Hand-Over-Hand Method written by, Jean M. Slater, MS Speech/Language Pathologist 2000 Slater Software, Inc.
Have you ever told your child to give you something that is dangerous and he or she ignores you? Have you asked that he pick up the banana he dropped on the floor and, again, you are ignored? What do you do? Do you repeat your request, this time a little louder? Do you repeat it several times? Do you run after your child, hoping that he won t trip with the dangerous object, and get it out of his hand? Do you give up and pick up the banana yourself? Whatever you do, the problem is solved. There is no longer and danger, or the floor is no longer a mess. If you have other children without disabilities, their actions may have been typified as being disobedient or not paying attention. Those judgements might lead to other consequences scolding, time-out, etc. But with your child with disabilities, other factors are probably at work. You child may not understand the words in your request. Perhaps she has not learned how to let go of an object. It may be even more basic because he doesn t understand that you are requesting him to do something. Sometimes you may not think that he is capable of completing the request, but you say it anyway, to include him in what s going on. Your child will be expected to follow directions at school. He or she will learn not to tear other s papers, not to pull hair, how to carry a snack to the table, and many other things. He or she can learn those things at home too. Your child can learn to follow directions. Many skills are taught using the strategy hand-over-hand. This means that another person usually another adult, but not necessarily helps the child follow through on the directions by literally holding their hand and getting them to complete the task. We have all learned by hand-over-hand. Perhaps a batting coach leaned over your shoulder and helped you position the bat correctly. Maybe you mother showed you the right way to scrub the floor by putting her hand over yours to demonstrate how much elbow grease you needed to apply to the job? Many of us have used the hand-overhand technique to teach others. Did you ever help a child learn to ride a bike by holding his hands on the handlebars to help steady the bike? How many times have you raised a toddler s hand to wave bye-bye before that child learned to do it himself? You can probably think of other examples when you have helped someone, or someone has helped you, learn a skill by using the hand-over-hand technique. 2
This is the same thing you will be doing with your child to help her learn new skills. The only difference is you didn t need hand-over-hand teaching to learn the skills that you are going to ask your child to learn. You may be asking your child to turn a page in a book, open a drawer, find her toothbrush, climb up into the chair, or get her coat. To learn these tasks your child may need your hand-over-hand help and direction. Always begin with a direction or a comment. By using language, you are helping your child in many ways. You are improving auditory attention, teaching vocabulary, training a motor act, helping refine movements, and/or teaching sequencing and responsibility. Take the snack to the table, Jeannie. Then help her grasp both sides of the plate of crackers and walk to the table. The adult keeps her hands on the child s hands until the task is completed. (This example shows the adult giving a direction.) You say, It s time for a snack, while the two of you are standing near a plate of crackers. Your child does not reach for the plate, so you grasp her hands and the plate, just like in the above example and help her take it to the table. (This example shows that adult giving a comment. It would be assumed that the child had been exposed to the snack sequence several times and may not need the explicit command, as in the first example.) I have already mentioned that you precede the task with the words or directions. It is also very important that you only give that direction once. Repetitions usually do not have a positive effect. Remember, the child may not be complying for a variety of reasons, and hearing the direction more than one time will not significantly help. It is also important that you only give a direction that you are prepared to act on. If you are comfortable in your chair, and your child has something that your spouse needs, and you tell her to give it to Mommy, you must be prepared to get up, gently turn her around and help her to get to Mommy. If you are not willing to get up out of your chair, don t give your child the direction. 3
Before you know whether or not hand-over-hand instruction is needed, you need to wait a second or two for your child to follow your direction. This is called wait time and is very important with some children. Often a child needs the extra seconds to understand the direction and begin the motion. Wait-time may be something that you will have to practice before you are completely comfortable with it. As you make the effort to learn the time your child needs to comply with a direction, you will find that it is easy to allow her that time. You have been playing with blocks, but now it is time to clean up. Let s put the blocks away. Blocks in the box. -----wait----- If there is not movement toward a block or toward the box, put your hand on your child s, move to a block, both of you pick up, take the block to the box and drop it in. Good! Picking up blocks. There are more. Blocks in the box. -----wait----- Repeat. Hand-over-hand is the term used to help your child learn a new skill or perform a function that you want him to do. Your child needs your assistance to be successful with a task. It is not limited to just tasks that use the hands, but we will use the term hand-over-hand. Sometimes you will gently turn your child s head to look out the window, lift his leg to help guide his foot into his snow boot, help her climb into the car, or grab him quickly to stop him in a busy parking lot. After you have helped your child complete a task, the final step is to praise and rephrase what he just did. This reinforces the direction and the action. It also tells your child that his participation was important and appreciated. When helping with the snack, praise and rephrase what just happened. Great! You brought the crackers to the table. Now everyone can eat. Remember, there are four very important parts of hand-over-hand assistance: 1. Give the direction first. Do not repeat the direction, and only give a direction that you are prepared to act on. 2. Allow for wait time. 3. Assist you child in completing the direction. 4. Praise you child and rephrase when the job is completed. 4
As you become comfortable with hand-overhand teaching, you will notice that your child is learning new skills. Each skill that is learned will lead to learning another skill, then another, and another. There are many opportunities throughout a child s day for hand-over-hand help and direction. Let s take just one small piece of a dressing task putting on a shirt. Assume your child does not help with this process at all right now. If we can teach your child a small skill, your task will be easier, your child will be an active participant, and both of you can feel you have accomplished something. The scenario may go something like this: OK, sweetie. Time to put on your Tigger shirt. Arms up. (wait, then help lift arm(s) up to go in sleeves) That s right arm s up. Good. Now the shirt goes over your head. Oh, my, where s Betsy? Where s my darlin? Pull your shirt down. (help her get a handful of shirt) Pull. (wait, both of you pull down the shirt) There she is. Now you re all dressed! Something to mention that I m sure you have already figured out you do not need to have your child complete or accomplish a task from start to finish. Helping him pick up three or four blocks while you are picking up that many in one handful and getting the blocks off the floor is probably sufficient probably. When your child is eating, assisting him to hold the spoon, scoop up food, and take to his mouth does not have to happen throughout the entire meal. If this is new learning for your child, start the meal with several hand-over-hand mouthfuls. Then you can take over and finish the meal. As your child begins to follow through on his own, you can remove the total hand-over-hand. You will start to prompt by touching his elbow, beginning hand-over-hand but removing your hand before the task is finished, or guiding only when needed. You can talk about fading the hand-over-hand with your child s speech/language therapist. Hand-over-hand is active, participatory, and educational. Cooperating together is also FUN! for you, your child, and the other members of your family. 5