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Sunday, November 18, 2018

Are You Tempted? Using Temptations in Intervention

One of the most powerful ways to teach others to be good communication partners to AAC users is to teach them about temptations.  (Now, I’m going to say that word really quietly, because in my house that usually means there are cat treats involved.)

But, seriously, use of temptations is not as widespread as it needs to be in the world of AAC.  And they’re so easy.  Parents are often worried that doing the modeling and teaching and trialing with AAC will be just that many more “things” to juggle.  But when I explain that this can be as easily accomplished as providing too small a portion at meal or snack time, or not jumping right in when they observe their child’s need for help, or even providing 2 or more choices, they begin to relax.

Weatherby & Prizant (1989) formalized the term “communication temptations.” Temptations are nonverbal actions that encourage the child to communicate.  By increasing the opportunities to practice communicating, we can increase the child’s use of communication. 

Sometimes you might hear the term ‘sabotage,’ which is essentially the same type of action, but with a less wholesome-sounding name.  We set up situations that the child has to solve - preferably by communicating - to get what he wants. 
Sometimes we provide something that tempts the child; sometimes we use something he doesn’t want, but we give him anyway.
Some really simple examples, beyond those named above, can include these:

  • Hand washing - remove the towel, or put soap on the child’s hands without turning on the water
  • Playing with toy cars, trucks, or trains - run the vehicle off of the table and leave it there, or when the vehicle comes to you; holding onto it instead of pushing it back to him
  • Meal times - forget to give the child utensils, or provide the wrong one (such as a fork for eating soup), or simply put a favorite item out of reach.
  • Making a favorite item inaccessible - don’t automatically offer the item when the child reaches or cries or tugs at you. 
  • Giving small portions - be careful with this strategy, too, to avoid frustration. Cut an apple into pieces and don’t provide the whole apple at once. On the other hand, don’t provide only 1/8 of the apple at a time, hoping to maximize communication opportunities. Model “Give” or “More” 
  • Creating a need for assistance - place the desired item into a sealed container, or out of reach, move the remote control for the T.V. or DVD player. Provide models for “Help” and “Want” and “Go.” 
  • Interrupting a favorite activity - blow bubbles only 1 or 2 times and wait, watch a part of a show then pause it, provide 2 colors of crayons but not the rest. Provide models for “More” and “Go” and “Do.” 
  • Offering something the individual does not like - model “No” or “Not” or “Different” or “Stop”  
  • Providing an activity with a part missing - model “Want” or “Give” or “Help” or “More.” (you can find more suggestions in my new book*)

    I’ve also used these: 
    • A carefully guarded clear snack bag
    • A racetrack with no cars
    • Giving a cookie to everyone but the ‘target’ child
    • Putting on his socks but no shoes, then getting up to leave the room or house

    And I’ve had a parent tell me she put her child in the bathtub but didn’t add water.

    Probably my favorite evaluation activity involves a portable DVD player and a selection of movies.  After the child chooses a movie or cartoon to watch, I let it run for a few minutes, then hit “Pause.”  I’ll start by modeling “More,” or “Go.”  The next time, I’ll look expectantly to see what the child will do.  I rinse and repeat as often as necessary; carefully balancing frustration, motivation, and saturation.  When I can move a child from no response to “more” to “go more” to “go more movie,” I’m quite pleased.

    When you’re thinking about those 200 opportunities each day to build a competent AAC communicator, think about ways to tempt the child, and plan how you will be a good model.  I’ve even had parents tell me they’ve practiced their “expectant look” in the bathroom mirror.

    I remember reading, a while ago, a post from Dr. Carole Zangari about temptations and smiling to myself as she recounted cutting m&m’s into 1/4ths because I have done that very same thing. (I actually once had a student who could bite an m&m into even smaller pieces than that, but that’s a story for another day).

    One of the key points I do remember from Carole’s post was the use of a time delay procedure to prompt the child.  I have a fondness for time delay prompting that harkens back to my research days. It is so effective for teaching skills without building prompt-dependency.  And while the research has been around for decades, it’s still not consistently taught to clinicians and certainly not to parents.

    So, when you’re talking about implementation practices with your team - including parents - remember to talk about  motivation through temptation. And be sure to remind them not to frustrate the child by using this too much!


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