Tuesday, April 9, 2013

Tip Tuesday! Using a Penny Board for children with ASD!

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Last week we talked a little bit about ONE (and I stress only 1) technique of MANY that can be used to teach children with ASD, discrete trial training (DTT).  Today I want to show you how I use some of the principles of DTT in a more functional way in the school environment for children with ASD.  I don't NOT use the technique for ALL students and I try to use this technique for a very short amount of time and as quickly as possible translate these skills to the classroom environment in order to support and facilitate carryover.  

Ok with that said, let's talk about using a penny board for therapy for children with ASD.  I don’t know who came up with the concept of the penny board so if you know, feel free to add that information in the comments so we can give credit accordingly.

Although many of you may have been taught in graduate school how to use a penny board in therapy, I hadn't heard of it until I was already practicing for 5 years.  I was trained on the use of the penny board by an early childhood special educator who had more than 15 years experience in the field working this 3-5 year olds with ASD at the time.  And it was an invaluable experience.  (Sidebar:  I urge SLPs out there to USE YOUR RESOURCES!  We have wonderful colleagues who have such great ideas and information we can benefit from knowing and modifying as necessary!)  So for those of you out there that haven't had to opportunity to learn how to use the penny board, here’s a quick look into what it’s all about.

I have seen many people use a clipboard for their penny board.  Because I travel between places to perform therapy, I like to use a file folder.  This way, I can close it up and I don’t lose any pennies along the way.

On one side of the penny board are two Velcro strips.  This is where I offer a choice of reinforcers for the child (note: these reinforcers are determined by observing the child's interests as well as via parent or teacher inventories).  The child will pick one of the two pictures available. What do I use as reinforcers?  It depends on the child’s currency and parent permission.  In the past I have been able to use fruit snacks, candy, stickers, bubbles, and various sensory toys as reinforcers.  It really just depends on what the child is willing to work for.  If I can use a penny board without requiring food reinforcers, all the better!

Once the child chooses his reinforcer, I turn over the penny board and place the picture in the center.  This way the child can visually be reminded of the object he is working for.  (Tip: for children who struggle with object/symbol association, I will actually place the real object on the board, if its small enough, or at the top of the board, out of reach of the child if the object is large or if the child tends to reach for the object.  Once object/symbol association is achieved I use pictures).

Then the child participates in 10 trials.  After each trial (regardless of whether the child’s response is correct) a penny is moved from the “rainbow” to the bottom strip. 

I have seen others use the pennies in a reverse manner starting on the bottom strip and moving to rainbow after each trial.  I like to move the pennies to the bottom strip because then I can use the placement of the penny as my data collection.  If the child responds correctly, I place the penny at the top of the Velcro strip.  If incorrect, the penny goes along the bottom of the strip.  So the picture below represents 7/10 (70% accuracy).

After 10 trials, I show the child he moved all of his pennies and I reward him with the reinforcement he chose.  During this time, I set up the penny board again for the next set of trials.  (Tip: If the object is NOT a food item, I like to use a timer to signal when it is time to return the object and begin a new set of trials)

What do I consider mastery for each skill?  80% 3xs in a row.  Then I quickly try to get this skills demonstrated in the classroom ASAP!!!!

As you can imagine by using this penny board you can get 30, 50, maybe even 100 trials in a session (depending on how long your session is and the response time of your student).  The key of course is then to immediately transfer that information/learned skills to other environments (see below for a brief explanation of how I fade out the penny board).

How does this differ from DTT?  

1)  Lacks immediate reinforcement after each trial: Definitely the use of positive reinforcement is similiar, but it is NOT immediately presented after each trial.  It is only presented after 10 trials.

2)  I do not use negative consequences with the penny board.  Also I do not use the informational "no" or errorrless learning correction.  I just present the answer verbally, wait a few seconds (if I know the child has a very long response delay I will wait the appropriate time), and whether the child responds or NOT a penny is moved.  So there are a few differences between DTT and how I use the penny board.  

That’s it!  Pretty simple premise.  

So why do I like to use the penny board for children with ASD?

1.)  Because its predictable and anxiety is observed to immediately decrease in some children.  

2.)  Once the child understands the process of the penny board, I can usually get a child to participate in more structured trials during a therapy session than if I did not use it AND I haven't needed to use any negative consequences to get that participation.  I see the movement of the penny as reinforcing enough for most children and participation is often spontaneous and voluntary.  (I do not cue with "Say ____" or "Now its your turn"...I just model and wait and allow the child to respond as he/she begins to understand the process and/or feels comfortable).

3.)  It's VERY easy to fade out.  For familiar activities and previously targeted skills the child is beginning to master with the penny board, I being to fade out the use of the board and reinforcement to facilitate generalization.  If I am trying to generalize the skill to play in my therapy session, I may place the penny board on the floor next to me and move a few pennies as needed, then quickly "forget" about the penny board and continue to interaction while focusing on that particular skill.  If I'm attempting to push into the classroom with this learned skill, I do the same thing if I need to...bring the penny board and use as needed, fade as quickly as possible. But when I am introducing a new skill, only if I need to, I bring my trusty penny board back out and teach the skill.

Now because I have worked with such cohesive teams in the past, I was not the only professional using the penny board.  The special educator, the OT, and even the paraprofessionals were able to do very short sessions with the penny board, than bring the child BACK into the classroom and trial those skills in a more functional way in the classroom environment.  It is amazing when everyone is on the same page, how quickly children progress with a simple 15-20 minute session followed by in class participation!  At least that was my experience.  

I really do believe the predictability of the penny board is what allows some children with ASD to successfully learn.  BUT of course I cannot stress enough that the penny board MUST be FADED out as QUICKLY as possible or generalization will not occur!!!!

**Sidebar:  A penny board can be adapted and modified for all types of communication goals and settings.  You aren’t bound to using it solely for therapy for children with ASD.  In fact, I also like to use the penny board for children with Apraxia.  It’s a nice way to get 10 trials in a row of the sound sequence we are working on following by a very short break before trialing the next set of sound sequences.  I’ve also used the penny board when I’ve had large articulation groups.  Older children can be paired up to practice their target sounds with each other, while I spend a few minutes with each child individually targeting their sounds very quickly and rotate to the next child.  It is a nice way to get many trials in a very short amount of one-on-one therapy time .**

Do you use the penny board?  How do you like to use it?  Share your ideas below!

How do I decide what to target with my penny board?

Well along with good clinical reasoning skills and knowledge of developmental milestones as well as the child's interest, I target skills that will make the child the most successful in the shortest amount of time.  So I ask myself, what is (child's name) biggest inhibitor to progress?  

  • Maybe the child lacks joint attention...then I work on eye contact, facial referencing and object referencing.  
  • Maybe the child lacks to ability to attend...then I work on basic sitting, looking, listening skills. 
  • Maybe the child lacks understanding...then I work on receptive language skills (beginning with our favorite...1step-single word, gross motor imitation, followed by verbal directions).  
  • Maybe the child lacks the ability to express him/herself...then I work on using a functional communication system for the child to communicate (more about a functional communication system will be presented in a few weeks...stay tuned).  

So as you can see, it all really depends on the individual child.  BUT I very much like using Behavioral Intervention for Young Children With Autism: A Manual for Parents and Professionals by Catherine Maurice as a nice guide.

Click on the link above and it will take to you Amazon's link for this book, but you can see my much loved copy to your left.

I like the curriculum for several reasons: 1) It has a beginning, intermediate and advanced curriculum within this book.

2) I LOVE that within each curriculum, it is divided in to various sections such as attention skills, imitation skills, receptive language, expressive language, academics, etc.

3) The activities and data sheets are already made!  That is the best part when one is just starting out working with persons with ASD.  This booklet takes you through, step by step the process of development and how to target each skills with various activities.  You don't have to reinvent the wheel!  (Here's an example below)  

I have been working with persons with ASD so long that I know how to target most of these skills using several different techniques and am not bound just by the activities in this book.  With that said, I still use this book as my guide, to keep me on track.  I just love how comprehensive it really is!  Totally worth the $55 its selling for on Amazon!!! 

So that's how I use DTT principles in the school setting and how I determine what to target!  How about you?  Do you have other techniques, ideas, suggestions?  Comment below!

Join me next week when I discuss principles of Dr. Greenspan's DIR/Floortime and Dr. Solomon's P.L.A.Y. Project and how they are helping children with ASD!

As always...happy talking!!!

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