The (Lack of) Effectiveness of Weighted Pressure Vests for Children with Autism

Situation 1: You've heard that weighted pressure vests may help reduce challenging behavior in children with autism, but you're not sure you believe it.

The use of weighted vests on children with autism has been studied extensively by impartial researchers. It's been determined that this strategy does not  result in significant positive effects on challenging behavior in children with autism.

When you are a caregiver for children with autism, whether they are part of your family, your classroom, or a therapy client, your goal is to use all the available resources to support their needs.  Choosing evidence-based interventions is essential to ensure the most effective strategies are used and that no valuable time is lost to ineffective, unproven interventions. In the case of weighted pressure vests, there have been a substantial number of studies that demonstrate and agree that there is no evidence of the vests effectively reducing challenging behaviors in children with autism.

Researchers who sought to determine if weighted pressure vests benefitted children with autism chose various behaviors as the target behavior. Challenging behaviors are often found to be comorbid with autism spectrum disorder (ASD), such as ADHD (Morrison, E. E., 2007), anxiety (Losinski, Mickey et al., 2017), self-injurious behavior (Doughty & Doughty, 2008), sensory processing problems (Morrison, E. E., 2007; Case-Smith, et al, 2015), and stereotypic behavior (also known as stimming or repetitive behavior) (Morrison, E. E.,2007; Watkins, et al, 2014)). Researchers targeting each of these behaviors have found that weighted pressure vests have not proven positive outcomes in children with ASD.

Refer to the matrix below for more details for each study.

 

Situation 2: You're convinced that weighted pressure vests help reduce challenging behavior such as anxiety and stereotypic behavior in children with autism.

There is a widely spread false belief that weighted pressure vests reduce challenging behaviors in children with autism spectrum disorder (ASD). This blog is one of many examples of how misinformation continues to be shared, in spite of an abundance of research that has disputed the belief and determined there is no evidence to prove any positive outcome by implementing this intervention. 

Neurodivergent Insights
https://neurodivergentinsights.com/blog/weighted-vests-autism#:~:text=Weighted%20vests%20are%20especially%20beneficial,regulation%20by%20providing%20proprioception%20input.

The internet has simplified the spread of misinformation by well-meaning individuals and by individuals seeking monetary gain, alike. As provided in this blog, there is often very little free information but plenty of opportunities to purchase products that promise results. However, researchers publish peer-reviewed articles detailing scientific information in scholarly journals, following the rigorous methods required for evidentiary proof of effectiveness or as in the case of weighted vests… the lack of evidentiary proof of effectiveness. 

                                                                                                                                                                Researchers who sought to determine if weighted pressure vests benefitted children with autism chose various behaviors as the target behavior. Challenging behaviors are often found to be comorbid with autism spectrum disorder (ASD), such as ADHD (Morrison, E. E., 2007), anxiety (Losinski, Mickey et al., 2017), self-injurious behavior (Doughty & Doughty, 2008), sensory processing problems (Morrison, E. E., 2007; Case-Smith, et al, 2015), and stereotypic behavior (also known as stimming or repetitive behavior) (Morrison, E. E.,2007; Watkins, et al, 2014)). Researchers targeting each of these behaviors have found that weighted pressure vests have not proven positive outcomes in children with ASD.

Families and caregivers of children with autism need effective, evidence-based strategies to support children with autism at home. When social media, news outlets, or bloggers promote products or equipment with the promise of making it easier to support their children, parents optimistically and eagerly want to believe the promises. Regardless of the numerous studies which have shown no evidence of effectiveness, the desire and willingness to try the product in hopes that there will be a positive outcome is powerful. When therapists tout weighted-pressure vests as a way to calm children with ASD, caregivers expect to be able to trust their professional advice. But is it scientifically-proven advice?

There have been studies that found one participant in the group of participants benefitted in some way from wearing the vest, which can give a caregiver hope. Rather than reading the headlines, caregivers must read the entire article to uncover all the facts.  For example, were all the participants children with autism? Bodison, et al (2018) found some limited evidence of effectiveness in increased participation in the classroom, for children with attention deficit with hyperactivity disorder. However, there was no significant reduction of challenging behavior found in children with autism.

When choosing an intervention to benefit children with autism, it's imperative that evidence-based strategies are implemented, to ensure no valuable time is spent unwisely on debunked methods.

Refer to the matrix below for more details for each study.  Please review the cited articles in the reference list to gain more understanding of the studies conducted.  Each study determined there is a lack of evidence of effectiveness when using weighted pressure vests for positive outcomes in children with autism.                                                                                                                                                                                                                                                                              

Synthesis Matrix- Weighted Pressure Vests 

	Losinski, Mickey et al. (2017)	Morrison, E. E. (2007)	Case-Smith, et al (2015)	Bodison, et al (2018)	Watkins, et al (2014)	Doughty (2008)
Intervention	Weighted pressure vest	Weighted pressure vest	Weighted pressure vest	Weighted pressure vest	Weighted pressure vest	Weighted pressure vest
ASD and anxiety	3 students were studied. Mixed results. Lack of sufficient evidence of effectiveness
ASD and stereotypic behaviors		5 studies which met criteria reviewed. No evidence of effectiveness to reduce stereotypic behavior			3 children studied. Analysis of the data found no reduction of stereotypic behaviors
ASD and undesired behaviors	Not effective in reducing undesired behaviors
ASD and Sensory processing problems		One study found a positive effect for remaining seated and pressure seeking behaviors	19 studies reviewed. No evidence of positive benefit with sensory processing
ASD and ADHD		No increased focus	One study showed positive results improving attention and mixed results for distractibility	8 studies reviewed. Limited evidence of effectiveness for ADHD but not ASD behaviors
ASD and Self-injurious behavior						One 14yo participant. No difference in frequency with or without vest. No evidence of effectiveness

 

 

 

 

 

References

Bodison, Stefanie C., and L. Diane Parham. “Specific Sensory Techniques and Sensory Environmental Modifications for Children and Youth with Sensory Integration Difficulties: A Systematic Review.” The American journal of occupational therapy 72.1 (2018): 7201190040p1-7201190040p11. Web.

Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2015). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism, 19(2), 133-148. https://doi.org/10.1177/1362361313517762

Doughty, Shannon S, and Adam H Doughty. “Evaluation of Body-Pressure Intervention for Self-Injury in Autism.” Behavioral development bulletin (Philadelphia, Pa.) 14.1 (2008): 23–29. Web.

Losinski, Mickey et al. “The Effects of Deep Pressure Therapies and Antecedent Exercise on Stereotypical Behaviors of Students With Autism Spectrum Disorders.” Behavioral disorders 42.4 (2017): 196–208. Web.

Morrison, E. E. (2007). A review of research on the use of weighted vests with children on the autism spectrum. Education, 127(3), 323+. https://link.gale.com/apps/doc/A205494745/AONE?u=tall85761&sid=bookmark-AONE&xid=9d1d5f52

Watkins, N., & Sparling, E. (2014). The Effectiveness of the Snug Vest on Stereotypic Behaviors in Children Diagnosed With an Autism Spectrum Disorder. Behavior Modification, 38(3), 412-427.
https://doi.org/10.1177/0145445514532128

They're waiting to hear it from you.

 There is so much about life that we don't understand unless it affects us personally.

During my two pregnancies I refused to take the tests to determine if my fetuses were developing as expected for "normal" babies. But I did wonder what parenthood would be like if they weren't...

It wasn't until my first grandchild was born that my daughter and I would begin an adventure into the amazing and intriguing world of Autism Spectrum Disorder. His language was not developing "on schedule" so the screening began at 20 months. By the age of 2 he was given the diagnosis of ASD by a neurologist and started speech-language therapy. After 6 months of speech he finally said his first word and he hasn't stopped talking since.

At the age of 5 he could use mental math skills to complete multiplication. By the age of (almost) 10 he has continued to expand his academic skills, with math in particular being well above his grade level expectations. My daughter began homeschooling him when the pandemic shut everything down in spring of 2020. They are the best team and he's ahead of schedule because they work year round, and throughout the day.

But having said all of this, there are many facets to ASD. One of the greatest challenges common to individuals on the spectrum is a noticeable deficit in social skills and my grandson is not an exception. It requires a lot of practice and a lot of reminders, for all of us.

A few months ago, my daughter and I felt it was time to explain to him that his brain works differently than most people's and that there is a term given to that difference: Autism Spectrum Disorder.

We explained that it's called a "spectrum" because no two people are the same who have ASD. Some have great difficulty getting their brain to process information, others have brains that can understand things that most others cannot, but from one end of the spectrum to the other, everyone's brain functions differently than people who are not on the autism spectrum.

After the explanation it was unclear whether he actually understood, or even cared about what we had both stressed over and so thoughtfully practiced before telling him. Neither of us brought it up again for weeks. I finally asked him if he remembered what we had told him, and he said he remembered but that he hasn't really thought about it.

Today, the three of us were doing a modified book study. Reading has not been his favorite subject, but he is tolerating "Wings of Fire." After doing a shared reading activity which involved each of us taking turns reading a page, quizzing the other two for comprehension, followed by my grandson writing a paragraph to summarize. He kept count of how many times he had to rewrite the words, and explained that part of his "autism spectrum" made him "very specific" about how he does his work.

I share this story, working through all the emotions that erupted as he spoke those words. He WAS listening. He DOES understand. And as difficult as it was for us to tell him that he's different from other people... it was just no biggie to him. It's just part of who he is and it doesn't faze him a bit.

How you explain it to your exceptional child is up to you. Just know that it is important to open that conversation. And know that chances are, they already know. They probably just don't know what the name for their exceptionality is... They're waiting to hear it from you.

Self-Advocacy | Adults with Disabilities: Preparing for Transition to Independent Living

  

From the moment our babies are born, as parents we understand that it is our responsibility to prepare our children for adulthood. As typically developing children grow and learn about the world we live in, they mature and travel the expected path into adulthood. Parents of children with disabilities watch as their children grow with a very different perspective.  Some of these parents will wonder how and even if their children will be able to live independently. It is true that some people with disabilities will always need assistance, but for many others, living independently is a well-planned reality. 

It is important to understand that this has not always been the case. When we research the history of how people with disabilities were treated, it is deplorable. While we think of how far we've come as a society, we should never forget the shame of how inhumanely people with disabilities were institutionalized. In the essay The New Disability History: American Perspectives, ed. by Paul K. Longmore and Lauri Umansky, we read about the extent to which there was no inclusion, no rights, and no humane considerations for people with disabilities. 

Thankfully, many changes have been made that ensure civil rights to adults with disabilities, requiring equal access to the enjoyment of having a home of their own. Thanks to the Americans with Disabilities Act (ADA), there are laws and policies in place to protect all people, regardless of ability. There are many agencies who help provide the necessary resources to support the unique needs of the adult.

In order to prepare for living independently, a young adult needs to understand the importance of self-advocacy. Educators who have extensive knowledge of the unique needs for students with disabilities, provide opportunities to work together with the IEP/TIEP/504 team, to teach the student daily living skills, including practice in self-advocating. Self-advocating, put into the simplest terms, means to be able to take care of oneself, stand up for oneself, to know how to ask for help when needed and whom to ask for help.

The National Technical Assistance Center on Transition has provided a list of the key independent living skills needed for adults with disabilities on their website: "Self-care/independent living skills are skills necessary for management of one’s personal selfcare and daily independent living, including the personal management skills needed to interact with others, daily living skills, financial management skills, and the self-management of healthcare/wellness needs." (NTACT)

There are many options used to begin to prepare for this transition. The first step towards independent living might be an ecological assessment to see what skills will be needed in the variety of environments the young adult will participate in. Once the skill needs are determined, a goal will be developed to target the skill development. For example, a Daily Checklist would be beneficial, to teach self-advocacy by ensuring that all aspects of hygiene, housekeeping, and financial management are completed on a daily basis. 

For additional resources please explore these Resource Round-Up pages: 

Self-Advocacy  | Resource Round-Up for Adults with Disabilities: Postsecondary Education & Employment 

https://anaedwardsautismteacher.blogspot.com/2023/07/self-advocacy-resource-round-up-for.html

Self-Advocacy  | Resource Round-Up for Adults with Disabilities: Policy Issues, Inclusion, Housing, and Assistance

https://anaedwardsautismteacher.blogspot.com/2023/07/self-advocacy-resource-round-up-for_16.html

References

Longmore, Paul K., Umansky, Lauri. The New Disability History: American Perspectives. New York:      New York University Press, (2001).

Americans with Disabilities Act. U.S. Department of Justice, Civil Rights Division.
  https://www.ada.gov/

National Technical Assistance Center on Transition (NTACT). Community Engagement and      Independent Living. https://transitionta.org/topics/community/ 

Self-Advocacy | Resource Round-Up for Adults with Disabilities: Policy Issues, Inclusion, Housing, and Assistance

 When you need help finding help, this is a great starting point! 

Advocating for your self can be overwhelming.  With the help of a knowledgeable, supportive agency, the assistance you need is available. 

The available resources are not limited to this list, but I've included some great options as a starting point. The first link is for Project 10 which is a valuable source of help for a variety of needs, for people with disabilities and their family or caregiver.

Project 10-
Resources for family and student
http://project10.info/Index.php 

Community Awareness, Statewide Issues, Promoting Inclusion

APD Cares- Connecting you to the community
FL SAND (Florida Self-Advocates Network’D)

Florida Self-Advocates Network’D (FL SAND) is Florida’s statewide network of self-advocacy groups. Through FL SAND, Florida’s self-advocacy groups unite to speak to others about statewide issues and topics that are important to them, create community awareness, and promote inclusion for all. Working with self-advocates that have joined FL SAND can help you to become a stronger self-advocate.  Go to https://www.flsand.org to learn more about FLSAND and to find a group near you.
https://apd.myflorida.com/selfadvocacy/

Disability Rights Florida
10 Steps to Effective Self-Advocacy

Advocating for yourself is very important because it lets others know that everyone, including people with disabilities, has rights. When you become a self-advocate, it helps others understand that you are entitled to be treated with respect and dignity. This is the best way to express your needs and to have your voice be heard.
https://disabilityrightsflorida.org/disability-topics/disability_topic_info/10_steps_to_effective_self_advocacy

National Council on Independent Living
NCIL advances independent living and the rights of people with disabilities. NCIL envisions a world in which people with disabilities are valued equally and participate fully.

Housing, Financial assistance, and Food Assistance

Disability Advocacy Organizations

These organizations protect and advocate for the civil and human rights of people with disabilities.

ADAPT
American Disabled for Attendant Programs Today DEFENDS OUR FREEDOM to live in our homes, not nursing homes!

Florida Center for Inclusive Communities
https://flfcic.cbcs.usf.edu/index.html
Since 1963, University Centers for Excellence in Developmental Disabilities Education, Research, and Service (UCEDD) have been working to accomplish a shared vision that foresees a nation in which all Americans, including Americans with disabilities, participate fully in their communities. Independence, productivity, and community inclusion are key components of this vision.

The Arc of Florida
Our Mission Working with local, state, and national partners, The Arc of Florida advocates for local chapters, public policies, and high quality supports for individuals with intellectual and developmental
 disabilities to be fully included in all aspects of their community.

Family Network on Disabilities
Florida’s resource for helping families of children with disabilities. You’ll find the resources and support your family needs.

Able United
An ABLE United account gives Floridians with a disability a tax-free way to save, without losing public benefits.
https://www.ableunited.com/?gclid=EAIaIQobChMIo7ShnOm76gIVibWzCh0KSQndEAAYASAAEgLV3fD_BwE

Agency for Persons with Disabilities- Work Incentive Planning and Assistance (WIPA) Projects
https://apd.myflorida.com/brochures/Keep%20your%20benefits2014.pdf

Financial assistance, Food, Housing, and Employment assistance
https://www.needhelppayingbills.com/html/government_assistance.html

Self-Advocacy | Resource Round-Up for Adults with Disabilities: Postsecondary Education & Employment

 There are so many great links to help you, your TIEP team, other family members, or caregiver create a plan for your postsecondary education. I've listed a few here to get you started.

The first link is for Project 10 which is a valuable source of help for a variety of needs, for people with disabilities and their family or caregiver.

Project 10-
Resources for family and student
http://project10.info/Index.php 


Postsecondary Education

Understood-The difference between accommodations and modifications
When a student has an Individualized Education Program (IEP) or a 504 plan, you’ll likely hear the word accommodation. You may also hear school staff members say modification. While the two words sound similar, they mean different things.
https://www.understood.org/en/articles/the-difference-between-accommodations-and-modifications

Florida Center for Students with unique Abilities (FCSUA)-
The purpose of the Florida Center for Students with Unique Abilities is to provide support to students, families, and institutions of higher education so that students with intellectual disabilities have opportunities for on-campus college experiences that lead to employment opportunities.
https://fcsua.org/

Florida Center for Students with Unique Abilities - Find a Postsecondary Education Program-
Approved Florida Postsecondary Comprehensive Transition Programs
provides basic program and contact information for each approved Florida Postsecondary Comprehensive Transition Program (FPCTP).
https://fcsua.org/E_postsecondary.php

Florida Center for Students with Unique Abilities- Florida Postsecondary Comprehensive Transition Program Scholarships
The Florida Postsecondary Comprehensive Transition Program Act (the Act) (FS 1004.6495) established the Florida Postsecondary Comprehensive Transition Program Scholarship for eligible students to attend approved Florida Postsecondary Comprehensive Transition Programs (FPCTPs). Scholarship are available only to eligible students, defined as a student with an intellectual disability, who has provided required documentation regarding his or her intellectual disability; who physically attends the eligible institution; and is enrolled in the FPCTP. 
https://fcsua.org/E_scholarships.php

Think College- GETTING ACCOMMODATIONS TO SUCCEED AT COLLEGE
Accommodations are supports and services provided at no cost to eligible students with disabilities to have equal access and opportunity to benefit from classes, programs, and activities.
https://thinkcollege.net/sites/default/files/files/resources/HTTC_04_Getting_Accomodations_to_Succeed.pdf

Think College-
This guide shares questions about important aspects of the college program, and are offered to help students and families learn as much as they can about program operations so they can make an informed choice about which college is best for them.
https://thinkcollege.net/sites/default/files/files/resources/Conducting_College_Search_HTTC1v2.pdf

Think College- The Family Guide to Secondary Transition Planning for Students with Disabilities
http://project10.info/Documents/FamilyGuide_FINAL_PLUS_CTE_Grad_Pthwy_3.26.20_1.pdf

Think College- Postsecondary guide- The Boggs Center on Developmental Disabilities
Self-Advocate’s Guide to Choosing a Post-Secondary Program: Charting Your Course Through a New Landscape
https://thinkcollege.net/sites/default/files/files/resources/Postsecondary-guide-fillable2018.pdf


Florida Department of Education- Career & Adult Education
The Career & Technical Education (CTE) Programs section is responsible for developing and maintaining educational programs that prepare individuals for occupations important to Florida’s economic development. 
https://www.fldoe.org/academics/career-adult-edu/career-tech-edu/

Employment

Able Trust-
The mission of The Able Trust is to be a key leader in providing opportunities for successful employment for Floridians with disabilities.

The organization was created by the state legislature in 1990 as the Florida Endowment for Vocational Rehabilitation, as a direct supporter of vocational rehabilitation efforts by state agencies and community organizations. Operating under the dba of The Able Trust, the organization has helped to put thousands of individuals with disabilities to work and has supported employment-related efforts in all counties of Florida.
https://www.abletrust.org/about-us/

CareerSource Florida- Career Services
Are you looking for a career change or programs that will help you land your dream job? Your local workforce development board and employflorida.com can help.
https://careersourceflorida.com/

Self-Advocacy | Adults with Disabilities: A Smooth Transition Begins Long Before Adulthood

 "Disability is not a brave struggle or courage in the face of adversity. Disability is an art. It's an ingenious way to live." ~ Neil Marcus, actor and playwright

These are the first words we read in Emily Ladau's enlightening and beautifully written book in 2021, Demystifying Disability: What to know, What to Say, and How to be an Ally. These profound words are important to keep in mind, whether you are a person with disabilities or a person who is presently free of disabilities. The world as most of us know it, has for the most part, been built for people without disabilities. Fortunately, over the last few decades there has finally been acknowledgement that not everyone's body works in the same manner. There are many barriers that need to be adjusted or removed to allow access to everyone, regardless of limitations their disability may include.

By the time a student with disabilities graduates from high school, he has not only completed all the necessary academic requirements, he has accomplished this goal in spite of many barriers and challenges that his non-disabled peers did not encounter. The student received the support of his IEP/TIEP or 504 team, the professionals who worked together to ensure he had all the resources that provided a level-playing field. 

But what comes next? After high school, a new, exciting chapter begins: adulthood and all that comes with it. Just like that, the expectations for 18-year-olds include getting a job, a home, a car, starting a family of their own... Are these aspirations possible for a young person with a disability? Absolutely. 

The most important step to ensure the success of any student is preparation for their future. Just as a non-disabled student would begin postsecondary planning with the school counselor, the Individuals with Disabilities Education Act (IDEA) requires that a disabled student will begin the transition process by the age of 16. As detailed on Disability Rights Florida website, in Florida the transition process begins at the age of 12 or in the 7th grade, whichever comes first. During this transitioning process, assessments will be administered to help the student determine his strengths, preferences, and needs.

While prior to the age of 12 the student may not have been present for the IEP/504 meetings, at this time the student not only has the opportunity to attend meetings, but he will also be participating in the meetings and advocating for himself in the planning process. This change doesn't signify the end of parental input and involvement, by any means. For some students, with more extensive disabilities, the parents or guardians will continue to make decisions. But having a disability should never prohibit a person from reaching their goals, they just need a good plan created by the student and his team.

Self-determination plays an important role in the outcome of any transitioning process, with many factors involved. In the article written by Karrie A. Shogren, PhD and Leslie A. Shaw, MA, The Impact of Personal Factors on Self-Determination and Early Adulthood Outcome Constructs in Youth With Disabilities, we learn that there are several factors that impact the success of young adults with disabilities.  Race, gender, and family income are factors that may impact the student's level of self-determination, autonomy, psychological empowerment, and self-realization.

However, when the necessary support unique to each student is provided, there is a development of confidence in his own power to overcome the challenges he will face. When a student is given the dignity to fail, he comes to realize there will be mistakes made but there are important lessons in those failures. His sense of empowerment grows as he learns how to problem solve and how to ask for help, as well as from whom. Self-determination comes from within, built in great part from the support every student requires and deserves. The family, the IEP/TIEP/504 team, and the student work together to design the path that will lead the way into a successful outcome for the student, as he enters adulthood.

For additional resources please explore these Resource Round-Up pages: 

Self-Advocacy  | Resource Round-Up for Adults with Disabilities: Postsecondary Education & Employment 
https://anaedwardsautismteacher.blogspot.com/2023/07/self-advocacy-resource-round-up-for.html   

Self-Advocacy  | Resource Round-Up for Adults with Disabilities: Policy Issues, Inclusion, Housing, and Assistance
https://anaedwardsautismteacher.blogspot.com/2023/07/self-advocacy-resource-round-up-for_16.html

References

Ladau, E. (2021). Demystifying Disability: What to know, What to Say, and How to be an 
           Ally. Ten Speed Press.

Disability Rights Florida. Intro to Transition: Students with Disabilities, School & Work.
 https://disabilityrightsflorida.org/disability-                            
 topics/disability_topic_info/students_with_disabilities_school_work#:~:text=Students%20i    n%20special%20education%20are,transition%20planning%20IEPs%20(TIEPs).  

Shogren, K. A., Shaw, L.A. (2017). The Impact of Personal Factors on Self-Determination 
               and Early Adulthood Outcome Constructs in Youth With Disabilities. Journal of
               Disability Policy Studies 2017, Vol.27(4) 223-233

Teaching Tip: Using Differential Reinforcement of Other (DRO) to Modify Behavior

 We have many opportunities for creating behavior modifications in an autism classroom, but the big question is always: Which evidence-based practice (EBP) should I use?

To find the best answer to this question, first determine the function of the behavior. What is the target behavior? Why is this behavior occurring? Once the function of the behavior is determined, an intervention can be designed.

I’ll use an example that is very common, both at school and at home. What could be the cause of frustration that leads to a meltdown? If the student can’t effectively communicate their needs, behavior can go from 0-60 in a matter of seconds. By using visual supports, such as a choice board with food options paired with a sentence strip, we can teach the student how to express their needs or wants.

Of course, there will be times when their desired choice is not available, which seems to be the quickest way to a meltdown. So, this is a great time to use differential reinforcement of other behaviors (DRO). A DRO is a procedure in which the absence of a problem behavior or the presence of any and all behaviors beside the problem behavior are reinforced.

The following video demonstrates the effectiveness of this EBP.  This student loves grapes more than any other food in the world. And because we love our kids, the staff would bring grapes to provide him with his favorite food. But when we were out of his favorite food the meltdowns were intense. We wanted to teach him that his favorites would not always be available.

By presenting a sentence strip with the words “I want _____” or “I want more ____” and a food choice card, paired with the question “What would you like to eat?”, you are teaching the child that his action will bring a reaction. It helps if you know what the child wants, so you can tap on that choice and say the name of the item. “Do you want grapes?” Tap your finger on the choice to model, then guide his finger to teach him to tap. Then, break the news that the grapes are all gone. It’s important to teach that what we want is not always available.

            

Now, explain the choices that are available: “We have raisins and Goldfish. Which would you like?”  It’s very important to ignore any tantrumming that will occur. Children learn early in life that tantrumming gets a lot of attention. Don’t give in by reinforcing that behavior with attention! Reinforce any other behavior that occurs EXCEPT tantrumming. So, continue to say “We have raisins and Goldfish. Which would you like?” Tap the choices as you name them.

It may take days, or weeks as in our case. But when you see the results of your hard, consistent work, you will celebrate that little bit of progress, as we did today. (Watch the video ‘til the end to see our success.)

Click here: Teaching How to Communicate Wants and Needs by Using a Choice Board

References:

Savage, M. N., & AFIRM Team. (2017). Differential reinforcement. Chapel Hill, NC: National Professional Development Center on Autism Spectrum Disorder, FPG Child Development Center, University of North Carolina. Retrieved from http://afirm.fpg.unc.edu/differential-reinforcement

Sam, A., & AFIRM Team. (2016). Antecedent-based intervention. Chapel Hill, NC: National Professional Development Center on Autism Spectrum Disorder, FPG Child Development Center, University of North Carolina. Retrieved from http://afirm.fpg.unc.edu/antecedent-based-intervention

Nowell, S., Sam, A., Waters, V., Dees, R., & AFIRM Team. (2022). Augmentative & Alternative Communication. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, Autism Focused Intervention Modules and Resources. https://afirm.fpg.unc.edu/augmentative-alternative-communication