Improving Eye Contact & Responsiveness Through Applied Behaviour Analysis

To protect privacy, identifying details have been withheld or modified. This case study is shared for educational purposes while respecting the child’s confidentiality and dignity.

Helping with eye contact, response to name, communication, social interaction, attention, and responsiveness.

Name Har******
Age / sex 3 years
Concern Absence of response to name call and responsiveness and diminished eye contact, no age adequate social development. Duration: More than an year
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The parents reported that the child was responding to name call and had eye contact with the parents till his 1 and half years of age. Then he had an increased screen expossure for more than 8 months. The parents observed worsening in responsiveness and eye contact after this.

The child appeared restless and distracted in sessions. Interaction, response to name, eye contact were obseved as poor. The child was screaming in the initial sessions and was unable to sit still in chair. When giving tasks or trying to build rapport, child showed tantrums and throwing behaviors. No functional communication and no age-appropriate psychosocial development obseved in the child.

Observed the child’s interests and enquired with parents about his interests and needs and prepared an applied behavior analysis intervention plan. Explained the plan to the parents and took consent from them. The strategies included:

  • Preference assessment to identify reinforcers
  • Building therapeutic rapport
  • Enhancing sitting tolerance and joint attention
  • Response to name training
  • Encouraging social responsiveness using prefered reinforcers
  • Physical activities and play therapy to reduce restlessness and improve sitting tolerance and interaction
  • Reinforcement strategies to improve consistency in desirable behaviors
  • Modeling, prompting, shaping and chaining for skill development
  • Parent training for home therapy plan and execution of the same

Progress

First 1 month: Started as obsevation and parental interview. Identified prefered reinforcers. Therapeutic rapport and compliance were established through singing rhymes, play therapy and reinforcement techniques. The child gradually became comfortable with the therapist and session environment.
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Month 2: Improvement was observed in sitting tolerance, eye contact, and responsiveness during sessions. The child started responding to the therapist by giving high-fives, clapping, saying “hi,” etc., and response to name also started but was not consistent. Continuous reinforcement and physical prompts were needed at that time.
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Month 3: The child started responding to name calls and maintained eye contact more consistently. He began giving high-fives, clapping, etc. consistently, and completed tasks such as beading and peg board activities with minimal verbal prompts while responding better to prompts.
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Month 4:The child started following simple commands and responding better during structured activities. Improvement was observed in eye contact, responsiveness, and participation in sessions. Group therapy sessions were gradually introduced to improve social interaction and peer engagement.
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15 weeks: The child started responding to familiar commands and unfamiliar commands with prompt. Responsiveness become consistent in sessions and at home. The child started expressing his needs with one word or with non verbal signs.
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Outcome 

The child demonstrated gradual improvement in eye contact, response to name and responsiveness. The child started following simple instructions, participating better in activities, and interacting more consistently with the therapist and parents. Tantrum behaviours reduced, and parents reported better interaction and engagement at home.

Family Impact

Parents reported that the child maintains eye contact with the parents and family members, responding to name call and commands(mostly familiar) in a better way and in consistent manner. The child engages in activities with minimal prompt and expressing his needs in one word or using non-verbal communication. Parents also reported that the child is responding better in pre school setting and interaction with others and peer groups with prompt.

Key insight

Structured applied behavior analysis plan and consistent therapy and home practice resulted significant result in the child in his responsiveness, functional communication skills and in social development.

Zac Livingston

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