Home-based Developmental Support

My eldest son is a child with ASD and an intellectual disability.
Between the ages of 4 and 6, he attended a municipal developmental support facility five days a week.
In this post, I will write about the developmental support we provided for him at home.

What is developmental support?

At the municipal developmental support facility (day-care type) he attended,
he learned group rules and communication.
However, regarding personal independence and language delays,
we decided to provide developmental support at home to the extent possible.

ABA Therapy

The ABA therapy we conducted at home is as follows.

In our case

<<What we did at home>>

• Behavioral Analysis: Analyze the child's behavior and identify the factors that trigger the behavior (antecedents), the behavior itself, and the consequences of the behavior (consequences).

• Reinforcement: Use reinforcement (such as praise or rewards) to encourage desirable behavior.

<<What we specifically did>>

• Identify what the child is showing resistance to

• Use picture cards and visual aids to provide predictability

• Use positive reinforcers (tokens) to increase desirable behavior

By the way, since we did not observe any significant problem behaviors,
we did not use negative reinforcers.
Negative reinforcers can potentially worsen problem behaviors if not used appropriately,
so please consult with a professional.

Now, I will write about each in detail.

Identify what the child is showing resistance to

We observed our child's behavior in detail.
The following are examples.

Why might they dislike playing in the sand?
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They panic when sand gets on their hands, right?
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Come to think of it, they also panic when paint gets on their hands.
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Maybe they are afraid of their hands looking different than usual.
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Let's keep a towel and a bucket of water ready so they can clean up immediately.
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They stopped panicking, didn't they?

Instead of vaguely thinking, "I guess they don't like playing in the sand," you need to
carefully identify what is causing it.

Once the cause is identified, you can think about how to respond.
Should you eliminate it, or get them used to it little by little?
Adjust your approach gradually to match your child's pace.

Utilize picture cards and visual aids

In my eldest son's case,
especially to alleviate his strong refusal to go to new places,
it was necessary to reduce his anxiety and fear.

Therefore,
I used picture cards and the like to establish a routine and communicate activity details clearly.

Let me give you an example.

① On the morning of a regular therapy day
Wake up → Change diaper → Get dressed → Breakfast → Leave the house → Take the bus to the facility

I stick picture cards representing each action on a whiteboard or similar surface,
and while showing them, I show or hand over the card while saying, "We'll do this next," to transition into the action.
For things that have become routine, I also grouped them together or skipped steps.

② On a day when going to a new place
Starting several days before, I explain using multiple photos of the destination.
I use photos that show who we are going with, what train we will take, what the building looks like from the outside, and what we can do there.
Naturally, using actual photos as much as possible prevents the "This doesn't look like the photo!" reaction.

By the way, while they might seem to dislike places like hospitals,
in my eldest son's case, it wasn't a problem if he had been there a few times,
and it was more important to explain "what we will do" there.

Explaining and getting them to understand is difficult, but
I try to explain using

words and pictures that are easy for the child to imaginesuch as "It's no fun to get sick, have a fever, and not be able to play, right?" or "Cars also need to be checked to make sure nothing is wrong, just like you, [Name]."

Use reinforcers (tokens)

In short, it's like a reward system.
When they perform a desirable behavior, you present something the child likes.

In our home, taking advantage of my eldest son's echolalia,
we did this during snack time to increase the frequency of speech and encourage verbal communication.

Example:
The child asks for chocolate using the crane phenomenon as usual
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The parent says, "This? This is chocolate. Do you want to eat it? Say 'Please give me chocolate.'" and encourages them, "Try saying it after me."
↓
Parent: "Chocolate"
Child: "Chocolate"
↓
Parent: "Please"
Child: "Please"
↓
Parent: "Please give me chocolate"
Child: "Please give me chocolate"
↓
Once the child can say it, give them the chocolate as requested.

Besides snacks, when he asks to be picked up, etc.,
whenever my eldest son asks for something,
I try to do this every time if possible.

Then, eventually, the repetition became smooth,
he started saying "Chocolate..." on his own,
and before I knew it, he was able to say "Please give me chocolate."

With this, I worked on moving from two-word sentences to three-word sentences, and then three or more words...

Once they can do this, I also recommend trying the token economy method as an advanced application.

What is the Token Economy Method?

A token is a substitute that can be exchanged for a reinforcer that has value to the individual.
It works by having points (tokens) accumulate when a desirable behavior is performed, and once a set number of points (tokens) are collected, a valuable reinforcer (reward) is received.
It is like a point card.

In our home, we created and posted a chart showing how many tokens are earned for specific actions, such as "1 token for doing (1)" and "2 tokens for doing (2),"
as well as a chart showing "You can exchange 5 for this" and "You can exchange 10 for that."
By posting the tokens we earned on a whiteboard or similar surface,
the siblings stimulated each other,
and they started performing desirable behaviors on their own to earn tokens.

You might wonder if it is okay to do things just for the sake of a reward,
but in our home, we adopted the stance of "That's fine! After all, adults really want rewards too, don't they?" and it went smoothly.

As for the results after continuing this,
we no longer see them performing desirable behaviors just for the sake of a reward,
and they are now performing desirable behaviors on their own initiative even without tokens.

I think the reason for this is their mental development and,
perhaps, the fact that we properly evaluated and appropriately praised the process of their hard work that wasn't written on the chart,
and gave them rewards.

Finally

How was it?

The ABA therapy and token economy method introduced this time
are actually effective not only for children with developmental disabilities but also for neurotypical children,
so please try them out in a way that suits your child.

Also, while we have had good results in our home,
there are times when it may not go well depending on your child's developmental stage and characteristics.
In such cases, I would like you to review whether the approach is appropriate,
and try it out while discussing it with support centers, medical institutions, or teachers at their school or daycare.