A Therapists Guide to Fix the Developmental Delay of Baby Milestones

boy not listeningI am going to make a statement that might create a lot of controversy. Attention is a learned behavior.

 There; I said it. As a child development specialist, I have heard parents defend, rationalize, justify and excuse their child’s inability to focus and improve based on a myriad of factors. While there may be both medical and developmental considerations that underlie the problem, they do not mean that inattention and/or poor performance is unavoidable.

I am going to make another controversial statement. Medications do not improve focus and attention.

Remember I said that it’s a learned behavior? Well, medications cannot affect learned behaviors. What they are able to do is slow the system so that information can be more readily processed. It gives children time. Once you have time on your side, your child has the opportunity to attend, process and respond. It is this window of opportunity that you want to work with to help your child learn to listen and focus.

Children with developmental disorders such as Autism spectrum disorder, ADHD, sensory processing disorder and dyspraxia all present with focus and attention issues. They can either be unfocused or over-focused. When a child gets over-focused, they cannot disengage and pay attention to other things. This is as much of a problem as not focusing. Many children have no problem attending to things that hold their interest. The problem lies in getting them to focus on other things, like you or their schoolwork.

Behavior based therapy can be used very effectively with all children. It does not matter if they have a diagnosis. The only criterion for implementing behavior management is that you want better behavior from your child.

 An essential component of desired behavior is the ability to respond appropriately. This requires focus and attention. You can work on behavior from the time your child is a baby. Behavior changes are made through reward which is meaningful (when you are working with positive reinforcement) or through “punishment” (I hate that word) which is meaningful.

So let’s talk about how you can use behavior strategies to help your child to manage better socially and academically. I will also discuss what you can do with an infant or toddler to help them with their behaviors. Before I go into specifics, I want to mention that it is very important that your goals for your child are developmentally appropriate and meaningful. Remember I said that the reward or punishment has to be meaningful? The key to success is in making goals realistic, attainable and meaningful. No one, and I mean no one, likes to do something that they are not good at. Of course, you can’t be good at something you haven’t attempted. But most people know when their skills can meet the demands of the task. You know your child better than anyone else. You should have a good sense of their capabilities. That knowledge is what you will need to use when you work with them.

There are four categories of reinforcement which you need to know so that you can help your child. They are as follows: natural reinforcement, social reinforcement, token reinforcement and tangible reinforcement.

 Natural reinforcement generally happens on its own. It’s what motivates most of us. When you hit a ball with a bat and the ball flies in the air, the feeling you get from seeing the ball soar reinforces your desire to hit the ball again. Social reinforcement is the high fives, cheers and applause you get from successfully hitting the ball. It makes you feel good to get approval from others. Token reinforcement is the stickers, stars, money, etc., that you get from a completed task. And tangible reinforcement is food, toys or valued activity that is given as a reward. The latter two should only be used when no result is obtained from the first two.

Depending on the age of the child, you need to decide what to use that your child will work to get. If your child is a baby, food or a toy is usually best. For an older child, a toy, book or activity of their choosing is good.

 Once you have decided what the reward will be, you need to determine at what level you need to start. What I mean is that if your child can’t focus for more than 2 minutes at a time, setting a goal of 20 minutes of homework probably won’t work. With all behavior programs, you want to start easy and with something that seems achievable to your child. You could start with anywhere from 5 to 10 minutes of homework, and with you supervising. Make it positive by encouraging your child and praising them (not too much) for making the effort. Have them work on the subject they do best and that they might already like. You can use a timer for younger children or if your child is very hyper. That makes the time issue more concrete. Try not to help but rather to be a re-assuring presence. If your child insists, suggest that they start and try for a few minutes and offer to help only after you have seen that they made an effort. This needs to be a positive experience. If you see that your child can’t handle the amount of time you’ve decided on, adjust the time so that it’s longer than their usual, but within their capabilities. When they are done, be sure to praise them. If you need to use a token or tangible reward, keep it small for something like this. The reward should be commensurate with the activity. Successful completion of the work should act as a natural reinforcement for your child. What you have done is given an activity which is realistic and attainable, helped your child to be successful, kept it limited so it was reasonable, and included at least 3 types of reinforcement.

baby listeningThe same strategies can be used with a baby who is learning to play. What I recommend is a trick called backward chaining. Essentially, you have your child perform only the last step of an activity. For example, if you are teaching your baby to insert shapes. Sit with them paced between your legs, and with their back against your abdomen. Hold their hand and help them pick up the circle shape and help them bring it to the circle hole. Then have them merely release the shape into the hole. It usually makes a thud, which is a natural reinforcement (as is it fitting in the hole). Clap for them and say “yay” or ‘great” or some other verbal praise. And you can give them a sticker or treat like a single gummy bear. I prefer stickers and to avoid sugary treats. But if food is all that works, then you should use it. This process is repeated every time you work with the shape sorter. As your baby learns to drop it in the hole, you start to decrease the amount of help you give. In 16 years of practice, this technique has never failed to work with any diagnosis, regardless of severity. Success elicits motivation, and makes a child want to be successful again. You can also try what therapists call discrete trials. Speech therapists use this frequently. For example, if you want your child to name an item, such as a cracker. You show them the cracker and ask them to name it, or sign for it. If they do, then you give them the cracker. If not, you hold on to the cracker and prompt them by saying cracker. They need to say the word to get the cracker. Alternatively, for a younger baby, you can show them the cracker and model the “give me” sign. If they do it, they get the cracker. If not, you prompt them again. This method of positive reinforcement helps teach your baby that appropriate responses get them a good outcome.

It would take too long to describe all the behavior techniques that you can use and when and how to use them. However, I do want to go over some general information. I can’t stress enough how important it is that you work on things that are meaningful and appropriate, and that you use meaningful reinforcement. Be sure to start with things that are easy, and then follow with something more difficult. For children who have communication issues, you can work on engaging your child. You can get your child to communicate either verbally or with signs by making them ask for more. Don’t give them as much as they want from the start. Start with a small amount, such as one cracker, and require them to ask for more if they want another. Keep toys and activities out of reach so they need to come to you to get them. Praise them for asking when they do. If they don’t ask, then don’t offer. It is always good to reduce additional distractions when working with your child. Keep work/play areas free of distractions when you are trying any of these strategies. If you don’t think your child heard you, ask them to repeat what you said. That will help to re-focus them.boy responding in school

Many undesirable behaviors can develop with a child who is not motivated . Success at an activity should create the motivation your child needs to want to do it again. It also creates interest, which is an element of attention. Keep in mind that there are very few children, even those with attention issues, who don’t focus on activities they enjoy. Remember I said that no one enjoys anything they are not good at? Well, then it follows that if they get good, the motivation develops to keep them focused on the task. Reward in the form of reinforcement helps build motivation and also self-esteem. Your goal is to help your child build their repertoire of good behaviors. Start by working on improving their attention. They will do better socially and academically, which is a good result for everyone.

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