One last comment about effective, varied reinforcement. Since the beginning, the Lovaas Institute's newsletter Meeting Point has featured 5 surprisingly different reinforcer ideas in each issue. I'd like to add my 5 favorite reinforcers to the list:

1. Put a child's hands on top of your hands. Count down slowly and with anticipation 5-4-3-2-1. Then yell "blast off!" and fling the child's hands into the air.
2. Pick up a child's foot and pound on the bottom of it with the side of your fist (with or without shoes on the child).
3. Blow air into the sleeves or back of a child's shirt.
4. Slowly lower a Kleenex in front of your face, then blow forcefully on it and let go so it zooms across toward the child.
5. Hasbro Playskool Busy Ball Popper Hands down one of the most entertaining ball toys.

Anyone else have a favorite reinforcer?

Here's a follow up to the importance of effective, varied reinforcement. When I initially started working in a behavioral treatment program, I was obsessed with delivering varied reinforcement. I once figured that I would be delivering 100-150 reinforcers during a 3 hour time period. Fresh out of college, I also had a summer job at a national telemarketing office. Between reading the script for each call, there was typically a 15-30 second delay while being connected to another person. I started bringing loose leaf paper to work, and would write down as many reinforcers as I could think of during the 15-30 seconds. This would culminate in lists of hundreds of different reinforcers – just what I needed!

What I realized over time was that the same basic reinforcer could be delivered in a variety of different ways, and each of those ways could help prevent satiation of the reinforcer (losing its effectiveness). For example, let's say a child likes to be tickled for reinforcement. You can:

1. vary where you tickle the person (foot, tummy, sides, armpits, neck)
2. vary the length of time you tickle the person (short or long until they fall to the floor laughing)
3. vary how quickly you start to tickle (immediately and surprisingly tickle or slowly move in with the anticipation you will tickle)
4. vary how quickly you actually tickle (slowly and methodically, quickly and haphazardly)
5. vary the strength of the tickle (light, barely touching tickles or deep pressure tickles)

Take all of these factors, create all the combinations possible, and you have at least 80 different ways to tickle! (I think...it may be more...feel free to check my math). I obviously wouldn't use all of these variations back to back, but keeping in mind this variety made the number of reinforcers from which I could choose that much broader.

Mindi Fisher, the first behavior consultant from the Lovaas Institute to train me, was right:
"If you don't break a sweat, you're not doing Lovaas" Only sometimes, the sweat is mental, not physical!