Unity Day 23: The Day of Tantrums

From Facebook:

"Today was the Day of Tantrums. Not fun. My nerves are frazzled. Somehow, we still managed to get some progress in there. The Summit Centre staff are awesome. I have no idea how they do this every day. They are special people. :)"

Things seemed fine when we arrived today.  Ryan was in a good mood. As soon as we took off our coats, he went right over to the wagon and tried to climb in. I prompted him to ask me for a ride, and he tapped the wagon, so in he went. (By the way, we're encouraging him getting in and out on his own by putting one leg over the side. He usually lifts the other one in/out.)  We met D.in the hallway, who said he'd be working with us today, but he let Ryan finish his ride up and down the hallway first.

Well, as soon as we got back into the Yellow Room to do our morning song, Ryan started to cry a bit. We chatted some about what we'd been working on lately and made an agenda for the morning, and then we headed over to the Blue Room. Ryan did not want to "stand up" and "follow Mommy" today. When we eventually coaxed him out of the Yellow Room, Ryan wanted to wander down the hall, not go in the Blue Room.

Once we got him into the Blue Room, we decided to start with a simple round of "push the train" on the floor.  I had to HOH the first one or two trials, then I think a wrist prompt, and he finally did one independently. 

D. had a new plan he wanted to try for "Go play." When we finished "push the train," D. had surrounded us with a circle of bins full of toys. We instructed Ryan to "Go play," and he just sat there.  D. pointed to and shook some of the bins to entice Ryan.  No luck.  Instead, Ryan whined and went to the one spot where there were no toys, but B was sitting and observing.  He tried to snuggle with her.  So much for the toys!  Even when we got B. to move away, he still wouldn't go for any of the toys.  He just whined and wandered away.  D. then opened a nearby cupboard full of toys and showed them to Ryan. Ryan looked in, and touched a few things. One was a big, electronic dinosaur. So, D. took that out and pressed the buttons, making it move and roar.  Ryan looked at it for a bit, and then he cried.  I guess we still haven't figured out how to make "Go play" work, even when he's surrounded by toys!

Anyway, he was pretty agitated so we pulled out the old program of the "car down the ramp" which he enjoys and is good at.  He didn't want to pick out a car, and tried to mouth them when I would hand him one.  I showed him how to do the car ramp again, and then he did both ramps (straight and twisty) several times independently, but he was still whiny and miserable.  D. pulled out a little helicopter that has a pull string that makes the rotors spin. Ryan was intrigued by that; I got a couple "more"s out of him (with wrist prompts or him tapping) to pull the string and make it go again. But he quickly lost interest in that. However, even though he was mad and crying, he still grabbed and slid the helicopter down the car ramp independently!

We decided to try and give him some time to wander and see what he was interested in so we could follow his lead. He went back to the toy bins and pulled out a nubbly ball. He was chewing on it, but B. encouraged him to play "roll the ball" with her. He wasn't too happy at first, but he eventually got into the game, and it soothed him a bit.  I've noticed he does tend to calm down during that activity.

Next, we tried the new program of colouring. As with all new programs, it took some tweaking to figure out what might work best for Ryan.  We sat him at the table with a marker (washable and non-toxic, of course!) and a picture to colour.  D. suggested marker might work better because it takes less effort to make a mark on the paper. It was a thin marker, and Ryan kept dropping it and rolling it around in his hand.  D. thought a fatter marker might work better, so he got out some Crayola  Tadoodles , which toddlers can hold in the palm of their hand to draw.  "Holding onto items" is still a tough one for Ryan, so he did fumble the marker a bit, but he did have a little more control than with the skinny marker.  Ryan let us do HOH drawing with him, and he did try to make some marks on his own, but he couldn't quite get the right angle to make his own marks. At least he wanted to try. 

I tried to bring him back down to the floor to do a different activity, and instead, he wandered out the connecting door into the kitchen.  When I went to guide him back into the Blue Room, he did not want to follow. He was crying again.  He dropped down to his knees and refused to move. D. came over, and we tried to entice Ryan with some of his reinforcers, to stand up and get them.  D. was holding the caged bell just above Ryan's reach and encouraging him to stand up and get it.  Ryan was reaching for it, and trying to tap it, but he needed to "stand up" to get that bell. Well, Ryan was just getting frustrated, so he started to cry harder. Finally, one time when D. asked Ryan, "Do you want the bell?" Ryan nodded his head YES!  It was a very clear, very emphatic nod of the head.  D. said we had to give Ryan the bell (and lots of praise) for that one. Any spontaneous communication like that gets plenty of reinforcement!  So, Ryan got his bell, we got him moving, and we got a great nod from him.

We then went into the Rainbow Room to try some "matching" again. I showed D. the steps we'd covered so far, and how Ryan was at the point of taking an elephant from my hand and independently matching it in the bowl with the elephant, and not the empty one.  Today, D. increased the difficulty a bit. He put an elephant in one bowl, and a bean bag in another. When we told Ryan to "match it," he independently put the elephant in the bowl with the other elephant!  That was great. He did this consistently.  So, D. went up another level.  This time, he put a blue elephant in one bowl and a green elephant in another.  I handed Ryan the blue elephant and asked him to "match it."  This time, he wasn't successful.  He understands that elephants go with elephants, but he can't distinguish between two items of different colours yet.  D. said maybe we should step back to having a completely different thing in each bowl, but move away from using the elephants, so that Ryan generalizes the skill a bit more.

While we were out there, we also tried "kick the ball" again. Today, Ryan continued to do well with that.  He kicked the ball from sitting several times with only a verbal prompt and the ball by his foot.  He even did a couple of kicks from standing again. 

When we went Back in the Yellow Room, however, things quickly turned ugly again. I was trying to do the chunky puzzle with him, and his tantrum suddenly escalated. He completed the three puzzle pieces (taking them out independently, and putting them back in with some HOH), but he started screaming.  Then he was inconsolable.  He was laying on the floor, sobbing, pushing toys away, and wouldn't let anyone hug him or soothe him.  He was red in the face, snot was flying everywhere, and he was hysterical.  D. got an idea and disappeared for a minute (also to grab us some tissues!).  When D. returned, he had an iPad, and he tried putting on a Thomas the Train video for Ryan. I was holding Ryan against my shoulder and rubbing his back, while D. put on the video. Ryan watched the video and snuggled with me, and after a few minutes, he calmed down.  Then we gently moved him to sitting in front of me. To keep the flow of learning going (and to show Ryan he can't tantrum and get rewarded) D. started stopping the video once in a while and asking Ryan to do something he knew well, but required an appropriate response (like give a high five or imitate patting the floor). Ryan whined the first time or two, but he caught on that he had to cooperate to get more video.  By circle time, Ryan had settled considerably.

Circle time went fairly well. Ryan did well matching the animals to the book and he also did a good attempt at a prompted clap for "If You're happy and You Know It." He was kind of fussy and restless, but he made it through circle time.

Oh, I forgot to mention that D. used the iPad, with Thomas playing, to entice Ryan to stand up and follow us to circle time, and later down the hall to snack time. It seems to work as an extra incentive to get Ryan moving. D. suggested I might try this as an incidental goal at home, using Thomas videos on my iPhone, to get Ryan to stand up and follow me.

Snack time was next. He looked so tired, but he made some good choices and requests. I lined up his star puffs, his yogurt, and his bottle just a bit out of his reach and encouraged him to ask for what he wanted.  He'd reach, and then tap the item when I presented it to him. He even fed himself, completely independently, about three good bites of yogurt.  Like yesterday, though, I had to put an end to snack time because he was really drawing it out, trying to make that bottle last forever!

After snack, we tried a couple programs in the Yellow Room. Since the Thomas videos were working as such a great reinforcer, and Ryan was in need of a high level of reinforcement to keep him focused today, we continued to use that for our trials, as well.  We did the shape sorter, and Ryan got to watch a clip of Thomas after each time he put the shape in the hole.  We also did a little more puzzle, and Ryan got to watch a Thomas clip after he removed all the pieces, and then when he put them back in.
We also tried a little bit of "holding an item" with the rings from the ring stacker, and he got a clip of Thomas after he cooperated with holding each one.  We ended on that positive note.

In terms of the shape sorter and puzzle, D. noted that I could be fading back my prompts on those more. I was really doing HOH a lot today (I think because I sensed Ryan was so floppy and unfocused).  D. suggested that I give more of a forearm prompt, and guide Ryan's arm so his hand is lined up over the hole for the puzzle piece/shape. Then, Ryan independently tries to drop/place the object in. As long as Ryan is trying, with intention, to put the piece/shape where it's supposed to go, we count it as a + in the data recording.  He can have plenty of attempts as long as he keeps trying.  We did this several times, and eventually, Ryan managed to wiggle in two of the shape sorter pieces independently.  He can do it; he just needs a little fine tuning of his coordination.

Overall, it was an emotionally exhausting day. But we ended on a positive note, as we always try to do. I was especially pleased that when it was time to say bye-bye, Ryan (with a forearm prompt) waved bye-bye to both D. and B. 

I know Ryan was exhausted, too. He fell asleep in the car on the way home, and didn't even wake up when I took off his coat and shoes and put him in his bed.  In fact, he just woke up! I hope the nap improved his mood. :p