I need therapy ideas for engaging activities that don’t involve an iPad for a nonverbal 5 year old with multiple disabilities including a hearing impairment. His attention span is very short. I use the iPad as a reward after an academic task is completed. We do first…work(picture of activity or object or sign Lang) then…iPad. He has a trach and just had an airway reconstruction surgery this summer. We are hoping to hear his voice when the trach is removed! ?He has possible ASD, CP, and has low cognitive functioning. He is learning and remembering a few basic signs. He has significant behaviors such as throwing items off the table, scratching others and throwing himself on the floor when he doesn’t want to work. It’s a very complicated case, and I hope I covered it all! Any ideas are appreciated! 3 yo developmentally

Functional Communication System:

Make sure he has a means of communicating with those around him.  If sign language works ok, go with that.  But if he’s having trouble learning them, it may be easier to use some basic AAC devices instead.  You can choose a picture exchange system like PECS, a Big Mac switch, or a GoTalk AAC device (or other static-screen AAC device so as not to confuse with the iPad).  Have him use the AAC system to communicate basic wants and needs (start with requests).

Following Directions:

Have him follow simple, one-step directions that you can hand-over-hand (like clapping hands or touching nose) and reward him with something highly preferred.  Once he does basic actions independently, start having him imitate mouth movements to get him ready for trach removal.

Find Replacement Behaviors:

Figure out the function of the child’s behavior and provide replacement behaviors.  If he’s throwing things to refuse work, teach him how to hand the teacher a break card to request a break.  Once he gets used to using this in all settings, start increasing the number of seconds he must stay at the activity before getting his break.