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[Learning-How-To-Learn Series] De-structuring One-to-One Therapy to Facilitate Attention in Children with ASD

Parents often report that although their children with ASD become attentive in one-to-one therapy, they find it hard to focus in natural settings like home and classroom. The reasons for such discrepancies are not hard to identified if we compare how teaching is delivered in one-to-one and natural settings. And only by addressing these differences directly and proactively in one-to-one therapy sessions, it will be more likely for our children to learn successfully across settings.

One obvious difference is the physical environment. In one-to-one setting, teaching is typically carried out at a children’s desk while the child is sitting next to or across the therapist. The level of distractions, such as noise and preferred items, is usually suppressed to a low level to allow children to focus to the teaching easily. In contrast, in natural settings like classroom, there are many physical factors potentially affecting their attention: teacher standing up and pacing around the classroom while students are sitting down, noise and movement produced by peers and distracting items like electronic devices and decorations. To minimize the difference of the two settings, in one-on-one therapy, therapist should actively and systematically de-structure the physical environment to simulate common natural settings. Some examples are changing locations where teaching is carried out, varying distance and positions of therapist and student, utilizing teaching materials typically found at home and in school and keeping distracting items, both visual and auditory, in the environment.



When the physical environment starts to simulate natural settings, in other words, when there are more attractions surrounding a student, it is not surprising for a student to pay less attention, causing more inaccurate responses. The increase in failures will create more opportunities to receive corrective feedback, redo the same trial and be assisted on familiar tasks, and potentially lead to disruptive behaviors like temper tantrum, crying or even aggression. To tackle inattentiveness and related disruptive behaviors, we should adopt a proactive strategy by teaching replacement skills to learn effectively in natural settings and increasing student’s tolerance to distractions and undesired events that come after inattentiveness. Some crucial replacement skills are responding to teacher under distractions, completing multiple-step task without teacher’s supervision, and repairing strategies like observing others after missing an instruction and seeking help from teacher.

Beside changing the physical features in the learning environment, therapist should also look into the intangible qualities found in the teaching process. One important feature is how instructions are delivered. Teaching instructions in classroom are usually less clear and wordier, and often assisted with different types of teaching tools, like writing on the white board, story books and textbooks, props and tools, etc. Therefore, therapists in one-to-one therapy should not be shy away from teaching like how school teachers do by systematically varying instructions and utilizing different teaching materials. It is common that some children with ASD do not understand complex instructions or find it hard to sustain their attention to long instructions, therefore we should also address these learning difficulties by teaching necessary replacement skills to help them to focus and learn effectively.



While de-structuring a therapy environment, therapist should also consider common settings that we would like learning to occur other than classroom. For young children, learning also happens at home, on playground, and in typical places in the community, such as park, library, restaurant and grocery store. To save the time and the cost spent on making a therapy room to look like one natural setting, probably the most efficient and effective way to destruct therapy is to conduct training in the real environment. We should identify and prioritize target settings based on a child’s needs, ability and potential learning environment in the future.


Information provided by:

Ms. Catherine Tam (Autism Partnership Behavioral Consultant)
Ms. Catherine Tam

Ms. Catherine Tam holds a Master of Science in Applied Behavioral Analysis and is a Board Certified Behavior Analyst. She joined Autism Partnership in 2005 and began working as a Program Specialist. She has extensive experience with children and teenagers with autism in one-on-one and group settings. She is now responsible for providing individual ABA therapy and counseling to teenagers and young adults with ASD, supervising individual cases in Hong Kong, and providing professional training and consultation to families and agencies in Mainland China and overseas countries. She also produces ABA training videos and articles in the APSPARKS website for public education.


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