Case Study: Elena


Elena is four years old and resisted sitting at the table for any type of table top activities. She would be fine with doing the activities on the floor but would melt down if we insisted on her doing the activities on the table. Even if we managed to get her to sit down at the table, she would be unable to sustain that and would try to escape in less than 5 minutes. Our concern is that when she goes to school, she will be unable to sit down at the table to have her lesson at all.
So, for the first session, the therapists started with doing some puzzles with her on the floor to get her familiarized with them. They have to conduct the session in the living room as Elena was reluctant to go into the room for session. After a few puzzles, the therapist shifted the puzzle to the table and introduced the token economy system to Elena. She responded very well to the system right from the start. Initially, she would try to escape from the table every few minutes but could go back to the table and sit on the chair once the therapist showed her the visual for sitting on the token economy. She was constantly rewarded with a token to reinforce her good behavior and it helped in increasing the amount of time she could remain seated at the table. A schedule was also shown to her of the activities she has to do on the table each time before she can go for a break. She responded well to that as well and grasped the idea quickly that she could only leave the table when she completed everything on the schedule.
During the second session, Elena shown improvement by being able to remain seated for around 10 minutes. She would verbal stim and fidget around but could always be reminded to sit nicely and keep quiet with the visuals on the token economy board. On the third session, the therapists shifted the table into the room and as Elena was familiar with them by then, she went into the room with them and did not have problem with it at all. The therapists started with doing 3 tasks per schedule with her on the table that would take around 15 minutes. Gradually, the therapists inserted more tasks with increasing difficulty in each schedule and Elena would be seated at the table for a longer period of time. The therapists continue to reinforce good behaviors from Elena using the token economy board and let Elene knows what she has to do every session with the schedule. She is responding very well to everything that has been done by the therapists and can now sit at the table for up to 45 minutes to an hour at a time during session. The improvement does not only show when the therapists are around. Now, when we want to do work with her at home, she can also sit at the table while we work with her. Her teachers in school have also feedback that is much better in school when they are conducting lesson.

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