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Hand Washing Task Analysis

Hope Bullard

EDU 347
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Student Information

Jake is a three-year-old, Caucasian, male, who was diagnosed with Autism Spectrum

Disorder. At three months old he was diagnosed with Neuroblastoma. He’s been through some

surgeries and chemotherapy. He is cancer free now. Jake has an older brother and his parents are

married. Despite all that Jake has been through, he is a fighter. He is very strong willed at times.

Yet, he is easy to redirect, when his teacher or the aide take him by the hand, he very rarely will

fight with them. He is an easy-going, and usually in a good mood. Jake is very intelligent. Even

though he is a three-year old, he is higher than many of his classmates. He knows each of the

uppercase and lowercase letters, colors, and basic shapes. Jake can even count to 20. He is still

very immature and does not like to sit still very long. He is able to verbalize some words and

phrases. Recently, he said, “I want that car.” His muscles on the right are weak, so his fine motor

skills need more practice. If he wants to do something like cutting paper with scissors, he will

squeeze the scissors to cut, then takes it off of his hand and opens the scissors up with both

hands. Jake is definitely a problem solver.

Targeted Task:

The targeted task for Jake is hand washing. This is a basic life skill he will need to know

how to do on his own. Due to the fact that Jake has Autism, the steps of handwashing may be

confusing or hard to remember what to do next without getting distracted or fixating on one part

of the task. Handwashing is to prevent him from contracting disease and weakening his immune

system. It is vital for Jake to stay healthy because of his history with cancer.

Task Analysis

This is the task analysis for this chaining procedure in this order:
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1. Turn on water

2. Rinse hands

3. Push lever

4. Rub hands together

5. Rinse hands

6. Turn off the water

7. Rip off paper towel

8. Dry hands

9. Throw paper towel in the garbage can

Table 1.

Jake will need to understand why it is important to wash his hands. Considering his age,

it might be easiest to explain by saying, “Germs are yucky! We need to wash the germs off our

hands.” He will need to know where the restrooms and sinks are located. He will also need to

have the different materials necessary, such as soap and paper towels. Jake is small for his age,

he will also need a step stool, this helps him reach the faucet and handles. When teaching begins,

Jake will have reinforcements each time he does a task without prompting.

Chaining Procedure

To teach task analysis there is forward chaining and backward chaining. According to

Slocum and Tiger, there is no reliable difference in task analysis given instruction consisting of

forward or backward chaining between or within students, and one is not more effective than the

other (Slocum & Tiger, 2011). A type of chaining procedure in which the last task of the chain is

taught first is called backward chaining (Miltenberger, 2016). Jake was able to throw away the

paper towel, so this is the reason backward chaining would be the most effective.
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When the student is not prompted, and the student does the task independently praise

must be immediate. The most effective positive reinforcement would be verbal pointed praise.

(Þorsteinsson, & Sigurðardóttir, 2007) In the middle of handwashing, one cannot stop to reward

with food after every task. Verbal pointed praise was given. The student must know right away

that he or she did something correctly. This way the behavior is being reinforced. At the end of

the task training, Jake was given a goldfish cracker for completing

He knows how to throw away the paper towel. Jake was prompted by hand over hand

and verbal cues. As he went through the steps, he was expecting someone to hold his hands out

and move them for him. When it was time for Jake to rinse off the soap, he reached for the water

all by himself. Also, when he got the paper towel, he used it to clean up the soap that had spilled

on the floor. That was not part of the task analysis, but it was interesting to see a three-year old

think about cleaning up his own mess.

Jake was able to remember the steps quickly. He would still reach out his hands and wait

but when given verbal prompts he would repeat and then do it.
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Results

Handwashing Results
9 Baseline Intervention
Number of Steps Completed Correctly

0
1 2 3 4 5 6 7 8 9 10 11 12 13
Sessions

Graph 1. Shows the baseline and the intervention. Jake made great progress when the
intervention was applied. He would remember the tasks, but sometimes get distracted and play in
the water.

Chaining Session 1 2 3 4 5 6 7 8 9 10 11 12 13
Procedure
Baseline/ B B B B B I I I I I I I I
Intervention
1. Turn on Water P P P P P J P J

2. Rinse Hands P P P P P J J J

3. Push Lever for Soap P P P P P P P J

4. Rub hands together P P J J J J J J

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5. Rinse soap off J J P J J J J J

6. Turn off water P J P J J J J J

7. Rip paper towel P P P P P P P P

8. Dry hands J J J J J J J J

9. Throw paper towel away J J J J J J J J

Table 2. J= Jake can do task independently and P= Prompt

The baseline shows that Jake was not able to complete any of the tasks without

prompting. He would reach his arms out and wait for someone to do hand-over-hand prompting.

Hand-over-hand prompting is the most intrusive way to teach. As Jake learns each task, they will

become less intrusive. When the intervention was applied, he was able to remember some of the

tasks. When he was able to do a task without prompting this was reinforced by praise and a

goldfish cracker. Positive reinforcement really helps the student remember that something good

happens each time he is able to do a step independently. Reaching the faucet was difficult

because he is short, the teacher gave him a step stool, this really helped. He did however

remember certain steps, for instance he knows that he needs to put soap on his hands, but he does

not have enough strength to push the lever for the soap. He is also not capable of ripping the

paper towel off because of the lack of fine motor skills. Turning the water on and off was also a

struggle for Jake again, because he does not have the strength in his hands to squeeze the

handles. Jake also liked to feel the water as it rinsed his hands. He enjoyed this, therefore it took

a little bit longer for him to finish the task.

Future Recommendations

Jake still needs to work on his fine motor skills. He needs the strength in his hands to

push the lever for the soap and for turning the faucet on and off. Instead of using hand over hand,
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his teacher will begin to fade out the prompts by using less intrusive prompts. Jake does need

reminders to not play in the water and to stay focused on his task. When completing this task, it

is necessary for Jake to use the step stool each time, even though other students do not use it, one

should be provided each time. Jake is very intelligent. I can see him mastering this skill quickly.

As Jake continues, he may need a visual story of pictures to show him what step is next.

According to Biederman, Fairhall, Raven & Davey, passive prompting is more effective than

hand-over-hand prompts (1998). Jake can even draw the pictures himself. In the future, Jake will

master the skill of handwashing, so that he will remain healthy.

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Bibliography
Biederman, G.B., Fairhall, J. L., Raven, K. A., Davey, V. A., (1998) Verbal prompting, hand-

over-hand instruction, and passive observation in teaching children with developmental

disabilities.

Þorsteinsson, H., & Sigurðardóttir, Z. G. (2007). Backward Chaining Used to teach a Woman

with Aphasia to Read Compound Words: A Single Case Study. Journal Of Speech-

Language Pathology & Applied Behavior Analysis,

Miltenberger, R. G. (2016). Behavior modification: Principles and procedures. Boston,

MA: Cengage Learning.

Slocum, S. K. & Tiger, J. H. (2011). An assessment of the efficiency of and child preference for

forward and backward chaining. Journal of Applied Behavior Analysis, 44(4), 793-805.