Using Reinforcement to Build Hand Skills

What is Behavior Modification?

A basic principle in shaping or modifying behaviors is that people want to repeat an action that leads to a desirable outcome. This is commonly referred to as a positive consequence. A simple example is:

  • Joey is sitting on a horse;
  • his therapist tells him to "hold the reins and say 'go'";
  • Joey follows the directions;
  • the assistant begins to lead the horse to walk.

In this situation, the therapist is attempting to modify his behavior to

  • increase attention,
  • follow directions,
  • communicate,
  • and motor plan to hold the reins, etc.

Movement functions as a positive reinforcer. Click here to learn more about the power of equine movement.

A reinforcer is a reward or an event that increases the likelihood of a behavior occurring. Reinforcement is best used to encourage positive behaviors. But sometimes adults unintentionally reinforce negative behaviors. An example is when a child learns that he will get a candy bar every time he screams in a restaurant and parents comply because they want to enjoy the meal.  Undesirable  behaviors often decrease if they are ignored. Used carefully, reinforcement can be very effective.

Finding Effective Reinforcers

Parents may use these principles when giving praise or Ipad time to the child who tries out a new vegetable but not to the child who refuses to attempt eating non-preferred foods. Note that praise and the Ipad only function as reinforcers if the child likes praise and Ipads.

Every child is an individual, so what is rewarding for one child may be meaningless, or even a negative consequence, for another. For example, parents usually think of "time-out" as a negative consequence. But for a child with Sensory Processing Disorder (SPD), time-out could be enjoyable because it offers a few minutes of "down time" when the child is getting overwhelmed. Similarly, a child who does not respond to words and avoids physical contact may find a hug and "I love you"  an undesirable experience.

The following lists a few reinforcers that children may like. Notice that many of them address sensory needs:

  1. stickers
  2. video or computer game time
  3. time with a favorite person
  4. a preferred food
  5. hand lotion
  6. a whiff of perfume
  7. one minute of being left alone-for the child who needs a break after working hard.
  8. playing on a swing, trampoline, merry-go-round, slide, or other movement equipment
  9. Time holding or playing with vibrating objects/toys
  10. Holding a "sensory bottle" such as the one shown above. It is filled with Karo syrup, beads and glitter.

The following video explains how to use sensory-based reinforcers to promote skills.

Intense Behavioral Interventions

Intense behavioral interventions for children with an Autism Spectrum Disorder (ASD) have been well researched and shown to be effective in teaching language cognitive, self-care, and play skills (2009, Case-Smith)

These interventions are "intensive" because they are provided several hours daily, perhaps by parents or by professionals working in the home or school. One commonly used intervention is called Applied Behavior Analysis (ABA). For many children with ASD, interventions that involve sensory-based reinforcers may be effective in promoting functional hand use.

Behavior Modification Terminology

The following are simple definitions of terminology commonly used by behavior therapists:

  • Mand-request for an item, action, attention, info
  • Operant-a behavior defined in terms of antecedent (what occurred before the behavior)  and consequence(what followed the behavior)
  • Reinforcement-A consequence following a behavior that increases the probability that the behavior will increase
  • Punishment-a negative condition (i.e. removing the child from the horse after hitting)
  • Satiation- reinforcement loses its value
  • Intermittent reinforcement-positive consequence follows behavior only some of the time

An example of intermittent reinforcement is when my son went fishing only if he  intermittently had a bite. If no fish were biting, he lost interest.  Another example is when parents praise children for brushing their teeth, but not every time. Caregivers  may gradually reduce reinforcement (this is called "fading")  so that children perform activities because of their intrinsic value such as having  healthy teeth.

The Movement-Learning Link

Like all animals, humans are programmed to respond to movement in the environment. Knowing when to freeze like a statue helps a child to avoid detection during a game of hide-and-seek. Humans acclimate to movement. For example, after a few minutes in the car we lose awareness of speed and startle when the driver slams on the brakes. A toddler in a swing notices when the movement slows down and anticipates hearing the words "all done."

For most of us, movement is a joyful and natural part of life that never loses its appeal nor fills up the belly. Non-food reinforcers such as movement, are desirable because they don't pose risks of choking, allergic reactions, running out of snacks or quick satiation.

Movement also makes the human brain work better. When we move, more oxygen goes to the brain and we generally feel better. Movement can be a powerful reinforcer because many children with ASD LOVE to move!

It is always possible to bring movement into an activity or use it as a reinforcer for completing a task. Suspended swings, min-trampolines, or other devices can provide intense movement. Even if you don't have this equipment, you can always have your child

  • alternate touching toes and sky
  • jump, hop, gallop, and skip
  • do jumping jacks
  • roll up inside a blanket or roll down a hill
  • turn in circles
  • dance.

A child becomes alert when sensations from movement begin, stop, or change in direction or intensity. We can use this brief state of transition to promote engagement and hand use. For example, after running in place to music, a child might be especially engaged. He might then be willing to lie on his back while air "painting" letters or numbers on the ceiling.

Sensory reinforcers are not a substitute for a Sensory Diet, but rather compliment the use of sensory input to build skills throughout the day. 

Using Deep Pressure and Resistive Activities to Reinforce Hand Use

Many children with ASD love deep pressure sensory stimulation, especially when combined with movement. A child may be more motivated to use her hands when movement is combined with deep pressure. Here are examples:

  1. Wendy lies prone on a large ball and gently bounces while reaching to match spelling word cards placed on the floor.
  2. Wendy scoots across the room while sitting on a scooter board to retrieve clothespins she will use to hang up doll clothes.
  3. Wendy squeezes snap cubes together to spell words

Sensory stimulation may be incorporated into an intervention activity such as when using a ring stack that vibrates, holding a vibrating toy as a reinforcement after completing the task, or both.  For example, you could give reinforcers such as hand lotion or scent bottles to smell after children finish putting away their toys.

Some children may be motivated to persist at an activity that involves moving heavy objects such as large sensory bottles (see photo above) from the floor to a tall box. These may be heavy and noisy and moving these bottles from low to high provides visual, auditory, proprioceptive and vestibular stimulation. The following video demonstrates how to use a peg board using small sensory bottles that provides visual, auditory, vibratory and proprioceptive sensory stimulation.

Adapting activities to provide sensory stimulation or sensory-based reinforcement can be especially helpful when teaching children with limited functional hand use. There's lots more strategies described in my book From Flapping to Function: A Parent's Guide to Autism and Hand Skills. 


Jane Case-Smith,  Occupational Therapy for Children  6th edition, (St. Louis, MO: Mosby,  2009.)

Scott D. Tomcheck and Jane Case-Smith, Occupational Therapy Practice Guidelines for Children and Adolescents with Autism  (Bethesda, MD: AOTA Press, 2009)



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