Unity Day 12: High Stress

From Facebook:

"Today was a roller coaster ... started out great, Ryan had a massive meltdown halfway through, then we levelled off again, and somehow managed to stay to 11 AM. I am exhausted. Thanks Leanne for the paczki; I needed that. LOL"

Forewarning: This one's going to have a lot of Mommy venting, and not so much focus on ABA therapy.

Okay, so my misery started last night.  I'd already had kind of a tough day. I was really tired.  I fell asleep on the couch around 9 PM. Suddenly, I awoke around  2 AM, sweating and feeling horrible nausea and stomach pain.  Next I was having wicked dry heaves, and feeling dizzy, and then wham! I get hit with a massive panic attack.  It took me at least a half hour to calm down, and thankfully, I was so exhausted I managed to sleep off the nausea.  I have no idea what brought all that on.

So, I'm awake with the alarm at six, still feeling drained and shaky and a bit of nausea, and seriously debating going into S.C. with Ryan today.  Then I think, no, I can't stay home; we already missed a day last week. Up I get, shower, then I remember that I have to drop the kids off at school today because Daddy has an 8 AM meeting. Oh, boy.  Kevin and Andrea were both acting crazy: Andrea was excited for her "100 Day" festivities at school, and Kevin was being difficult because his routine had been changed, with me getting them ready and dropping them off at school.  So, they were fighting, and Kevin was refusing to do anything for me (put on boots, put on coat, get in the car, etc.) I did get them dropped off on time, and iIdid get to S.C. on time.

Things were okay for a while. Ryan started out the day with some tired behaviour (needing extra help climbing stairs, kind of floppy during opening song), but he perked up for a bit while we cycled through some therapies with D.  We were really working with H. today, but D. filled in for a bit while she finished up a meeting.

Suddenly, around 9:30 AM, Ryan just LOST IT.  We were in the Blue Room, working on holding the ring stacker rings, and he had a major meltdown. I guess the signs were there that something was coming: he had started to whine a bit, and kept tyring to lay down/not participate well, but I seriously didn't foresee the severe and prolonged agitation that followed. Ryan stretched out on the floor, screaming and sobbing, and nothing could seem to soothe him.  I tried rocking him, massaging him, giving him free access to his reinforcers, and just backing off.  He might stop crying for about 30 seconds, and then, even if we made absolutely no move toward him, he'd start freaking out again.  I actually felt helpless. It was awful. I was looking to H. for guidance: What should I do when he gets like this?

Well, we tried to tease out what exactly might have led to Ryan's meltdown.  We had been working on the rings, and he kept wanting to mouth them, and I had been blocking him quite a bit. In fact, for almost the whole time we'd been in the Blue Room, Ryan had been trying to mouth any material we were working with. Maybe he was frustrated because we'd kept blocking him from mouthing? Some days he craves that oral stimulation a lot more than others, and it's kind of a self-soothing thing. H. said today seemed like a Level 10 (out of 10) mouthing day, so maybe we should try some programs that didn't involve any items he'd be tempted to mouth.  We also considered that the Blue Room was busier/noisier than it's been yet (lots of kids getting their ABA in there today), so maybe the noise/distractions were too much for him. So, we decided to go work in the Single Treatment Room (it was time to rotate back to there anyway).  Once in there, we focused on finding more powerful reinforcement to get him to want to interact with us. It worked. After about a half hour, we finally got him levelled off enough to be ready for circle.

I'll go back to the details of Ryan's day at the end. We somehow made it to about 11 AM!

My afternoon and  evening were also all over the place.  Ryan's mood swings continued all day; for awhile he'd be calm, then he would be screaming, then he would be hyper and getting into stuff, then he would almost doze off, then he would be laughing.  I was exhausted and generally not feeling well, and desperately wanted to lie down.  Finally, around 2 PM, I got him to settle in the rocking chair and me on the couch. Thankfully, Papa was available to pick up Andrea and Kevin after school when I called and asked him, so Ryan and I were able to get about an hour to try and relax. We were both dozing when the kids got home.

The evening was wild. Ryan's mood swings continued; he was mostly cranky, and wouldn't eat.  Andrea had double the homework as usual because she'd forgotten to bring home her work yesterday, so it took us a while to slog through that.  And though I don't have time to get into it here, let me tell you, Andrea and homework-time is a stress-inducing experience all on its own. Meanwhile, Kevin is getting into things he shouldn't be, and annoying his sister as I try to keep her focused on homework.

We had one good hour where we actually had some fun, but it was still stressful for me, because I was playing three different games with three different kids at the same time:  rocking and soothing Ryan; red-green-and yellow light with Kevin as he spun around in the Bilibo toy; naming summer and inter Olympic events for Andrea to enact and me awarding her scores/medals.  My brain hurt!

Then, I still had to do my homework with Ryan with the car chaser and the shape sorter.  Again, I had two eager, but hyper and interfering, young assistants. I told them they could watch, but again, Kevin was playing with the reinforcers and doing things with the toys before Ryan even got a chance. Andrea was trying to tell me when I should reinforce Ryan and what I should be doing for prompting (she's watched me two or three times, so she's the expert now, right?!).

Now you may be wondering where Daddy was during all this. Well, he had a dinner to attend with a client, so he wasn't home till 8 PM. I don't blame him; it's just so much harder to do home therapy programming with Ryan when there is no one else to distract his siblings.  It's new and exciting, and they can't understand all the procedures that need to be followed. They just see Mom giving special attention to Ryan and playing fun new activities with him. They also, unfortunately, have fallen in love with the new reinforcer I got for Ryan last night: a mini massager. Tonight, by the end of Ryan's home therapy, we did come to a bit of a compromise:  the older kids could take turns giving Ryan his reinforcement with the massager when I directed them to administer it.  Andrea was a little smoother and caught on to the concept pretty well, but Kevin was still more hindrance than help. Sigh.

I will say this:  I really think Ryan was encouraged by their presence once they fell a little more into the program procedures. In fact, during car chasers, he pulled the gear shift totally independently (no prompts!) one time, and followed Andrea's verbal prompt one time, and my gestural prompt one time. Considering we were working at an elbow prompt level, that's awesome!  For the shape sorter, I let him play with and mouth the pieces when he picked them up, and then I guided him with a wrist prompt to drop them back in the container. He was surprisingly compliant.  I don't know if it was the kids' effusive praise or their constant administering of the mini massager that made this work, or if it was because I let him mouth every piece before I guided him to put it in the container.

After Daddy got home, I finished the laundry and finally had dinner. Yay me.

It's 11:15 PM, and I am finally doing the blog I usually do around noon. My stomach still feels sick and I'm still jittery.

Question: Am I stressed because I'm sick, or sick because I'm stressed?

Ryan's Day at Summit Centre

I am going to do this point form because I'm totally exhausted and I need a shower and sleep.

Positives

• rolling the ball to D.: 4/5 trials totally independent
• started the stacking rings well (first 2 trials) with wrist prompt
• found a way to calm him in the STR room using dry rotini noodles in a bin (new reinforcer)
• pulled a velcroed picture off the circle-time poster independently for the first time (he did the grasp and the pull, I just held his wrist)
• lots of good manding opportunities during snack (he was reaching for his bottle and the yogurt; I was prompting for more "sign" or pointing)
• pushed a car independently twice after snack
• made it to about 11 AM (he was playing quietly while H. , and then L., and I talked for a bit)

Negatives

• Ryan losing focus due to fixation on mouthing things
• prolonged meltdown left Mommy feeling helpless and confused (and noticed a bit of Mommy's shaky hands appearing during snack time)

NOTES

• ending on a positive when Ryan is in meltdown mode may mean changing activities or reinforcers first, but still ending on a different teachable/programming moment (not just stopping all therapy)
• when Ryan's level of need for mouthing is high, switch to an activity that does not require an object he could mouth (i.e., high fives); return to activity with objects when his level of need for mouthing has decreased
• might also spend some time letting Ryan search for new reinforcers when he gets too focused on mouthing
• Ryan loved the bin of rotini noodles: can be used to get mands for "more" by giving him a small amount in a small container, and then presenting him with another cupful from the larger container 
• when a reinforcer seems to be losing its strength, hold out two other options and use the one he chooses (reaches for)
• toys with built-in reinforcement work best for engaging Ryan (today=push car with lights and sounds)
• accept snack-time mands like reaching or the food or drink, and count them as mands for recording in the Blue Room; but be sure to prompt for "more" sign (yogurt) or pointing at the item (bottle) before giving it to him