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 story is about a young man named Brody. Brody’s mom contacted us because Brody needed to take a medication that needed to be swallowed. (Some medications can be crushed or sprinkled but when medication has an extended release, it must be swallowed to allow time for it to progress through the digestive system before dissolving.) The problem was that Brody did not know how to swallow pills. On top of that, Brody engaged in serious challenging behavior when his mother asked him to do something he did not want to do. Brody also had autism which complicated the entire process.
My colleagues over at CARD developed a wonderful pill swallowing technique based on research. The technique utilized some of the basic procedures in ABA. So we used those techniques with Brody and his mom.
Well, there was one more complication. Brody lived in a different state. Travel to us was not financially feasible nor was it practical for something that can be accomplished so easily. So, we utilized technology to make it happen. Voice Over Internet Protocol (VOIP) works great in situations like this. Skype and Facetime are perfect examples of this. However, due to HIPAA and privacy issues, a more secure connection is needed. Thus, we utilize WebEx for our work. All Brody’s mom needed was a camera, speaker, microphone, and internet connection.
We arranged times with Brody and his mom to train with us. We taught mom the procedures while Brody was out of the room. Then Brody came back in and his mom applied the techniques. Mom reinforced Brody and we reinforced Mom! And yes, it was that easy! In fact, we accomplished this in a total of 8 therapy hours spread over the course of several days. Here is how we did it:
First, we purchased a variety of stimuli that we could use to teach swallowing. You can start with something as small as a mustard seed. We use items like tapioca pearls, quinoa pellets, and similar. We purchased items in varying size take care to include items up to the size of a navy bean or flageolet. We also purchased blank pills in various sizes starting at size 4 going up to a size 0.
Note: some folks might suggest that you use small candies or cake decorating items. We advise against this because those items taste good and could possibly encourage chewing. Remember, we want children to swallow the stimuli WITHOUT chewing.
Then we arranged the stimuli in order from smallest to largest. FYI, a flageolet is about the same size as a size 5 capsule. A size 0 capsule is quite large (but they do come larger! 00 and 000). When Brody demonstrated that he could swallow a tiny object, we gradually increased the size of the stimuli. After only a few sessions, Brody was able to swallow a size 1 capsule which happened to be the size of the medication he needed.
The next step is to model pill swallowing for your child. Initially, we recommend that you model it every time you take your medication. Then, when you are ready to teach your child, tell him/her to “watch me” then over-exaggerate the action and promptly say, “your turn”
The final step is to reinforce the child for attempting and for successfully swallowing. Reinforcement can be as simple as verbal praise but it can also include brief access to a favorite movie, song, or iPad game.
Ok, it’s obvious that you don’t believe us. Check out this link for additional information including videos. This professor utilizes a head turn that you can teach if you want. We have not had to use this technique in our practice thus far.
Readers, it would help our case if you would share your success with this too! Seriously, this is one easy skill to teach. ABA Rocks!