Hi and welcome to “What Works Wednesdays” where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be.
Today’s success story is about a little guy that we call Nihar. Nihar was not even three when we first met him. His mother contacted us because she needed help. Nihar was having difficulty with eating, getting dressed, and brushing his teeth. For a toddler, well, that was most of his life’s daily activities. Nihar had extreme difficulty coming to the table for all meals. He also had food selectivity, a condition that is common among children on the spectrum. Nihar often rolled around on the floor when it was time to get dressed. His mother often had to chase him and she could not get him to be still in order to put clothes on him. Tooth brushing was a nightmare. He screamed and ran and fought at even the mention of brushing his teeth.
The first step when we are introduced to a situation like this is to complete a functional behavioral assessment (FBA) to determine why the behavior is happening. We discovered that:
- Nihar was trying to avoid meal times at the table.
- Nihar was trying to avoid non-preferred foods.
- Nihar was trying to gain access to TV during meal time.
- Nihar was trying to gain access to preferred foods.
- Nihar was trying to gain his mother’s attention during meal times.
- Nihar was trying to avoid tooth brushing.
- Nihar did not have any tooth brushing skills.
- Nihar was trying to gain his mother’s attention during tooth brushing.
- Nihar was trying to avoid getting dressed.
- Nihar was trying to gain his mother’s attention during dressing routines.
We offered Nihar’s mother a variety of interventions from which to choose. We have found that when parents are decision makers in their child’s behavior plan, they are more likely to implement the plan. When plans are implemented, they are more likely to be successful. Nihar’s mom selected an intervention called Premack’s Principle. In early childhood we call it If:Then or First: Then. Still others may call it Prespecified Reinforcement or Grandma’s Rule (“First eat your vegetables and then you can have dessert”). Regardless of what you call it, the Premack Principle is an easy intervention to implement. It is effective and it has substantial research to support its use. See for example this study, or this one, or even this one.
We first introduced the intervention during meal times. We used some other helpful strategies here as well (e.g., appropriate size table and chair, mom sitting with Nihar during meals). We simply told Nihar (and showed him with a visual support), “First eat your chicken and then you can have some mango.” Nihar quickly responded. When things were going well during meal times, we added the picture card to the dressing routine. Here we told Nihar that “First put on pants, and then have car”. His dressing behaviors improved immediately. Finally, we added it to tooth brushing. “First brush your bottom teeth, then you can have a hug from mommy”.
Congratulations Nihar on your great behaviors and congrats to your mom for all of her hard work. Also, Dr. Mandy Rispoli needs a shout out as she worked closely with Nihar’s family during this intervention.
Do you use Grandma’s Rule/Premack Principle/If Then with your child? Does it work? Please share with us!