Teaching COVID-19 Skills

As states take their first tentative steps toward reopening, we want to support families navigating new rules that may be encountered in the outside world: hand hygiene, wearing masks, and physical distancing.  You may be considering sending your child back to a center-based program soon, or thinking about what things will look like at school in the fall; whatever the circumstance, these are health and safety issues that we should address with all of our children.  Here are some topics to discuss with your clinician.

Hand Hygiene

We know that the spread of Covid-19 is primarily through touch, so it is a good time to talk to your clinician about where your child is with hand hygiene, and what is the next step in teaching them to maintain hygienic hands.

Thorough hand washing is most likely something you have already begun to teach your child that will remain a priority.  For those who are just learning this skill, it is more important for them to tolerate a longer, prompted, handwashing than to achieve independence at a less-thorough level.  Children should also be able to use hand sanitizer effectively, cough and sneeze into their elbow, and be able to refrain from touching common surfaces and their own faces.

There are many different methods of teaching handwashing: prompting and reinforcing, chaining (teaching certain steps first and then adding on to the “chain”), video modeling, picture schedules, or peer (sibling) tutoring.  These same approaches can be slightly modified for teaching effective use of hand sanitizer.  Coughing and sneezing into an elbow may also be taught through modeling, video modeling, peer (sibling) tutoring, or repeated practice and role-play.

Another thing to think about is ways to help our kids build the habit of keeping their hands to themselves in public – we don’t want them touching items others have touched, or their own face.  The easiest method is  to teach them an alternative response, like keeping their hands in their pockets, clasping their hands together, or holding an object with both hands.  First, you use instructions and reinforcement to teach the target behavior to occupy their hands.  Then, begin to slowly increase the amount of time they can keep their hands occupied before they receive a reinforcer.  Ultimately, when they are in the community, you want to be able to give them the instruction and feel confident they will not touch common surfaces or their face.

Face Coverings

Masks and other face coverings will likely be in use for the foreseeable future, so it’s a good idea to begin teaching our kids to tolerate wearing face coverings and getting used to others wearing them.  One way to tackle this is “desensitization,” a fancy term for starting small and building up tolerance slowly.  If you were using desensitization, you might begin with first having your child touch the mask with her hand, then allowing the mask to be held up to her face, then allowing the ties to be secured for a second.  Another way is “pairing,” which would entail having a lot of reinforcers available when a mask is present, and getting your child to associate the mask with positive experiences.  Other topics to address with your clinician are whether it’s appropriate to teach your child to put a mask on him/herself, or learn how to take a mask off hygienically, without touching the front of the mask, and putting it directly into the laundry.

Physical Distancing

Another skill that will continue to be relevant is learning how to physically distance.  For children who can learn to give others 6 feet of distance, your clinician can modify techniques from social skills research that have been used to teach children personal space.  Many children will not be able to gauge 6 feet on their own, and the focus moves to ensuring they can follow instructions for their parents or caregivers to guide them in public.  You can begin by looking at the instructions that your child already responds to that may help you to guide him to physically distance, for example, “stop,” “come here,” “wait with me,” and “stand right there.”  It’s likely that your child has learned or worked on these or similar instructions in the past; now it becomes more important that they are able to follow them quickly and reliably.  Talk to your clinician about appropriate ways to solidify these responses, such as increasing the amount of reinforcement earned for physical distancing instructions, practicing them frequently in a variety of settings, and practicing them in the presence of significant distractions.

As parents and service providers, our goal is always to support children in staying healthy and safe as we guide their development. Though these specific goals may not be the things we would have expected to focus on, our aim is to stay flexible and continue to adapt (and help our children adapt) to the changing practices in our community.

Continuing Progress During COVID-19

By Dr. Hanna Rue and Justin Funches

COVID-19 has changed the daily life of most families in the United States. Many in the autism community are now faced with challenging decisions. Families must decide how they’ll continue their child’s therapy program. Should they increase or decrease therapy hours? Consider online therapy? Or just keep things the same?

This is a complex decision with no simple answer. Every loved one with autism has different needs and faces different challenges. Each family must consider their situation and determine what’s best for them when speaking with their Behavior Analyst.

When making these tough decisions, there are several important factors that each family should consider.

 

Intensity of Challenging Behaviors

There are families who face significant challenges due to their child displaying aggression, self-injury, elopement, or other dangerous behaviors. For these families, clinical support is critical to maintaining safety in the home. Families concerned about managing their child’s challenging behaviors have to compare the risks of COVID-19 to the safety risks posed by the challenging behavior. In these situations, when continuing services is a matter of safety, it’s important to work with your clinical team to ensure proper health and safety procedures are in place. LEARN has implemented successful practices including pre-session health risk assessments, frequent handwashing, thorough sanitization of workspaces, restricting parent/caregiver participation, and limiting the number of technicians in the home.

 

Household Dynamics

Families with high risk individuals in their home, such as elderly or immune-compromised family members, may decide to put home-based ABA services on hold or move to online therapy – which reduces the risk for vulnerable household members.

While ABA services in the home can be delivered safely through strict health and safety protocols – none of these strategies are fool-proof. The only way to fully social distance and receive ABA services is through online therapy via services such as teleABA. In households where the risk of having staff in the home is too great, continuing ABA therapy online helps to decrease the risk of COVID-19 exposure and allows therapy (and progress) to continue.

tel·e·aba

noun: teleABA;

The provision of ABA therapy via computer, tablet or smartphone.

“By starting teleABA services, the family was able to help maintain their child’s behaviors when they couldn’t access session in-person.”

 

Risk of Skill Loss and Behavior Regression

There are families who have witnessed significant improvement in their child’s communication and social skills. These families may determine that the benefits of continuing in-home ABA services are greater than risks of COVID-19 – which we minimize by working closely with a clinician and taking ALL recommended precautions per the CDC. Other factors such as location in the U.S. and access to reliable technology impact a family’s decision to continue home-based ABA services.

 

Opportunities for Additional Learning

While the widespread closures of schools and center-based programs has created a challenge for many families, it’s also created opportunities for additional learning opportunities. In some circumstances, children may benefit from increased intensity of services in the home. Whether that’s to support new skill acquisition or work on a behavior reduction program. This could be particularly relevant for young learners and older learners focused on learning life skills.

It is our hope that the considerations outlined above will help families determine the best path forward. There is no one-size-fits all but we will partner with you to determine how your family can continue to benefit from ABA therapy. Whether that means keeping things the same, changing the intensity of service or embracing teleABA, every family has the opportunity to get the support that fits their individual needs. We highly recommend that families don’t go too long without services and work with their BCBA to find a solution to their challenges, as well as stay up to date on community news and happenings.

Independent Play for Kids: Bathtub Fun

Being a working parent is demanding.  Being a working parent with your kids home all day is demanding squared.  Being a working parent with your kids home all day when your child does not have a lot of independent play skills is relentless

For parents of children who require a lot of supervision, there are a number of activities that many children can do independently, and that may provide you a few minutes to yourselves.  For kids who enjoy messy, sensory fun, here are some fun activities that you can contain in a very washable location: the bathtub.   

Many of the activities you might normally do on an activity table or in the yard can be converted to the tub.  When play time is over, you can turn on the water for easy clean up of your child and the play area.

Paint

Bathtub paint is available online, or make your own by mixing liquid hand soap, cornstarch, and food coloring.  Let your kiddo paint the entire bathtub, with brushes or their fingers, whatever they like!  Use food coloring if your child is apt to get some in his/her mouth; use liquid watercolor if you’re concerned about staining clothes. 

Oobleck

If you don’t know about oobleck, it is a magical substance that feels solid to the touch, but becomes a liquid when you pick it up,  Add food coloring or liquid watercolor and it’s the coolest, messiest thing around.  I like to make a humongous bowl of it, putting one liquid watercolor on one side of the bowl and another color on the other side of the bowl; as they play with it, the colors swirl and change and mix and are truly mesmerizing.  Again, your own circumstances dictate whether food coloring or liquid watercolors are best for your family.

Edible playdough

There are many different recipes online –  choose the one that fits your kid’s allergy situation.  Here are my favorites:

Slime

Slime is always sensory fun, and there are a number of different types of recipes. 

Bubbles

For children who get excited by foaming bubbles, let them create miniature volcanoes in the bathtub.  Line up a bunch of paper cups in the tub and fill them half-way with vinegar.  Drop in some color, either food coloring or liquid water color.  Show your child how to put a spoonful of baking soda into one cup – and watch the eruption!  Exciting, non-toxic fun.   

Last, just a reminder that for kids who like water-play, actual baths are always an option for a family stuck in the house.  Now, you don’t want to leave your children alone in a bathtub full of water, but if your kid is able to play in the water safely while you are supervising, you might be able to get in a phone call or two.  If you want to mix things up, check out bathtub color tablets, different colored/scented bubble-baths, or (my kids’ favorite): water beads.  Please note that water beads are not edible, and only appropriate for children who will not ingest them.  Pre-soak the water beads first so they get plump and as big as a marble, and dump a bunch in the tub.  For kids who like to taste all of their toys, dump a container of blueberries in the water instead! They are the same size as water beads and also float!  Other novel floatable fun objects include bars of soap, apples, corks, sponges, and ice cubes.

Here’s hoping that at least one of these ideas will spark delight in your kiddo’s eyes and give you a few minutes to breathe.