Therapists can help teach people with autism useful skills to improve their quality of life. One therapy that is often used for autism is application of the science of behavior or Applied Behavior Analysis (ABA).
Autistic individuals may be uncomfortable and even uncooperative in social interactions, which makes therapy sessions difficult. One way to improve the changes of effectiveness is to use pairing.
What is Pairing in ABA?
Pairing means connecting a therapist with their student’s favorite items or activities. When autistic people associate these good times with their therapist, they will become more comfortable in their presence. This seems like an easy concept, but it is very important for the therapist to start with enjoyable activities rather than introducing demands early on.
Pairing generally increases the chances of children attending therapy sessions and successfully engaging in the activities there. Pairing helps autistic people develop a relationship of trust and comfort with their therapist, which allows them to respond favorably to the therapist’s instructions.
Initially, ABA sessions are all about pairing. This may involve doing everything the autistic client prefers with little to no restraint. Having a low-demand and high-reward situation initially helps to build rapport with the autistic person, forming a trusting relationship with their therapist.
The Science Behind ABA Pairing
Behavioral Foundations
Pairing is based on key behavioral principles, like reinforcement theory, which uses preferred items to create positive associations with the therapist. The concept of establishing operations highlights how antecedent conditions (like offering desired items) increase the value of a therapist’s presence.
Evidence-Based Approaches
Research shows that pairing therapy with positive reinforcers plays a crucial role in boosting participation and engagement. A study published in Behavior Analysis in Practice highlights how pairing pre-session conditions, such as preferred items and therapist presence, can positively influence a child's behavior and preference for therapeutic conditions. This approach reduces challenging behaviors, improves cooperation, and enhances the overall effectiveness of ABA therapy sessions.
Customizing Pairing for Individual Needs
Adjusting for Developmental Stages
Pairing strategies change depending on age and ability. Younger children might engage better with sensory activities, while older individuals may connect more through shared interests like games or conversations.
Considering Sensory Preferences and Non-Verbal Cues
Pay attention to sensory needs. For instance, children who are visually focused may enjoy light-up toys, while non-verbal cues like eye contact can show when a child feels comfortable or ready.
Handling Unique Challenges
Some children may prefer parallel play before engaging directly with others. Starting with activities that focus on parallel play can help them gradually build trust and comfort.
Tracking Progress in Pairing
Measuring Success with ABA Data
ABA data collection methods, such as frequency counts, duration, or interval recording, help track engagement levels and reductions in escape behaviors. This allows therapists to monitor progress in real-time and ensure pairing is effective.
When to Adjust
If a child shows signs of disinterest, avoidance, or challenging behaviors, this may indicate a need to reassess the reinforcers or modify the pairing process to maintain positive outcomes.
What Does Successful Pairing Involve?
Successful pairing means the child feels comfortable and excited about their therapist. They associate the therapist’s presence with enjoyable things and are more willing to engage. Signs of success include:
- Eagerness to attend therapy
- Fewer challenging behaviors
- Willingness to participate in activities
- Engaging with the therapist through their actions
- Staying near the therapist throughout the session
- Facial expressions and sounds/words that indicate success
Does Pairing Cause Therapist Dependency?
It can be worrisome to assume the child will only comply with the acquired skill or behavior in the therapist’s presence but that is not the case with pairing. Pairing allows autistic people to dissociate the activity from the therapist, this means that even if they don’t like the activity or find it enjoyable, they can still successfully complete the task or sit through the entire therapy session.
Is Pairing Permanent?
Pairing is not permanent. This means after a long break, illness, holiday, or change in setting, it is often necessary to go back to pairing. Therapists usually use pairing on an ongoing basis to avoid this risk.
How to Pair with People with Autism?
As autism is unique for each individual, pairing can look different for every client the therapist has. The nature of pairing and the time taken to achieve it depends heavily on the child’s skill level, developmental age, interests, and overall tendency to interact with others.
However, regardless of the time it takes to build rapport, the process is more or less the same. Here are some simple steps involved in the pairing process:
Step 1: Observe
The first step for the therapist is to observe the autistic person and see what they are interested in or steer away from. Therapists can also conduct a preference assessment by interviewing the client’s parents. Caregivers, teachers, or other family members to see what they like and don’t like, or which activities they enjoy, etc.
Step 2: Become Secondary Reinforcer
Then the therapist has to provide their favorite things or activities in the therapy sessions without making any demands initially. This is just to allow the autistic client to associate the therapist with their favorite items, and make them look forward to the therapy sessions. The therapist becomes the secondary reinforcer by associating with established or primary reinforcers to build rapport.
- Remember: No Restrictions
Initially, the autistic client does not know the therapist. So how can they follow the therapist's instructions, what will motivate them to carry out the therapist’s requests? This is why it is important to hold off on any specific demands or instructions till after rapport has been established between the client and therapist.
Step 3: Restrict Access to Primary Reinforcers
After the autistic person has become comfortable with the client and begins to trust them, they can slowly start restricting access to the primary reinforcers. This can look like completing a puzzle before playing with their favorite toy or following a clean-up routine before going to play outside.
It is important to keep changing the reinforcers to ensure the client’s motivation remains intact. In addition, the demands should be introduced slowly to avoid overwhelming the autistic person.
- Remember: No Playtime without the Therapist
For therapy to be effective, the therapist’s room has to be the most interesting place for the client. They should not want to go anywhere else and the therapist’s company should be the preferred company. This means the autistic individual wants to play or complete the activity with the therapist and follow the therapist’s instructions, not in isolation.
Benefits of ABA Pairing
ABA pairing is a key part of the therapeutic process, helping to shape a positive experience for both children and caregivers. It lays the groundwork for progress and sets the stage for success in therapy.
Tips for Effective Pairing
Pairing is a unique relationship between the therapist and their client - each autistic person will bring their own set of challenges and pairing is not always easy. It can also take longer than expected for the child to be successfully paired in ABA therapy sessions. Nevertheless, pairing is an indispensable part of ABA therapy and has a great impact on the success of the therapy sessions. Here are some tips for effective pairing:
- The therapist should allow the client to lead initially to learn what their reinforcers are, and what type of settings they are comfortable in.
- The therapist can place reinforcers like toys or edibles (as approved by the parents) in a place where they are visible but inaccessible for the autistic person, for example, a high shelf or a locked cabinet. This way they will need the therapist to access their favorite items and therefore, learn to associate the therapist with the reinforcers. Never block access to something the child needs; and do not always require the child to engage with the therapist in order to access a reinforcer. Pairing is a complex process and parents should be involved.
- The therapist should keep changing the reinforcers to prevent the client from becoming bored. Incentives need to be present in each situation.
- When pairing, the therapist should only comment on the activity or praise the client for their progress. They should avoid asking questions or giving instructions because, without an established rapport, the client will not be comfortable with following instructions or rules.
- If the client wants to play independently or does not want to interact with the therapist, then that is a sign to restart the pairing process.
- Even if you have determined the pairing process has ended for the time being, it is important to always gain assent during therapy.
Conclusion
Pairing is a necessary, non-negotiable first step in implementing any therapy for autism, especially ABA. Therapy sessions are successful only if the autistic clients engage in the process, participate in the planned activities, and show positive progress.
Without a good, trusting relationship with the therapist, therapy can be difficult or even impossible. Pairing allows the autistic client to reach a safe zone in the therapist’s presence, and learn to associate them with their favorite items/activities. Therefore, pairing is necessary to make any autism therapy effective.
