From Facebook:
"Today was the Day of Tantrums. Not fun. My nerves are frazzled. Somehow, we still managed to get some progress in there. The Summit Centre staff are awesome. I have no idea how they do this every day. They are special people. :)"
Things seemed fine when we arrived today. Ryan was in a good mood. As soon as we took off our coats, he went right over to the wagon and tried to climb in. I prompted him to ask me for a ride, and he tapped the wagon, so in he went. (By the way, we're encouraging him getting in and out on his own by putting one leg over the side. He usually lifts the other one in/out.) We met D.in the hallway, who said he'd be working with us today, but he let Ryan finish his ride up and down the hallway first.
Well, as soon as we got back into the Yellow Room to do our morning song, Ryan started to cry a bit. We chatted some about what we'd been working on lately and made an agenda for the morning, and then we headed over to the Blue Room. Ryan did not want to "stand up" and "follow Mommy" today. When we eventually coaxed him out of the Yellow Room, Ryan wanted to wander down the hall, not go in the Blue Room.
Once we got him into the Blue Room, we decided to start with a simple round of "push the train" on the floor. I had to HOH the first one or two trials, then I think a wrist prompt, and he finally did one independently.
D. had a new plan he wanted to try for "Go play." When we finished "push the train," D. had surrounded us with a circle of bins full of toys. We instructed Ryan to "Go play," and he just sat there. D. pointed to and shook some of the bins to entice Ryan. No luck. Instead, Ryan whined and went to the one spot where there were no toys, but B was sitting and observing. He tried to snuggle with her. So much for the toys! Even when we got B. to move away, he still wouldn't go for any of the toys. He just whined and wandered away. D. then opened a nearby cupboard full of toys and showed them to Ryan. Ryan looked in, and touched a few things. One was a big, electronic dinosaur. So, D. took that out and pressed the buttons, making it move and roar. Ryan looked at it for a bit, and then he cried. I guess we still haven't figured out how to make "Go play" work, even when he's surrounded by toys!
Anyway, he was pretty agitated so we pulled out the old program of the "car down the ramp" which he enjoys and is good at. He didn't want to pick out a car, and tried to mouth them when I would hand him one. I showed him how to do the car ramp again, and then he did both ramps (straight and twisty) several times independently, but he was still whiny and miserable. D. pulled out a little helicopter that has a pull string that makes the rotors spin. Ryan was intrigued by that; I got a couple "more"s out of him (with wrist prompts or him tapping) to pull the string and make it go again. But he quickly lost interest in that. However, even though he was mad and crying, he still grabbed and slid the helicopter down the car ramp independently!
We decided to try and give him some time to wander and see what he was interested in so we could follow his lead. He went back to the toy bins and pulled out a nubbly ball. He was chewing on it, but B. encouraged him to play "roll the ball" with her. He wasn't too happy at first, but he eventually got into the game, and it soothed him a bit. I've noticed he does tend to calm down during that activity.
Next, we tried the new program of colouring. As with all new programs, it took some tweaking to figure out what might work best for Ryan. We sat him at the table with a marker (washable and non-toxic, of course!) and a picture to colour. D. suggested marker might work better because it takes less effort to make a mark on the paper. It was a thin marker, and Ryan kept dropping it and rolling it around in his hand. D. thought a fatter marker might work better, so he got out some Crayola Tadoodles , which toddlers can hold in the palm of their hand to draw. "Holding onto items" is still a tough one for Ryan, so he did fumble the marker a bit, but he did have a little more control than with the skinny marker. Ryan let us do HOH drawing with him, and he did try to make some marks on his own, but he couldn't quite get the right angle to make his own marks. At least he wanted to try.
I tried to bring him back down to the floor to do a different activity, and instead, he wandered out the connecting door into the kitchen. When I went to guide him back into the Blue Room, he did not want to follow. He was crying again. He dropped down to his knees and refused to move. D. came over, and we tried to entice Ryan with some of his reinforcers, to stand up and get them. D. was holding the caged bell just above Ryan's reach and encouraging him to stand up and get it. Ryan was reaching for it, and trying to tap it, but he needed to "stand up" to get that bell. Well, Ryan was just getting frustrated, so he started to cry harder. Finally, one time when D. asked Ryan, "Do you want the bell?" Ryan nodded his head YES! It was a very clear, very emphatic nod of the head. D. said we had to give Ryan the bell (and lots of praise) for that one. Any spontaneous communication like that gets plenty of reinforcement! So, Ryan got his bell, we got him moving, and we got a great nod from him.
We then went into the Rainbow Room to try some "matching" again. I showed D. the steps we'd covered so far, and how Ryan was at the point of taking an elephant from my hand and independently matching it in the bowl with the elephant, and not the empty one. Today, D. increased the difficulty a bit. He put an elephant in one bowl, and a bean bag in another. When we told Ryan to "match it," he independently put the elephant in the bowl with the other elephant! That was great. He did this consistently. So, D. went up another level. This time, he put a blue elephant in one bowl and a green elephant in another. I handed Ryan the blue elephant and asked him to "match it." This time, he wasn't successful. He understands that elephants go with elephants, but he can't distinguish between two items of different colours yet. D. said maybe we should step back to having a completely different thing in each bowl, but move away from using the elephants, so that Ryan generalizes the skill a bit more.
While we were out there, we also tried "kick the ball" again. Today, Ryan continued to do well with that. He kicked the ball from sitting several times with only a verbal prompt and the ball by his foot. He even did a couple of kicks from standing again.
When we went Back in the Yellow Room, however, things quickly turned ugly again. I was trying to do the chunky puzzle with him, and his tantrum suddenly escalated. He completed the three puzzle pieces (taking them out independently, and putting them back in with some HOH), but he started screaming. Then he was inconsolable. He was laying on the floor, sobbing, pushing toys away, and wouldn't let anyone hug him or soothe him. He was red in the face, snot was flying everywhere, and he was hysterical. D. got an idea and disappeared for a minute (also to grab us some tissues!). When D. returned, he had an iPad, and he tried putting on a Thomas the Train video for Ryan. I was holding Ryan against my shoulder and rubbing his back, while D. put on the video. Ryan watched the video and snuggled with me, and after a few minutes, he calmed down. Then we gently moved him to sitting in front of me. To keep the flow of learning going (and to show Ryan he can't tantrum and get rewarded) D. started stopping the video once in a while and asking Ryan to do something he knew well, but required an appropriate response (like give a high five or imitate patting the floor). Ryan whined the first time or two, but he caught on that he had to cooperate to get more video. By circle time, Ryan had settled considerably.
Circle time went fairly well. Ryan did well matching the animals to the book and he also did a good attempt at a prompted clap for "If You're happy and You Know It." He was kind of fussy and restless, but he made it through circle time.
Oh, I forgot to mention that D. used the iPad, with Thomas playing, to entice Ryan to stand up and follow us to circle time, and later down the hall to snack time. It seems to work as an extra incentive to get Ryan moving. D. suggested I might try this as an incidental goal at home, using Thomas videos on my iPhone, to get Ryan to stand up and follow me.
Snack time was next. He looked so tired, but he made some good choices and requests. I lined up his star puffs, his yogurt, and his bottle just a bit out of his reach and encouraged him to ask for what he wanted. He'd reach, and then tap the item when I presented it to him. He even fed himself, completely independently, about three good bites of yogurt. Like yesterday, though, I had to put an end to snack time because he was really drawing it out, trying to make that bottle last forever!
After snack, we tried a couple programs in the Yellow Room. Since the Thomas videos were working as such a great reinforcer, and Ryan was in need of a high level of reinforcement to keep him focused today, we continued to use that for our trials, as well. We did the shape sorter, and Ryan got to watch a clip of Thomas after each time he put the shape in the hole. We also did a little more puzzle, and Ryan got to watch a Thomas clip after he removed all the pieces, and then when he put them back in.
We also tried a little bit of "holding an item" with the rings from the ring stacker, and he got a clip of Thomas after he cooperated with holding each one. We ended on that positive note.
In terms of the shape sorter and puzzle, D. noted that I could be fading back my prompts on those more. I was really doing HOH a lot today (I think because I sensed Ryan was so floppy and unfocused). D. suggested that I give more of a forearm prompt, and guide Ryan's arm so his hand is lined up over the hole for the puzzle piece/shape. Then, Ryan independently tries to drop/place the object in. As long as Ryan is trying, with intention, to put the piece/shape where it's supposed to go, we count it as a + in the data recording. He can have plenty of attempts as long as he keeps trying. We did this several times, and eventually, Ryan managed to wiggle in two of the shape sorter pieces independently. He can do it; he just needs a little fine tuning of his coordination.
Overall, it was an emotionally exhausting day. But we ended on a positive note, as we always try to do. I was especially pleased that when it was time to say bye-bye, Ryan (with a forearm prompt) waved bye-bye to both D. and B.
I know Ryan was exhausted, too. He fell asleep in the car on the way home, and didn't even wake up when I took off his coat and shoes and put him in his bed. In fact, he just woke up! I hope the nap improved his mood. :p
Thursday, February 28, 2013
Wednesday, February 27, 2013
Unity Day 22: Some Things Old, Some Things New
From Facebook:
"We had a pretty good day today at Summit Centre. We're trying some new programs. Ryan is definitely showing more personality, inquisitiveness, and attitude . . . which can be both amazing AND annoying. ;)"
It was just L.. Ryan and I this morning, so we had some time to chat and look back at all Ryan has accomplished in about 5 weeks. The changes in him are astonishing. Not only have we accomplished about 7 goals already, but Ryan is showing a lot more personality and inquisitiveness, both at home and at Summit Centre.
It is, quite frankly, a mixed blessing. There are many times when I'm laughing and groaning, or celebrating and sighing, at the same time. For example, Ryan has become quite the explorer. It's wonderful to see him going from room to room, checking out toys, opening cabinets, climbing up on furniture, and trying to open doors. But as you can imagine, opening cabinets, climbing up on furniture, and trying to open doors can also lead to some potential danger and lots of mischief! And toys, well, I love that he is pulling out and examining toys, and even playing appropriately with many of them now. However, he hasn't learned the concept of "clean up" yet. If you could have seen my house this afternoon, it looked like a toy bomb went off, and it was all from Ryan! I never believed I would see the day Ryan would be dragging out every toy he could find, and even transporting some favourites to various rooms in the house.
In terms of personality, L. remarked today, we've discovered that Ryan has a great sense of humour, as well as a very stubborn streak. He knows what he wants and doesn't want, and can indicate that quite clearly in many situations. Through his gestures (like tapping or pushing away) and his body language (frowns, smiles, turning away) he's built up some basic communication skills. He'll giggle and laugh when you're talking about how silly he is, or he'll give you a dirty look when he's not impressed about something. Today he threw the rings when he got tired of working with them. Was that appropriate behaviour? Not exactly, but L. views Ryan's new, occasionally non-compliant and defiant behaviours as a good thing. He cares about things now. He's starting to show the signs of the typical inquisitive, stubborn, mischievous three-year-old that's in there.
Here's a perfect example from today of the mixed blessing, the laugh and the groan: We were in the Rainbow Room, talking about some new things we could try with Ryan. Since he had just thrown the rings across the room, L. suggested Ryan might try throwing in a constructive way: bean bags into the holes. I picked up a bean bag and showed it to Ryan. He was wandering a bit, so I tossed it up and down a few times and shook it to get his attention. He started to walk back toward me, so I held it out to him, waiting him to come and grab it. Well, Ryan walked right up to me, turned his head away, put his hand up in a "stop" motion, and kept right on walking. In other words, it was a perfect, and very clear, "TALK TO THE HAND, MOM!" L. and I laughed so hard! Again, it wasn't really an appropriate social interaction with Mommy, but he sure made his stance clear! He wanted nothing to do with me and my stinkin' bean bag! LOL
For "push a train" today, he did really well. Right now, he's pushing the train down on the floor with no track (remember, he our "track addict"). I had to wrist prompt him for one or two trials, and then he did the rest independently. L. said if we have a few more days of him consistently being independent, then we'll introduce a single, long piece of track, but still on the floor. The train table has way too many distracting pieces for Ryan to mouth.
"Where's the ball?" was a complete success again. I said, "I wonder if he will do it with anything else?" so we tried a few toys, and yes, he uncovered them all independently. Therefore, "uncovering" has been replaced with a new, higher-level skill: matching.
Matching is new territory for us. I mean, he does it at circle time, matching the animal pictures to the ones in the book, but they always hand him the correct one to match or put it close by for him to pick it up. Now, we're actually starting the basics of him matching up different pairs of things together. We moved through several basic steps today on our way to full-out matching. First, L. put a little elephant toy in a small basket. Then, she took the matching elephant and put it in the basket, telling Ryan, "That's matching." Next, she did the same thing, but HOH'ed it with Ryan a few times. Then, she put the one elephant in the basket, held the matching one out to Ryan, and told him to "match it." She HOH'ed him taking it out of her hand and putting it in the basket with the other one. Finally, she did it again, but only with the verbal prompt to "match it." Ryan took it out of her hand, and dropped it in the basket with the other elephant. "That's matching!"
Next, we moved on to using a distractor bowl. (We had to switch to bowls because Ryan liked to chew on the baskets. They became a reinforcer. LOL You know, follow his lead . . . anyway . . .) What that means is two bowls are side-by-side; one has an elephant, and one is empty. After a few tries, Ryan caught on that he should put his elephant in the bowl that has the other elephant! When he got this consistently, I suggested we switch the position of the bowls, just to see if he really had the concept. L. thought that was a great idea. So, we tried it, and I believe he was inconsistent at first; after switching it around a few times, he caught on that elephant goes with elephant, no matter where it is. We also tried it with a pair of different coloured elephants, and he got it. Next step is to try matching with 2 or 3 different sets of animals. It was so cool to see his little brain working out this new skill, and it starting to click.
Later we went into the Yellow Room and decided to try another new skill. We wanted another imitation skill to replace "pat floor," so we went with "stomp feet" since it's in some of our new circle songs. We know he can stomp because he does it all the time sitting down, when he's excited. The key now is getting a controlled reaction. It took some playing around to figure out what prompts would work best for this, but L. determined that it works best when one person sits across from Ryan and models "stomp feet" while another person prompts from behind by holding his leg up a bit at the knee. That way, Ryan has to drop his foot down (the stomp). It took quite a few tries before Ryan caught on to what he was supposed to do, but eventually, he was doing "stomp feet" when prompted as above. In fact, at circle time, we did "If you're happy and you know it, stomp your feet," and I prompted Ryan as described, and he did it!
On the other hand, we are all struggling with "Go play" still. L. and I sat and wracked our brains over why we can't get this one through to Ryan, when he's doing so well with everything else. We need to find a way to make it more concrete for him. L.'s going to ask around for suggestions from other therapists and senior staff to see what we can do to make this one clearer for Ryan. He was very confused today. When we told him to "Go play" he looked lost, even when we set out and gestured to the toys, nudged him toward the toys, put out his favourite items, tried to entice him by modeling play a bit, etc. It was heartbreaking because he was trying so hard to figure out what we wanted; he patted the floor, grabbed L's hands, did the "more" sign, tried to give her high 5s . . . He was pulling out all his skills to try and give us what we wanted, or communicate something, but we hit a roadblock. It was great to see him tyring so hard to work with us, but also frustrating that we couldn't help him more.
At the end of the day, we tried "kick the ball" again, and it was back to normal. Yesterday he seemed to have no attention on the ball, but today he was very attentive and did several independent kicks from sitting, and even a few kicks from standing. I guess he just needed a reminder of how it worked yesterday. If he keeps up with consistent, independent kicking for a few more days, we'll move on to kicking from standing, and then maybe some basic soccer skills!
"We had a pretty good day today at Summit Centre. We're trying some new programs. Ryan is definitely showing more personality, inquisitiveness, and attitude . . . which can be both amazing AND annoying. ;)"
It was just L.. Ryan and I this morning, so we had some time to chat and look back at all Ryan has accomplished in about 5 weeks. The changes in him are astonishing. Not only have we accomplished about 7 goals already, but Ryan is showing a lot more personality and inquisitiveness, both at home and at Summit Centre.
It is, quite frankly, a mixed blessing. There are many times when I'm laughing and groaning, or celebrating and sighing, at the same time. For example, Ryan has become quite the explorer. It's wonderful to see him going from room to room, checking out toys, opening cabinets, climbing up on furniture, and trying to open doors. But as you can imagine, opening cabinets, climbing up on furniture, and trying to open doors can also lead to some potential danger and lots of mischief! And toys, well, I love that he is pulling out and examining toys, and even playing appropriately with many of them now. However, he hasn't learned the concept of "clean up" yet. If you could have seen my house this afternoon, it looked like a toy bomb went off, and it was all from Ryan! I never believed I would see the day Ryan would be dragging out every toy he could find, and even transporting some favourites to various rooms in the house.
In terms of personality, L. remarked today, we've discovered that Ryan has a great sense of humour, as well as a very stubborn streak. He knows what he wants and doesn't want, and can indicate that quite clearly in many situations. Through his gestures (like tapping or pushing away) and his body language (frowns, smiles, turning away) he's built up some basic communication skills. He'll giggle and laugh when you're talking about how silly he is, or he'll give you a dirty look when he's not impressed about something. Today he threw the rings when he got tired of working with them. Was that appropriate behaviour? Not exactly, but L. views Ryan's new, occasionally non-compliant and defiant behaviours as a good thing. He cares about things now. He's starting to show the signs of the typical inquisitive, stubborn, mischievous three-year-old that's in there.
Here's a perfect example from today of the mixed blessing, the laugh and the groan: We were in the Rainbow Room, talking about some new things we could try with Ryan. Since he had just thrown the rings across the room, L. suggested Ryan might try throwing in a constructive way: bean bags into the holes. I picked up a bean bag and showed it to Ryan. He was wandering a bit, so I tossed it up and down a few times and shook it to get his attention. He started to walk back toward me, so I held it out to him, waiting him to come and grab it. Well, Ryan walked right up to me, turned his head away, put his hand up in a "stop" motion, and kept right on walking. In other words, it was a perfect, and very clear, "TALK TO THE HAND, MOM!" L. and I laughed so hard! Again, it wasn't really an appropriate social interaction with Mommy, but he sure made his stance clear! He wanted nothing to do with me and my stinkin' bean bag! LOL
Reviewing Skills and New Goals
In discussing Ryan's regression in some skills which we witnessed yesterday, L. mentioned that some kids pick up on a new skill, and once it clicks, they always have it. Other kids may lose their skills if they are not practiced frequently. We are not exactly sure where Ryan is on that spectrum, but since he did show some uncertainty in a few of the skills we hadn't practiced in a while, L. suggested that we keep practicing things he's already learned. Even if they're not in our formal program, I should probably throw a couple in each day to keep it fresh in Ryan's mind. Like I mentioned earlier, we already have an amazing 6 or 7 skill programs Ryan has successfully completed in the past few weeks, so we'll work those in occasionally to make sure he still knows them.For "push a train" today, he did really well. Right now, he's pushing the train down on the floor with no track (remember, he our "track addict"). I had to wrist prompt him for one or two trials, and then he did the rest independently. L. said if we have a few more days of him consistently being independent, then we'll introduce a single, long piece of track, but still on the floor. The train table has way too many distracting pieces for Ryan to mouth.
"Where's the ball?" was a complete success again. I said, "I wonder if he will do it with anything else?" so we tried a few toys, and yes, he uncovered them all independently. Therefore, "uncovering" has been replaced with a new, higher-level skill: matching.
Matching is new territory for us. I mean, he does it at circle time, matching the animal pictures to the ones in the book, but they always hand him the correct one to match or put it close by for him to pick it up. Now, we're actually starting the basics of him matching up different pairs of things together. We moved through several basic steps today on our way to full-out matching. First, L. put a little elephant toy in a small basket. Then, she took the matching elephant and put it in the basket, telling Ryan, "That's matching." Next, she did the same thing, but HOH'ed it with Ryan a few times. Then, she put the one elephant in the basket, held the matching one out to Ryan, and told him to "match it." She HOH'ed him taking it out of her hand and putting it in the basket with the other one. Finally, she did it again, but only with the verbal prompt to "match it." Ryan took it out of her hand, and dropped it in the basket with the other elephant. "That's matching!"
Next, we moved on to using a distractor bowl. (We had to switch to bowls because Ryan liked to chew on the baskets. They became a reinforcer. LOL You know, follow his lead . . . anyway . . .) What that means is two bowls are side-by-side; one has an elephant, and one is empty. After a few tries, Ryan caught on that he should put his elephant in the bowl that has the other elephant! When he got this consistently, I suggested we switch the position of the bowls, just to see if he really had the concept. L. thought that was a great idea. So, we tried it, and I believe he was inconsistent at first; after switching it around a few times, he caught on that elephant goes with elephant, no matter where it is. We also tried it with a pair of different coloured elephants, and he got it. Next step is to try matching with 2 or 3 different sets of animals. It was so cool to see his little brain working out this new skill, and it starting to click.
Later we went into the Yellow Room and decided to try another new skill. We wanted another imitation skill to replace "pat floor," so we went with "stomp feet" since it's in some of our new circle songs. We know he can stomp because he does it all the time sitting down, when he's excited. The key now is getting a controlled reaction. It took some playing around to figure out what prompts would work best for this, but L. determined that it works best when one person sits across from Ryan and models "stomp feet" while another person prompts from behind by holding his leg up a bit at the knee. That way, Ryan has to drop his foot down (the stomp). It took quite a few tries before Ryan caught on to what he was supposed to do, but eventually, he was doing "stomp feet" when prompted as above. In fact, at circle time, we did "If you're happy and you know it, stomp your feet," and I prompted Ryan as described, and he did it!
On the other hand, we are all struggling with "Go play" still. L. and I sat and wracked our brains over why we can't get this one through to Ryan, when he's doing so well with everything else. We need to find a way to make it more concrete for him. L.'s going to ask around for suggestions from other therapists and senior staff to see what we can do to make this one clearer for Ryan. He was very confused today. When we told him to "Go play" he looked lost, even when we set out and gestured to the toys, nudged him toward the toys, put out his favourite items, tried to entice him by modeling play a bit, etc. It was heartbreaking because he was trying so hard to figure out what we wanted; he patted the floor, grabbed L's hands, did the "more" sign, tried to give her high 5s . . . He was pulling out all his skills to try and give us what we wanted, or communicate something, but we hit a roadblock. It was great to see him tyring so hard to work with us, but also frustrating that we couldn't help him more.
At the end of the day, we tried "kick the ball" again, and it was back to normal. Yesterday he seemed to have no attention on the ball, but today he was very attentive and did several independent kicks from sitting, and even a few kicks from standing. I guess he just needed a reminder of how it worked yesterday. If he keeps up with consistent, independent kicking for a few more days, we'll move on to kicking from standing, and then maybe some basic soccer skills!
Things We Want to Try
One thing I love about L. is that she's always looking ahead. What will be our next steps for Ryan? We want to try- colouring (I told her about Ryan and the magnetic drawing board yesterday afternoon),
- riding a tricycle (Ryan seems interested in the bikes at S.C.), and
- throwing (we've seen him toss puzzle pieces and rings today!).
Andrea and the S.C. Sibling Group
Summit Centre has a fantastic group for siblings of children with autism. I started taking Andrea a few months ago, and she loves it. They have it at the same time as the monthly parent group, so she goes off to her group and I to mine. They have pizza, play games, do crafts, and share feelings about having siblings with autism. I think Andrea enjoys that this is something special, just for her and Mommy. I'm posting a picture of the card she made for me at this month's group (which was on Monday). It touched my heart, and I also wanted Summit Centre people to know how much she appreciates the sibling group.
("Thank you for taking me here.")
Tuesday, February 26, 2013
Unity Day 21: One Step Forward, Two Steps Back
From Facebook:
"Another day of 1 step forward, 2 steps back; he tantrums, then he's a superstar; he forgets one thing, but surprises us with another ... Sigh."
Ryan's day started out very grumpy. He cried as soon as we walked into the building and got to the top of the stairs.
Today we were supposed to start working with each other's boys. Unfortunately, J. and his mom couldn't come in. However, I think that was okay because of how miserable Ryan was all day today. He was definitely not at his best. The day started out with another tantrum. This one wasn't quite so bad, but he still got really mad, had a few good screams, and did not want to cooperate with us for a while. Maybe it helped that I had a lot of back-up today since we were one-on-on with T. , and the grad student, B., was also with us quite a bit this morning. Anyway, once we got Ryan settled, I went off for weekly evaluation and homework discussion with H.
Evaluation was great. The only thing I got a low score on was attendance (a 2) which is totally fair, considering we missed two days out of a four day week. They did note in the comments that Ryan had been sick, though.
I have over 200 Parent Points because Ryan didn't like the reinforcers they picked out for him (they really weren't like what I had requested); I didn't keep them, so no charge. Instead, I asked for some circle-time activities that we can use later. For example, Ryan likes the "Brown Bear, Brown Bear" book and matching pictures, so she gave me a copy of the book and will have the matching pictures ready for me later. I also picked out a "Wheels on the Bus" activity, and a counting song activity, that they will put together for me. They're also going to get a circle time board started for me.
We tried some more clapping today, and it was strange: yesterday Ryan was bringing one hand over to clap independently every time. Today, he didn't even want to clap. So, we had to increase the prompt back to the wrist for the first few trials, and then we were able to fade it back to the one-hand prompt by the last trial. (NOTE: We usually do five trials each time for these programs.) T. said sometimes that happens; if we need to, we can increase the prompt for the first few trials and then fade it back again if necessary.
Ryan's interest in clapping was fading, so I followed his lead in that I saw he was interested in the ball. T. thought that was a good idea because it builds in natural reinforcement. If he wants the ball, he's more likely to be willing to work with it, right? So, we moved on to uncovering the ball. Again, today, he was ripping the towel off the ball the instant I asked, "Where is the ball?" This time, however, he wanted that ball so badly that he was grabbing it before I could even get it covered. In fact, one time he wanted to roll the ball to B. so much that he tried to roll it with the towel on it, before I could ask him to uncover it! It was too funny seeing him trying to get the ball without doing the work, but it backfired. A ball wrapped in a towel doesn't roll very well!
We tried the new puzzle again today. It was a bit awkward at first; Ryan and I were both fumbling the pieces. T. thought about it, and she realized that it might be the way we were positioned. She figured out the activity works best on the floor, with me sitting behind Ryan, and the puzzle on Ryan's right side. That way, I can block with my left hand and guide with my right hand, while Ryan grasps the puzzle piece with his right hand. It went more smoothly after that. We also agreed that we will not count it against Ryan (in the trials) if we have to block him from taking pieces out again after he just put them in. That's a whole different issue, so it isn't really tied to Ryan getting the concept of taking the puzzles pieces in and out (or improving hand-eye coordination).
We tried the stacking rings today, and for some reason, Ryan kind of regressed on this one, too (like the clapping). We had been doing a wrist prompt, but he wouldn't hold the rings and kept trying to mouth them. So, I had to go back to an HOH, and he still only got 2/5 trials correct. There wasn't much intention in his placement of the rings, and he didn't want to hold them. But that could have been an off-shoot of his bad mood today. Who knows?
We decided to see if Ryan would do another independent "more" in the wagon. So, we took him down the hallway, pausing now and then to get him to respond. Generally, he just got irritated. We tried me modeling "more" in front of him, and T. prompting him from the wrist/forearm/elbow. He did it when prompted, but we didn't get any more spontaneous requests. Oh, well. At least we know he did it once, so he is capable of it.
By circle time, Ryan was really worn out. He was not happy during circle today. He participated a bit for the "Panda Bear, Panda Bear" book (good holding and matching pictures), but he did a lot of crying for the rest, and even tried to get up and walk away a few times. He was not interested in his reinforcers. He just wanted out of there.
Thankfully, snack time was next. However, Ryan didn't want to sit down; he wanted to walk around with his bottle, and he kept sliding down out of his seat. When I put my arm around him to encourage him to sit up nicely, he stood up and leaned against me with his bottle. His eyelids were very droopy, and he was snuggling in. I was afraid he was falling asleep!
Luckily, I suppose, we were in for a change of pace: We had a fire drill! Admittedly, we had coats nearby as we had been forewarned one was coming, but the timing was good. T. helped Ryan into his coat while I grabbed mine, but Ryan wouldn't part with his bottle, so we had to bring it outside with us. The funny thing was, as soon as we got out in the cold, windy air, Ryan was wide-eyed and smiling. He thought the fire drill was funny! He enjoyed walking outside to the front driveway and getting some fresh air with the other kids. We had a few minutes outdoors while they did a roll-call and safety check, and then we went back in. Ryan was kind of upset when we went back in, though; maybe he thought we were leaving for the day when we went outside.
Anyway, we gave him a little more snack time where he ate a few star puffs and tried to stretch out the time with his bottle of milk as long as possible (eventually we had to take it away). Then we tried one more program, since he seemed a bit more settled.
We decided to do "kick the ball" because we haven't done it in a while (at least a week). The last time we did it, he was doing well; he mostly needed verbal prompts, and few physical prompts. Today, it was like he didn't even know the ball existed. He also didn't want to sit in the chair; we tried to do it from standing, but he'd just walk away. After a bunch of trial and error, T. figured out that we needed to get Ryan's attention on the ball. We did this by shaking one of his noisy reinforcers by the ball. T. had a ball, too, and modeled the kick, while I shook the reinforcer by the ball and told Ryan to "kick the ball." That finally got us a few good kicks out of him. T. said to make sure we do "kick the ball" again tomorrow to keep that one fresh in Ryan's mind. Then maybe we'll be able to fade back the prompts again.
After that, it was my call whether Ryan was ready to go. I decided to end it at that. Today was kind of blah. Hopefully tomorrow will be better for us all, as long as we don't get snowed in (3-7" expected tonight!).
This is a brief update on the programs we were doing with Thames Valley Children's Centre. J. came over for our meeting today, and she was very pleased with the data I had taken for her (thank you very much!). Kevin is being discharged from his emotional regulation program; we can put him on the waiting list to start a new goal (whatever we choose) ASAP because it's about a 5-month turn-around time to get another program. He is doing much better at controlling his anger and frustration. The hitting and screaming has decreased dramatically. We still have incidents, but he is a 5-year-old boy, and he does have peers and a 7-year-old sister who can be quite provoking at times.
Ryan is due to be discharged in 3 weeks. J. said he will automatically be put back on the waiting list (I don't have to call) because he clearly still has a need (his goal/program was independent feeding). He's made great progress over the past few weeks, but it's far from consistent. So Ryan, also, will be back on an ABA program through TVCC in about 5 months.
What I really enjoyed about my meeting with J. today was her reaction to the changes in Ryan. It's fun to see the amazement from people who have worked with Ryan, but haven't seen him since we started Unity. When she came in, Ryan was trying to figure out how to use the pen on a magnetic drawing board. He wasn't chewing on it; he was actually sitting there, running the pen through his fingers, and rubbing it on the board, trying to make it write! J. was fascinated. She watched him for a while, then modeled how he could do it, and helped him hold the pen. He actually made a few intentional marks on the board. I have never seen him do that!
J. was also shocked when Ryan came up to me and tapped on me because he wanted me to rock hm in the rocking chair. Then he got down and started tapping the chair because he wanted it for himself. She was so happy for us that he's starting to express his wants and needs more clearly.
When J. was leaving, and she said "bye bye" to Ryan, I gave him the wrist prompt, and he waved bye bye to her. I thought she was going to fall over. LOL Seeing the changes in Ryan through the eyes of someone who hasn't seen him in a while is very refreshing. ;)
"Another day of 1 step forward, 2 steps back; he tantrums, then he's a superstar; he forgets one thing, but surprises us with another ... Sigh."
Ryan's day started out very grumpy. He cried as soon as we walked into the building and got to the top of the stairs.
Today we were supposed to start working with each other's boys. Unfortunately, J. and his mom couldn't come in. However, I think that was okay because of how miserable Ryan was all day today. He was definitely not at his best. The day started out with another tantrum. This one wasn't quite so bad, but he still got really mad, had a few good screams, and did not want to cooperate with us for a while. Maybe it helped that I had a lot of back-up today since we were one-on-on with T. , and the grad student, B., was also with us quite a bit this morning. Anyway, once we got Ryan settled, I went off for weekly evaluation and homework discussion with H.
Evaluation was great. The only thing I got a low score on was attendance (a 2) which is totally fair, considering we missed two days out of a four day week. They did note in the comments that Ryan had been sick, though.
I have over 200 Parent Points because Ryan didn't like the reinforcers they picked out for him (they really weren't like what I had requested); I didn't keep them, so no charge. Instead, I asked for some circle-time activities that we can use later. For example, Ryan likes the "Brown Bear, Brown Bear" book and matching pictures, so she gave me a copy of the book and will have the matching pictures ready for me later. I also picked out a "Wheels on the Bus" activity, and a counting song activity, that they will put together for me. They're also going to get a circle time board started for me.
Homework
- Manding: This has changed. Instead of doing 5 timed minutes of manding, I am moving on to the less formal mode of working on various mands throughout our day, whenever the opportunity arises. In terms of notes, then, what I'm doing now is jotting down any issues/questions that arise during at-home manding and/or writing down any ideas for new situations in which I'd like to use manding.Then H. can help me with suggestions for those issues or how to set up the new manding situations.
- Play Goals: Cause and Effect has changed. Ryan is just getting too confused with the police chase portion of the car racers toy because he's so used to using the gear shift (which I taught him first). Now, H. has lent me a toy farm that has cubes you push into the openings; when the cube goes in one spot, it light up and spins a windmill and in the other spot, it makes music. Close-ended is the same. We will continue with the shape sorter that H. loaned us on Friday.
- Incidental Goals: We are going to continue the same goals we had as of Friday. In terms of "holding an object," we will focus on holding the farm animals from the play farm. However, I had asked about how Ryan seemed so HOH dependent for holding, and how I might fade that back. H. suggested that I HOH once, then using the same animal, fade back the prompt. It's kind of like if we do it together first, then maybe he'll be more comfortable trying it on his own right after. As for our other goal, "waving hi and bye-bye," it continues pretty much the same. The only thing I mentioned was Ryan having some confusion between Waving Hi and giving a High 5 (which he has mastered). Often, when a person is close to him and waves hi, he sees their hand up and interprets that as them wanting a high 5. Plus, the words are very similar-sounding. H. and I decided a solution might be to ensure there is some distance between the person who is waving hi and Ryan; that way, he won't be tempted to pat their hand in a high five.
The Rest of Ryan's Day
Well, when I got back from my time with H., T. and B. were so excited to tell me about something Ryan did. They had been taking him up and down the hallway in the wagon. Once in a while they would stop, and wait to see if he would request "more." He tried, but they had to prompt from the wrist or forearm. Anyway, he enjoyed the ride. When they went to park the wagon, and T. said, "All done!" (and signed it), Ryan made a very firm, very clear "more" sign! This is the first time he has done it perfectly independently: no prompt, perfectly formed, and with a great deal of intention. He wanted that wagon ride! T. said she couldn't say no that to that, so he got another cruise up and down the hallway. ;)We tried some more clapping today, and it was strange: yesterday Ryan was bringing one hand over to clap independently every time. Today, he didn't even want to clap. So, we had to increase the prompt back to the wrist for the first few trials, and then we were able to fade it back to the one-hand prompt by the last trial. (NOTE: We usually do five trials each time for these programs.) T. said sometimes that happens; if we need to, we can increase the prompt for the first few trials and then fade it back again if necessary.
Ryan's interest in clapping was fading, so I followed his lead in that I saw he was interested in the ball. T. thought that was a good idea because it builds in natural reinforcement. If he wants the ball, he's more likely to be willing to work with it, right? So, we moved on to uncovering the ball. Again, today, he was ripping the towel off the ball the instant I asked, "Where is the ball?" This time, however, he wanted that ball so badly that he was grabbing it before I could even get it covered. In fact, one time he wanted to roll the ball to B. so much that he tried to roll it with the towel on it, before I could ask him to uncover it! It was too funny seeing him trying to get the ball without doing the work, but it backfired. A ball wrapped in a towel doesn't roll very well!
We tried the new puzzle again today. It was a bit awkward at first; Ryan and I were both fumbling the pieces. T. thought about it, and she realized that it might be the way we were positioned. She figured out the activity works best on the floor, with me sitting behind Ryan, and the puzzle on Ryan's right side. That way, I can block with my left hand and guide with my right hand, while Ryan grasps the puzzle piece with his right hand. It went more smoothly after that. We also agreed that we will not count it against Ryan (in the trials) if we have to block him from taking pieces out again after he just put them in. That's a whole different issue, so it isn't really tied to Ryan getting the concept of taking the puzzles pieces in and out (or improving hand-eye coordination).
We tried the stacking rings today, and for some reason, Ryan kind of regressed on this one, too (like the clapping). We had been doing a wrist prompt, but he wouldn't hold the rings and kept trying to mouth them. So, I had to go back to an HOH, and he still only got 2/5 trials correct. There wasn't much intention in his placement of the rings, and he didn't want to hold them. But that could have been an off-shoot of his bad mood today. Who knows?
We decided to see if Ryan would do another independent "more" in the wagon. So, we took him down the hallway, pausing now and then to get him to respond. Generally, he just got irritated. We tried me modeling "more" in front of him, and T. prompting him from the wrist/forearm/elbow. He did it when prompted, but we didn't get any more spontaneous requests. Oh, well. At least we know he did it once, so he is capable of it.
By circle time, Ryan was really worn out. He was not happy during circle today. He participated a bit for the "Panda Bear, Panda Bear" book (good holding and matching pictures), but he did a lot of crying for the rest, and even tried to get up and walk away a few times. He was not interested in his reinforcers. He just wanted out of there.
Thankfully, snack time was next. However, Ryan didn't want to sit down; he wanted to walk around with his bottle, and he kept sliding down out of his seat. When I put my arm around him to encourage him to sit up nicely, he stood up and leaned against me with his bottle. His eyelids were very droopy, and he was snuggling in. I was afraid he was falling asleep!
Luckily, I suppose, we were in for a change of pace: We had a fire drill! Admittedly, we had coats nearby as we had been forewarned one was coming, but the timing was good. T. helped Ryan into his coat while I grabbed mine, but Ryan wouldn't part with his bottle, so we had to bring it outside with us. The funny thing was, as soon as we got out in the cold, windy air, Ryan was wide-eyed and smiling. He thought the fire drill was funny! He enjoyed walking outside to the front driveway and getting some fresh air with the other kids. We had a few minutes outdoors while they did a roll-call and safety check, and then we went back in. Ryan was kind of upset when we went back in, though; maybe he thought we were leaving for the day when we went outside.
Anyway, we gave him a little more snack time where he ate a few star puffs and tried to stretch out the time with his bottle of milk as long as possible (eventually we had to take it away). Then we tried one more program, since he seemed a bit more settled.
We decided to do "kick the ball" because we haven't done it in a while (at least a week). The last time we did it, he was doing well; he mostly needed verbal prompts, and few physical prompts. Today, it was like he didn't even know the ball existed. He also didn't want to sit in the chair; we tried to do it from standing, but he'd just walk away. After a bunch of trial and error, T. figured out that we needed to get Ryan's attention on the ball. We did this by shaking one of his noisy reinforcers by the ball. T. had a ball, too, and modeled the kick, while I shook the reinforcer by the ball and told Ryan to "kick the ball." That finally got us a few good kicks out of him. T. said to make sure we do "kick the ball" again tomorrow to keep that one fresh in Ryan's mind. Then maybe we'll be able to fade back the prompts again.
After that, it was my call whether Ryan was ready to go. I decided to end it at that. Today was kind of blah. Hopefully tomorrow will be better for us all, as long as we don't get snowed in (3-7" expected tonight!).
TVCC ABA
(Don't you love these acronyms? They're almost as bad as the ones in the education sector! LOL)This is a brief update on the programs we were doing with Thames Valley Children's Centre. J. came over for our meeting today, and she was very pleased with the data I had taken for her (thank you very much!). Kevin is being discharged from his emotional regulation program; we can put him on the waiting list to start a new goal (whatever we choose) ASAP because it's about a 5-month turn-around time to get another program. He is doing much better at controlling his anger and frustration. The hitting and screaming has decreased dramatically. We still have incidents, but he is a 5-year-old boy, and he does have peers and a 7-year-old sister who can be quite provoking at times.
Ryan is due to be discharged in 3 weeks. J. said he will automatically be put back on the waiting list (I don't have to call) because he clearly still has a need (his goal/program was independent feeding). He's made great progress over the past few weeks, but it's far from consistent. So Ryan, also, will be back on an ABA program through TVCC in about 5 months.
What I really enjoyed about my meeting with J. today was her reaction to the changes in Ryan. It's fun to see the amazement from people who have worked with Ryan, but haven't seen him since we started Unity. When she came in, Ryan was trying to figure out how to use the pen on a magnetic drawing board. He wasn't chewing on it; he was actually sitting there, running the pen through his fingers, and rubbing it on the board, trying to make it write! J. was fascinated. She watched him for a while, then modeled how he could do it, and helped him hold the pen. He actually made a few intentional marks on the board. I have never seen him do that!
J. was also shocked when Ryan came up to me and tapped on me because he wanted me to rock hm in the rocking chair. Then he got down and started tapping the chair because he wanted it for himself. She was so happy for us that he's starting to express his wants and needs more clearly.
When J. was leaving, and she said "bye bye" to Ryan, I gave him the wrist prompt, and he waved bye bye to her. I thought she was going to fall over. LOL Seeing the changes in Ryan through the eyes of someone who hasn't seen him in a while is very refreshing. ;)
Unity Day 20: What is it about Mondays?!
From Facebook:
"I'm worn out from a tough but productive morning at Summit Centre. Mommy already made me do all my homework, too. What a taskmaster that woman is! But it's time to relax with a nice bubba, now." --Ryan
Today was a bit different because the therapists are starting to fade themselves out of the picture. In other words, instead of a therapist working one-on-one with each family, there was one therapist keeping an eye on both Unity families. This means the moms were more independent in terms of selecting and carrying out trials and programs, and following the daily schedule of when to change rooms and do different activities. The therapist was there to see things were flowing smoothly and step in when necessary.
What an up and down day we had! It started out with Ryan in a terrible mood: he refused to do any work the instant we set foot in the Blue Room. I tried to encourage him with his reinforcers, but he didn't want any of them. L. suggested I let him wander the Blue Room and just see what might interest him, but all he did was wander around and cry and flop down on the floor. Next, he escalated to full-out tantrum. We tried to see if he had some sensory needs (something to chew), but he just threw down his train track and screamed. Then, they said to do what I do at home, so I picked him up and tried to rock him. He would let me for a minute or two, but then he'd get down and run away and scream again. Finally, we agreed a change of scenery might do the trick, so I took Ryan for a walk down the hallway (it's a long hallway). Ryan enjoys running his fingers along the wall and the vents/grates as we walk. He whined for a bit, but the walk did eventually settle him. It only took, oh, about a half hour to settle him down. It was rough. Mommy was definitely stressed.
But after that, it was like he got the demons out of his system, and he became a super star! I started with the piano, which is something he likes. The instant I put it down and said, "Okay, we're going to play piano now," Ryan reached over to it and tink-tink-tink--just like that--he was playing with it totally independently! I wasn't even ready to take data yet. I hadn't modeled it. All I did was say the words and set down the piano, and he played it. What's more, while we were marveling over this, he continued to spontaneously reach out and tink-tink-tink away. Piano has been removed from our goals.
Next, I tried having him imitate me patting the floor. Previously, we were at a wrist prompt. Today I said, "Ryan, do this" (and patted the floor), and he immediately imitated me! There was no physical prompt needed. In fact, he did all 5 trials with only me showing him and then asking him to copy. It was great!
We also worked on clapping. This is a newer one, so I usually model the clap, then ask him to do it while I hold his one hand palm-up and prompt him (from the forearm or elbow) to bring his hands together to clap. On the first trial, as soon as I put his one palm up, he independently brought his other hand over and tried to clap it! In fact, he did this for 4/5 trials. It was unbelievable!
He did some good work with the shape sorter, too. I still have to do a lot of HOH for this because he wants to mouth the pieces (so I have to block and guide in the right direction), but he did try to put in a piece or two independently, and he was cooperative during the activity.
We got a few good "stand up" and "follow Mama" responses, too. Once he came the first time I asked him, and another time he came even before we turned the lights off in the room (one of his prompts). One thing we did notice, though, is we have to be patient with this one; sometimes it takes him a minute before he realizes it's time to go, or before he can get himself moving. This is a case where it's okay to wait a bit longer to see what he'll do.
The concept of "Go play" is still a bit foreign to Ryan. I've tried moving the toys closer to him when he doesn't respond, or giving him a little nudge in the right direction (in addition to pointing and verbal prompt). Sometimes I try to entice him by playing with the toys myself, or shaking them around a bit. Most times he needed all these prompts, and some time to think about it, before he'd move to the toys. It's a work in progress.
In place of the piano, L. decided we should try a basic puzzle. It has three shapes with big knobs on them. For taking the pieces out of the puzzle, Ryan has to pick them up independently, and then I brush them off to the side (so he doesn't mouth them). For putting the puzzle pieces back in, Ryan picks up the piece independently, then I guide him (HOH or wrist prompt) toward the puzzle. If he drops it on the puzzle, that's good; then I model how to put the piece in correctly. Ryan was cooperative, and even tried to put the puzzle pieces in a few times. Of course, he thinks it's way more fun to pull them out, though. He always loves emptying things/pulling things out better than putting them in.
We also tried uncovering the ball again, which he hasn't worked on in a while. Um, he did it perfectly. Every time I covered the ball with the towel and asked, "Where's the ball?" he whipped that towel off with force! No prompts needed.
Circle time had all new songs this week. I guess they switch to a new group of songs every month. Ryan loved the new songs! He was very engaged in the new book "Panda Bear, Panda Bear, What Do You See?" and continued to hold pictures and match them to book characters independently. He also initiated another turn with the song "A Building We Will Go": he grabbed at the blocks because he wanted to go again!
Ryan also wowed everyone at the end of the day when we said goodbye. We've been working on waving "Hi" and "Bye-Bye" at home. When L.A. got down and waved "bye-bye" to Ryan, I gave him a wrist prompt, and he waved back. Then T. gave it a try. He waved back at T., too!
It's just crazy how this boy can be screaming inconsolably for a half hour, and then be an absolute superstar the rest of the day. Can you say, "Emotional Roller Coaster"?!
"I'm worn out from a tough but productive morning at Summit Centre. Mommy already made me do all my homework, too. What a taskmaster that woman is! But it's time to relax with a nice bubba, now." --Ryan
Today was a bit different because the therapists are starting to fade themselves out of the picture. In other words, instead of a therapist working one-on-one with each family, there was one therapist keeping an eye on both Unity families. This means the moms were more independent in terms of selecting and carrying out trials and programs, and following the daily schedule of when to change rooms and do different activities. The therapist was there to see things were flowing smoothly and step in when necessary.
What an up and down day we had! It started out with Ryan in a terrible mood: he refused to do any work the instant we set foot in the Blue Room. I tried to encourage him with his reinforcers, but he didn't want any of them. L. suggested I let him wander the Blue Room and just see what might interest him, but all he did was wander around and cry and flop down on the floor. Next, he escalated to full-out tantrum. We tried to see if he had some sensory needs (something to chew), but he just threw down his train track and screamed. Then, they said to do what I do at home, so I picked him up and tried to rock him. He would let me for a minute or two, but then he'd get down and run away and scream again. Finally, we agreed a change of scenery might do the trick, so I took Ryan for a walk down the hallway (it's a long hallway). Ryan enjoys running his fingers along the wall and the vents/grates as we walk. He whined for a bit, but the walk did eventually settle him. It only took, oh, about a half hour to settle him down. It was rough. Mommy was definitely stressed.
But after that, it was like he got the demons out of his system, and he became a super star! I started with the piano, which is something he likes. The instant I put it down and said, "Okay, we're going to play piano now," Ryan reached over to it and tink-tink-tink--just like that--he was playing with it totally independently! I wasn't even ready to take data yet. I hadn't modeled it. All I did was say the words and set down the piano, and he played it. What's more, while we were marveling over this, he continued to spontaneously reach out and tink-tink-tink away. Piano has been removed from our goals.
Next, I tried having him imitate me patting the floor. Previously, we were at a wrist prompt. Today I said, "Ryan, do this" (and patted the floor), and he immediately imitated me! There was no physical prompt needed. In fact, he did all 5 trials with only me showing him and then asking him to copy. It was great!
We also worked on clapping. This is a newer one, so I usually model the clap, then ask him to do it while I hold his one hand palm-up and prompt him (from the forearm or elbow) to bring his hands together to clap. On the first trial, as soon as I put his one palm up, he independently brought his other hand over and tried to clap it! In fact, he did this for 4/5 trials. It was unbelievable!
He did some good work with the shape sorter, too. I still have to do a lot of HOH for this because he wants to mouth the pieces (so I have to block and guide in the right direction), but he did try to put in a piece or two independently, and he was cooperative during the activity.
We got a few good "stand up" and "follow Mama" responses, too. Once he came the first time I asked him, and another time he came even before we turned the lights off in the room (one of his prompts). One thing we did notice, though, is we have to be patient with this one; sometimes it takes him a minute before he realizes it's time to go, or before he can get himself moving. This is a case where it's okay to wait a bit longer to see what he'll do.
The concept of "Go play" is still a bit foreign to Ryan. I've tried moving the toys closer to him when he doesn't respond, or giving him a little nudge in the right direction (in addition to pointing and verbal prompt). Sometimes I try to entice him by playing with the toys myself, or shaking them around a bit. Most times he needed all these prompts, and some time to think about it, before he'd move to the toys. It's a work in progress.
In place of the piano, L. decided we should try a basic puzzle. It has three shapes with big knobs on them. For taking the pieces out of the puzzle, Ryan has to pick them up independently, and then I brush them off to the side (so he doesn't mouth them). For putting the puzzle pieces back in, Ryan picks up the piece independently, then I guide him (HOH or wrist prompt) toward the puzzle. If he drops it on the puzzle, that's good; then I model how to put the piece in correctly. Ryan was cooperative, and even tried to put the puzzle pieces in a few times. Of course, he thinks it's way more fun to pull them out, though. He always loves emptying things/pulling things out better than putting them in.
We also tried uncovering the ball again, which he hasn't worked on in a while. Um, he did it perfectly. Every time I covered the ball with the towel and asked, "Where's the ball?" he whipped that towel off with force! No prompts needed.
Circle time had all new songs this week. I guess they switch to a new group of songs every month. Ryan loved the new songs! He was very engaged in the new book "Panda Bear, Panda Bear, What Do You See?" and continued to hold pictures and match them to book characters independently. He also initiated another turn with the song "A Building We Will Go": he grabbed at the blocks because he wanted to go again!
Ryan also wowed everyone at the end of the day when we said goodbye. We've been working on waving "Hi" and "Bye-Bye" at home. When L.A. got down and waved "bye-bye" to Ryan, I gave him a wrist prompt, and he waved back. Then T. gave it a try. He waved back at T., too!
It's just crazy how this boy can be screaming inconsolably for a half hour, and then be an absolute superstar the rest of the day. Can you say, "Emotional Roller Coaster"?!
Friday, February 22, 2013
Unity Day 19: Trying to Get Back on Track
The last few days have been rough around here. We missed Day 17 and 18 at Summit Centre. Here are the Facebook posts from the past few days:
Wednesday
"Stayed home today. Ryan was up a lot again last night and crying off and on today. I'm not sure what's bothering him, but I know I need a "mental health day." Although, Ryan's not helping much by being cranky and completely uncooperative when I've tried to do our Summit Centre homework this morning. :p"
Thursday
"No Summit Centre again today. :( Took Ryan into the clinic. Trying to put him on Pedialyte and clear fluids for 24 hours (whatever doc--you don't know my child--he threw the Pedialyte across the room), and hoping to collect two "samples" for analysis. At least he seems to be doing a lot better so far today. *shrug* Hopefully we can return to S.C. tomorrow."
Today
"Finally back to Summit Centre today. Of course, the weather had to be horrific--almost got into 2 accidents, one on the way there and one on the way back. Ryan did not want to work, but when he was left to play with the students while I was off doing research and theory, he was completely happy and cooperative with them. Naturally. :P "
On Wednesday night, I went shopping and got Ryan two animal and transportation sound puzzles and a cute ring stacker. I thought the new toys might get him more engaged in our home programming. I believe it worked. He did a much better job with his homework yesterday than he had the previous few days. At least he seemed more interested in using these toys appropriately (although I still had to block him mouthing the puzzle pieces and rings).
I believe a lot of Ryan's troubles the past 2 weeks are digestive-system-related. He was having a loose BM or two each night, and then when we were home on Wednesday, it increased to six episodes. He has been really gassy and having unexpected fits of crying like something's really hurting him. Other times, he's okay. When we went to the clinic yesterday, they said to put him on a clear fluid diet (he refused, so I stuck to his plain oatmeal) and that seemed to help. He didn't have any BMs until just now, and it was so-so. They wanted a stool sample to test, so I just collected that, too. Eww.
Anyway, yesterday/last night Ryan was much better overall, until bath time (7-ish). Usually, he loves his bath. Suddenly, he started screaming and shaking like he was having some kind of night terror in the daytime, and he was inconsolable for about half an hour, no matter what I tried to soothe him. Then, he was fine until about 10 PM, when he had another frantic bout of shrieking and running around mindlessly and sobbing. These are the times when I really wish he could communicate with me more. It was so scary and heart-wrenching to see him fall apart like that, and I felt so helpless. It seems like he's truly terrified and panicking about something. That time, I managed to get him (eventually) to settle with me in the rocking chair.
I still suspect pain in the tummy might be a trigger of these episodes, but we have to figure out what's causing the tummy trouble first. Hopefully, the stool sample analysis will give us an answer. Also, I've been reading that autistic children seem to have a higher incidence of gastrointestinal problems than neurotypical children. I could see that in Ryan; he's had a sensitive gastrointestinal system since he was a newborn.
When we went back to get the day started in the Yellow Room, J. and his mom L.A. (the other Unity family) were there. L.A. put up her hand and asked Ryan for a high five, and he gave her one! That was great generalizing. She asked him for another one ("Again?") and he seemed to make an "Oh" sound, like "No." Then she asked if he was all done giving high fives, and he made a sound like "Yahh." Then he kept trying to get into her face and snuggle with her. LOL (I told you he likes her.)
Work time was a bit more challenging. As soon as D. walked in, Ryan's mood changed. He got fussy and floppy. We did our opening song (lacking enthusiasm on Ryan's part), and then D. took Ryan and I over to the Blue Room to work on some goals.
Today we started with trying to get Ryan in a good mood! As soon as we sat on the rug with the toys we usually work with, he started to cry. D. tried to get out some new toys/reinforcers to cheer Ryan up. We had some success playing roll the ball back and forth just for fun, and he also still loves D.'s tickles and squeezes. We tried to get Ryan to "pat the floor." I got three decent attempts out of him, but then he cried. D. had to remind me to follow through on the instruction on the last trial because I was so distracted by Ryan's crying that I didn't get him to pat the floor after I asked. So, I had to go back and give him a solid HOH to follow through with that final pat on the floor.
We also tried the rings for holding items. Ryan was interested in the rings, and surprisingly, he remembered that they need to go on the stacker. I was simply focused on him practicing holding an object; he took the initiative and tried to put it on the ring stacker! So, we followed his lead and changed it over to his play goal of putting rings on the stacker, instead of the incidental goal of holding an item. That worked well. He completed most of the trials successfully and with minimal whining. He needed a little more HOH prompting than previously with the ring stacker, but at least he was trying to stack them.
I thought Ryan would like to play the Winnie the Pooh piano, as he enjoys that toy, but we only got about 3 good plays out of him. He did tap the piano keys once after I showed him, and then wrist prompted. He did turn the page of the little book after the upturned page caught his attention. And, as usual, he did enjoy the spinning portion of the toy. But after three trials, he didn't want to work on it anymore. More crying!
Then, we went into the Rainbow Room to try doing some "kick the ball." Ryan didn't want to sit in the chair, but he did like the ball. We got three or four good kicks out of him once he was settled. Then, he plunked himself down on the floor and just wanted to play with the ball. Since he was content, we let him play "roll the ball" to D. I also got out the shape sorter H. loaned us, and gave it a try. Ryan wanted to mouth the pieces a bit, but he was very cooperative with HOH prompting to hold the pieces and put them in. We did 5 successful trials, and then let him go back to playing with the ball.
It was research and theory time, so I left Ryan with the students/volunteers. They play with him, and take data, but it's a lot less formal than our programming. I know he enjoyed it today; I could hear him making happy and excited noises when I came out of research and was waiting for theory. When I got back, he was doing excellent playing "roll the ball" back and forth with a volunteer. They also said he did some great manding while I was gone. Before we left, they got him to play with a hula-hoop. It was funny because he caught on that it was supposed to go around him, and he kept trying to pick it up and turn it, but he was sitting down. ;) He didn't want to leave; he kept ignoring me, even when I brought over his coat and said it was time to go! I'm happy that he enjoys his Friday "play-time" with the volunteers and students.
Theory continued to focus on examples of positive reinforcement and how it works. We also chatted a bit about surviving our first month of Unity, and how much we and our children have learned and changed this past month. I can't believe we are already a third of the way through!
Wednesday
"Stayed home today. Ryan was up a lot again last night and crying off and on today. I'm not sure what's bothering him, but I know I need a "mental health day." Although, Ryan's not helping much by being cranky and completely uncooperative when I've tried to do our Summit Centre homework this morning. :p"
Thursday
"No Summit Centre again today. :( Took Ryan into the clinic. Trying to put him on Pedialyte and clear fluids for 24 hours (whatever doc--you don't know my child--he threw the Pedialyte across the room), and hoping to collect two "samples" for analysis. At least he seems to be doing a lot better so far today. *shrug* Hopefully we can return to S.C. tomorrow."
Today
"Finally back to Summit Centre today. Of course, the weather had to be horrific--almost got into 2 accidents, one on the way there and one on the way back. Ryan did not want to work, but when he was left to play with the students while I was off doing research and theory, he was completely happy and cooperative with them. Naturally. :P "
The Past 2 Days
On Wednesday night, I went shopping and got Ryan two animal and transportation sound puzzles and a cute ring stacker. I thought the new toys might get him more engaged in our home programming. I believe it worked. He did a much better job with his homework yesterday than he had the previous few days. At least he seemed more interested in using these toys appropriately (although I still had to block him mouthing the puzzle pieces and rings).
I believe a lot of Ryan's troubles the past 2 weeks are digestive-system-related. He was having a loose BM or two each night, and then when we were home on Wednesday, it increased to six episodes. He has been really gassy and having unexpected fits of crying like something's really hurting him. Other times, he's okay. When we went to the clinic yesterday, they said to put him on a clear fluid diet (he refused, so I stuck to his plain oatmeal) and that seemed to help. He didn't have any BMs until just now, and it was so-so. They wanted a stool sample to test, so I just collected that, too. Eww.
Anyway, yesterday/last night Ryan was much better overall, until bath time (7-ish). Usually, he loves his bath. Suddenly, he started screaming and shaking like he was having some kind of night terror in the daytime, and he was inconsolable for about half an hour, no matter what I tried to soothe him. Then, he was fine until about 10 PM, when he had another frantic bout of shrieking and running around mindlessly and sobbing. These are the times when I really wish he could communicate with me more. It was so scary and heart-wrenching to see him fall apart like that, and I felt so helpless. It seems like he's truly terrified and panicking about something. That time, I managed to get him (eventually) to settle with me in the rocking chair.
I still suspect pain in the tummy might be a trigger of these episodes, but we have to figure out what's causing the tummy trouble first. Hopefully, the stool sample analysis will give us an answer. Also, I've been reading that autistic children seem to have a higher incidence of gastrointestinal problems than neurotypical children. I could see that in Ryan; he's had a sensitive gastrointestinal system since he was a newborn.
Today at Summit Centre
The first thing I did after arriving today was head down to H.'s office to ask for advice in dealing with Ryan's homework issues. For example, doing the incidental "go play" at home just isn't working out. It's better suited to a more structured environment, like Summit Centre, where we work through a program, and then he can have a chance to "go play." So, I asked if we could change our incidental goal for home to waving "hello" and "goodbye" to people. We get many opportunities for that during the day, and it's a social skill, too. H. agreed that was a good decision. I also talked about how our shape sorter at home isn't the best toy for close-ended play goals because Ryan pulls the lid off and flings the pieces everywhere. H. offered me the loan of the good, old-fashioned type of shape sorter I remember, where parents have more control of the access to the pieces. We tried it at S.C. before going home today, and it did seem to work a lot better. We've also tried his new sound puzzles for close-ended play at home, and since he's engaged by the sounds, that was fairly successful, too.When we went back to get the day started in the Yellow Room, J. and his mom L.A. (the other Unity family) were there. L.A. put up her hand and asked Ryan for a high five, and he gave her one! That was great generalizing. She asked him for another one ("Again?") and he seemed to make an "Oh" sound, like "No." Then she asked if he was all done giving high fives, and he made a sound like "Yahh." Then he kept trying to get into her face and snuggle with her. LOL (I told you he likes her.)
Work time was a bit more challenging. As soon as D. walked in, Ryan's mood changed. He got fussy and floppy. We did our opening song (lacking enthusiasm on Ryan's part), and then D. took Ryan and I over to the Blue Room to work on some goals.
Today we started with trying to get Ryan in a good mood! As soon as we sat on the rug with the toys we usually work with, he started to cry. D. tried to get out some new toys/reinforcers to cheer Ryan up. We had some success playing roll the ball back and forth just for fun, and he also still loves D.'s tickles and squeezes. We tried to get Ryan to "pat the floor." I got three decent attempts out of him, but then he cried. D. had to remind me to follow through on the instruction on the last trial because I was so distracted by Ryan's crying that I didn't get him to pat the floor after I asked. So, I had to go back and give him a solid HOH to follow through with that final pat on the floor.
We also tried the rings for holding items. Ryan was interested in the rings, and surprisingly, he remembered that they need to go on the stacker. I was simply focused on him practicing holding an object; he took the initiative and tried to put it on the ring stacker! So, we followed his lead and changed it over to his play goal of putting rings on the stacker, instead of the incidental goal of holding an item. That worked well. He completed most of the trials successfully and with minimal whining. He needed a little more HOH prompting than previously with the ring stacker, but at least he was trying to stack them.
I thought Ryan would like to play the Winnie the Pooh piano, as he enjoys that toy, but we only got about 3 good plays out of him. He did tap the piano keys once after I showed him, and then wrist prompted. He did turn the page of the little book after the upturned page caught his attention. And, as usual, he did enjoy the spinning portion of the toy. But after three trials, he didn't want to work on it anymore. More crying!
Then, we went into the Rainbow Room to try doing some "kick the ball." Ryan didn't want to sit in the chair, but he did like the ball. We got three or four good kicks out of him once he was settled. Then, he plunked himself down on the floor and just wanted to play with the ball. Since he was content, we let him play "roll the ball" to D. I also got out the shape sorter H. loaned us, and gave it a try. Ryan wanted to mouth the pieces a bit, but he was very cooperative with HOH prompting to hold the pieces and put them in. We did 5 successful trials, and then let him go back to playing with the ball.
It was research and theory time, so I left Ryan with the students/volunteers. They play with him, and take data, but it's a lot less formal than our programming. I know he enjoyed it today; I could hear him making happy and excited noises when I came out of research and was waiting for theory. When I got back, he was doing excellent playing "roll the ball" back and forth with a volunteer. They also said he did some great manding while I was gone. Before we left, they got him to play with a hula-hoop. It was funny because he caught on that it was supposed to go around him, and he kept trying to pick it up and turn it, but he was sitting down. ;) He didn't want to leave; he kept ignoring me, even when I brought over his coat and said it was time to go! I'm happy that he enjoys his Friday "play-time" with the volunteers and students.
Theory continued to focus on examples of positive reinforcement and how it works. We also chatted a bit about surviving our first month of Unity, and how much we and our children have learned and changed this past month. I can't believe we are already a third of the way through!
Tuesday, February 19, 2013
Unity Day 16: Increasing Demands
From Facebook:
"Ryan had another great day at Summit Centre. It's Mommy who's struggling today. Feeling exhausted, achy, and cranky. Plus a bit stressed. Hope it was just lack of sleep last night and I'm not coming down with something. :s "
Okay, I'm going to start with my whining for this entry. Then I'll end on a positive with Ryan's progress.
Ryan was up last night several times, and at one point, I was up with him, and he was crying off and on, for over 2 hours. Needless to say, I was emotionally and mentally and physically weary all day. Plus, I had another Mommy-has-to-drop-the-kids-off-at-school morning, and it went even worse than last time. Kevin refused to put on his coat and boots to get ready to go, and I practically had to shriek to get him into the car. Then, we are finally in the van and I notice this smell. We pull up at the queue to drop off the kids at school, and Kevin starts to bawl. He's had a BM "accident." There are other cars waiting to drop off their kids, he is refusing to exit the car and screaming, "I want to get changed!" and I have a bad parenting moment. I consciously decide to make him get out of the van, go into the school, and get changed there. I know they have a change of clothes for him (he's still in kindergarten, after all). But I also know he is freaking out because he's embarrassed and scared. Still, I shrug at the VP and EA who help my kids out of the van, and say, "Sorry, Kevin, I have to leave now." Do I feel guilty about this decision? Absolutely. My son will probably bring this up in a psychotherapy session in the future. Bad parenting moment. (His teachers wrote me a note saying he was fine and has a great day as soon as they changed him. I still feel like a bad parent.)
I was also a bit overwhelmed by the changes in homework this week. We're now adding in a third component (incidentals) which means two more goals to work on each day. I'm having some difficulties making a few other adjustments in the homework go smoothly, too (more details later).
Plus, we started talking about how next week, the moms will be working with each other's son for a bit a few days each week. That really makes me nervous. We have to decide what goals we would like the other mom to work on with our son. I really have no clue. My nervousness is not about Ryan working with J.'s mom; she's always very friendly with him and Ryan seems to like her, as he has tried to sit in her lap or go over and touch her a few times. My worries are about working with J. because he's so different from Ryan. J. is much more high-functioning, and I think his program is probably a lot more complicated. I'm also afraid he won't like me! Silly, I know, but as much as I don't like making Ryan uncomfortable, I know it will be even more alarming to me if I upset someone else's child! Of course, we won't be alone; the therapists will be with us, and we may start out working with the child for smaller increments of time if it's not going smoothly. We are also supposed to get details about the program/goal we will be working on with the other child on the Friday, so we have the weekend to become familiar with their program.
Finally, what got me really overwhelmed today was I got a call from our ABA person at John McGivney Children's Centre (but the ABA program is actually run by Thames Valley Children's Centre). Both Kevin and Ryan have been working through TVCC's new ABA program for the last 6 months. For Kevin, we've been working on a behavioural program to help him regulate his emotional control. Basically, we've been helping his decrease behaviours like hitting, throwing, and screaming when he's frustrated; we've tried to teach him some self-calming techniques and and appropriate techniques for dealing with difficult situation with peers/siblings. For Ryan, we've focused on the occupational therapy aspect of eating: trying to get him to eat new textures, to use a spoon properly, drink from a cup, etc. Our major focus for Ryan has been trying to get him to eat independently with a spoon.
Anyhow, why this call caused me stress is because our ABA person there wants to come out and discuss discharging the boys from the current program. The program cycle is 6 months, and Kevin's 6 months is up in a few days. The problem is, our ABA person wants data. Since I've been at Summit Centre, I've come to understand why data is important for ABA programs. She needs it to determine if Kevin and Ryan can be discharged from these goals and begin new ones, or if we need to continue with the same goals. Why I'm irritated by this is for the next week, I'm going to be taking data for two different institutions, for two different ABA programs, for 2 children, and for, let's see . . . Between Kevin and Ryan, 7 goals. And after today's exhausting day, what did I forget to do? Take data for TVCC's ABA program. CRAP! In fact, I need to go dig out those sheets and write down anything I can remember from today. I hate numbers in the first place. I'm struggling with Ryan to get the homework done in the second place (once he gets home, he thinks he's done working for the day). At least this is just for one week, I hope.
Okay, enough of my complaining. Now for our day at Summit Centre:
We were working with L. again, which kept up a good flow/momentum from last week. We tried some "push train" on the floor, to see if Ryan would try to mouth it. He did, so I had to do a lot of HOH pushing the train with him. I thought that was pretty weird, considering what he'd done on the train table earlier. Meh. I guess he hasn't generalized that one yet.
We tried the car ramp again, and he still had that one down pat. He was placing and pushing cars down the ramp independently.
L. surprised me when she said, "I think we're going to replace High 5s with something else." I was a bit confused; I thought he still needed a wrist prompt for that one. I think L. saw the look on my face, so she held up her hand to Ryan and said, "Ryan, give me a high five!" and he did, totally independently! When did he master that one?! I don't know how I missed it. Maybe it was on Friday, when I was in doing research and theory? Anyway, she requested a high five three or four times, and he did it independently each time. Then she had me try, and he gave me a high five, too! (I think he has to be in the mood/setting to work, though. I tried it at home tonight and he did it once; the other times he gave me a half-hearted touch on the hand or ignored me). Still, that means it's time to move on to something else.
Our next step is clapping. It took some trial and error before L. could figure out the best way to teach him clapping. She tried high 10s, which would get both his hands connecting with hers at the same time. It was so-so. He did give her a few high tens. Then, she tried using his "tapping" to advantage. She held his one hand palm-up and encouraged him to tap his up-turned palm with the other hand. That got some better results, and more of a clap, so that's what we're sticking with for now.
Other skills we can build on from the successful High Fives are waving Hello and Goodbye. L. tried holding Ryan's wrist and waving at Ryan, and verbally prompting, "Wave hello," and he did it! It's an incidental goal I think I can work on with Ryan whenever we are greeting someone or leaving someone. Remind me if you see us!
We went into the Yellow Room and tried to see how he's do playing the piano. This time, we used a basic piano with no extra toys on it, and used the Winnie the Pooh piano as his reinforcer. L. showed Ryan, "Do this," and banged on the keys of the toy piano. Ryan reached out and tapped the top of the piano, so we wrist prompted him to the keys, and he tapped on them. He caught on quickly that we tap the piano, but he kept touching the top part of the piano and needed to be guided to the keys. After several trials, it clicked, and he copied L. pressing the keys. Suddenly, he hit one just the right way to get the "tink" of the key's music. A few times after that, he even hit the keys independently, and got a couple of good "tinks" out of that piano. It is amazing how quickly he is picking up on these new concepts!
Circle time showed a great advancement today: during "Brown Bear, Brown Bear," where the boys match their animal to the one on the page when it's handed to them, Ryan independently grabbed the picture from T.'s hand, held it, and then placed it back on the book (matching)! That was a first; I always had to HOH or wrist prompt that. L. decided, seeing this today, that Mom is no longer going to touch him when it's time to put pictures on the book; we know he can do it independently! He continued to do well with pulling pictures off the circle time board without much assistance. Another cute thing he did, for "Head and Shoulders, Knees and Toes," was although I was wrist/elbow prompting, he was tapping those body parts as we sang about them!
In terms of manding, I think we broke a record in the Blue Room today. Ryan made 33 mands for the noodles in the container (tap tap tap!) in five minutes! It was insane. We couldn't keep up with him, and noodles were everywhere! Based on this, L. decided it's time that Ryan has to work harder if he wants those noodles. She tried getting him to look at her face when he made the request. It didn't have to be direct eye contact, yet; he just had to look at her face while he was requesting (tapping). That was tougher for Ryan. She often had to hold the container right up against her face/below her eyes to get him to look at her. He can still simply tap for other things, but for noodles, he has to tap and look at the person, now.
Oh, and as for our manding issue of, What do I do if he can't have it? H. explained you have to say no sometimes, but offer an alternative instead, so it doesn't discourage Ryan's efforts to communicate. So, if he wants to chew on Kleenex, I offer him something more appropriate to chew on. Makes sense, right? ;)
This week and next are "transition" weeks, though. Some parts of the evaluation may carry over if necessary, but they'll start evaluating us on a different set of criteria for the next few weeks.
Changes in the program are coming. As I mentioned before, the moms will start occasionally working with the other's child next week. Furthermore, the therapists/staff will be fading themselves back and more autonomy and responsibility for programming will be given to the moms.
But now, being in Week 4 of unity, and having 3 weeks to reflect back on, I can see so many positive changes in Ryan.
Thank you to my Mom, who sent me this on Facebook today. I bet lots of moms out there need to see this right now, so I'll share it. ;)
"Ryan had another great day at Summit Centre. It's Mommy who's struggling today. Feeling exhausted, achy, and cranky. Plus a bit stressed. Hope it was just lack of sleep last night and I'm not coming down with something. :s "
Okay, I'm going to start with my whining for this entry. Then I'll end on a positive with Ryan's progress.
Ryan was up last night several times, and at one point, I was up with him, and he was crying off and on, for over 2 hours. Needless to say, I was emotionally and mentally and physically weary all day. Plus, I had another Mommy-has-to-drop-the-kids-off-at-school morning, and it went even worse than last time. Kevin refused to put on his coat and boots to get ready to go, and I practically had to shriek to get him into the car. Then, we are finally in the van and I notice this smell. We pull up at the queue to drop off the kids at school, and Kevin starts to bawl. He's had a BM "accident." There are other cars waiting to drop off their kids, he is refusing to exit the car and screaming, "I want to get changed!" and I have a bad parenting moment. I consciously decide to make him get out of the van, go into the school, and get changed there. I know they have a change of clothes for him (he's still in kindergarten, after all). But I also know he is freaking out because he's embarrassed and scared. Still, I shrug at the VP and EA who help my kids out of the van, and say, "Sorry, Kevin, I have to leave now." Do I feel guilty about this decision? Absolutely. My son will probably bring this up in a psychotherapy session in the future. Bad parenting moment. (His teachers wrote me a note saying he was fine and has a great day as soon as they changed him. I still feel like a bad parent.)
I was also a bit overwhelmed by the changes in homework this week. We're now adding in a third component (incidentals) which means two more goals to work on each day. I'm having some difficulties making a few other adjustments in the homework go smoothly, too (more details later).
Plus, we started talking about how next week, the moms will be working with each other's son for a bit a few days each week. That really makes me nervous. We have to decide what goals we would like the other mom to work on with our son. I really have no clue. My nervousness is not about Ryan working with J.'s mom; she's always very friendly with him and Ryan seems to like her, as he has tried to sit in her lap or go over and touch her a few times. My worries are about working with J. because he's so different from Ryan. J. is much more high-functioning, and I think his program is probably a lot more complicated. I'm also afraid he won't like me! Silly, I know, but as much as I don't like making Ryan uncomfortable, I know it will be even more alarming to me if I upset someone else's child! Of course, we won't be alone; the therapists will be with us, and we may start out working with the child for smaller increments of time if it's not going smoothly. We are also supposed to get details about the program/goal we will be working on with the other child on the Friday, so we have the weekend to become familiar with their program.
Finally, what got me really overwhelmed today was I got a call from our ABA person at John McGivney Children's Centre (but the ABA program is actually run by Thames Valley Children's Centre). Both Kevin and Ryan have been working through TVCC's new ABA program for the last 6 months. For Kevin, we've been working on a behavioural program to help him regulate his emotional control. Basically, we've been helping his decrease behaviours like hitting, throwing, and screaming when he's frustrated; we've tried to teach him some self-calming techniques and and appropriate techniques for dealing with difficult situation with peers/siblings. For Ryan, we've focused on the occupational therapy aspect of eating: trying to get him to eat new textures, to use a spoon properly, drink from a cup, etc. Our major focus for Ryan has been trying to get him to eat independently with a spoon.
Anyhow, why this call caused me stress is because our ABA person there wants to come out and discuss discharging the boys from the current program. The program cycle is 6 months, and Kevin's 6 months is up in a few days. The problem is, our ABA person wants data. Since I've been at Summit Centre, I've come to understand why data is important for ABA programs. She needs it to determine if Kevin and Ryan can be discharged from these goals and begin new ones, or if we need to continue with the same goals. Why I'm irritated by this is for the next week, I'm going to be taking data for two different institutions, for two different ABA programs, for 2 children, and for, let's see . . . Between Kevin and Ryan, 7 goals. And after today's exhausting day, what did I forget to do? Take data for TVCC's ABA program. CRAP! In fact, I need to go dig out those sheets and write down anything I can remember from today. I hate numbers in the first place. I'm struggling with Ryan to get the homework done in the second place (once he gets home, he thinks he's done working for the day). At least this is just for one week, I hope.
Okay, enough of my complaining. Now for our day at Summit Centre:
Ryan's Day
Ryan had a great day. When we first got there, we went into the Blue Room to put some things away and Ryan, as always, made a beeline for the train table. This morning, when he picked up a train and tried to mouth it, I blocked him and showed him how to push it on the tracks. To my surprise, he reached down two or three times and (after a block) independently pushed the trains very nicely along the tracks for a few seconds. That was a promising start!We were working with L. again, which kept up a good flow/momentum from last week. We tried some "push train" on the floor, to see if Ryan would try to mouth it. He did, so I had to do a lot of HOH pushing the train with him. I thought that was pretty weird, considering what he'd done on the train table earlier. Meh. I guess he hasn't generalized that one yet.
We tried the car ramp again, and he still had that one down pat. He was placing and pushing cars down the ramp independently.
L. surprised me when she said, "I think we're going to replace High 5s with something else." I was a bit confused; I thought he still needed a wrist prompt for that one. I think L. saw the look on my face, so she held up her hand to Ryan and said, "Ryan, give me a high five!" and he did, totally independently! When did he master that one?! I don't know how I missed it. Maybe it was on Friday, when I was in doing research and theory? Anyway, she requested a high five three or four times, and he did it independently each time. Then she had me try, and he gave me a high five, too! (I think he has to be in the mood/setting to work, though. I tried it at home tonight and he did it once; the other times he gave me a half-hearted touch on the hand or ignored me). Still, that means it's time to move on to something else.
Our next step is clapping. It took some trial and error before L. could figure out the best way to teach him clapping. She tried high 10s, which would get both his hands connecting with hers at the same time. It was so-so. He did give her a few high tens. Then, she tried using his "tapping" to advantage. She held his one hand palm-up and encouraged him to tap his up-turned palm with the other hand. That got some better results, and more of a clap, so that's what we're sticking with for now.
Other skills we can build on from the successful High Fives are waving Hello and Goodbye. L. tried holding Ryan's wrist and waving at Ryan, and verbally prompting, "Wave hello," and he did it! It's an incidental goal I think I can work on with Ryan whenever we are greeting someone or leaving someone. Remind me if you see us!
We went into the Yellow Room and tried to see how he's do playing the piano. This time, we used a basic piano with no extra toys on it, and used the Winnie the Pooh piano as his reinforcer. L. showed Ryan, "Do this," and banged on the keys of the toy piano. Ryan reached out and tapped the top of the piano, so we wrist prompted him to the keys, and he tapped on them. He caught on quickly that we tap the piano, but he kept touching the top part of the piano and needed to be guided to the keys. After several trials, it clicked, and he copied L. pressing the keys. Suddenly, he hit one just the right way to get the "tink" of the key's music. A few times after that, he even hit the keys independently, and got a couple of good "tinks" out of that piano. It is amazing how quickly he is picking up on these new concepts!
Circle time showed a great advancement today: during "Brown Bear, Brown Bear," where the boys match their animal to the one on the page when it's handed to them, Ryan independently grabbed the picture from T.'s hand, held it, and then placed it back on the book (matching)! That was a first; I always had to HOH or wrist prompt that. L. decided, seeing this today, that Mom is no longer going to touch him when it's time to put pictures on the book; we know he can do it independently! He continued to do well with pulling pictures off the circle time board without much assistance. Another cute thing he did, for "Head and Shoulders, Knees and Toes," was although I was wrist/elbow prompting, he was tapping those body parts as we sang about them!
In terms of manding, I think we broke a record in the Blue Room today. Ryan made 33 mands for the noodles in the container (tap tap tap!) in five minutes! It was insane. We couldn't keep up with him, and noodles were everywhere! Based on this, L. decided it's time that Ryan has to work harder if he wants those noodles. She tried getting him to look at her face when he made the request. It didn't have to be direct eye contact, yet; he just had to look at her face while he was requesting (tapping). That was tougher for Ryan. She often had to hold the container right up against her face/below her eyes to get him to look at her. He can still simply tap for other things, but for noodles, he has to tap and look at the person, now.
Oh, and as for our manding issue of, What do I do if he can't have it? H. explained you have to say no sometimes, but offer an alternative instead, so it doesn't discourage Ryan's efforts to communicate. So, if he wants to chew on Kleenex, I offer him something more appropriate to chew on. Makes sense, right? ;)
Future Goals
Ryan's learning so rapidly, and surprising us all the time, so we have to keep thinking one step ahead of him. Here are a few goals we foresee working on in the near future:- In terms of our incidental goal of "holding onto items," I need to practice with him holding things we will be using to teach appropriate play skills in the future: toy animals, dolls, kitchen items, bean bags, blocks, etc.
- We might move to stacking blocks soon.
- With manding, we'll look at turning the "tapping" into more of a "point," and also looking at the person he is making the request of (like we're staring with the noodles).
- Sitting in a chair at a table is another goal. Ryan is a wanderer. I usually have to remind him 10 times during snack to "sit down." He also wants to stand up whenever we work on a goal at the table. It's an essential school skill he'll eventually need. And it would make it a lot easier to help him eat appropriately.
- In play, we may try some open-ended play goals (with 3 steps) for things like the car ramp toy, which he has mastered. For example, the three steps of play might be use the blue ramp; use the red ramp; use the elevator.
Homework
- Manding for 5 minutes a day continues. I am finding it a bit difficult to keep Ryan on task for a straight 5 minutes, though. Usually he wants to wander away for awhile. I've tried using lots of different toys, and sometimes that helps. H. said that, at this point, I could stop having manding listed as a formal homework piece, as long as it's something I remember to incorporate naturally throughout the day. I do, but with how scatterbrained I'm feeling this week, I think I'll try to stick with formal manding periods for at least another week.
- 2 Play Goals: one cause and effect, one close-ended. For cause and effect, I'm trying to build on Ryan's success with the car chasers toy (he's got the gear shift "make it go" mastered). Now, I want him to place the police car on the police station roof and dump it down to start the car chase. He was a bit confused by the change in function of the toy today, but I think this will work out. The close-ended goal is tougher. I've had some problems with the shape sorter at home, so we talked about switching toys. The problem is, all the toys that work best for this, I don't have! I gave them all away to charity because Ryan never used them! So, now I need to find myself a ring stacker, a puzzle that makes sounds, a shape sorter with sounds and lights, etc. H. said she'd check to see if S.C. might have some I could borrow for short-term goals.
- NEW: 2 incidental goals. The incidental goals I picked to work on at home are ones we are doing at S.C., too. "Holding onto an item" is so important for any other skill Ryan needs to learn, and he's very weak at it, so I want to work on that at home as well. Luckily, I do have a Little People farm with animals that's Ryan's, so we will work on him holding the animals (leading to an eventual goal of functional play with the farm). The other goal is getting Ryan to understand the concept of "Go play"; in other words, it's free time or get off your butt and go explore some toys! This one is a bit more difficult for Ryan. I was having hard time tonight encouraging him to "Go play" or find a natural situation to entice him to head for his toys. Finally, I just did what we do at S.C.: I put out a bunch of reinforcers he likes and pointed at them, telling him to "Go play!" It worked twice. (?)
Weekly Evaluation
I was really pleased with my weekly evaluation: all 3s and 4s! Last week was a good week.This week and next are "transition" weeks, though. Some parts of the evaluation may carry over if necessary, but they'll start evaluating us on a different set of criteria for the next few weeks.
Changes in the program are coming. As I mentioned before, the moms will start occasionally working with the other's child next week. Furthermore, the therapists/staff will be fading themselves back and more autonomy and responsibility for programming will be given to the moms.
But now, being in Week 4 of unity, and having 3 weeks to reflect back on, I can see so many positive changes in Ryan.
Thank you to my Mom, who sent me this on Facebook today. I bet lots of moms out there need to see this right now, so I'll share it. ;)
Monday, February 18, 2013
More Tapping Requests
[no Summit Centre today, due to the Family Day holiday]
I had to add a few more notes in here about Ryan's breakthrough with "tapping" to request things. There were just so many good examples yesterday and today:
I had to add a few more notes in here about Ryan's breakthrough with "tapping" to request things. There were just so many good examples yesterday and today:
- Ryan was not only tapping to request more bites of food, but tapping when I paused for too long between spoonfuls, like, "Hurry up, Mom, I'm hungry!"
- He has been following me around and tapping at me when he really wants my attention. I've been getting a lot of taps on the bum because he often follows right behind me. LOL
- This one I've seen him do before, and thought it was just a coincidence. He did it twice yesterday, so now I'm sure it's intentional: Andrea was on the rocking chair. He went over and tapped her legs as if to say, "I want to sit there." But then he takes it one step further: he taps his own chest as if to say, "It's my turn now!" It's like he's saying, "Hey you [taps you], that's my spot! [taps his own chest]".
Sunday, February 17, 2013
Tap Tap Tap!
I mentioned, yesterday, about Ryan generalizing the skill of "tapping" (the precursor to pointing) on a container when he wanted me to give him "more." Well, that skill has blossomed into other areas overnight and this morning:
- Last night, Ryan tapped his bottle when I offered it to him (as in, "I want that"). I had been HOH prompting him to do this since Week 1 of Unity, and last night he did it all on his own!
- Several times over the past day he has tapped my hand when he's ready for a bite of food. Usually he just grabs my hand, opens his mouth, or puts his hand near mine.
- This one is my favourite: Late last night, I was on the computer. Ryan came over and stood next to me. Then, he touched my arm. I greeted him and then went back to what I was doing. Suddenly, he put his hand over my hand that was controlling the mouse. I kind of laughed and said, "You want some attention, don't you?" and tried to finish up my typing. Then, he tapped my hand so gently . . . tap, tap, tap . . . Aww, I couldn't refuse that request! So, I picked him up and we had a good cuddle. He was all smiles and snuggles. :)
Saturday, February 16, 2013
Coincidences?
At the end of the Day 13 post, I mentioned how many coincidences seem to be popping up between what we say and what Ryan will suddenly do. He often gets the timing just right. Here's two from the last 24 hours:
- Last night, Andrea walked into the living room when Ryan was in a good mood and laughing. She said, "Hi, Buddy!" and he glanced at her and made an "Aaaaaaeeeeeeee" sound that sure sounded like he was saying, "Hiiiiiiiii!"
- This morning, Ryan was grumpy when I got up. He'd been up for a while. Figuring he was hungry, I fed him his cereal. When he was done, I went back to the kitchen to make the other kids breakfast. He wandered in with a smile on his face, so I said, "Are you feeling better now, Buddy?" He glanced at me briefly, and did a thumb up! We haven't taught him to do a thumb up, but we do it frequently with Andrea and Kevin. I wonder if he picked it up from watching us? It's not the type of random gesture he normally does, and his timing was spot on!
Friday, February 15, 2013
Unity Day 15: Keeping the Momentum Going!
From Facebook:
"We had a good end to the week. Continued the positive momentum of the past few days, and Ryan was wow-ing us again. :)"
Thankfully, Ryan overcame his upset tummy last night and had a decent sleep, and seemed to be in pretty good form today. He was a little tired and floppy at first, but we ended up having another great day.
In the Blue Room we wanted to start off with "pat the floor" (imitation), but he just wasn't interested. He kept wanting to watch the other children, and to get up and walk away. So, L. decided to give Ryan some tickles to get his attention. Well, he grabbed her hands because he wanted more. Okay, so we followed his lead, and switched to the incidental goal of requesting "more" with the sign. L. was tickling the inside of Ryan's thighs, and he was giggling like crazy and rolling all over the floor! But every time she paused, he was right back in her face/grabbing her hands. Every time, she made him ask for "more tickles" with the sign. Usually we HOH the "more" sign, but we've been testing Ryan's independence the past three days and focusing on seeing whether he really needs a prompt, or if it's just habit for him to wait for someone to help. In this case, L. moved back from HOH and wrist prompted him for more. She did get him to put his hands together 3 or 4 times with just the wrist prompt, which was really nice improvement. Of course, Ryan was enjoying the tickles so much that it was hard to get him to focus enough to ask for "more"!
We noticed that Ryan was having a high-level mouthing day. For the most part, he was concentrating on his chewy (which is good), but it was distracting our efforts to engage him more in the programs. L. said it might be better just to let him chew for a bit because he wasn't focusing on us until he had that need met (so to speak). So, Ryan got frequent chew breaks today. It seemed to work, though; after we let him chew a bit, we tried "high fives" with a wrist prompt, and I think we got a good three out of 5 pats in our trial.
We also noticed Ryan seemed to be seeking harder objects to chew on too, today. I still had a piece of wooden train track in my basket from yesterday, and L. suggested Ryan might like that for a reinforcer. Well, ya! It ended up being our go-to reinforcer all morning. L. made a comment about Ryan being "addicted to track," and well, we kind of got the giggles from there. All day long, we kept coming up with sayings like "Ryan's track addiction," "He's a track addict," "He needs his track fix,"and making sure "we have a good supply of track for him." The adults need a laugh once in a while, too, you know!
We tried a little "go play" again, using Ryan's "track addition" as an enticement for him. He didn't want to go play with other toys, but when L. moved the track away from him and said, "Go play!" he generally went to it with no other prompts.
Now, obviously, Ryan will not always be able to chew on the track as reinforcement! Eventually, when it's time to teach him how to push the train on the tracks, he will not be allowed to mouth the tracks anymore. We'll have to find something else he's interested in chewing on.
Next we worked on a play goal with the Winnie the Pooh piano. L. said she'd like to see him start using the other functions of the toy, besides the piano and the spinner. On one part, there is a little book where you can turn the pages. L. showed him how to do it, then HOH'ed and wrist prompted a few times. Then, she lifted the one page and let it stand up (it's stiff) to see what Ryan would do. He immediately reached over and turned the page, with no prompt! So, we tried it a few more times: while he was playing with the spinney parts, we would set up a page to see what he'd do. Every time, he'd reach over and turn the page on his own! L. then showed him how to press the buttons to cause the characters to pop up. He also did that, independently, once or twice. Then, he reached over to the book part and flipped a page on his own initiative; we hadn't even set it up for him! He still enjoys the spinning parts most, but it was great to see him exploring other functions of the toy, independently, once he was aware of what was there. L. said we might move to a more basic piano next week, and use the Winnie the Pooh one as a reinforcer now, since he likes it so much.
Back in the Yellow Room, we worked on the shape sorter again. Ryan wanted to mouth all the pieces, but L. was the blocker today, and she did a great job showing me how to block Ryan from mouthing the shapes, with a flat hand. We had to HOH most of the shape sorting today because he was so into mouthing that he wanted every shape in his mouth, but at least he cooperated and even tried to put the circles in by himself once or twice. He got to have his "track" to chew on when he let us help him put the shapes in appropriately.
We also went into the Rainbow Room and practiced "kick the ball" today. And here's where Ryan became a "superstar" (L.'s term). It took a few tries to get him to sit (stay) in the chair, but L. only had to help him kick the ball the first one or two times. Then, she just set it on the floor by his foot, and said "Kick it!" and he did! Several times after that, we just set it by his foot and he automatically kicked! It was like "kick the ball" clicked today. That's pretty amazing, considering that one was new this week! Also, at one point, Ryan crawled off the chair and was sitting on the floor as L. and I chatted/made notes. The ball was near him, so he picked it up, and rolled it away with his hands! When L. put it back near him, it was closer to his foot, and he kicked it away! She said, "Do you know how long it takes some of my kids to figure out that we roll it with the hands and kick it with the feet?!" Her excitement is infectious. :)
Next, we were back in the Yellow Room, and decided to work on Ryan's pointing for more. We worked with the dry noodles again, since we'd had success with that yesterday. Remember, when Ryan had been grabbing the bin for more noodles, L. had been wrist prompting the tap on the lid to indicate he wanted "more." Today, we did that maybe twice with him, and suddenly, he reached out and tapped the lid on his own--no prompts whatsoever--because he wanted those noodles! Then he was tapping with both hands on the lid . . . again, and again, and again! For about 10 minutes straight, it was a noodle extravaganza! L. said when he's totally independent he gets extra reinforcement, so the noodles were flying. And we knew he'd made that connection, and it was exciting for him, because I could barely keep up with opening and closing the lid; his requests (taps) were coming so fast! L. and I were both breathless and laughing because we could barely keep enough noodles in the bin for him because he was doing so awesome requesting: tap after tap after tap!
[By the way, notice all the exclamation points today? It was very exciting. :) ]
Before I knew it, it was time for research and theory. Ryan went off with the students and volunteers to play. From their reports, he continued to do some great manding for bubbles, and also enjoyed a string of Mardi Gras-style beads. We have some of those beads around here. I'll have to dig them out and see if we can use them for our manding homework.
Theory started off more with a side discussion of sibling issues. It was actually a great conversation; I felt like it brought to light even more similarities between our two Unity families, and Dr. G. had some good insights on the situation. Actually, I'm also planning on attending an information session at Autism Services Inc. in March that is focusing on that topic. I hope it will give me some resources for Andrea. I know she loves the monthly Sibling Group at Summit Centre, but I wish I could do more for her. Imagine having two little brothers on the autism spectrum; she's naturally sensitive and anxious, so that has to be an extra burden for a seven-year-old girl to bear.
The rest of our theory session focused on the importance of recording data and the principle of positive reinforcement, two essential components of ABA and what we do at Unity in working with our boys.
Overall, the week started out rough, and we've had a few chaotic nights at home, but in the end, Ryan's had an amazing week. He's shown astonishing progress the past three days.
"We had a good end to the week. Continued the positive momentum of the past few days, and Ryan was wow-ing us again. :)"
Thankfully, Ryan overcame his upset tummy last night and had a decent sleep, and seemed to be in pretty good form today. He was a little tired and floppy at first, but we ended up having another great day.
In the Blue Room we wanted to start off with "pat the floor" (imitation), but he just wasn't interested. He kept wanting to watch the other children, and to get up and walk away. So, L. decided to give Ryan some tickles to get his attention. Well, he grabbed her hands because he wanted more. Okay, so we followed his lead, and switched to the incidental goal of requesting "more" with the sign. L. was tickling the inside of Ryan's thighs, and he was giggling like crazy and rolling all over the floor! But every time she paused, he was right back in her face/grabbing her hands. Every time, she made him ask for "more tickles" with the sign. Usually we HOH the "more" sign, but we've been testing Ryan's independence the past three days and focusing on seeing whether he really needs a prompt, or if it's just habit for him to wait for someone to help. In this case, L. moved back from HOH and wrist prompted him for more. She did get him to put his hands together 3 or 4 times with just the wrist prompt, which was really nice improvement. Of course, Ryan was enjoying the tickles so much that it was hard to get him to focus enough to ask for "more"!
We noticed that Ryan was having a high-level mouthing day. For the most part, he was concentrating on his chewy (which is good), but it was distracting our efforts to engage him more in the programs. L. said it might be better just to let him chew for a bit because he wasn't focusing on us until he had that need met (so to speak). So, Ryan got frequent chew breaks today. It seemed to work, though; after we let him chew a bit, we tried "high fives" with a wrist prompt, and I think we got a good three out of 5 pats in our trial.
We also noticed Ryan seemed to be seeking harder objects to chew on too, today. I still had a piece of wooden train track in my basket from yesterday, and L. suggested Ryan might like that for a reinforcer. Well, ya! It ended up being our go-to reinforcer all morning. L. made a comment about Ryan being "addicted to track," and well, we kind of got the giggles from there. All day long, we kept coming up with sayings like "Ryan's track addiction," "He's a track addict," "He needs his track fix,"and making sure "we have a good supply of track for him." The adults need a laugh once in a while, too, you know!
We tried a little "go play" again, using Ryan's "track addition" as an enticement for him. He didn't want to go play with other toys, but when L. moved the track away from him and said, "Go play!" he generally went to it with no other prompts.
Now, obviously, Ryan will not always be able to chew on the track as reinforcement! Eventually, when it's time to teach him how to push the train on the tracks, he will not be allowed to mouth the tracks anymore. We'll have to find something else he's interested in chewing on.
Next we worked on a play goal with the Winnie the Pooh piano. L. said she'd like to see him start using the other functions of the toy, besides the piano and the spinner. On one part, there is a little book where you can turn the pages. L. showed him how to do it, then HOH'ed and wrist prompted a few times. Then, she lifted the one page and let it stand up (it's stiff) to see what Ryan would do. He immediately reached over and turned the page, with no prompt! So, we tried it a few more times: while he was playing with the spinney parts, we would set up a page to see what he'd do. Every time, he'd reach over and turn the page on his own! L. then showed him how to press the buttons to cause the characters to pop up. He also did that, independently, once or twice. Then, he reached over to the book part and flipped a page on his own initiative; we hadn't even set it up for him! He still enjoys the spinning parts most, but it was great to see him exploring other functions of the toy, independently, once he was aware of what was there. L. said we might move to a more basic piano next week, and use the Winnie the Pooh one as a reinforcer now, since he likes it so much.
Back in the Yellow Room, we worked on the shape sorter again. Ryan wanted to mouth all the pieces, but L. was the blocker today, and she did a great job showing me how to block Ryan from mouthing the shapes, with a flat hand. We had to HOH most of the shape sorting today because he was so into mouthing that he wanted every shape in his mouth, but at least he cooperated and even tried to put the circles in by himself once or twice. He got to have his "track" to chew on when he let us help him put the shapes in appropriately.
We also went into the Rainbow Room and practiced "kick the ball" today. And here's where Ryan became a "superstar" (L.'s term). It took a few tries to get him to sit (stay) in the chair, but L. only had to help him kick the ball the first one or two times. Then, she just set it on the floor by his foot, and said "Kick it!" and he did! Several times after that, we just set it by his foot and he automatically kicked! It was like "kick the ball" clicked today. That's pretty amazing, considering that one was new this week! Also, at one point, Ryan crawled off the chair and was sitting on the floor as L. and I chatted/made notes. The ball was near him, so he picked it up, and rolled it away with his hands! When L. put it back near him, it was closer to his foot, and he kicked it away! She said, "Do you know how long it takes some of my kids to figure out that we roll it with the hands and kick it with the feet?!" Her excitement is infectious. :)
Next, we were back in the Yellow Room, and decided to work on Ryan's pointing for more. We worked with the dry noodles again, since we'd had success with that yesterday. Remember, when Ryan had been grabbing the bin for more noodles, L. had been wrist prompting the tap on the lid to indicate he wanted "more." Today, we did that maybe twice with him, and suddenly, he reached out and tapped the lid on his own--no prompts whatsoever--because he wanted those noodles! Then he was tapping with both hands on the lid . . . again, and again, and again! For about 10 minutes straight, it was a noodle extravaganza! L. said when he's totally independent he gets extra reinforcement, so the noodles were flying. And we knew he'd made that connection, and it was exciting for him, because I could barely keep up with opening and closing the lid; his requests (taps) were coming so fast! L. and I were both breathless and laughing because we could barely keep enough noodles in the bin for him because he was doing so awesome requesting: tap after tap after tap!
[By the way, notice all the exclamation points today? It was very exciting. :) ]
Before I knew it, it was time for research and theory. Ryan went off with the students and volunteers to play. From their reports, he continued to do some great manding for bubbles, and also enjoyed a string of Mardi Gras-style beads. We have some of those beads around here. I'll have to dig them out and see if we can use them for our manding homework.
Theory started off more with a side discussion of sibling issues. It was actually a great conversation; I felt like it brought to light even more similarities between our two Unity families, and Dr. G. had some good insights on the situation. Actually, I'm also planning on attending an information session at Autism Services Inc. in March that is focusing on that topic. I hope it will give me some resources for Andrea. I know she loves the monthly Sibling Group at Summit Centre, but I wish I could do more for her. Imagine having two little brothers on the autism spectrum; she's naturally sensitive and anxious, so that has to be an extra burden for a seven-year-old girl to bear.
The rest of our theory session focused on the importance of recording data and the principle of positive reinforcement, two essential components of ABA and what we do at Unity in working with our boys.
Overall, the week started out rough, and we've had a few chaotic nights at home, but in the end, Ryan's had an amazing week. He's shown astonishing progress the past three days.
Thursday, February 14, 2013
Unity Day 14: Visible Changes
From Facebook:
"Another great day today. Mr. Ryan keeps surprising us. We continue to change the programming and goals to keep pace with this little man!"
Today we were working with L. again. It was nice because we were able to keep the flow and momentum going from yesterday. We did a lot of playing around with the programming because Ryan is surprising us so much, and picking up on things so quickly. We did a lot of tweaking, to the point that Ryan will already need new goal sheets for tomorrow. L. was also hinting at some big plans for Tuesday (Monday is the Family Day holiday).
Today we started on "push a train" instead of "push a car." We went over to the train table and were showing Ryan how to push the trains, but Ryan wanted to mouth everything. If we put his hand on a train to prompt pushing it, he would pick up the train and mouth it; if we blocked him from mouthing the train, he'd grab a piece of track with is other hand and mouth that. So, it was time to figure out what was making pushing a train difficult for Ryan. Was it the train or the tracks that were making it difficult for Ryan? We tried pushing a car on the train table instead. He was still distracted with trying to mouth pieces of track, even when we moved them away from him. So, we took a train and moved it to the floor (no tracks involved). Ryan still wanted to mouth the train, but he did give it a few pushes after some modeling and a verbal/wrist prompt. There was less distraction from other items on the floor.
L. decided we should build on his success with "push a car" and try a higher-level activity: putting a car on a ramp and pushing it down. We set up the car ramp and showed Ryan how to put the car on it, and then push it down. Then we gave him a verbal and wrist prompt, and he pushed the car down the ramp for us. That was a good start. Suddenly, he picked up the car without us even asking or prompting, put it on the ramp by himself, and pushed it down! We freaked out with excitement! Then he did it again, and again, and again . . . all on his own. We weren't even prompting him; he was just enjoying playing independently. It was awesome! Then he reached over to his basket of reinforcers, pulled out a rattle, and pushed it down the slide! He did this with a few other items, too. L. said that's amazing; he's exploring on his own, and showing generalization of the skill. It was like he was thinking, "Hmm . . . let's see what else can slide down the ramp!" So, now we have to decide how we can build on this skill next week.
Related to the story above, at the end of our morning, L. was watching Ryan for me while I packed up. When I came back into the room, she had shown him how to use the more complicated, twisty ramp for the car. He was doing that one with minimal prompting. Even more impressive, L. showed me how Ryan had made the connection to start it at the top and watch for it to come out the bottom at another side. As soon as he started it, he would lean over and watch for it to come out the other side!
We also practiced some of the incidental "go play" today. Once or twice he headed over when I gave him the verbal prompt and gestured to his toys a few feet away, but we also had to give him a nudge a couple of times to get him going in the right direction. I think the whole idea of free time at S.C. is lost on him because most of our time there is so structured. So, this is a good way for him to learn to connect the words "go play" to the idea that he can wander off and explore what toys he wants at those times.
When we practiced requesting "more" today, we used the uncooked noodles again. Those are one powerful reinforcer and motivator for Ryan! He loves playing with those noodles. We get a big bin and let him run his hands through them and throw them around a bit. I think he likes the texture and the rattle sound they make. Anyway, for requesting more, today L. put the noodles in a clear bin with a lid, and gave Ryan a little tub for a few noodles. Ryan would go wild with his noodles, running his hands through them so swiftly and roughly that they soon tumbled out of his tub. Then he wanted more. L. showed him the big bin which had the rest of the noodles. Ryan tried to grab it and open it. Instead, L. showed him to tap it gently to indicate he wanted more. We had to verbally, HOH and wrist prompt at first, to remind Ryan the proper way to ask for more noodles, especially when he got excited and wanted to grab. When he started to just put his hand on the bin to ask for more, L. changed the prompt to verbal/gestural: she tapped the lid and said, "I want more noodles." Next thing we knew, Ryan was imitating her gesture! When he reached for the bin, she would model the tap and say the words, and then he would gently tap it on his own. What a change from the beginning to the end of the session! By the way, he managed to get a noodle into his mouth and bite it. We thought he'd spit it out, but crunch, crunch, crunch . . . he actually finished it off! LOL
Oh, and with regards to food, an incidental "more" opportunity came about unexpectedly. J.'s mom had brought in Valentine's cookies, and L. and I had snitched a couple during our transition between rooms. As I was munching on mine, Ryan looked interested. I broke off a little piece and gave it to him. Now, you know he prefers soft foods. To my surprise, he enjoyed that little piece of cookie! He worked it around for awhile, then reached out to grab another piece from me! I HOH'ed and said "more cookie" for him, then gave him a second piece. He enjoyed that one, too.
We also did some work with the shape sorter. We took out the circles and wrist prompted him to pick them up and place them in the holes. I had to do a lot of blocking because he really wants to mouth those shapes. L. taught me something important here, though, that I need to work on: Block with a flat hand above the item. Try not to touch Ryan's hand because as soon as he feels Mom's hand he drops the item. We don't want him to drop the item; we just don't want it in his mouth. Besides the mouthing, Ryan was trying really hard to put the circles in the holes with me wrist prompting. He even picked up a few circles and tried to put them in all by himself (no prompt!) and threw a few over the top of the lid to L. We were just happy he wasn't mouthing them!
Ryan did some excellent work in circle, too. For "Wheels on the Bus," he was patting away at the leader's hand for "the horn goes beep beep beep" with me only holding up his wrist. He was also putting some intention into my wrist prompts of "the doors go open and shut": I could feeling him pushing and pulling a bit. He continued to do well independently pulling the velcroed pictures off the circle board with just a little wrist prompt in the right direction. He did pretty good for holding and matching his animals, too; we'll probably start fading back the wrist prompt at circle time soon.
Oh, I forgot to mention Ryan was improving with his "stand up" and "come with Mommy" today. We've noticed that shutting off the lights in the room we're leaving, and walking out but calling Ryan to follow us, seems to work as a good prompt. At least twice today, those were sufficient prompts for him to get up and follow me on his own. L. still had to go back and physically prompt him once or twice, too, but it was great to see when he just stood up and came along!
However, Ryan hit his limit during circle time. We don't know if it was because of all the amazing new things he did today, and he was worn out. Another factor was circle time was a bit louder today (we had a third little guy join us, who unfortunately is a screamer at times), and we also had a new leader for circle who has never done it with us before.
Snack time went pretty well. Ryan was a bit whiny, but we got him to eat some of his yogurt independently and got a few mands for bottle and yogurt. Unfortunately, he bumped his yogurt and it hit the floor when he was only about a third through, and the rest was splattered under the table. So, we cleaned him up and I took him over to the carpet with his bottle to snuggle for a bit and relax. Dr. G. came in, and we explained that she'd missed the best of Ryan's day. By the time she showed up, he was cranky and tired.
Still, we ended on our terms with a little more pushing the car, since he'd been so successful and had fun with that earlier.
Now here's where having two autistic boys becomes really difficult: they begin setting each other off. Ryan's crying upsets Kevin, who starts to yell and scream. When Kevin yells and screams, Ryan gets upset, and he cries more loudly. Then Kevin screams more loudly. You see how this cycles on and snowballs until both are out of control and I can't calm either one. These moments are the worst. And they've been happening off and on all night: Kevin's in a bad mood because, according to him, "Valentine's Day is my worst day of the whole year." When asked why, he says he doesn't know why he has to give things to other people and not to himself (i.e. Valentines and treats). He also says, "They already know I love them." He also doesn't like all the Valentine's activities/crafts they've had to do at school over the past few days. So basically, Kevin's already moody because he hates Valentine's Day, so he's being difficult with everyone. He picks fights with Andrea, and then she screams, and he laughs. Then she screams more, and he laughs more. When she's screaming, Ryan gets upset and starts to cry again, which makes Kevin start to scream again . . . And I'm so overwhelmed because I can't stand the screaming, either (I swear I have sound sensory issues, too)!
Eventually, I get Kevin to sit on the couch, Andrea doing her homework, and I'm rocking Ryan. It settles. It's relatively peaceful. And of course, that's when Daddy comes in the door! I love how he always shows up just after the chaos, so I look like I'm totally exaggerating/overreacting to whatever happened earlier.
Or maybe not. As I sit here typing, trying to finish today's entry, Ryan broke into another seemingly random tantrum. However, it appears my tummy discomfort theory from earlier is correct. Daddy said, "He smells just like diarrhea," checked him, and got a finger full of yes, you guessed it. What a romantic Valentine's Day! ;P
"Another great day today. Mr. Ryan keeps surprising us. We continue to change the programming and goals to keep pace with this little man!"
Today we were working with L. again. It was nice because we were able to keep the flow and momentum going from yesterday. We did a lot of playing around with the programming because Ryan is surprising us so much, and picking up on things so quickly. We did a lot of tweaking, to the point that Ryan will already need new goal sheets for tomorrow. L. was also hinting at some big plans for Tuesday (Monday is the Family Day holiday).
Today we started on "push a train" instead of "push a car." We went over to the train table and were showing Ryan how to push the trains, but Ryan wanted to mouth everything. If we put his hand on a train to prompt pushing it, he would pick up the train and mouth it; if we blocked him from mouthing the train, he'd grab a piece of track with is other hand and mouth that. So, it was time to figure out what was making pushing a train difficult for Ryan. Was it the train or the tracks that were making it difficult for Ryan? We tried pushing a car on the train table instead. He was still distracted with trying to mouth pieces of track, even when we moved them away from him. So, we took a train and moved it to the floor (no tracks involved). Ryan still wanted to mouth the train, but he did give it a few pushes after some modeling and a verbal/wrist prompt. There was less distraction from other items on the floor.
L. decided we should build on his success with "push a car" and try a higher-level activity: putting a car on a ramp and pushing it down. We set up the car ramp and showed Ryan how to put the car on it, and then push it down. Then we gave him a verbal and wrist prompt, and he pushed the car down the ramp for us. That was a good start. Suddenly, he picked up the car without us even asking or prompting, put it on the ramp by himself, and pushed it down! We freaked out with excitement! Then he did it again, and again, and again . . . all on his own. We weren't even prompting him; he was just enjoying playing independently. It was awesome! Then he reached over to his basket of reinforcers, pulled out a rattle, and pushed it down the slide! He did this with a few other items, too. L. said that's amazing; he's exploring on his own, and showing generalization of the skill. It was like he was thinking, "Hmm . . . let's see what else can slide down the ramp!" So, now we have to decide how we can build on this skill next week.
Related to the story above, at the end of our morning, L. was watching Ryan for me while I packed up. When I came back into the room, she had shown him how to use the more complicated, twisty ramp for the car. He was doing that one with minimal prompting. Even more impressive, L. showed me how Ryan had made the connection to start it at the top and watch for it to come out the bottom at another side. As soon as he started it, he would lean over and watch for it to come out the other side!
We also practiced some of the incidental "go play" today. Once or twice he headed over when I gave him the verbal prompt and gestured to his toys a few feet away, but we also had to give him a nudge a couple of times to get him going in the right direction. I think the whole idea of free time at S.C. is lost on him because most of our time there is so structured. So, this is a good way for him to learn to connect the words "go play" to the idea that he can wander off and explore what toys he wants at those times.
When we practiced requesting "more" today, we used the uncooked noodles again. Those are one powerful reinforcer and motivator for Ryan! He loves playing with those noodles. We get a big bin and let him run his hands through them and throw them around a bit. I think he likes the texture and the rattle sound they make. Anyway, for requesting more, today L. put the noodles in a clear bin with a lid, and gave Ryan a little tub for a few noodles. Ryan would go wild with his noodles, running his hands through them so swiftly and roughly that they soon tumbled out of his tub. Then he wanted more. L. showed him the big bin which had the rest of the noodles. Ryan tried to grab it and open it. Instead, L. showed him to tap it gently to indicate he wanted more. We had to verbally, HOH and wrist prompt at first, to remind Ryan the proper way to ask for more noodles, especially when he got excited and wanted to grab. When he started to just put his hand on the bin to ask for more, L. changed the prompt to verbal/gestural: she tapped the lid and said, "I want more noodles." Next thing we knew, Ryan was imitating her gesture! When he reached for the bin, she would model the tap and say the words, and then he would gently tap it on his own. What a change from the beginning to the end of the session! By the way, he managed to get a noodle into his mouth and bite it. We thought he'd spit it out, but crunch, crunch, crunch . . . he actually finished it off! LOL
Oh, and with regards to food, an incidental "more" opportunity came about unexpectedly. J.'s mom had brought in Valentine's cookies, and L. and I had snitched a couple during our transition between rooms. As I was munching on mine, Ryan looked interested. I broke off a little piece and gave it to him. Now, you know he prefers soft foods. To my surprise, he enjoyed that little piece of cookie! He worked it around for awhile, then reached out to grab another piece from me! I HOH'ed and said "more cookie" for him, then gave him a second piece. He enjoyed that one, too.
We also did some work with the shape sorter. We took out the circles and wrist prompted him to pick them up and place them in the holes. I had to do a lot of blocking because he really wants to mouth those shapes. L. taught me something important here, though, that I need to work on: Block with a flat hand above the item. Try not to touch Ryan's hand because as soon as he feels Mom's hand he drops the item. We don't want him to drop the item; we just don't want it in his mouth. Besides the mouthing, Ryan was trying really hard to put the circles in the holes with me wrist prompting. He even picked up a few circles and tried to put them in all by himself (no prompt!) and threw a few over the top of the lid to L. We were just happy he wasn't mouthing them!
Ryan did some excellent work in circle, too. For "Wheels on the Bus," he was patting away at the leader's hand for "the horn goes beep beep beep" with me only holding up his wrist. He was also putting some intention into my wrist prompts of "the doors go open and shut": I could feeling him pushing and pulling a bit. He continued to do well independently pulling the velcroed pictures off the circle board with just a little wrist prompt in the right direction. He did pretty good for holding and matching his animals, too; we'll probably start fading back the wrist prompt at circle time soon.
Oh, I forgot to mention Ryan was improving with his "stand up" and "come with Mommy" today. We've noticed that shutting off the lights in the room we're leaving, and walking out but calling Ryan to follow us, seems to work as a good prompt. At least twice today, those were sufficient prompts for him to get up and follow me on his own. L. still had to go back and physically prompt him once or twice, too, but it was great to see when he just stood up and came along!
However, Ryan hit his limit during circle time. We don't know if it was because of all the amazing new things he did today, and he was worn out. Another factor was circle time was a bit louder today (we had a third little guy join us, who unfortunately is a screamer at times), and we also had a new leader for circle who has never done it with us before.
Snack time went pretty well. Ryan was a bit whiny, but we got him to eat some of his yogurt independently and got a few mands for bottle and yogurt. Unfortunately, he bumped his yogurt and it hit the floor when he was only about a third through, and the rest was splattered under the table. So, we cleaned him up and I took him over to the carpet with his bottle to snuggle for a bit and relax. Dr. G. came in, and we explained that she'd missed the best of Ryan's day. By the time she showed up, he was cranky and tired.
Still, we ended on our terms with a little more pushing the car, since he'd been so successful and had fun with that earlier.
This afternoon/evening . . .
It's been rough. After a successful day at S.C., Ryan's had a rough afternoon/evening. He did well when we first got home, and thank goodness I chose to do homework then, because it went well. But soon Ryan was having some wild mood swings, with tantrum-like crying off and on, for no reason I could guess except he was tired and maybe having some tummy discomfort (as evidenced by a few nasty diapers). On top of that, he fell asleep 20 minutes before we had to go pick up the kids. I didn't want to bother Papa for a third day in a row, so I woke him up and brought him along. He was okay until just before we left the school. Then he got really mad again.Now here's where having two autistic boys becomes really difficult: they begin setting each other off. Ryan's crying upsets Kevin, who starts to yell and scream. When Kevin yells and screams, Ryan gets upset, and he cries more loudly. Then Kevin screams more loudly. You see how this cycles on and snowballs until both are out of control and I can't calm either one. These moments are the worst. And they've been happening off and on all night: Kevin's in a bad mood because, according to him, "Valentine's Day is my worst day of the whole year." When asked why, he says he doesn't know why he has to give things to other people and not to himself (i.e. Valentines and treats). He also says, "They already know I love them." He also doesn't like all the Valentine's activities/crafts they've had to do at school over the past few days. So basically, Kevin's already moody because he hates Valentine's Day, so he's being difficult with everyone. He picks fights with Andrea, and then she screams, and he laughs. Then she screams more, and he laughs more. When she's screaming, Ryan gets upset and starts to cry again, which makes Kevin start to scream again . . . And I'm so overwhelmed because I can't stand the screaming, either (I swear I have sound sensory issues, too)!
Eventually, I get Kevin to sit on the couch, Andrea doing her homework, and I'm rocking Ryan. It settles. It's relatively peaceful. And of course, that's when Daddy comes in the door! I love how he always shows up just after the chaos, so I look like I'm totally exaggerating/overreacting to whatever happened earlier.
Or maybe not. As I sit here typing, trying to finish today's entry, Ryan broke into another seemingly random tantrum. However, it appears my tummy discomfort theory from earlier is correct. Daddy said, "He smells just like diarrhea," checked him, and got a finger full of yes, you guessed it. What a romantic Valentine's Day! ;P
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