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Executive Functioning - Identifying Problems Needing Immediate Attention

  • Published:

    May 4, 2023

  • Updated:

    May 4, 2023

Executive Functioning - Identifying Problems Needing Immediate Attention

Identifying Problems Needing Immediate Attention

Children with ASD can find the long-term goal of identifying problems needing immediate attention difficult to master. The ability to identify situations that are urgent versus those that are non-urgent can be difficult for children with ASD due to struggles related to labeling situation(s) or event(s). This can lead to frustration, particularly if your child wants to tend to a situation immediately and is not able to do so for logistical or practical reasons (for example, the situation may require your assistance when you are not available). Helping your child to identify situations that require immediate attention versus those that do not can teach your child the concepts of waiting and task prioritization. These skills can be applied in a variety of situations, from identifying emergency situations that require the help or attention of an adult to helping to understand when a situation may warrant your child interrupting an adult to ask for assistance (for example, in school, if they urgently need to visit a bathroom and cannot wait). Use the following techniques to help your child gain an understanding of problems that are immediate and those which can wait. 

The following strategies and resources may help your child make progress towards mastering the long-term goal of identifying problems needing immediate attention:

  • Teach the concepts of Now and Later. Demonstrate these concepts to your child using structured waiting. Using a preferred item, ask your child if they want the item. When your child responds, say “you can have [the item] now” and pass your child the item. Repeat and instead say “you can have [the item] later.” Wait for 2-3 seconds and hand your child the item. Slowly increase the amount of time that your child has to wait. Always provide positive reinforcement, praise/encouragement after your child waits patiently. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behaviors to be supported solely by social reinforcement.
  • --> First/Then Chart. Create a chart to show your child which activity will be done first (“now”, e.g., playing with toys), and which activity will be done then (“later”, e.g., cleaning up toys). It is important to note that this is not an If/Then chart. Both activities must be honored during activities related to First/Then Charts. This resource from Autism Circuit will teach you how to use First/Then Charts.‍

Set: Traffic Light behavior visual, task box set and first then statement sheet (teacherspayteachers.com)

First/Then Chart | Behavior Chart | FREEBIE by Limitless Littles (teacherspayteachers.com)

Visual Schedule First Then Task Board Cards | Classroom Management (teacherspayteachers.com)

First Then Behavior Chart Visual with 30 pictures by Eleanor Maeve (teacherspayteachers.com)

  • --> Use visual timers. You can use a visual timer (such as the ones on this webpage) to visually show your child when it is “later.” For example, you can say, “We will eat a snack later, when the green ring is gone,” and set the timer to whatever amount of time will need to pass before the next activity.
  • Tact events. Use simple labels to identify the event and the urgency. You can use an image. Have your child tact the image, after which they should tact the urgency through the selection of one of two simple phrases: “now,” or “later.” As an example, you may provide an image of an individual who is in need of first aid. First, using the method of communication that your child prefers, ask your child to label the image. Next, ask your child if the individual in the image needs help Now or Later. Repeat with images that also portray non-urgent scenarios. Provide positive reinforcement, praise, and encouragement. This may be in the form of verbal praise (“Good job!”) and/or offering a preferred item as a reward. Phase out the positive reinforcement when the skill has been sufficiently acquired. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behaviors to be supported solely by social reinforcement.
  • Use a social story. Select the social story you want to read with your child. This can be a social story from a resource or one that you have made yourself. You can also use a short story/book that your child enjoys if it teaches about a problem that needs immediate attention. It is recommended to read a social story with your child when they are calm and attentive, and to read them as many times as your child wants. While reading the social story, you can also employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child what to say when seeing a picture of a fire such as a house on fire, such as “this is an emergency,” “they need to call 911,” or “they need to call for help”). Below are some examples of scenarios needing immediate attention, as well as picture resources associated with the scenarios.

Social Stories | ECLKC (hhs.gov)

How to Write a Social Story + 13 Editable Stories - Speech Therapy Store

Free Social Story Templates | And Next Comes L - Hyperlexia Resources

  • When to call 911. Part of identifying a situation that needs immediate attention is knowing when it is necessary to call emergency services (U.S. phone number: 911) and when it is not appropriate to call emergency services.
  • Not feeling well. It can be difficult for your child to determine when being sick warrants an emergency versus when it is a non-emergency. Social stories can help your child distinguish between when feeling unwell warrants contacting emergency services and when it does not.
  • Natural catastrophe. Natural catastrophes can include winter weather, fires, floods, thunder and lightning storms, extreme heat, and power outages. Identifying which of these situations require emergency-levels of attention is important for the safety and well-being of your child.
  • How to stay safe: Fire Safety. As stated above, a fire is an event that requires immediate attention. Teaching your child to identify an unsafe fire can also prove to be an opportunity to teach them what to do in response to a fire, including contacting emergency services.
  • Use prompts. Prompts can be used to help your child learn to label any item (object, place, etc.) or identify any person. Use situation and age-appropriate images and language to teach your child the difference between an emergency and non-emergency medical situation. For example, show your child a picture of a scraped knee and say, “non-emergency.” Next, ask your child to identify the image through a question like, “Is this an emergency?” If your child does not respond, prompt them by naming the situation in the photo, “This is a non-emergency.” If your child responds correctly, give encouragement and praise. If your child does not respond correctly, re-start the process. If the reinforcer for the behavior is a tangible item, such as a small snack or a token for a token board, ensure that it is provided with a great deal of verbal praise. Ideally, you want your child’s positive behaviors to be supported solely by social reinforcement.  Again, the images and situations used, as well as the language depends on your child’s comfort with the necessary language and the age appropriateness.
  • Avoid prompt dependence. If your child is conditioned to only provide a tact after a question, such as “What is this?” is asked, they may not be able to spontaneously provide a label or tact without this prompt. To practice tacts without a prompt, use the Object Only technique. A good way to practice this for emergency/non-emergency medical situations is through videos or images. Show your child the image or, if watching a video, pause the video and show the paused scene to your child. Do not ask your child whether it is a medical emergency or medical non-emergency. Instead, if your child does not say whether it’s an emergency or not, instruct them to “Say ‘emergency’” (assuming that the video or image is of an emergency). Continue practicing until your child can identify the situation as an emergency without verbal prompt.

In order to help your child master the long-term goal of identifying problems needing immediate attention, you can work with your child on the short-term goals of distinguishing now and later, identifying problems needing immediate attention in an outdoor environment, identifying problems needing immediate attention in an indoor environment, identifying problems needing immediate attention within 1 minute, labeling emergency/non-emergency medical situations, and labeling emergency/non-emergency medical situations within 1 minute. For the short-term goal of distinguishing now and later, you can choose a target such as distinguishing now and later in a daily routine at home or distinguishing now and later in a daily routine at school.

Distinguishing Now and Later

Step 1: Select the pictures of scenarios that you want to practice with your child to identify as being Now or Later. For example, you can choose the target of distinguishing now and later in a daily routine at home while working on the short-term goal of distinguishing now and later. Pick an activity that you do most days at the same time and in the same order, and select two pictures as follows: eating dinner for now and brushing teeth for later. 

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will inform your child that the task will start. This SD can be a visual SD, such as the image of the child eating dinner, or a verbal SD (“Now or Later?”) 

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt to independently distinguish between activities that are now and later for which you prompted. The baseline level will vary according to your child and their specific abilities. As an example, you can count how many times in a row your child independently identifies the “now” activity, as well as the “later” activity. Alternatively, you can count how many times your child independently identifies the “now” activity, as well as the “later” activity over a given time interval (e.g., 5 min, 10 min, 15 min, etc.).

Step 4: To begin a trial for monitoring progress towards meeting the target (i.e., distinguishing between now and later in a daily routine at home), provide the SD from Step 2 and allow your child to independently attempt to label the activity as being now or later. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item such as a small snack or a token for a token board ensure that it is provided with a great deal of verbal praise. Ideally, you want your child's positive behaviors to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, show your child the matching image and say, “eating dinner now,” followed by showing your child the matching image for “later” and saying “brushing teeth later.”

Step 5: Collect data on how your child makes progress. For example, count how many times in a row your child can meet the target of distinguishing now and later in a daily routine at home independently. Alternatively, you can track progress by recording how long it takes your child to meet the target of distinguishing now and later in a daily routine at home independently. Or, alternatively, you can track progress by counting the number of successful attempts at distinguishing now and later in a daily routine at home during a session. 

Step 6: Track how your child makes progress to meet the target of distinguishing now and later in a daily routine at home by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at distinguishing now and later in a daily routine at home over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can distinguish now and later in a daily routine at home, and compare that with the percentage threshold necessary to meet the target.

For the short-term goal of identifying problems needing immediate attention in an indoor environment, you can choose a target such as identifying problems needing immediate attention indoor fire safety or identifying problems needing immediate attention where something dangerous is broken (e.g., glass).

Identifying Problems Needing Immediate Attention in an Indoor Environment

Step 1: Select the problem that you want your child to practice identifying as needing immediate attention. For example, you can choose the target of identifying the problem of an indoor fire needing immediate attention while working on the short-term goal of identifying problems needing attention in an indoor environment. Select two pictures as follows: one image of food on fire on the kitchen stove and one image of food cooking normally on the stove. 

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will inform your child that the task will be starting. This SD can be a visual SD, such as the image of the food on fire on the kitchen stove, or a verbal SD (“Which is an emergency?” or “When do we call for help?”) 

Step 3:  Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently to identify the situation for which you prompted. The baseline level will vary according to your child and their specific abilities. As an example, you can count how many times in a row they independently identify a picture you prompted for as needing immediate attention. Alternatively, you can count how many times they independently identify a picture as needing immediate attention in a given time interval (e.g., 5 min, 10 min, 15 min, etc.). Once your child can consistently and independently identify a picture as needing immediate attention you can move to teaching the skill of identifying a picture as needing immediate attention within 1 minute.

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of identifying problems needing immediate attention - indoor fires), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item such as a small snack or a token for a token board ensure that it is provided with a great deal of verbal praise. Ideally, you want your child's positive behaviors to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, you can show your child the image of the food on fire on the kitchen stove and say, “We should call for help.” 

Step 5: Collect data on how your child makes progress. For example, count how many times in a row your child can meet the target of identifying problems needing immediate attention - indoor fires - independently. Alternatively, you can track progress by recording how long it takes your child to meet the target of identifying problems needing immediate attention - indoor fires - independently. Or, alternatively, you can track progress by counting the number of successful attempts at identifying problems needing immediate attention - indoor fires - during a session. 

Step 6: Track how your child makes progress to meet the target of identifying problems needing immediate attention - indoor fires - by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at identifying problems needing immediate attention - indoor fires - over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can identify problems needing immediate attention - indoor fires - and compare that with the percentage threshold necessary to meet the target.

For the short-term goal of identifying problems needing immediate attention in an outdoor environment, you can choose a target such as identifying problems needing immediate attention outdoors (e.g., fires) or identifying problems needing immediate attention outdoors where something is broken (e.g., broken glass, live electrical fallen/broken cables, etc.).

Identifying Problems Needing Immediate Attention in an Outdoor Environment

Step 1: Select the problem that you want to practice with your child to identify as needing immediate attention. For example, you can choose the target of identifying the problem of outdoor fires as needing immediate attention while working on the short-term goal of identifying problems needing attention in an outdoor environment. Select two images as follows: one image of an out of control fire outdoors and one image of an area without a fire.

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as the image of an out of control fire outdoors, or a verbal SD (“Which is an emergency?” or “When do we call for help?”).

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently to identify the situation for which you prompted. The baseline level will vary according to your child and their specific abilities. As an example, you can count how many times in a row they independently identify a picture as needing immediate attention. Alternatively, you can count how many times they independently identify a picture as needing immediate attention in a given time interval (e.g., 5 min, 10 min, 15 min, etc.). Once your child can consistently and independently identify a picture as needing immediate attention you can move to teaching the skill of identifying a picture as needing immediate attention within 1 minute.

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of identifying the problem of outdoor fires as needing immediate attention), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item such as a small snack or a token for a token board ensure that it is provided with a great deal of verbal praise. Ideally, you want your child's positive behaviors to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, you can show your child the picture of an out of control outdoor fire and say, “We should call for help.”

Step 5: Collect data on how your child makes progress. For example, count how many times in a row your child can meet the target of identifying the problem of outdoor fires as needing immediate attention independently. Alternatively, you can track progress by recording how long it takes your child to meet the target of identifying the problem of  outdoor fires as needing immediate attention - independently. Or, alternatively, you can track progress by counting the number of successful attempts at identifying the problem of outdoor fires as needing immediate attention during a session. 

Step 6: Track how your child makes progress to meet the target of identifying the problem of outdoor fires as needing immediate attention by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at identifying the problems of outdoor fires as needing immediate attention over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can identify the problem of outdoor fires that need immediate attention, and compare that with the percentage threshold necessary to meet the target.

For the short-term goal of identifying problems needing immediate attention within 1 minute, you can choose a target such as identifying problems needing immediate attention within 1 minute in an outdoor environment or identifying problems needing immediate attention within 1 minute in an indoor environment.

Identifying Problems Needing Immediate Attention Within 1 Minute

Step 1: Select the situation that you want your child to practice identifying as needing immediate attention within 1 minute. For example, you can choose the target of identifying problems needing immediate attention within 1 minute in an outdoor environment while working on the short-term goal of identifying problems needing immediate attention within 1 minute. Select pictures as follows: an image of a car crash and an image of cars driving safely on the road. 

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as the image of a car crash, or a verbal SD (“Which is an emergency?” or “When do we call for help?”) 

Step 3: Collect baseline level data by providing the SD from Step 2 and allow your child to attempt independently to identify the situation for which you prompted. The baseline level will vary according to your child and their specific abilities. As an example, you can count how many times in a row they independently identify a picture as needing immediate attention within 1 minute. Alternatively, you can count how many times they independently identify a picture as needing immediate attention within 1 minute over a given time interval (e.g., 5 min, 10 min, 15 min, etc.).

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of identifying problems needing immediate attention within 1 minute in an outdoor environment), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item such as a small snack or a token for a token board ensure that it is provided with a great deal of verbal praise. Ideally, you want your child's positive behaviors to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, you can show your child the image of the car crash and say, “We should call for help.” 

Step 5: Collect data on how your child makes progress. For example, count how many times in a row your child can meet the target of identifying problems needing immediate attention within 1 minute in an outdoor environment independently. Alternatively, you can track progress by counting the number of successful attempts at identifying problems needing immediate attention within 1 minute in an outdoor environment during a session. 

Step 6: Track how your child makes progress to meet the target of identifying problems needing immediate attention within 1 minute in an outdoor environment by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at identifying problems needing immediate attention within 1 minute in an outdoor environment over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can identify problems needing immediate attention within 1 minute in an outdoor environment, and compare that with the percentage threshold necessary to meet the target.

For the short-term goal of labeling emergency/non-emergency medical situations, you can choose a target such as labeling emergency/non-emergency medical situations at the park, labeling emergency/non-emergency medical situations at home, or labeling emergency/non-emergency medical situations at school.

Labeling Emergency/Non-emergency Medical Situations

Step 1: Select the situation that you want your child to practice labeling as a medical emergency or non-emergency. For example, you can choose the target of labeling emergency/non-emergency medical situations at the park while working on the short-term goal of labeling emergency/non-emergency medical situations. Select pictures as follows: one image of a broken arm and one image of a not broken arm. 

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as the image of a broken arm, or a verbal SD (“Which is an emergency?” or “When do we call for help?”).

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently to label the situation for which you prompted. The baseline level will vary according to your child and their specific abilities. As an example, you can count how many times in a row they independently label a picture as a medical emergency. Alternatively, you can count how many times they independently label a picture as a medical emergency in a given time interval (e.g., 5 min, 15 min, 30 min, etc.). Once your child can consistently and independently label a picture as a medical emergency you can move to teaching the skill of labeling a picture as a medical emergency within 1 minute.

Step 4: To begin the trial to monitor progress towards meeting the target (i.e., the target of labeling emergency/non-emergency medical situations at the park), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item such as a small snack or a token for a token board ensure that it is provided with a great deal of verbal praise. Ideally, you want your child's positive behaviors to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, you can show your child the image of a broken arm and say, “This is an emergency,” or, “We should call for help.”

Step 5: Collect data on how your child makes progress. For example, count how many times in a row your child can meet the target of labeling emergency/non-emergency medical situations at the park independently. Alternatively, you can track progress by recording how long it takes your child to meet the target of labeling emergency/non-emergency medical situations at the park independently. Or, alternatively, you can track progress by counting the number of successful attempts at labeling emergency/non-emergency medical situations at the park during a session. 

Step 6: Track how your child makes progress to meet the target of labeling emergency/non-emergency medical situations at the park by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at labeling emergency/non-emergency medical situations at the park over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can label emergency/non-emergency medical situations at the park, and compare that with the percentage threshold necessary to meet the target.

For the short-term goal of labeling emergency/non-emergency medical situations within 1 minute, you can choose a target such as labeling emergency/non-emergency medical situations within 1 minute at school or labeling emergency/non-emergency medical situations within 1 minute at home.

Labeling Emergency/Non-emergency Medical Situations Within 1 Minute

Step 1: Select the situation that you want your child to practice labeling as a medical emergency or non-emergency within 1 minute. For example, you can choose the target of labeling emergency/non-emergency medical situations within 1 minute at home while working on the short-term goal of labeling emergency/non-emergency medical situations within 1 minute. Select two pictures as follows: one image (CAUTION! viewer discretion advised, the hyperlinked image shows a small burn on the back of a child’s hand) of a burned hand and one image of a non-burned hand. 

Step 2: An initial/specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as an image of a burned hand, or a verbal SD (“Which is an emergency?” or “When should we call for help?”)

Step 3: Collect baseline level data by providing the SD from Step 2 and allowing your child to attempt independently to label the situation for which you prompted. The baseline level will vary according to your child and their specific abilities. As an example, you can count how many times in a row they independently label a picture as a medical emergency within 1 minute. Alternatively, you can count how many times they independently label a picture as a medical emergency within 1 minute over a given time interval (e.g., 5 min, 15 min, 30 min, etc.). 

Step 4:  To begin the trial to monitor progress towards meeting the target (i.e., the target of labeling emergency/non-emergency medical situations within 1 minute at home), provide the SD from Step 2 and allow your child to attempt independently. When your child is successful, provide reinforcement. If the reinforcer for the behavior is a tangible item such as a small snack or a token for a token board ensure that it is provided with a great deal of verbal praise. Ideally, you want your child's positive behaviors to be supported solely by social reinforcement. If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, you can show your child the image of a burned hand and say, “We should call for help.”

Step 5: Collect data on how your child makes progress. For example, count how many times in a row your child can meet the target of labeling emergency/non-emergency medical situations within 1 minute at home independently. Alternatively, you can track progress by counting the number of successful attempts at labeling emergency/non-emergency medical situations within 1 minute at home during a session. 

Step 6: Track how your child makes progress to meet the target of labeling emergency/non-emergency medical situations within 1 minute at home by comparing with either a number threshold or a percentage threshold (necessary to meet the target). For example, you can record the number of successful attempts at labeling emergency/non-emergency medical situations within 1 minute at home over a certain number of sessions, and compare that with the number threshold necessary to meet the target. Alternatively, you can record what percentage of times your child can label emergency/non-emergency medical situations within 1 minute at home, and compare that with the percentage threshold necessary to meet the target.