Wearing a mask has become a new norm due to the current public health climate. CDC guidelines recommend mask wearing to prevent the spread of COVID-19. This recommendation has led to several cities, counties, and states releasing official mask mandates. In addition, with the likelihood that schools will be back in session, in person, this upcoming school year, it is critical for children and other individuals to possess the skills of tolerating and wearing masks.
General Strategies
Incorporating Preferences
What?
Incorporating preferences is when the parent provides choices to the child to choose what they would prefer. The parent is in control of what is offered, and the child is on control of what is chosen.
Why?
Individuals, whether children or adults, often cooperate with something new/different when they are able to feel in control of the situation.
How?
When purchasing a mask, have the child be involved. Allow the child to choose one or multiple masks that they like. Be sure to show a variety of colors, patterns, characters, etc.
In addition to choosing patterns/colors, allow the child to choose the style of the mas, if they want it tighter or loose around the nose, filter vs. no filter, disposable vs. cloth masks, or a mask with draw strings where the mas can be pulled tighter.
Once the mask is purchased, different scents (essential oils, fabric softener, etc.) can be used to incorporate a preferred smell.
If multiple masks are purchased, allow the child to choose which one they will wear for the day.
Setting Expectations
What?
Setting expectations is when the parent tell the child exactly what they can expect from a situation and how the child should behave.
Why?
Individuals often cooperate with something new/different when they know exactly what to expect.
How?
Let your child know when they will need to wear the mask and when they are allowed to have the mask off.
Example: We need to go to the store today. I will need you to take your mask with you. When we ride in the car, you do not need to wear your mask; however, before we get out of the car, you will need to put your mask on and keep it on until we get back in the car." Or "I need you to wear your mask while in the store, you will only have you mask on for about 10 minutes, You can take it off when we get back in the car."
Social Stories
What?
Social stories are visual resources that explain and model a variety of social situations in a way that children can understand.
Why?
Social stories can be useful when a child will be expected to behave appropriately in an unfamiliar environment or social situation (such as a classroom full of students and teachers with masks.
How?
Social stories can be read once or repeatedly to assist the child in understanding what is going on in the world around them. For best results social stories should be used in conjunction with reinforcement procedures outlined below.
Click here for several resources for adults, teens, and children pertaining to wearing masks/COVID-19.
Visuals
What?
Visuals are picture tools that may increase the effectiveness of various behavior modification strategies.
Why?
Some individuals learn more quickly when a visual is used. Some strategies may be less effective without the use of a visual.
How?
Setting expectations can be supplemented with a visual by telling the child how long they need to wear the mask and by providing a visual timer.
First-then (see below) statements can be supplemented by using a visual that says “First”, “Then” and having a picture of a mask under first and a picture of a reinforcer under then.
A double-sided card can also be used with a picture of a mask on and the flipped side that has a picture of a mask off. This can signal to the child when a mask should be worn and when a mask can be taken off. Visuals can also be used within a schedule, to signal what activities will require mask on and when mask breaks will be available.
Click Here for an example of a visual timer.
Click Here to personalize/place an order for a double-sided card.
Reinforcement
General Reinforcement Strategies
What?
Reinforcement is the process in which something that occurs after a behavior makes that behavior more likely to occur in the future.
Examples: a hug, praise statements, preferred edible/activity/toy, a break from wearing a mask
Why?
Reinforcement will increase how often, the length of time, and the compliance with tolerating mask wearing.
How?
Reinforcement can be provided upon the completion of successfully wearing the mask when needed or throughout the time that the mask is successfully worn. Reinforcement could be in the form of specific praise (e.g., “I love that you are wearing your mask” or “I love how your mask matches your shoes”), providing a preferred edible (e.g., delivering a marshmallow every few minutes the mask is kept on), or offering a small break from mask wearing, if appropriate.
Reinforcement that would not typically occur naturally in the situation should be faded once the child is demonstrating consistent tolerance of wearing the mask. If the parent is providing the child with a reinforcer every few minutes, the parent will want to fade this over time (e.g., start out with every 3 minutes, then every 5 minutes, every 10 minutes, etc.).
First-Then Statements
What?
First-then statements are simple reinforcement contingencies that improve engagement in non-preferred behaviors/situations.
Why?
First-then statements will signal what reinforcement can be received after tolerating mask wearing. This can motivate compliance.
How?
Simply state the behavior required first and then state what reinforcement would be available (e.g., “first you wear your mask in the store and then you can watch a show on the iPad.”)
A way to increase the effectiveness of first-then statements would be providing praise throughout the occurrence of the behavior (e.g., “You are doing amazing wearing your mask and working so hard to earn the iPad”). This will bridge the gap between non-preferred behavior engagement and the reinforcement.
Click Here for an example of a first-then board.
Behavioral Contracts
What?
Behavioral Contracts are contracts written between the parent and the child with a specific agreement for what the child is expected to do and what the child can earn when completing this expectation.
Why?
Increased understanding of expectations and guidelines can improve compliance with a behavior. Additionally, when a child has something to earn, the behavior is more likely to occur.
How?
Behavioral Contracts can require the behavior to occur for a day, several days, a week, etc. depending on how the contract is written.
The contract should clearly outline the following things:
What is expected of the child (i.e. wear a mask when leaving the house)
How long the child needs to demonstrate this behavior
What the child will earn
When the child will receive what they have earned
Click Here for an example of a behavioral contract.
Basic Desensitization
Disclaimer: Desensitization is typically systematic, involved, and very individualized procedure. The strategies listed below are for individuals who will at least tolerate putting a mask on. If the child engages in problem behaviors at the sight of a mask, a more individualized intervention will be needed with the assistant and monitoring conducted by a behavior analyst.
Note: If at any point your child engages in higher intensity problem behaviors, discontinue the strategy immediately until you can consult with a behavior analyst.
Basic Desensitization to Wearing Masks
What?
Desensitization is a process that results in gradual exposure to a less preferred item/activity.
Why?
To assist the child in increasing wearing a mask without making the mask more aversive.
How?
Have the child put on the mask and start a stopwatch to see how long the child will tolerate wearing the mask.
Once the child takes the mask off, use this as your starting point for time.
Allow highly preferred activities while the child is wearing the mask.
The expectation can be set that the child can only continue engaging in the preferred activity if the mask is worn for a certain amount of time.
Run this strategy several times a day, with space in-between practices (e.g., after breakfast, before lunch, before snack, after dinner).
Once the child has tolerated the set amount of time for a few consecutive opportunities, increase the time.
Continue to repeat the steps above until the desired length of time is achieved.
Once the desired time is achieved, fade to a reinforcement system listed above (e.g., first-then).
Basic Desensitization to Tolerating Others Wearing Masks
What?
Desensitization is a process that results in gradual exposure to a less preferred situation/activity.
Why?
To assist the child in tolerating others wearing masks without the interactions becoming more aversive. Being desensitized to others wearing masks may improve compliance and learning such as compliance with instruction while a teacher is wearing a mask.
How?
Have a highly preferred person put a mask on around the child and start a stopwatch to see how long the child will tolerate the individual wearing the mask.
Once the child no longer tolerates the individual wearing the mask (e.g., vocal contest, trying to take it off, agitation), stop the stopwatch and use this as your starting point for time.
Engage the child in highly preferred activities while wearing the mask. Have the preferred person interact positively with the child.
The expectation can be set that the child can only continue engage in the preferred task if the mask is worn for a certain amount of time.
Run this strategy a few times a day, with space in-between practices (e.g., after breakfast, before lunch, before snack, after dinner).
Once the child has tolerated the set amount of time for a few consecutive opportunities, increase the time.
Continue to repeat the steps above until the desired time is achieved.
Once the desired length of time is achieved, begin introducing other individuals wearing masks and repeat the steps above as needed.
Note: If the child tolerates others wearing masks, but does not comply with instructions when an individual is wearing a mask, complete the steps above; however, incorporate simple instructions into the procedure (i.e. stand up, throw this away etc.). As the child continues to comply, increase the instruction (i.e. working up to completing a worksheet). When working on completing a worksheet, the individual can place the demand to complete one question then take a break and build from there.
General Strategies for Teachers
Group Contingencies
What?
A reinforcement contingency that is put in place to increase desired behavior for a group of people.
Why?
When time or resources prevent the use of individual strategies for each student, group contingencies allow teachers to improve mask wearing in the classroom.
How?
Add the contingency that will be put in place to the current classroom rules (i.e. each of you has the opportunity or all of you are working together to earn __).
The contingency can be for the duration of a single activity, a day, or a week depending on what is put in place.
Individual Responsibility:
Each student’s own behavior is responsible for their own reinforcement (i.e. “Those students that keep their mask on during all the required times, will earn extra free time before the end of the school day). Another example is “If you wear your mask for the week, you will have no homework on Friday.”
Teamwork:
The entire group of students is responsible for the outcome for everyone (i.e. “If everyone keeps their mask on during this entire activity, everyone can have a piece of candy.”). Another example is (i.e. “If the whole class keeps their masks on during all of the required times, the last 15 minutes of the day will be free time.
Controlled Mask Breaks
What?
A designated time and place that a student can take a break from wearing their masks.
Why?
For some students, the most reinforcing thing may be escape from wearing the mask. This allows for appropriate escape from wearing the mask while keeping the child and others safe, which will ultimately improve compliance with the required wearing times.
How?
Note: This should only be done if the classroom or designated area is appropriately socially distanced from everyone else (i.e., 6ft away from the nearest person).
Have a mask break station (e.g., desk, table) that the students can go to ONE AT A TIME to use that has hand sanitizer and appropriate cleaning wipes.
Have the student ask to go to the area.
Once the student is in that area, have them sanitize before taking their mask off.
Once their mask is off, start the timer for the designated amount of time the student can have their mask off.
Once the timer goes off, have the student sanitize before placing their mask back on.
Have the student use the sanitary wipes to wipe down the mask break area, if appropriate.
Download the complete Guide to Teaching Mask Wearing below.
If you are interested in learning more about Behavioral Progression or would like individualized consultation in Applied Behavior Analysis strategies for your child/classroom, Contact us:
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About the author
Stephanie Thornburgh is a Board Certified Behavior Analyst (BCBA). After writing a research paper on autism in a high school English class, Stephanie began volunteering with children with autism. This experience led Stephanie to babysitting children with autism, where she eventually discovered ABA when a mom recommended she become a behavior analyst. Stephanie looked into the field of ABA and never looked back! Stephanie has been with Behavioral Progression since 2019. Not only does Stephanie provide training and supervision to therapists, but she also has the important role of providing training and support to other behavior analysts in the company. Stephanie is passionate about using her ABA knowledge and experience to help her clients and co-workers meet their goals!