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. 

Homework

1. 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.
2. 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.
3. 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. ;)