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:

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. ;)