Bridging Sensory Processing Theory and Practice with Discrete Trial Teaching
By Amy Zier, M.S., OTR/L and Kimberly Garvey Hoehne, M.A.
What is Discrete Trial Teaching?
Discrete trial teaching (DTT), often used in Applied Behavior Analysis (ABA) programs, is a methodology aiming to help children learn developmentally appropriate skills of imitation, receptive/ expressive language, pre-academic concepts, social relations, toy/peer play, and self-help/adaptive abilities. A discrete trial consists of an instruction or question to the child, the child’s response, reinforcement or consequences, and prompting, followed by fading prompts, as necessary. Skills are broken down into small, manageable tasks according to the child‘s level of ability. The method promotes natural learning by teaching children how to learn from their environment.
What does sensory processing have to do with DTT?
Children who have difﬁculty processing sensory information often cannot efﬁciently utilize the range of learning activities used in DTT. They may respond to the daily experience of touch, movement, sight and sound with a variety of negative behaviors and be unable to sustain an optimum level of arousal. However, when a DTT therapist makes adjustments to accommodate a child’s individual sensory processing proﬁle, that child is more likely to master skills and concepts and generalize them across settings.
How can DTT therapists and parents at home bring sensory processing concepts into their interactions with children?
- Modifying environmental stimuli. Be aware of sounds and sights which may distract the child. Lower your voice for the hypersensitive child. Organize or limit the use of visual materials that are too exciting or distracting. Use light or heavy touch depending on the child’s level of sensitivity.
- Encouraging posture during seated activities to enhance attention. The child’s feet should be stabilized on the ground for sensory feedback and support. A Move N’ Sit cushion or wedge may help the child with low muscle tone or inadequate postural stability to keep the pelvis in a position that will facilitate muscular activation and arousal.
- Providing opportunities for individualized sensory input. Children need different sensory inputs at different moments throughout the day depending upon their physiological state. Sometimes touch will help a child focus, while at other times movement is more helpful. Each child has a unique sensory proﬁle and varying responses to different inputs on a moment to moment basis. Allowing a child to choose, rather than prescribing the input in a standardized manner, may enhance regulation. However, children with motor planning difﬁculties may be unable to initiate or sequence the steps necessary to obtain the input needed for helping them to be calm and attentive.
- Adapting imitation/object manipulation programs. If a child is having difﬁculty with imitations of actions across space, pair the imitative action with objects on the body. This type of interaction may also enhance social relatedness. For example, imitating the therapist putting glasses on/off, silly hats on/ off, patty-cake, peek-a-boo, or giving/receiving objects paired with affect cues. Imitation is a stage of communicative interaction which becomes increasingly intentional and referential throughout early childhood years. Imitation between peers notably increases social interest and eye contact. Children’s attention has proven to be more partner focused when both partners hold the same toy. Therefore, forming dyads of children using two identical objects in the context of object manipulation/imitation may enhance social reciprocity as well as imitation.
- Using reciprocal social praise to enhance self-regulation, attention, and social responsivity. In order to enhance purposeful communication, the therapist may simply wait to give praise until the child provides an affect cue by gaze, gesture, or vocalization. Using "rhythmic praise" in these frequent moments during DTT is effective because the therapist is not overwhelming the child with praise but waiting for a response, giving him/her a very natural experience of conversation.
DTT and Sensory Processing Perspective: A Good Combination.
Both DTT and sensory integration therapy are important tools for working with children on the autism spectrum. When therapists take underlying sensory issues into account and integrate the sensory modality into DTT, children improve in their ability to attend and to maintain appropriate levels of arousal. As a result, they achieve an optimal state for interaction and learning. Children are the winners when DTT is enriched with sensory integration practices.
[Amy Zier treats children with autism spectrum disorders in Libertyville, IL. Kimberly Garvey Hoehne is a child development specialist at Early Intervention Approaches, also in Libertyville.][Initially published in New Developments: Volume 6, Number 3 - Winter, 2000-2001]