to respond with severe tantrums when placed in frustrating situations, tantrums may initially be reduced or avoided by identifying and removing particularly frustrating situations while still achieving the main teaching goals. The following anecdote submitted by a behavioural aide is an example of how this can be accomplished.

Sally

Sally appeared to be extremely attached to her mother. In addition, her reinforcement history of escaping demands was great from what I had observed earlier that morning. Every time Sally whined or threw her arms back, her mother would say, 'Okay, okay,' and remove her demands.

I also observed that Sally was interested in about three toys. I was able to redirect her attention from her mother to the toys on the floor and play with her for a few minutes. Sally was not upset and appeared to actually enjoy this interaction between her, the toys, and myself, tolerating being separated from her mother while I played with her. Whenever I drew attention to her mother, however, Sally would immediately jump onto her mother's lap, suck her thumb, and twirl her hair. Although going to her mother constituted a powerful reinforcer, removing her from this reinforcing situation and placing her in the chair in order to teach the instruction 'Sit' caused major tantrums.

I then decided to try something different. Instead of having Sally's mom so nearby, I requested that she sit in a different part of the room where she was not easily seen by Sally. I engaged Sally in some play with toys on the floor and then transferred the toys onto the table. Sally followed myself and the toys to the table. Once she was there, I prompted her to sit down and she continued to play for a couple of seconds. 1 abundantly reinforced Sally with food (which she was actually willing to take from me at that moment) and then directed her onto the floor to continue playing with other toys. We continued with this procedure for about 15 minutes. We also increased the time at the table from a couple of seconds to about 1 minute. My goal was to establish a positive reinforcement history at the table. By the end of this intervention, Sally actually approached the table on her own, sat in the chair, and started to play with some toys placed there. The major changes in emotional behaviour came about effortlessly.

Teachers will encounter problems in every program. Sally's severe tantruming when separated from her mother is only one example. Some students do not tantrum at all when separated from a parent, but they may show other kinds of behavioural difficulties. This becomes increasingly evident as you work through the many and varied programs presented in this manual. However, the longer you teach the less rigid and more creative you will become in using the teaching procedures described in this manual such that the difficulties displayed by the student are alleviated.

Before beginning to teach a student a particular skill, you cannot accurately gauge the speed at which you should increase task difficulty. We suggest that if the student appears to have reached a plateau in his rate of mastery, you should step back and simplify the response requirement to recover successful performance before introducing more difficulty. Remember, the student's experience of success in the teaching situation is critical. The student shows you how fast to proceed; you are as much under the student's control as he is under yours.

Throughout the teaching of all tasks, the team members need to agree about and be consistent in their expectations of the student. For example, when teaching 'Sit,' if 5 seconds of sitting on the chair is the criterion, all teachers should consistently require this period of time. No one should introduce his or her personal requirements, as in going up to 10 or 15 seconds or down to less than 5 seconds. If a team member wants to try a different task or criterion, this needs to be discussed with all team members and agreed upon prior to introducing it. No aide's solo performances are allowed in the beginning of treatment; consistency is the rule. As the student improves, however, inconsistencies are introduced in a systematic and planned manner so that the effects can be measured and failures minimized. Obviously, for the student who masters a large number of programs, inconsistencies or variations in instructions and response requirements must be introduced and mastered. The real world is not consistent, and the student eventually needs to respond appropriately to variations.

When teaching the skills outlined in this chapter, also keep in mind that connecting the reinforcer to the behaviour is essential. In some tasks, such as eye contact or babbling, the response is so subtle and fleeting that the student may not initially be able to make the connection between the behaviour and the reinforcer. (Technically speaking, the student does not discriminate the reinforcement contingency.) Therefore, one should not explicitly teach subtle behaviours such as eye contact, vocalizations, or smiling in the early stages of treatment. As you proceed with teaching, however, appropriate behaviours such as eye contact and smiles may spontaneously emerge, and they may be prompted by the reinforcers provided within the teaching situation. For example, some students smile or babble when given reinforcement such as food or a kiss. (Technically speaking, the reinforcing stimulus contains unconditioned stimulus properties, eliciting respondent or reflexive emotional behaviours.) Other students look around the room, seeking recognition (reinforcement) for completing a correct response. Amply reinforce such socially appropriate and spontaneous behaviours. As you become increasingly competent as a teacher, you will also act more natural in the sense that youre prompting and reinforcing of various behaviours will flow smoothly, entering you into a dynamic relationship with the student.

Concluding Comments

The technical concepts presented in this chapter are defined in more detail in Chapter 10. We introduce these concepts here, but detailed descriptions of them may not be essential to helping the student learn to sit in a chair, reduce tantrums, put blocks in a bucket, and go to her parents and other adults. Increased exposure to such concepts, however, facilitates a complete understanding of how they can be used when teaching more advanced programs.

Although the tasks taught in the first hours of treatment may seem trivial, keep in mind that many students have never sat in a chair for an extended period of time, not even at mealtime, or have only done so inconsistently. Most students with developmental delays have not come to their parents when requested to do so. Many have given their parents a very tough time by screaming and hitting, tyrannizing them in a way. Some students may have complied in the past, off and on, when they felt like it. To succeed in the teaching environment, a student must learn to comply with what adults want. If the student does not, no one will be able to teach her what she needs to master in order to develop more typical behaviours. Thus, the beginning tasks are designed with the intent of establishing the foundation needed to learn the skills detailed in this manual and to build the student's trust in you and pride in her.

Behaviourists do not ordinarily use terms such as trust, pride, and sense of accomplishment. This is for reasons of objectivity. Instead, phrases such as 'cooperation training' and 'bringing the student under instructional control of the teacher' are prevalent in behavioural literature. Such terms should not be used to obscure the importance of behavioural teaching programs in creating what is commonly referred to as pride, motivation to learn, and the many other descriptions that are familiar to everyone whether or not they are behaviourally oriented. Further, the student who begins to smile and look at others when coming to the teaching situation on her own allows parents and teachers to feel successful as well. Adults also must obtain some reinforcement; otherwise they will lose motivation and eventually quit.