From Facebook:
"Better day today! We still ended at 10:30, but it was on the grown-ups' terms, and on a positive note. Saw some good things today as we worked on "manding" (teaching Ryan ways to make requests). Both Ryan and I were smiling as we came home today. ;) "
I was feeling apprehensive as we left this morning, since Ryan was awake most of last night, then fell asleep at 6 AM, and I had to wake him at 8 AM to get ready for Unity. He was sleepy, cranky, and didn't want to eat a lot of breakfast. We arrived at a good time, but it was starting to snow, freezing and windy, and someone has taken my reserved parking spot. Grr.
Surprisingly, Ryan perked up as soon as we got into the Centre. I put him on the rocker teeter-totter to keep him happy (and contained!) while I put our things away and prepared for the day.
A twist was added to our day when we discovered that both the usual lead therapists for Unity were away today, so we'd be working with other lead therapists today. Ryan and I were working with D., a low-key, easy-going guy with whom we both quickly became quite comfortable.
The ultimate goal for today was simple: end on a positive note. This way, Ryan will not be learning to associate his crying with, "If I cry, I get to go home." In fact, this is a general principle for all the activities we do at Summit Centre: it's better to do less and end on a positive note than do more and have the child make negative associations with it. Plus, if we leave when Ryan's happy, we're leaving on Mommy's or the therapist's terms, and not just because Ryan is trying to manipulate us with a tantrum.
Anyway, our day started in the Blue Room again going through his reinforcers (to make sure they're still valuable/interesting to him), with a focus on "manding." Manding means the child makes their own request for something in an appropriate manner. For Ryan, we decided to start manding by showing him how to touch the item he wanted with one finger--the prelude to pointing. We also accepted if he gently touched the item, but he was not allowed to grab. We used the reinforcers to encourage him to ask for them. The trick is, you can't ask, "Ryan, do you want the rattle?" You just have to hold it in his vision, maybe rattle it a bit, and wait for him to initiate the request by pointing or touching. Of course, his natural instinct is to grab, but that's not an appropriate response, so he can't have the rattle. If he insists on grabbing, we take his hand and help him point or tap the item. Then he gets the item and verbal praise. We did a lot of hand-over-hand (HOH) modeling today, but even him allowing us to do that is a step in Ryan's learning process.
D. also did some trials of Ryan's tracking. If Ryan was playing with one toy, and D. used another favourite toy to make a noise, would Ryan look up and follow the sound of the new toy? He usually did, which is a really good skill. D. also took some of the toys and hid them under a basket, with Ryan watching. Would Ryan lift the basket to find the toys? It took him a minute and some verbal prompts, but he did do it--another plus. Then we tried a bit more manding. Ryan likes pinwheels, whether we are blowing them, or he can spin them with his hands. D. tried blowing the pinwheel a few times, then pausing before he blew, and looking at Ryan expectantly, waiting for Ryan to make a request for him to blow some more. Suddenly, one time D. did this, Ryan pursed his lips and let out a little puff of air! We were so excited! We got him to do this a few more times, and even accepted approximations (like if he pursed his lips in the blowing gesture). Even if it was inconsistent, I was stunned: I've never seen him do something like that before!
D. then tried to see if he could get Ryan to begin participating in some clean-up skills. He got out a bin of chunky beads, showed them to Ryan, then put some on the floor. Then he modeled how to pick one up and put it back in the bin. He gave Ryan a bead, and HOH helped Ryan put it in the bin. Then he let Ryan choose a bead, and just put his hand in the bin to direct Ryan where Ryan should put the bead. Ryan, of course, just wanted to mouth the beads, and got a bit irritated. However, he did let D. help him put the beads in the bin, HOH.
One thing I really liked is that they have come to understand that Ryan has limits, and works better when he has a break to do as he pleases now and then. So, after the clean-up trial we just let Ryan play with his reinforcers for about 5 minutes without intervention, and voila--he was a much happier and cooperative little man.
Next it was circle time, and D. ran circle. Once again, I was truly pleased with the adjustments they made for Ryan. "Itsy Bitsy Spider" was removed from the line-up, and when D. sensed Ryan was getting agitated, he quickly removed about a third of the circle-time items off the board (it's a poster with velcroed-on pictures representing the circle-time activities), and skipped to the end. Ryan was a little less involved in circle today, but at least he didn't cry; he just whined a bit once or twice. He tried to get up and walk away, but we encouraged him to sit, and he got reinforcement for sitting with us for circle. A funny thing that happened was D. discovered a great reinforcer for Ryan by accident: he waved the circle time board at Ryan to get his attention, and it made a breeze. Ryan laughed: he loved it! So, all through circle, D. reinforced Ryan's positive attempts and behaviours by fanning him with the circle time board! Actually, the other little guy liked it, too. D. said we'll have to find a way to work that into Ryan's basket of reinforcers. It's so amazing how we can randomly stumble upon things that work!
Ryan was in a stable mood after circle, so we decided to do his snack a bit early (keep the positive times rolling). Snack was awesome! He ate a whole cup of yogurt and was happily letting me HOH his spoon feeding. D. was also pleased that I was giving Ryan verbal models when he would make noises like "Mmm" (I would say "More!") and "Umm" (I would say "Yummy!"). Ryan was also making sounds like "Mmm" or "Ahh" when he wanted more Gerber rice puff stars (nice manding!), and he was taking them nicely and attempting to chew. I think yogurt and star puffs are going to be our snack time staples now.
After snack, we tried the Snoezelen Room to see if that might be something we could use to soothe Ryan when he needs a break from the program. Briefly, a Snoezelen Room "is a therapy for people with autism or developmental disabilities. It consists of placing the person in a soothing and stimulating environment... . These rooms are specially designed to deliver stimuli to various senses, using lighting effects, color, sounds, music, scents, etc. The combination of different materials on a wall may be explored using tactile senses... .- the focus is to assist users to gain the maximum pleasure from the activity... . An advantage of Snoezelen therapy is that it does not rely on verbal communication and may be beneficial for people with profound autism, as it may provide stimulation for those who would otherwise be almost impossible to reach" (Wikipedia). Ryan liked the textured carpets on the floor, and lay right back on the little rocking bed with his arms up behind his head, but he wanted to go explore other things after a minute or two. Maybe we'll try it again in the future.
Finally, we went into the Single Treatment Room (STR) to play with some toys, work on manding, etc. While we were in there, D. was tickling Ryan's face. To get Ryan to ask for more, he was showing Ryan the sign-language motion for "more" while also saying it. He would get his hand into tickle position to set up Ryan's anticipation, and then model "more" with signs and verbal for Ryan. After D. did this several times, we saw Ryan attempting to put his hands into the "more" gesture 5 or 6 times, all on his own! But then he really shocked us. D. set up the tickle motion with an expectant face, and Ryan clearly said, "Mow." I thought I was hearing things until D. got totally excited and praised and hugged Ryan (while giving the requested tickles, of course). We heard a quiet "mo" one or two more times. We also got him to give D. a few high-fives to get some squeeze-cuddle reinforcement (we also stumbled onto that reinforcer today: Ryan loves deep-pressure squeeze and massage). He couldn't do it for Mom, though, because he was starting to get worn out.
When he started to fuss and wander, D. said, "I know what you're doing, and you're not leaving till we've got you happy again!" D. had an idea. He went and got some bubbles. As Ryan and I left the STR, D. went ahead, enticing Ryan to follow him, with bubbles! It worked. Ryan stopped fussing, and was intrigued, as we headed over to get our coats. While Mommy got things ready to go, D. played bubbles with Ryan until Ryan was smiling and grabbing at them, and even reaching out to request more. By the time I went to put on Ryan's coat, he didn't want to leave; he wanted to stay and play with more bubbles! D. said this was the perfect time to end: Ryan was having a great time, and he was leaving on our terms. Ryan was all smiles as we left, and I was so happy at how well our day had gone.
I felt a renewed sense of "This will work!" and happiness as we left Summit Centre today. :)
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