Friday, December 27, 2013

The Power of WAIT!

This past summer I had the opportunity to go to the Level 1 PECS course. PECS stands for Picture Exchange Communication System. It is an augmentative and alternative mode of communication for a wide variety of patients.

One topic that was briefly covered was “wait time.” I am so thankful that I was able to begin implementing this into my practice. I can’t tell you how many children I have on my caseload that will grab toys without permission (which I typically like to turn into a language opportunity). Out of these children that want things immediately there are several that will begin to have a behavioral breakdown due to not receiving their desired item/object/attention immediately.

How often have you seen this scenario occur?

Child: (Going to the slide unsupervised while mom and therapist talks).

Mom: “No no you need to wait until we are done talking”

Child: (Continues to go to slide).

Mom: “No no you need to wait.” (Mom begins to approach child).

Child: (Anticipates his/her mother stopping him/her from going down the slide and more aggressively climbs up the slide and/or goes down the slide anyway).

Mom/Therapist: (Trying to stop situation and takes child by hand).

Child: (Begins to tantrum characterized by yelling, screaming, etc.).

End Result: Child being carried out of therapy by patient’s mother or mother caving in and allowing child to slide despite child having tantrum.

What did the child learn in either end result? One, they learned that when mom or therapist says, “wait” they will most likely not get their reinforcement. Or two, if they throw a tempter tantrum despite mom or therapist saying, “wait” they will still get what they want. Either way this is not the lesson we want to teach our children. We want to teach that when you wait for a set amount of time you will get a positive reinforcement. This reinforcement could be an object, action, or some sort of social reinforcement. We have to give our children the opportunity to learn what a positive waiting experience feels like!

As you can see above this is the wait card that I created for my patients. I try to make the wait card in the child’s favorite color to automatically reinforce a positive emotion. My wait cards are made out of a cut out circle of foam with bold writing.

I start with purposefully putting out toys that the patient may have interest in. When the child reaches for the toy I quickly give them the “wait card” and state “please wait,” a half of a second later I reinforce the patient with their desired object, praising them for waiting.  Each child is different and you will have to feel out how much you can increase the wait time for each child. You may do several trials at a half of a second or you may decide to try 5 seconds, then 10 seconds, 30 seconds, etc.… The most important thing about this process is to create the act of waiting into a positive experience and with reassurance that their desired object, action, or social reinforcement will be available to them.

For my children that are up to a minute wait time or above I personally use a timer that looks like the picture below. The red slowly decreases as the time passes, this gives a great visual reinforcement and expectation to how long the wait time will last, wait time is not this unknown time that could feel like eternity, wait time has an end with a positive result. I have also found that all of my children that I work with enjoy holding their wait time card. When they have finished their wait time they turn it back into me and they receive their reinforcement for waiting along with praise.

With my extended trials I am sure to set out my entire expectation such as,

“You want the toy car? I would like you to please wait for five minutes. During these five minutes you will sit calmly in the chair with still and safe feet. Your mother and I may be speaking during this time. When wait time is over you will get to play with the car.”

During a child’s wait time (after they have had several successful trials at a particular set time) then I like to either talk with their parent, play on the iPad or try to talk on the phone. I do this because it is simulating the real world. When they are waiting at school, in line at a restaurant, or at home for a reinforcement from their teachers, mothers, fathers, and playmates that communication partner will most likely be finishing a project or a conversation they were already doing before the child requested to do the new activity. They need the real life practice of the attention not focused directly on them.

So far, with the patients that I have started this with I have seen and heard wonderful results. One mother told me that she is now able to use the restroom independently. Her child now waits just outside the door until she has finished. This mother hasn’t been able to do this for four years.

The ability to wait is such a critical skills for our children. They need to be able to wait to listen to all of directions, to learn if an activity is safe or not, to wait there turn in social games, etc.… Now I am sure there are several methods to teach waiting, this is just one that I have personally found effective. What techniques have you used to teach wait time?

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