"Decent day at Summit Centre. Got some good programming time and data with Ryan, despite his fussing. Also realized we may be investing in an iPad soon. Ryan was really engaged by a virtual instrument app on it. *shrug*"
Today felt (and feels) like kind of an "off" day, but it really wasn't that bad. I think it's a combination of lack of sleep (Ryan had a rough night, so I had a rough night); Daddy being away (I'm always extra stressed when alone with the three kids for an extended period of time); the older kids being home when we got back from S.C. (not used to that--they have a P.D. day); and the weather (winter storm outside--driving was a bit scary on the way in).
Ryan and I got to S.C. (my new short-form for Summit Centre) way early because I had left early, not knowing what the roads would be like. It was okay, though, because I had a new folder to organize for my data sheets and a home-made-old-shirt smock to put away for Ryan's snack time. Ryan was tired and a bit whiny when we got there, so I took the extra time to calm him down. I put him on the rocking teeter-totter (I guess it's called a wooden rocking boat?) for about 10 minutes, and he enjoyed that. He was requesting more by rocking himself forward and back when I paused it, so I would show him the sign (and HOH it) to remind him.
Our partner family did not come in today, I assume due to the weather. We still did our opening song in the STR room. Ryan thought "Mr. Sun" was hilarious this morning; he giggled the whole time I did the actions with him! It was good to see him laughing after his cranky start.
It felt strange when T. (our therapist today) said, "Okay, you have your programming and data sheets from yesterday, so what do you want to work on first?" This was really the first time I was making some choices about how our day was going to progress. So, I decided we should try some things we didn't get to yesterday. The first activity was the more structured trial of patting the floor and getting Ryan to imitate the action. T. was doing the modeling/verbal prompting, while I was recording data and doing physical prompting when necessary. The first time T. called Ryan's name and patted the floor, then asked him to do it, he imitated totally independently! Of course, she gave the floor a firm pat, while Ryan would lift his hand and give it a gentle tap, but that's a good enough approximation for us. The rest of the times, I had to prompt Ryan by holding his wrist when it was his turn. I think he tapped once more doing that, and the rest I had to do HOH because he wasn't imitating T., and add the verbal, "That's how you pat the floor!" Still, it was a good start.
Next we switched to a play goal. We decided to focus on a close-ended activity, the ring stacker. The goal was to get Ryan to hold the ring and place it on the stacker with minimal prompting. We discovered an important thing about Ryan's prompting here: He is more successful when Mom is holding his wrist (wrist prompting) before he starts the task, and then Mom can fade back the prompt. T. would hold out the ring to Ryan; I would hold Ryan's hand at the wrist as he reached for the ring, and then guide his hand to the stacker. Then, I would let go and Ryan would independently place the ring on the stacker. I believe he did this properly on 4 out of 5 trials, which is great! We also decided, however, that we wouldn't count when Ryan had to be blocked/redirected because he was trying to mouth the rings. We have to give him a chance to be successful, and not focus on that other issue, to keep him encouraged/positive.
Our next activity, an incidental goal, flowed nicely from our play goal. Ryan liked the stacking rings, so we decided work on his ability to hold onto an object by having him hold/handle the rings. In terms of measurement/recording, a simple + or - didn't seem to fit this activity. T. decided we would measure it by how long Ryan held the object independently (with me wrist prompting) before he tried to let it go. Then, to teach him that he should try to hang onto it, I would try to keep him grasping it when I sensed he was about to release. Basically, our goal is to increase the amount of time he will hold onto an object. Today, we mostly got in the 3-5 second range, but of course, he still got reinforced for any effort to hold.
We gave Ryan a break because he was getting miserable and tired by that point. T. took some notes while I rocked Ryan in my lap to soothe him.
Next, we went back to the STR to go back to some more structured programming. We worked on uncovering, which means if we show Ryan a toy and hide it under something, will he uncover it to get the toy? We used a towel and a ball. T. played with the ball with Ryan to get his attention, then she hid it under the towel and waited for him to pull the towel off to get the ball. He did it independently two times! Then he got mad and fussy, so I had to do some wrist/HOH prompting to encourage him to pull the towel. T. also made it a bit easier for Ryan by putting only part of the towel over the ball, and a rolling ball itself is more easily uncovered, again to give him a better chance at success. I believe he got 3 out of 5 on these trials.
We had a little more time before I had to go for research and theory (Friday routine), so we tried one more play goal. We got out the Winnie the Pooh music toy he loves, and tried to get him to press the keys. He was touching them, but so lightly that he wasn't getting the natural reinforcement of the toy's music. Plus, he was getting upset again. Suddenly, T. had a light bulb-over-the-head moment: iPads respond to light touches, and their iPads have a virtual piano/instrument app on them. She ran off to get an iPad for Ryan (they have a few to share around at S.C.). She brought it back in for Ryan with the app ready to go. She modeled how it worked, then took his fingers and showed him how to tap the virtual keys. The iPad was very sensitive; Ryan just skimming the surface with his hands/fingers made music come out. He was fascinated! Soon, he was reaching out and tapping it gently with his fingers as we had shown him. Voila--music! He picked up the iPad and checked it out a few times, turned it over, dropped it a couple times (I was cringing, but T. reassured me it had a special rubber case), and then went back to skimming his hands over the screen. Once in a while, he would tap it gently just as we'd shown him. He played with it for a long time. It was definitely providing that inherent reinforcement he wasn't getting from the other pianos which required a more forceful finger pressure. Plus, as he loves T.V./visual, I have a feeling the iPad will start playing a greater role in our future programming . . . and we might just end up investing in one for home. We'll see.
Anyway, after that, it was time to discuss homeworker with H. (no major changes from the other day), fill out my weekly research questionnaire, and go for theory with Dr. G. Theory focused on a detailed discussion of manding (the how's and why's), the benefits of journaling (um, got that one down already!), and an in-depth examination of what a "behaviour" is and why ABA is the most trusted therapy for autism at this point. We also chatted informally about how Ryan and I had changed over the first two weeks. Dr. G. sees me as a bit more confident and relaxed (especially dealing with Ryan's upsets). Regarding Ryan, we both see some changes already in him trying new things and surpassing expectations we'd had. We also notice that his crying is less frequent, and less distressed, than during the first week. He seems to have more of a "fuss" now, and settles a bit more easily. Hopefully, both Ryan and I will grow in confidence and skills as each week passes!
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