Unity Day 9: Ryan's "Independence Day"

Note:  I decided to number the days of Unity according to which day it would be in the program, and not by our attendance. Therefore, yesterday would've been Day 8, but we couldn't attend due to illness.

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From Facebook:

"Today should be called 'Independence Day' at Summit Centre for Ryan. He pushed a car independently; rolled a ball to a therapist independently; and most amazing of all, fed himself at least 3 bites of yogurt, using a spoon, totally independently. It was awesome!"

I would say the day started off pretty well. Ryan was in a good mood, but a bit floppy/tired.  He enjoyed a little free time on the slide in the Rainbow Room since we got there early, and went right for his basket of reinforcers as soon as we got in the STR room.  He was floppy, but laughing, while we did our opening song, "Mr. Sun" (he was smiling and giggling as I helped him do the song actions). 

We were working with L., and she and I had a lo to discuss. Today we really got into the procedures so I could begin doing some programming and record-taking for Ryan. We have three separate areas (and 3 recording sheets) to switch between to work on different goals throughout the day.  The "work" sheet has specific skills like roll a ball, push a car, stand up, sit down, and what kind of prompts he needs to follow through on commands associated with these situations.  The "play" sheet is similar to the one I got for homework: we are looking at cause and effect play (we chose the piano toy) and close-ended play (we chose the shape sorter), again deciding what types of prompting he needs to follow through and play with the items appropriately.  The "incidentals" sheet is a bit different: it involves things that come up in a more natural teaching situation, where we follow Ryan's lead; this is where we are looking for Ryan to sign/try to say "more," point at items he wants, hold an item independently, etc.

The sheets are organized by date and goals, and we record using a + or - system. A + means Ryan completed the task independently at the prompt level we expected; a - means we had to give him extra prompting to complete the task.  A + in a circle means he went beyond what we expected.

As always, a major focus is on Ryan having a positive experience, so if he doesn't do attempt what we want in 3-5 seconds, I show him HOH how to do it and say happily, "That's how you ___!" We don't want to get him too frustrated.  I also have to make sure reinforcers are there to present as soon as he completes a task appropriately (with or without an extra prompt).

We played with the Winnie the Pooh piano to try and get him to press the keys.  We tried modeling how, then prompting from the wrist. I held his wrist to position his hand over the keys, to see if he would press them.  We got a couple good approximations of him tapping the keys while I held his wrist (he may not have the strength [weak fine motor] to actually press them yet).

Circle time was the usual. We've pushed it back to its regular time (10:00), and Ryan's pretty worn out by then.  He fussed a bit, so the focus was on keeping him sitting up nicely and being relatively calm. One nice thing we saw in circle was during "Wheels on the Bus", he started to move L.'s hands "up and down" for the windows and was patting her hand for the horn goes "beep, beep, beep." It took a little prompting, but he caught on.

Here are some great things that happened today as we worked with Ryan.  They were all totally unexpected, and he surpassed our expectations:

1. While L. went to get some more materials, I was playing with Ryan's rotating/vibrating magic light wand reinforcer.  When I stopped it, he manded twice in a row, totally independently, with a perfect pointy finger right at/on the wand!
2. When we tried to see if Ryan would push a toy car appropriately, we started by prompting him by putting his hand on it, then from the wrist, then the elbow, then we just modeled it. Suddenly, he pushed the car by himself when we put it in front of him, at least 5 times, with only verbal prompting!
3. We also tried rolling the nubbly ball back and forth again today.  We started with a verbal prompt and putting his hand on the ball, but soon, he was rolling it right back to L. with only verbal prompting. He even went us one better: one time, he rolled the ball back to L. with NO prompts!  That got a plus in a circle. :)
4. Snack time turned into an incidental teaching extravaganza.  We had discussed fading back the HOH I was doing when spoon feeding Ryan.  So, once he got interested in his yogurt, I faded the prompt back to holding his wrist.  Ryan was a bit clumsy, and dropped his spoon a few times, but he also held on to it pretty well a few times, too.  Next, we decided to go from the elbow. Again, he dropped the spoon quite a few times, but managed to get a bite or two in his mouth. Finally, L. said, "Just let him go, and see if he'll do it by himself. Don't worry about the mess!"  So, we waited; Ryan grabbed the spoon, fumbled it, but tried to put it in his mouth!  It was so exciting just to see him trying on his own. Yogurt was everywhere now (his shirt, his pants, the table, the floor), but everyone was so impressed with Ryan's attempts that they decided to keep the momentum going and extend our snack time to see what Ryan would do next.  We helped him out a bit by holding the yogurt cup much closer to him (instead of it being on the table), and to my shock and amazement, he grabbed the spoon, scooped some up, and got it in his mouth. Ryan just fed himself totally independently, using a spoon, for the very first time. Then he did it again.  I was almost crying, and L. was freaking out with happiness. He kept trying, and spilled several spoonfuls on himself and the floor, but he was trying! He even got another bite or two in on his own. And his grin--it was awesome--he was so proud of himself! He knew we were proud of him, and he was revelling in it. You could see it in the sparkle in his eyes.

Looking Forward

In light of today's positive developments, there are a few considerations we are discussing.

• We need to work on Ryan's fine motor strength. We have to get him to hold onto items independently. That skill will be key to moving forward more quickly with other goals. He has a tendency to just drop items once we let go of his hand/wrist.
• With rolling the car and the ball, we are going to fade back the physical prompts. He seems to be doing these fairly independently. We need to revise those goals.
• In terms of play, we are now looking at kicking the ball instead of rolling. Kicking is a new, gross-motor skill for Ryan. We tried a bit from sitting on a chair today, just to see what he'd do. He didn't really understand, so it might be a good play goal to work on.
• We need to get Ryan some kind of apron/smock for eating, so we can encourage independence, without needing several changes of clothes. LOL
• We might focus on one type of manding--either "more" or pointing--at one time. It might be less confusing for him.
• Mommy needs to let Ryan try things for himself.  We never know when he'll surprise us by attempting something on his own--like spoon feeding today--if I don't step back and just let him go at something new.

Dr. G. was in to observe circle time, and she was there to witness and encourage Ryan's snack-time success. She commented on how much Ryan has picked up in the few days since she last saw him. That was great to hear. 

As L. kept saying, Ryan was a "Super-Star!" today.