Backward Chaining Technique for Self-Care Activities

Learning how to perform self-care activities can be challenging for some children, especially when an activity involves multiple steps.

Backward chaining is a behavioral approach that can be used to break down and teach steps of a task in a progressive way. In backward chaining, the occupational therapist would perform most of the task and teach the child how to perform the last step of a task.

 

This strategy can be beneficial for children with:

• Low self-esteem
• Low frustration tolerance or easily discouraged
• Difficulties completing tasks with multiple steps

This strategy provides them with immediate positive reinforcement after completing the last step of a task. Taking part in their self-care routine and feeling successful can provide children with a sense of accomplishment and increased self-efficacy.

As practice of this task continues, the child would then complete the last two steps of a task. Over time, the occupational therapist would perform fewer steps at the beginning of the task as the child continues to complete additional steps. Eventually, the child learns how to complete all of the steps of a task on his or her own.

Steps for using backward chaining technique:

1. Break the task down into steps
2. Complete all of the steps of a task, except for the last step which will be taught to the child.
3. Teach the last step to the child and practice until the child can complete step independently. This can be taught in various ways:
   1. Demonstrate or model the step for the child.
   2. Providing verbal prompts such as specific instructions or actions to help the child perform the task.
   3. Physical prompts  such as hand over hand assistance.
4. Repeat the task again, only this time, complete all but the last two steps.
5. Teach the child the second to last step, as previously mentioned, and then allow them to complete the last step independently.
6. Repeat this process until the child can complete all of the steps independently.

Here is an example of how putting on pants can be broken down and taught to a child using the backward chaining technique.

 

First time teaching task:

1. Adult holds the pants by the waistband with the label facing toward the back.
2. Adult lowers pants towards the child’s feet.
3. Adult lifts and brings one of the child’s leg into the pant hole.
4. Adult lifts and brings the other leg into the pant hole.
5. Adult pulls pants up and over the child’s knees.
6. Have the child stand up and teach the child how to pull his or her pants up to their waist.

Once the child learns how to pull their pants up from their knees to their waist, they are ready to move on to the next step of the backward chaining process.

Second time teaching task:

1. Adult holds the pants by the waistband with the label facing toward the back.
2. Adult lowers pants towards the child’s feet.
3. Adult lifts and places one of the child’s leg into the pant hole.
4. Adult lifts and places other leg into the pant hole.
5. Teach the child how to pull their pants up and over their knees.
6. The child stands up and pull their pants up to their waist.

Third time teaching task:

1. Adult holds the pants by the waistband with the label facing toward the back.
2. Adult lowers pants towards the child’s feet.
3. Adult lifts and places one of the child’s leg into the pant hole.
4. Teach the child how to place other leg into the pant hole.
5. The child stands up and independently pulls their pants up and over their knees and waist.

This process continues until the child can independently perform all the steps of putting on their pants.

Backward chaining can be used for other self-care activities such as:

• Putting on or taking off clothing (shirt, socks, shoes)
• Fastening buttons, snaps, and zippers
• Brushing teeth
• Washing hands
• Feeding
• Toileting and hygiene

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