Meet Them Where They’re At

Recently, I was in a session with a young elementary individual who has a particularly hard time staying still. We use a written schedule, structured activities, work towards a preferred activity and offer hand fidgets and provide frequent verbal reminders to sit still. But on this day, they were particularly wiggly, especially as they started to tell me about a jump rope challenge they are having at school – trying to jump rope 100 times. As they popped up out of their seat (again) and began to “air jump rope” to demonstrate, instead of another prompt to sit down or reminder of our schedule, I rolled with it. I started counting. They did 100 air jump ropes right there, in the middle of my speech room. And guess what? As soon as they were done, they sat back down, a little out of breath but very pleased, and stayed seated and engaged the remainder of the session. Ultimately, we lost about 2 minutes of the session, but got optimal engagement for the vast majority of the time. How much time would I have lost otherwise continuing to redirect, struggling against that urge to move out of the seat? I can’t say for sure, but at LEAST 2 minutes seems like a fair estimate.

Meeting them where they’re at can be hard. Even when we chart review or get a referral report, we don’t know who is going to walk through the door. Even when we’ve known them for months – or years – we don’t know what’s going on that day. We have goals to address, data to report and a limited amount of time to do so. But it’s OK to deviate from the plan. It’s OK to modify goals, environment, expectations, entire treatment plans as you go. It’s ok to get it wrong a few times before you get it right. But when something isn’t working, figure out what adjustments you can make. Here’s some of my go-to modifications.

• Change the environment. Can you go to a different room or area with fewer distractions? If that’s not an option, can you modify the environment you’re already in? Some ways I’ve done this is locking drawers, using gym mats or cabinets as barriers, putting “stop” signs or other visuals on objects that shouldn’t be touched, switching chairs so they are looking at something else, moving things off the walls or shelves. Have them sit on a yoga ball or wobble seat to get movement input. If you know what the triggers or distractions are, be set up before they arrive so that the problem can be avoided all together.
• Build in breaks, and adjust individually. You’ll get to know pretty quickly how long you’ve got with each individual. Sometimes a few minutes at the end of session to do a preferred activity is motivation enough. Sometimes you’ll need intermittent pauses to talk, play, or get some movement. For some, short but frequent breaks are best (eg, complete one target task, earn 1 turn at a game). Others may benefit more from a longer burst of activity and a longer break (ie finish one full worksheet or activity and play one round of a game). Consider their attention span, ability to alternate between tasks, transition, etc. Even for the those who don’t “NEED” a break, I still like to provide some opportunity for individual connection, whether it is a preferred activity, reinforcer or just conversation.
• Re-negotiate or implement “ONE MORE” Sometimes, even when we have a built in break, it’s clear that we aren’t going to last through the whole activity. Focus is fading, wiggling has begun, maybe there is whining, complaining, verge of tears. When we get to this tipping point, I try to catch them before all is lost – I might re-negotiate the rules of the activity (“ok, how about THREE words until your break instead of ten?”) If we are really on the edge I will try to get “just one more.” Basically, I try to catch those moments where we are going to have to take a break regardless of whether it is on my terms or theirs and make sure it stays on my terms. The crying or escaping isn’t what got them out of the work. It was their effort and our joint collaboration.
• Change how you target your goals: Instead of sitting at a table and naming picture cards, put them around the room or hallways and do a scavenger hunt. Trade roles and let them be the leader for a few minutes and teach YOU their goals. Use active activities – ball toss, freeze dance, swings, trampolines, scooters. Use preferred characters in stories to target sequences or story grammar. Use songs with target sound or word type.

Of course, I approach from my area, speech therapy, but these concepts can be applied to a number of other areas including OT, PT, social work, rec therapy, other therapies, tutoring, home schooling and more.