Unity Day 7: Tough Day

From Facebook:

"Tough tough day today. Ryan cried almost the whole time, I was surprised by a weekly parent evaluation (!), and I got my first daily homework therapy assignments. I did fine on the evaluation, and the homework isn't too demanding; I just feel kind of overwhelmed today (and Ryan's continual crying frayed my nerves). :p "

Ryan was really testing us today.  He cried as soon as we arrived and I took off his coat.  He was limp and uncooperative.  He was tired and cranky (and I'm not sure why). He just wanted to lay around and do nothing.

After opening song ("Mr. Sun, Sun, Mr.Golden Sun"), during which Mommy HOH'ed a fussy, limp Ryan like a puppeteer, I was surprised by a meeting with H. (the Executive Director). I knew we were supposed to have weekly meetings with her, and I knew parent evaluations would be involved at some point, but I wasn't ready for both of those to start today. It didn't help that D. kept teasing about "the dreaded parent evaluations" because it made me even more nervous than I usually am about any kind of evaluation. Anyway, I volunteered to meet with H. first, while D. and B. played and worked with Ryan.

The evaluation really made it clear that the Unity program is actually focused more on ME than on Ryan.  Maybe some of you didn't realize that either, from the way I've described it.  It's really the parents/caregivers being trained, and it just happens that many children show incredible progress by the end of the process.

On the parent evaluation form for Weeks 1-4, a "4" is the strongest score, meaning you do whatever's being evaluated "most of the time."  I got seven 4's, four 3's, two 2's, and two 1's.  However, H. said the two 1's aren't really negatives because they are something "new" we are working on.  The two 2's had to do with prompts: "delivering an instruction only 1x (then prompt)" and "understands the difference in prompt types."  I'll admit, I'm not sure when I'm supposed to jump in and prompt when I'm with the therapist, or what types of prompts are best in which situations for Ryan. Hopefully, that will improve in next week's evaluation.

Homework (up to Sun., Feb. 10)

This more for me, so I don't forget the important points discussed with H.:

1. Manding:  5 minutes per day.  Record number of mands in dark squares on data sheet.

N.B.: In manding, a key for Ryan is strong motivators--things he really likes, and will continue to request. Also, try to find things where he can request more, rather than giving him something and taking it away. Adding is always better than removing an item--less frustration for the child.

2. Play: Pick 2 goals--1 "cause and effect", 1 "close ended" (look up in Unity binder).  Write a description of them on the play data sheet.  On Friday, H. will review the goals and procedures with me.  I will implement the goals and take data on the weekend.

Back to Ryan's Day . . .

D. said while I was gone, Ryan was really testing his limits with the crying.  D. would do an activity with him, and then let Ryan wander and have a break to see what he'd do.  As D. was writing up his notes, Ryan would walk up to him and cry, and touch him, or try to lean on him. He was clearly trying to get D. to react to his crying. We tried the same thing with Ryan when I got back; we did some activities, then he'd cry; we'd give him a break, he'd calm a bit, then come over and start fussing at me.  Oh, so we know for sure now that he's totally playing us with his tears, to get a reaction. 

D. and I tried many of the same things we have been over the past few days, but we got almost no cooperation from Ryan.  He just wanted to lay down and fuss. We noticed he wanted to wander a lot today. Usually he gets distracted easily, so we do a lot of work in the STR, but we decided to take him to the Blue Room to see if a change of scenery would cheer him up.  We even opened up the cupboards and gave him free access to all the toys and activities in the Blue Room, but he just wasn't interested in anything. He didn't even want to explore. He just stood there and cried.

D. remembered that he'd liked the bubbles before, so we tried to entice Ryan with that.  We got 3 mands out of him in 5 minutes.  He did pay attention to the bubbles for a while, and popped a few, and reached for the bottle to request more (those were our three mands).  We HOH'ed him to point and also gave the verbal prompt of "B-b-b-bubbles."  But soon he was cranky again.

We tried the Snoezelen Room again to get him calmed down before circle, but Ryan wanted nothing to do with it.

In circle, I had to HOH Ryan for most activities, and he fussed throughout.  He didn't even want to do "Roll the Ball" today.  We made it through the full circle time, and he got reinforced for letting me HOH the activities with him, but he wasn't happy.

Next we tried a snack break.  He drank a little and I encouraged his pointing to the bottle when he wanted it, and HOH for yogurt feeding.  He did reach out and grasp the yogurt spoon once, which was good.  He liked the lattice work on the wall behind the snack table, and was more interested in that than eating, but at least he mellowed a bit.

So, we decided to try a bit more after snack.  Ryan cried as he played with the bead toy, but we got him to push a few beads around on his own.  He made better eye contact and even smiled a few times when D. brought out the expanding ball and opened and closed it for Ryan. When that lost its allure, D. resorted to another thing Ryan liked last time they worked together: the deep-pressure squeezes.  Soon Ryan was smiling again, and we even got a few giggles! The best part of this was when D. encouraged him to sign "more"; after several tries, Ryan clearly signed "more" two times in a row for more squeezes! Ryan also made one or two more attempts where his hand gesture wasn't quite right, but we were happy to see him trying. 

Then D. had Mommy try the activity with Ryan.  Suddenly, he didn't want to do it anymore. The fusses started up again, and he kept turning back to D.  Maybe D. gives better squeezes?  Or maybe Ryan just knew he could play on Mommy's emotions with his tears?  Anyway, we decided it was time to end, since the squeezes had been a positive closing activity for Ryan.  So, we made it to 10:30 again.  That's not so bad, considering he was a miserable little man today!

Chew Toys

I just wanted to add a  note here that the "chewelry" I ordered for Ryan came in last night. So far, it seems to be a hit!  The people at the Summit Centre think it's a great idea, too.  It's specially-made non-toxic pendants that hang on a necklace or a clip, and autistic or special-needs children who enjoy oral-sensory stimulation can suck or chew on them. Ryan seems to be using his quite a lot.  We hope to reduce the amount of other objects he mouths by allowing him to fulfill his sensory needs with the chewy clip-on.