16/09/2020
Physical Guidance! Teaching a new skill
For many young children and those with severe learning abilities, physical guidance is often used as a training tool. With physical guidance, the trainer (teacher/parent) uses their physical touch (e.g., hand over hand) to guide the child through the desired movement, until the child learns to do it without guidance. As the child learns what is needed, the physical guidance is gradually faded out until the child can implement the response on his own. This procedure is often used when the child does not respond adequately to verbal prompting, visual prompts, gestures, or demonstration (modeling what to do).
For example, when prompting the child to brush his teeth, the parent may say “brush teeth” (verbal), show the child the toothbrush (visual), or model the response (brush their own teeth). If no response, the trainer might place the brush in the child’s hand and physically guide the moment, either to start the response or assist the child in brushing part or all his teeth. Usually, for longer, more complex skills like tooth brushing, the task is broken down into simpler steps (pick up the brush, wet brush, put the paste on the brush, etc.) and taught only one step at a time.
The use of physical guidance can bring with it inherent problems. First, some children are tactile defensive and find touch distracting or extremely uncomfortable. Their brains will reactive negatively to the touch, and the child will resist the guidance. Also, some children have a defensive reaction to anyone physically forcing movement. Unless they have total control over the action, they may resist it. For other children they may be passive and allow others to physically guide them without making any active attempt to do it on their own or to learn from it. Lastly, unless faded quickly, many children become overly dependent on physical guidance and will not respond without it. On the positive side, using physical guidance maximizes success by minimizing errors (errorless teaching). It allows the children to feel the “correct” response, so they have a mental map of how to do it...
There are different techniques in using physical guidance. Some people provide “prompt fading,” which may require full physical assistance and then systematic fade the location of the assistance as the child becomes more independent. Usually, guidance starts with hand over hand guidance to allow the child to feel the right motor pattern. Once the child has a chance to experience the motor pattern we start to change the location of our physical guidance to give the child more responsibility in implementing the response (e.g., brushing teeth, washing hands, dressing, etc.). Usually, this consists of gradually moving our location of guidance up the hand to the wrist, then the forearm, elbow, upper arm, etc. By moving the location of guidance further up the arm, the child takes on more responsibility for the action.
Another strategy for fading the hand guidance is by keeping the location of guidance the same but lessening the amount of pressure and guidance that you provide. While keeping the guiding hand in the same location, the trainer slowly releases his pressure, from full guidance to partial guidance, until he is simply shadowing the child’s hand as the child more independently performs the action.
The approach I prefer is called “graduated guidance.” With graduated guidance, you use the least amount of assistance, at any given moment, to initiate the response and keep it going through completion. My hands shadow their hands. I may provide a light touch to nudge them to initiate the response and use only enough pressure to get them moving. Once moving, I immediately fade back the pressure and guidance, as long as they are moving on track. If they stop, I reinstate only enough pressure to reinstate the desired movement. I keep my hands shadowing theirs. If they start to steer off course, I am framing their movement to redirect them back on the right path. From moment to moment, my touch and guidance will fade in and out, providing touch and pressure only if needed, allowing them to “do it themselves.” I steer their response, rather than physically making the response.
What I like about the use of “graduated guidance” is that (1) I am framing the response with my guidance to ensure the correct action, (2) the child is actively initiating the movement (I just direct the child’s willful movement), and (2) the child feels himself mastering the response (rather than allowing me to do it for him). I also am always fading my touch, rather than waiting and trying to fade it out later. There is less chance for the child to become conditionally dependent on the guidance. I am assisting by framing the child’s movement, rather than doing it for them.
For tasks that require both hands, I often work from behind the child (only if they feel comfortable with it). I shadow both their arms and hands with my arms and hands. They can better see the framing, even though I may not be touching them. I may start by framing my arm and hands only an inch outside of theirs, as to block any erroneous movement or gently nudge forward movement, so they can “see” and “feel” themselves doing the correct response. However, they always feel “themselves” doing it while feeling the “mastery” of completing it.
My preferred choice of teaching is demonstrating and modeling, doing the task together, in “we-do” fashion. We do the task together, with the child learning by observing and doing it together with me. The child learns by “doing with me,” referencing and learning through watching and copying my actions. However, if the child cannot learn that way or the response is too complex for them to learn by observing then doing, then I will use “graduated guidance.” If done correctly, it is very effective. However, it is important to respect the child’s responsiveness to such guidance. If they are actively resistant to such an approach, I avoid using it.
This series on “mentoring children on the spectrum” can be found in the green book “Autism Discussion Page on Anxiety, Behavior, School and Parenting Strategies.”
