I first met T when he was just 6 years old. He was highly motivated to learn, and I was tasked with providing both home intervention and shadow support in his Kindergarten class. However, despite his eagerness, I quickly observed two challenging behaviors.

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The Challenges

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The first challenge was T’s difficulty accepting mistakes. Even minor issues, like spilling water on his uniform, would lead to a meltdown. He would cry and become very upset.

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The second challenge was T’s tendency to avoid difficult tasks. In certain classes, he would display avoidance behaviors and cry when tasks became too challenging.

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Functional Behavior Assessment

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To better understand T’s behavior, I spoke with his parents about his learning history. From our conversation, I hypothesized that T had grown up in an environment where mistakes were not easily accepted. At his previous ABA provider's center, T often received negative feedback when he made mistakes, which led him to develop a perfectionist mindset. As a result, he loved being correct and became extremely anxious whenever he made an error. This was likely due to negative experiences following mistakes in the past.

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Additionally, as T became more aware of his abilities, he began avoiding tasks that seemed difficult. This behavior acted as a way for him to "prevent" mistakes from happening altogether.

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The Intervention

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It was assessed that T used crying for two purposes: First, crying served as a form of emotional regulation. It was more of a respondent behavior, where the situation of making a mistake brought him back to a moment of upset, triggering his crying. Second, crying served as a way to escape the task at hand. Whenever he cried, teachers would allow him time to calm down, sometimes even stopping all demands placed on him.

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With this understanding, it became clear how to approach T’s intervention. The goal was to help him build tolerance for making mistakes and to associate mistakes with positive outcomes. We started practicing this skill at home by introducing the concept of a "sad star." Whenever T made a mistake, he received a "sad star." At the end of the day, he could exchange his collected stars for a reward, such as screen time. This intervention was tailored to T's motivation for correctness, as he did not show a tendency to make mistakes on purpose.

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​​​​​​At first, T would still cry when he noticed mistakes, but I reassured him that he only needed to collect one "sad star" to earn his reward. After a few weeks of practicing, the crying reduced significantly. I also reinforced the idea that "it's okay to make a mistake" every time a mistake occurred.

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Another strategy I used was a role reversal game, where T acted as the "teacher" and observed me making mistakes. I would laugh it off and say, "It’s okay, I can try again." This helped normalize mistakes and showed T that everyone makes them, not just him.

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On one occasion, when his teacher returned a worksheet with several mistakes, T calmly said, "It's okay, I can try again." He did not cry.

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The Other Skill: Asking for Help

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Another key skill I taught T was how to ask for help or indicate when a task was too difficult. This allowed him to communicate when he needed assistance, reducing his anxiety in challenging situations.

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After the Intervention

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Today, T had graduated from our program and attends an autism-focused school with mainstream curriculum and is a happy, confident boy. He has learned that mistakes are an important part of learning. Rather than fearing mistakes, he now sees them as valuable opportunities to grow and improve.

I first met K when he was 12 years old. K struggled with speech clarity, making it difficult for others to understand him. He had also shown aggression towards his previous therapist. Due to concerns about his behavior in public, K had very limited outdoor experiences. His daily routine was simple: go to school and return home on the school bus.

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The Challenges

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K exhibited several self-stimulatory behaviors. He would lick his fingers and play with saliva, which created hygiene issues and could be problematic in public. He also sought sensory stimulation from jumping and occasionally ran off, presenting safety concerns. Another challenge was his unclear verbal communication, making it difficult for others to understand him.

 

Additionally, K needed explicit instructions before attempting tasks, which is a potential risk if ABA practitioners do not recognize it. In one instance, his mother told him there was food on the table for him to eat, but he did not eat it until she instructed him again, even though the food was left for him hours earlier.

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Functional Behavior Assessment

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To better understand K’s behavior, I observed and recorded his self-stimulatory behaviors. I found that these behaviors were more frequent under two conditions: when he was not engaged in activities and when his requests were denied.

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The Intervention

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With this information, I designed an intervention to increase K’s engagement at home. I introduced a daily timetable, which also aimed to give him more autonomy. His helper planned the day’s activities in advance, allowing K to provide some input. He could then refer to the timetable and check off completed tasks. Several prerequisite skills needed to be taught:

• K had to understand the timetable, follow it, and check off tasks once completed.

• He needed to learn how to read a digital clock and understand the concept of time.

• We also introduced enjoyable activities, such as looking at his childhood photos, coloring, and doing vocational tasks like making bracelets.

K was taught to complete household chores, such as folding his clothes. Over time, we created a weekly schedule with at least 20 activities, rotating them throughout the week. As K became more engaged in these tasks, his self-stimulatory behaviors decreased.

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Tolerance to Denial

 

I also worked on increasing K’s tolerance to denial. Initially, when K requested something, I would refuse but offer an equally desired alternative. Over time, the alternatives became more neutral. We incorporated this tolerance training into his timetable, showing K when he could have what he wanted on specific days or times.

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For example, K loved going to the park. I would deny his request to go immediately but show him when he could go on the timetable. This helped K understand and anticipate when he could engage in his preferred activity, reducing frustration and improving his ability to tolerate delayed gratification.

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Focus on Community Skills and Independence

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As K entered his teenage years, the focus of the intervention shifted away from academics and toward community skills, which would be more valuable as he grew older. One of his parents’ main concerns was K’s independence. I envisioned a future where K could inform his parents when he wanted to go out, follow his timetable (with some adult input), go outdoors to purchase food independently, use public transport, and ask strangers for help when needed.

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Today, K is still with Learning to Learn Singapore. He is learning how to cross the road and look out for dangers independently. He is also becoming familiar with how the MRT and buses work and which routes stop near his home. He now leaves home at 3 pm daily, spends an hour at the playground for sensory stimulation, and returns home by 4 pm independently. Recently, I encouraged K’s parents to purchase an Apple AirTag so his parents can know his whereabouts in case he gets lost. 

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There is still a long way to go, but as K approaches 18, the next goal is to help him plan a simple home-based business. Thankfully, we’ve planned ahead, and K is already learning how to make bracelets, which could serve as a potential business opportunity for him to make a living.

I first met C when he was 4 years old. C was largely non-verbal and displayed many tantrums. He was fascinated by objects that spun, often turning the fan on and off, happily smiling and laughing throughout the activity.

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The Challenges

C’s main challenges were his difficulty with communication and toileting. His parents struggled to get him out of diapers, and when they tried, C would become upset and anxious. If he felt the urge to relieve himself, he would cry and refuse to use the toilet, insisting on putting on a diaper instead.

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Functional Behavior Assessment

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To understand C's tantrums, I observed his behaviors. I noticed that he would tantrum when he wanted something and didn’t get it—this included toys and, in particular, diapers when he felt an urgent need. C seemed to have a fear of "letting go" outside of a diaper, and found comfort in using it. He had grown accustomed to using diapers so much that he was unsure how to manage without them.

I assessed that C’s tantrums were largely a result of unmet desires and anxiety. Also, he had learned to rely on diapers and had difficulty with the idea of urinating in the toilet, likely due to fear of change and unfamiliarity with the process.

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The Intervention

We designed an intervention to address two main areas: teaching C to request what he wanted something, and making the process of using the toilet more positive.

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For requesting, we identified at least 20 items C liked, and worked on encouraging him to point to those items. The goal was to establish a way for C to communicate what he wanted. Initially, I gave him access to these items, then would take them away and prompt him to point at them before returning the item. Once C consistently pointed, we started prompting him to imitate my speech before giving the item back. This approach helped C begin to understand communication and request things in a more structured way.

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As C learned to imitate and label items, he began to request independently, though a new challenge emerged: when items were out of sight, C struggled to request them. He would pull at an adult or fuss when he couldn’t find what he wanted. To address this, I introduced an Augmentative and Alternative Communication (AAC) device—an iPad app with pictures and voice functions. This helped C learn to request desired items even when they were not immediately visible. He would use the device to select an icon, then verbally request the item from his parents.

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For the toileting issue, the approach involved creating a positive association with using the toilet. First, I ensured that C had no access to diapers by removing them from the bathroom and closing the door. When he seemed anxious, I provided M&Ms as a reward to help him stay calm. We used positive reinforcement, gradually introducing the toilet with the reward system.

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To help C understand the process, I used a cup to catch his urine when he was unable to hold it. This allowed him to experience "letting go" without anxiety about wetting the floor. After a few weeks, he became comfortable urinating into the cup. I then instructed C’s parents to pour the urine into the toilet bowl in front of him, allowing him to observe that it was okay to use the toilet.

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Once this behavior became consistent, we proceeded to have C pee directly into the toilet bowl. His parents would hold the cup near the toilet and quickly remove it as K began to pee, guiding him to use the toilet.

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We applied a similar approach to C's constipation issue, as he began holding his bowel movements when there was no diaper. After consulting with his pediatrician, we used a mild laxative to help him have less control over his bowel movements, which made it easier for his parents to prompt him to sit on the toilet and wait for the poop to come out.

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After the Intervention

C has since graduated from Learning to Learn Singapore. His verbal communication improved, and he was able to use simple 1-2 word sentences. By addressing his toileting challenges and improving his classroom behaviors, C was accepted into an APSN (Association for Persons with Special Needs) school where he continues his learning.