Below is a general skill sequence for helping learners hold hands with and adult.
Handholding is a crucial skill to teach early learners, as it offers numerous benefits in their development and safety. By learning handholding, children can be protected from elopement into dangerous settings and guided more effectively during the shaping process. It serves as a helpful skill for caregivers as well as it brings about the opportunity for the learner to enter new environments. Handholding can function as a component skill for activities such as waiting in line, walking in groups, walking and talking, and navigating unfamiliar environments, handholding is essential for a child's growth. However, it is important to teach safety skills, ensuring the child knows who it is safe to hold hands with, and to allow the learner to withdraw assent in various situations. This approach ensures that handholding and/or the therapist do not become paired as punishers.
How this skill area relates to your assessments!
This skill area aligns with various assessments and their respective domains, with milestone and domain codes provided for reference. Additionally, DSM-5 diagnostic criteria for Autism are included to help clinicians identify how this skill area potentially supports medical necessity in relation to the diagnosis.
VB-MAPP (Verbal Behavior Milestones Assessment and Placement Program)
Group, G 8-M, Transitions between classroom activities with no more than 1 gestural or verbal prompt
Listener Responding, LR 4-M, Performs 4 different motor actions on command without a visual prompt (e.g., Can you jump? Show me clapping)
AFLS (Assessment of Functional Living Skills)
Basic Communication, BC1, Follows instructions
Basic Mobility, MB5, Stays beside caregiver
Basic Mobility, MB18, Stays in the area when told to "wait here" or "stay put"
DSM-V Diagnostic Criteria for Autism
A2, Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
CDC’s Developmental Milestones
18 Months, Language/Communication Milestones, Follows one-step directions without any gestures, like giving you the toy when you say, “Give it to me.”
Treatment Plan Goal Ideas
This is a list of treatment plan goals. These are different from the goals you will find in the skill sequence below. Your treatment plan goals encompass any number of goals from the skill sequence. Sometime they will include multiple goals from the sequence (”Learner will label 5 toys”) and sometimes the treatment plan goal will be simply consist of a really important goal from the skill sequence (”Will label caregiver”). An analogy I like to use goes as follows: Each skill sequence goal (commonly known as a “target”) represent each stair in a flight of stairs. The treatment plan goal is the flight itself.
Treatment plan goal ideas for this particular skill area are as follows:
Learner will hold the hand and walk with a familiar adult for 10 feet while engaged with a high value item.
Learner will hold the hand and walk with a familiar adult for 30 feet, changing directions three times without elopement or significant problem behavior.
Learner will hold the hand and walk with a familiar adult for 60 seconds, changing directions five times without elopement or significant problem behavior.
Learner will hold the hand and walk with a familiar adult across a parking lot or on a sidewalk for 60 seconds without elopement or significant problem behavior.
Component Skills
Your learner may need to be fluent in these component skills first before introducing this goal/skill area. Component skills for this skill sequence may include skill areas that are fundamental to other areas. Fluency in the skill areas listed below may increase the likelihood that your learner will succeed in this skill sequence and those afterward.
Below is a possible skill sequence for working on increasing your learner’s ability to hold hands. Note that every learner is different and that you likely will need to tweak and vary some programming to their needs. Click the triangle icon to view the full description for each skill in the sequence/area.
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#1 Grabs adult hand when it is presented
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand.
Learner should grab the outstretched hand.
Reinforce the learner contingent on desired response.
Additional Notes
You can run this program in any environment during any activity.
Materials
Research/Resources
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#2 Holds hand for 5 seconds
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand.
Learner should grab the outstretched hand.
Therapist should hold the learner’s hand for 5 seconds.
Reinforce accordingly.
Additional Notes
You can run this program in any environment during any activity.
Materials
Research/Resources
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#3 Grabs hand, get’s up
How to Run
Observe learner sitting down on floor or in small chair.
Gain the attention and motivation of the learner.
Present an outstretched hand.
Learner should grab the outstretched hand.
Therapist should give the instruction to “Walk with me!”
Learner should get up while continuing to hold the therapist’s hand.
Once the learner get’s up, the therapist should reinforce accordingly.
Additional Notes
You can run this program in any environment during any activity.
Learner can be holding a high value item during this program.
Materials
Research/Resources
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#4 Grabs hand walks 10 ft with high value
How to Run
Observe learner engaging with a preferred item.
Gain the attention and motivation of the learner.
Present an outstretched hand.
Learner should grab the outstretched hand.
Therapist should give the instruction to “Walk with me!”
Learner should get up while continuing to hold the therapist’s hand.
Learner should walk 10 feet with the therapist while holding the therapist’s hand..
Once the learner walks 10 feet, therapist should reinforce accordingly and allow the learner to return to their preferred area.
Additional Notes
You can run this program in any environment.
Materials
Research/Resources
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#5 Grabs hand walks 10 ft with neutral
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand.
Learner should grab the outstretched hand.
Therapist should give the instruction to “Walk with me!”
Therapist should offer the learner a neutral value item (ex: fidget spinner, stress ball, etc.)
Learner may or may not accept but should proceed to walk at least 10 feet with the therapist while holding the therapist’s hand..
Once the learner walks 10 feet, therapist should reinforce accordingly and allow the learner to return to their preferred area and engage in a preferred item/activity.
Additional Notes
You can run this program in any environment.
Materials
Research/Resources
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#6 Holds hand 20 ft, change direction 2x with neutral
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand.
Learner should grab the outstretched hand.
Therapist should give the instruction to “Walk with me!”
Therapist should offer the learner a neutral value item (ex: fidget spinner, stress ball, etc.)
Learner may or may not accept but should proceed to walk at least 20 feet with the therapist while holding the therapist’s hand..
In walking, therapist should also change directions twice during this time.
Once the learner walks 20 feet and changes direction twice with the therapist without engaging in elopement (or other significant problem behavior), therapist should reinforce accordingly and allow the learner to return to their preferred area and engage in a preferred item/activity.
Additional Notes
You can run this program in any environment during.
Materials
Research/Resources
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#7 Holds hand 30 ft, change direction 3x with neutral
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand.
Learner should grab the outstretched hand.
Therapist should give the instruction to “Walk with me!”
Therapist should offer the learner a neutral value item (ex: fidget spinner, stress ball, etc.)
Learner may or may not accept but should proceed to walk at least 30 feet with the therapist while holding the therapist’s hand..
In walking, therapist should also change directions three times during this time.
Once the learner walks 30 feet and changes direction three times while holding hands with the therapist without engaging in elopement (or other significant problem behavior), therapist should reinforce accordingly and allow the learner to return to their preferred area and engage in a preferred item/activity.
Additional Notes
You can run this program in any environment.
Materials
Research/Resources
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#8 Holds hand 40 ft, change direction 4x with neutral
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand.
Learner should grab the outstretched hand.
Therapist should give the instruction to “Walk with me!”
Therapist should offer the learner a neutral value item (ex: fidget spinner, stress ball, etc.)
Learner may or may not accept but should proceed to walk at least 40 feet with the therapist while holding the therapist’s hand.
In walking, therapist should also change directions four times during this time.
Once the learner walks 40 feet and changes direction four times while holding hands with the therapist without engaging in elopement (or other significant problem behavior), therapist should reinforce accordingly and allow the learner to return to their preferred area and engage in a preferred item/activity.
Additional Notes
You can run this program in any environment.
Materials
Research/Resources
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#9 Holds hand 50 ft, change direction 5x with neutral
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand.
Learner should grab the outstretched hand.
Therapist should give the instruction to “Walk with me!”
Therapist should offer the learner a neutral value item (ex: fidget spinner, stress ball, etc.)
Learner may or may not accept but should proceed to walk at least 50 feet with the therapist.
In walking, therapist should also change directions five times during this time while holding the therapist’s hand..
Once the learner walks 50 feet and changes direction five times while holding hands with the therapist without engaging in elopement (or other significant problem behavior), therapist should reinforce accordingly and allow the learner to return to their preferred area and engage in a preferred item/activity.
Additional Notes
You can run this program in any environment.
Materials
Research/Resources
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#10 Holds hand 60 seconds, change direction 5x with neutral
How to Run
Gain the attention and motivation of the learner.
Present an outstretched hand.
Learner should grab the outstretched hand.
Therapist should give the instruction to “Walk with me!”
Therapist should offer the learner a neutral value item (ex: fidget spinner, stress ball, etc.)
Learner may or may not accept but should proceed to walk for 60 seconds with the therapist.
In walking, therapist should also change directions five times during this time while holding the therapist’s hand..
Once the learner walks for 60 seconds and changes direction five times while holding hands with the therapist without engaging in elopement (or other significant problem behavior), therapist should reinforce accordingly and allow the learner to return to their preferred area and engage in a preferred item/activity.
Additional Notes
You can run this program in any environment.
Materials
Research/Resources
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#11 Holds hand and walks across parking lot
How to Run
Before leaving a car or building and crossing a parking lot, gain the attention and motivation of the learner.
Present an outstretched hand.
Learner should grab the outstretched hand.
Therapist should give the instruction to “Walk with me!”
Learner should proceed to walk across the parking lot while holding the therapist’s hand.
Once the learner has walked across the parking lot without engaging in elopement (or other significant problem behavior), therapist should reinforce accordingly and allow the learner to return to their preferred area and engage in a preferred item/activity.
Additional Notes
IMPORTANT: Ensure that the learner is completely safe in these instances. If the learner is still a high risk for elopement in these areas, it may not be recommended to target this program until absolute fluency has been gained in other areas.
Materials
Research/Resources
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#12 Holds hand and walks down sidewalk (1 block)
How to Run
Before leaving a car or building to walk down a street, gain the attention and motivation of the learner.
Present an outstretched hand.
Learner should grab the outstretched hand.
Therapist should give the instruction to “Walk with me!”
Learner should proceed to walk down sidewalk while holding the therapist’s hand.
Once the learner has walked one block without engaging in elopement (or other significant problem behavior), therapist should reinforce accordingly and allow the learner to return to their preferred area and engage in a preferred item/activity.
Additional Notes
IMPORTANT: Ensure that the learner is completely safe in these instances. If the learner is still a high risk for elopement in these areas, it may not be recommended to target this program until absolute fluency has been gained in other areas.
Materials
Research/Resources
Concurrent Skills
Working on these skills at the same time could help with goal mastery. Maybe your learner has mastered these skills already. Perhaps they are already listed as component skills above. That’s okay! Targeting other learning channels might help your learner.
These are the possible next steps for learners who have mastered, or are mastering, the skills listed above. Note that new skill areas may require fluency in other component skills not listed above. Also, you can introduce composite skill sequences prematurely to keep your learner progressing, as generativity may occur earlier than expected.
Elizabeth R. Lorah, Shawn P. Gilroy, Philip N. Hineline,
Acquisition of peer manding and listener responding in young children with autism,
Research in Autism Spectrum Disorders, Volume 8, Issue 2, 2014, Pages 61-67,
ISSN 1750-9467,
https://doi.org/10.1016/j.rasd.2013.10.009.
Kaitlin G. Causin, Kristin M. Albert, Vincent J. Carbone, Emily J. Sweeney-Kerwin,
The role of joint control in teaching listener responding to children with autism and other developmental disabilities, Research in Autism Spectrum Disorders, Volume 7, Issue 9, 2013, Pages 997-1011, ISSN 1750-9467,
https://doi.org/10.1016/j.rasd.2013.04.011.
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Disclaimer
Consistent with ethical obligations outlined by the Behavior Analysis Certification Board (BACB), users acknowledge that goal selection/direction is the responsibility of the BCBA. Users understand that goals should be tailored to the learner while ultimately involving the input of clients/stakeholders. Users understand their ethical obligations to the client/stakeholder concerning the selection, implementation, design, and minimization of risk regarding behavior change interventions as outlined in BACB Code. As such, this skill sequence serves as a general framework for generating ideas around this particular skill area and not as an assessment or curriculum.
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Intro to Reinforcer/Preference Expansion
Imitates Actions with Preferred Items
Imitates Actions During Familiar Routines
Performs Action During Familiar Routines (LR)
Intro to Sitting 
Greetings (Non-Verbal) 
Approaching Others When Asked
Transitioning With Others
Intro to Toileting 
