Understanding How Compliance Works And How to Gain It
What Is Compliance?
Compliance is when the student follows your directions consistently in various settings and time. It is one of the key factors to success in therapy. Consistent compliance occurs when the child test you in various ways and in different settings and then afterwards realizes the best option for him is to follow your instructions. I will explain below:
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1. Why is compliance needed?
2. Why it is challenging to gain compliance from children with ASD?
3. How to gain compliance.
Why Is Compliance Needed?
Children with ASD will require a lot of therapy especially right after being diagnosed. This means they need to follow the instructions of various people like their speech therapist or special education teacher or ABA therapist, etc.. This is more instruction than typical children will receive. Due to their diagnosis, though, they have to receive more instruction in order to gain significant progress. If the children are compliant and follow instructions well, they will achieve a lot of progress. If they are non-compliant, then more time is needed to spend on managing their behavior issues, and less time can be spent on increasing IQ.
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Teaching children with ASD is not like teaching typical children. In “traditional” parenting methods parents try to balance letting the children make their own decisions and telling them what to do. If we let children with ASD decide what they want to do, they will very likely go down the wrong "path" and focus on doing their self-stimulatory behaviors and insist on doing things their way, which is often inappropriate (e.g. play with toys only in a certain way, walk on only family streets, etc.). It is therefore, very important for parents to assertively lead their children down the correct “path to progress.” In order to lead them though, the children must be compliant and willing to follow.
Why It Is Challenging To Gain Compliance From Children With ASD?
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1. Lower IQ
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Children with ASD often have a lower IQ than typical children. This makes it challenging for you to explain to them why following your instructions is important. It’s also difficult for them to understand why they should follow you. Imagine trying to tell someone to follow your instructions but you cannot use explanations and reasoning. For example, when children walk on their toes, a common self-stimulatory behavior, explaining to them that toe walking will hurt their legs and may lead to surgery if they do not stop will not be effective. They will not understand your explanation.
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2. Social Skills
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Many children with ASD also do not have the social skills typical children have. Specifically, they lack the empathy and fear that prevents a lot of children from doing certain inappropriate behaviors. For example, most typical children will not bite another child. There are various reasons why: fear that the other person will get angry and possibly fight back. There's also the fear of the consequences from their teacher and parents. There's also the fear of what their other classmates will think of them. Will they still want to play with them after they bit someone? These are the things that will not influence the child’s thinking before they act.
3. Self-Stimulatory Behaviors (Stims) and Insistent Behaviors
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These two characteristics of children with ASD are major obstacles to gaining compliance because they care about doing these behaviors more than what you are trying to teach them. For the stims, children with ASD can do things like play with their fingers or talk to themselves constantly throughout the day. It is done because it is reinforcing to them but they will do it sometimes as a way to escape from doing something. They learn if I talk to myself, then others will leave me alone and not ask me to work on tasks or do chores. As for the insistent behaviors, they strongly want to do things their way for some reason that only they know, therefore, when you try to teach them the correct way to do something, they will not want to do it. To illustrate, if they like a particular color, they may only want to wear clothes of that color and not other colors. They may like only particular foods and will tantrum if you don’t give them those foods.
Procedure For Gaining Compliance From A Child With ASD
I. Do an assessment of the reinforcers
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Due to certain characteristics of a child with ASD such as low IQ level, not being able to understand what others feel, and their insistent behavior, trying to explain the reason why they should listen to you is not effective. On the other hand, finding what they like and using those things as a consequence can produce effective results.
Before trying to teach them to listen to your instructions, Find out what they like. Make a list. Prioritize them to show which are most liked on downward. If it is difficult to figure out what they like, find what they like then think of varieties from that category. For example, if they like to eat chips, find different flavor chips or other crunchy salty snacks similar to chips. If they like cars, try introducing other vehicles like trucks, buses, vans, construction vehicles, etc. If he likes chocolate, find other kinds of chocolate. Find videos and books about chocolate.
II. Decide on the rules concerning the targe behavior
Next, determine the consequences for following the rules and for breaking them. For example, a child keeps asking for a toy despite being told many times by his parents that he cannot have it. The rule here could be he cannot ask about the toy for 3 minutes (a timer will be set). If he follows the rule, he can watch 5 minutes of a video he gets to choose. If he doesn’t follow the rule, he has to write, “I will stop asking about the toy” ten times.
Parents, teachers, therapists, and other people living with the child must all be on the same page. Everybody must know the rules. If one person gives one consequence while another gives a different consequence, the child will be confused about what to expect. He will also behave differently depending on the consequences given by that person.
III. Give the child opportunities to experience the consequences
Let him test the boundaries you have set for them. When they receive a sufficient amount of the consequence, they will learn to fear breaking the rules. If they do not experience the consequences sufficiently, they will not learn and keep testing. In reference to our example above, allow the boy to ask about the toy. If you tell him to be quiet before he is allowed to ask, you will not give him the opportunity to experience the consequences.
IV. Apply rules and consequences to other behaviors and settings
It is important to teach the child he has to follow the rules not just, for example, with Mom, but with other people as well (e.g. Dad, grandma, his teacher, etc.) . He also has to follow the rules not just at home but also at school and other settings. This process of applying rules and consequences to different people and settings will teach him his actions are accountable all the time. As you do this more frequently, he will get used to you writing rules and setting up consequences. He will learn to follow the rules quicker and with less and less resistance.
Two important points to keep in mind
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1. When starting to teach your child to be more compliant, select actions that you can follow through with if he doesn’t do what you want. Do not start by asking him questions he has to verbally respond to because if he refuses to respond, it can be very challenging to follow through and have him say what you want. For example, ABA therapists will usually start with 1-Step Directions which consist of actions like clap, wave, give me object, and point to a body part. If the child is non-compliant and does not do these actions, you can, for example, take his hands and clap for him, or you can hold his arm and wave for him. If you select something like, say, “Good morning,” and he doesn’t want to say it, you cannot physically make him say it.
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Once you achieve consistent responses with these 1-Step Directions, proceed to ask questions that require a verbal response.
2. Do not be afraid of the child’s tantrums or other inappropriate behaviors. If the child sense that you are afraid of him, the whole teaching process will change. He will use that fear you have to get what he wants. This is easier said than done, but you have to remember that the child will grow bigger and stronger, so it’s a situation of do you want to decrease his inappropriate behaviors now or when he is bigger and stronger and likely will be more non-compliant. This is why a lot of research shows teaching while the child is younger produces more results. As the child grows older, the behavior issues become more intense and will present a significant obstacle to progress.
Examples Of How Behaviors Are Increased Or Decreased
Come Here - Gives Reinforcer
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Parent: "Come Here."
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Child: (walks to her mother within 4 seconds)
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Parent: "Thanks for coming over." (gives child a hug)
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Parent ask child to
go to her
Child goes to her
parent
Parent gives a
reinforcer
immediately after
behavior
The reinforcer (praise and hug)
will increase the likelihood the
child will go to his parent after
being told to in the future
Antecedent
(The instruction)
Behavior
Consequence
Behavior will increase or decrease
in the future
After the child performed the task, a positive consequence was given (praise and hug). The
child will continue to listen to her parent in the future.
Come Here - No Consequences
Parent: "Come Here."
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Child: (keeps watching video)
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Parent: "Come Here. I need to talk to you."
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Child: (no response)
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Parent: "Hurry up and come here please."
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Child: (keeps watching video)
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Parent: (Parent gives up and lets child keep watching video)
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Parent ask child to
go to her
Child does not
respond
Parent does
nothing
Child will continue to not
respond in the future
Antecedent
(The instruction)
Behavior
Consequence
Behavior will increase or decrease
in the future
If the child does not receive any kind of consequences for doing or not doing the task, she will continue to respond the same way.
Come Here - Follows Through
Parent: "Come Here."
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Child: (keeps watching video)
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Parent: Four seconds after the child did not respond, parent go gets the child
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Child: Child walks over to her parent
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Parent ask child to
go to her
Child does not
respond
Parent has the
child go to her
Child will more likely listen next time knowing her parent will follow through
Antecedent
(The instruction)
Behavior
Consequence
Behavior will increase or decrease
in the future
The parent followed through which taught the child if she does not listen in the future, her parent will still make her do the task by herself.
Give Me - No Consequences
Parent: "Give me the toy."
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Child: "No." (child runs away with the toy)
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Parent: (let's child run away with the toy)
Parent ask child to
give him the toy
Child does not
give toy and runs
away
Parent does
nothing
Child will continue to not
respond in the future
Antecedent
(The instruction)
Behavior
Consequence
Behavior will increase or decrease
in the future
The child learns if he runs away he can keep his toy because his father will not chase him. He will very likely respond this way again in the future.
Give Me - Give Consequence
Parent: "Give me the toy."
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Child: "No." (child runs away with the toy)
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Parent: (Parent immediately gets the child and retrieves the toy and tells the child he cannot play with his Ipad for two days because he ran away)
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Parent ask child to
give him the toy
Child does not
give toy and runs
away
Parent gets the toy
and gives a
consequence
The child will likely not running
away in the future
Antecedent
(The instruction)
Behavior
Consequence
Behavior will increase or decrease
in the future
The child learns running away is not an effective way to keep playing with his toy because his father will chase him, and he will lose his Ipad privileges. He will likely not run away in the future.
Put On Clothes - Gives Reinforcer
Parent: "Put on your clothes please."
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Child: Child puts on clothes independently.
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Parent: "Great job putting on clothes by yourself. You can listen to music in the car."
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Parent asks child to
put on clothes
Child follows the
instruction
Parent gives a
reinforcer
The reinforcer (music) will increase the
likelihood the child will wear clothes
independently after she is told to in the
future
Antecedent
(The instruction)
Behavior
Consequence
Behavior will increase or decrease
in the future
After the child performed the task, a positive consequence was given (music). The child will continue to listen to her parent in the future.
Put On Clothes - No Consequences
Parent: "Put on your clothes please."
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Child: (keeps playing with his toys)
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Parent: "Come on. Put on your clothes please."
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Child: (no response)
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Parent: "Put on your clothes. We will be late."
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Child: (keeps playing with his toys)
Parent: (Parent helps child put on clothes)
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Parent ask child to
put on clothes
Child does not
respond
Mom helps child
put on clothes
Child will continue to not
respond
Antecedent
(The instruction)
Behavior
Consequence
Behavior will increase or decrease
in the future
The child learns if she doesn't respond, her Mom will put the clothes on for her. She will very likely respond like this again in the future.
Put On Clothes - Follows Through
Parent: "Put on your clothes please."
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Child: (keeps playing with his toys)
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Parent: Four seconds after the child did not respond, parent takes away the toys and watches the child put on his clothes by himself.
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Child: Child puts on clothes independently.
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Parent: OK (simple praise)
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Parent ask child to
put on clothes
Child does not
respond
Parent follows
through and has
child do the task
by himself
Child will more likely listen next
time knowing her parent will
follow through
Antecedent
(The instruction)
Behavior
Consequence
Behavior will increase or decrease
in the future
The parent followed through which taught the child if she does not listen in the future, her parent will still make her do the task by herself.
Yelling and Screaming - Correct Consequences
Parent: "You cannot drink soda tonight..."
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Child: "I want soda." (child yells and screams)
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Parent: "If you want soda, ask me nicely, 'When can I drink soda?'"
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Child: "When can I drink soda?"
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Parent: "If you don't yell, you can drink soda tomorrow. If you yell, then you have to wait until Friday (2 days later). Do you want soda tomorrow or Friday?"
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Child: "Tomorrow"
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Parent: "Good choice and good saying that nicely."
(At this point the child is still thirsty. You can offer him something else to drink. Don't offer soda or something better than soda like an ice cream milkshake because he did yell. Giving him something better will reinforce the yelling. Prompt him to ask you nicely for the drink.)
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Child: "Can I have juice please?"
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Parent tells child
she cannot have
soda
Child yells and
screams
Parent teaches
the child
With more responses like this from the parent, the child will yell less. She will learn it is more effective to ask for things nicely than to yell.
Antecedent
(The instruction)
Behavior
Consequence
Behavior will increase or decrease
in the future
One of the best ways to decrease yelling is to correct the child immediately and teach her to say what she wants nicely instead. Not responding to them until they ask nicely is a very effective method.
When a child has difficulty hearing "no" for an answer, prompt her to ask you, "When can I have (desired item)?" Knowing that they cannot have it now, but at a later time will make it easier for them to accept because they will know when they can expect to have it.
Yelling and Screaming - Wrong Consequences
Parent: "You cannot drink soda tonight..."
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Child: "I want soda." (child immediately yells and screams)
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Parent: "You cannot have soda, but you can have ice cream?'"
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Child: (Child stops screaming and eats the ice cream)
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Parent tells child
she cannot have
soda
Child yells and
screams
Parent offers ice
cream to stop the
screaming
Soda and ice cream are both
positive reinforcers to the child.
The child learns she can manipulate her parent if she yells and screams. Child will
continue to yell in the future.
Antecedent
(The instruction)
Behavior
Consequence
Behavior will increase or decrease
in the future
Yelling is an inappropriate behavior. Giving a positive reinforcer (ice cream) after the yelling will increase the likelihood the yelling will happen again in the future. Giving the child something she does not like (e.g. chores or loss or privileges) would have decreased the behavior in the future. It's important to know what the child likes and dislikes in order to clearly know what can be used as effective consequences.