About 3 years ago, I had just headed out on a walk with Tony and Hannah when Andy called me. The garage door had broken free from its rails and he was trapped inside the garage. Because I was strength training pretty heavily still at that time, I was physically the strongest person in our family and he needed my muscle to help get the door up so he could get his car out. We were about two blocks from our house.
I let both of our kiddos know that we would need to be going back to help out their father. Tony was not happy (that is definitely an understatement), making multiple attempts to elope and push past me, ultimately refusing to go back. So I had no other choice than to carry him back to the house because he wasn’t going to cooperate on his own. I realized then that we had more problems with directional flexibility than I had heretofore realized, because typically we never had to go back to the house right away. But sometimes life circumstances require us to do just that, and I knew as fast as he was growing because of Sotos, a time would be fast approaching that he would be far too big for me to safely carry.
What follows is how we implemented an idea of mine starting first in habilitation with Emily, which has now been expanded into Tony’s ABA sessions with Casandra. This is a therapy goal that we started and stopped a couple of times until early last winter (when we incorporated it permanently into his programs until mastery).
For Tony, who has level 3 Autism, he is not motivated at all to complete something he finds aversive for praise. He can love you and still feel that is a very separate matter from whether or not he should cooperate with something he doesn’t want to do. He also does not do well being promised rewards in the future that he can earn with certain choices or behaviors (therefore token systems- which he finds far too abstract to apply to what he wants- also aren’t very effective with him) because his impulse control issues are substantial and he’s very focused on the now and what he wants in that moment.
The top two motivators for our little man are french fries and TV. Because he gets french fries less, they are much more effective to use as a reward for modification. How we set this up was the first few times we ran this program, Emily would walk ahead of us about 20 feet, stop, and then tell Tony to come to her for the french fry. If he didn’t wait for her to call for him, he didn’t get the french fry until he came back to me, waited appropriately, and came when she asked. I would stay with Tony to be the blocker in case he did something unsafe, like try and elope towards to road. If he did elope (or run towards some place he shouldn’t), he would also have to go back and start over until the process was correctly completed.
Emily holding the french fry and calling to Tony, December 2020 
Tony, running towards the fry. 
Waiting for Emily to ask for him to come to where she is
Once Tony had his french fry, Emily would then walk back the opposite direction a random amount and we repeated the process of having him come to her when she called him. The first day we just worked on going back and forth for random distances along one direction of the street block our house is on. The next session we ran this program we would do it on a different side of the street block. After a few weeks of this, we expanded it to doing back and forth directional changes for longer walks, making sure we did not closely mimic any of his preferred routes initially so that he could focus on the concept of flexibility. Then we moved to making these kinds of changes along his typical walking routes. And once he adjusted to the idea of making route changes, we stopped having the therapist go ahead and call for him, he is just asked to follow or walk with that person and then given the reinforcer once he’s successfully walked about 50 feet or so in the appropriate direction.
Currently if you want Tony to have high levels of flexibility and be safely cooperative on a walk on the streets of our community, french fries are needed. But if french fries are used too often, they loose motivating power. So when we looked to expand this program so that he could generalize flexibility with other providers, we spoke with his ABA team and we decided that we would make a few modifications for implementation with Casandra.
Since we couldn’t use french fries, we’d have to use a reinforcer that has less motivating power. We tried out a few different things (preference assessment) to see what would be effective, and ultimately landed on mini gluten-free chocolate chip cookies. For his ABA sessions with Casandra, we focused first on making only one change per route. When he could do that without pushing or eloping over a period of time, we increased the number of expected changes to 2. Just this week he advanced to a third change per route, though right now depending on the day it’s too hot to walk when Casandra comes in, so progress on this goal and generalizing with her has slowed down over these past couple of months, where evening temperatures are often still above 110 at the start of her shift.
When we go into stores, we can’t use food motivators right now because we are still having Tony wear a mask for his own safety. What I have found in those environments is that we have benefited greatly from him being out of the stores for nearly 9 months because of the pandemic. I was initially quite concerned that the severity of his sensory issues would give us some significant regression in his ability to tolerate public places being out that long, but thankfully there was only a modest decrease. However, the length of time we were out of the stores coupled with the practice in making route changes outside meant that he was able to more easily let go of his preferred walking routes inside of stores that we had done extensive work in, and his flexibility on those trips is currently unreinforced and at a much higher level than it is for community safety walks run with cookies alone.
As the weather cools down, we’ll soon be making a switch and giving Casandra the power of the french fries so that we can more rapidly expand the number of changes he is willing to make for her, with the ultimate goal of fading the reinforcers to the point where they are no longer needed on the community streets also. This typically happens once he has habituated a certain behavior and it has become his new routine. French fry flexibility is what works for Tony- his preferred motivators might not be as interesting to another individual with similar desires for a rigidly unvarying route or routine. But the concept can still be used as needed with just swapping out the reinforcers to something valued more by the particular individual.
