Having Fun with Ryan!



I decided it's time to upload some videos to share a bit of The Ryan Personality with everyone.  Some of you haven't seen him in person for a while, and some of you haven't seen him as he is in his comfortable home environment.  Plus, he had some great interaction with his big sister, Andrea, yesterday. It was so wonderful, I just had to share!

 

 



I love this video because it's a minute-and-a-half of pure Ryan Personality: active, mischievous, sweet, and funny.  After his bath, he loves to flop down and wiggle all over Mommy and Daddy's bed.  We usually have to chase him and wrestle him down to get him dried off and into pyjamas! It's all a big game to Ryan.  This video was taken during the daytime, but you still get to see him goofing around a bit on our bed. :)

 



 

Ryan's new "thing" is walking backwards. He seems to enjoy the sensation, but we have to watch to make sure he doesn't walk into anything!

 

 

He loves watching Andrea and Kevin run around and have fun. One of the cutest things about this video, which I didn't realize till I saw the playback, is Ryan asked Andrea for "more" at the end!

(Watch his hands for the sign: his is like a clap.)

 

 

After watching Andrea run, Ryan got down and started to chase her!  She started a game of tag with him, and he caught on right away!  He needed a few reminders to "go get Andrea," but I was amazed to see him participating in his first game of tag, and having so much fun with his sister! It was so sweet and funny. :) Andrea was thrilled. She kept saying, "Ryan's so cute tonight!" and "Ryan's so much fun tonight!"



Unity Day 43: First In-Home Session

From Facebook:

"It was an interesting first home day. I was kind of lost without the usual schedule to follow, but got lots of great information about how to work with Ryan at home. Gram (Linda Gagnon) also did a great job learning about reinforcement today. :)"

So, today was our first in-home session. We'll be having one each Thursday for our last four weeks of Unity.  One of the senior therapists comes to our home to see how programming will work in our home, make suggestions how to use other toys we have, and basically get us ready for when Unity is finished, and we continue the work on our own.

I have to say, this first home visit felt really awkward. H. was our visiting therapist today, and she seemed to be looking to me to lead the proceedings.  I was lost. (?)  I am so used to our Unity schedule; I know what to do and where to go and which programs to work on at any given time.  But this was our first home visit, so I really didn't know what H. was expecting.  Eventually I brought out some of the goals we'd been working on for homework, showed her how I run those home programs, and asked some troubleshooting questions.  That format seemed to work well, once we got into it.

I'll list some of the things we did/talked about, and add some notes I took about what we discussed.

1. Push-Button Toys/Pushing Down with Force: It seems like I have to HOH for anything that needs Ryan to press down or put hand pressure on it to get the desired result (letter and music buttons on Thomas alphabet toy; pressing buttons on mini-computer toy; squashing down Play-Doh, etc.). I had thought it was a matter of hand strength, but H. disagrees.  She says Ryan can push down the pop-up toys and pull back the lever on his car racer toy, so it's not a strength issue. H. believes it is a motivation issue. Ryan has learned that it's just easier to let Mommy do everything.  So, we got out another toy with a push-down portion (animal barn--push down hay to hear sheep baa).  She had me HOH it a few times, and then back off (fade the prompt). Ryan was able to make it "baa" a couple of times.  H.'s suggestion is to rotate between his various push-button toys during a given session (some might be more motivating than others), while trying to fade back that HOH prompt.
2. Magnetic Stacking Blocks: I told H. about how hard it is to keep Ryan from mouthing the blocks.  Then she got to witness it. I showed her how each time I hand him a block, he immediately puts it in his mouth first (even when I try to stop him), and then he will let me forearm prompt him to stack it, but he sometimes gets upset.  The blocks themselves have a texture he really likes, so he'd rather mouth them than stack them.  H. thought about it a bit, then suggested that we try a different kind of blocks (bristle blocks) that can stick together.  Then, we can use the magnetic blocks as reinforcers, instead, because Ryan is so attracted to them. She's going to check back at S.C. to see if they have some bristle blocks we can try.
3. Matching: I mentioned, in previous entries, how we've decided to move from matching concrete objects to matching with pictures because that seems to work better with Ryan.  The trial run we did yesterday with the coloured squares went well, but L. had wanted clearer pictures of real objects.  Well, she got them ready and sent them over to us to try out with H. today.  They worked really well. Ryan was having a high sensory-needs day (lots of mouthing), but that was the only hurdle we had to overcome with the pictures (blocking him from putting them in his mouth).  Otherwise, the trials went well.  We did the same thing as yesterday, but with pictures of different things, like a car and a ball.  We did some practicing just matching one-to-one (no distractor); then we threw in the distractor; then we changed the position of the distractor and the matching picture; finally, we had him match the distractor with its match.  Overall, he did really well. He was kind of flinging the pictures at each other, but for now, we're happy as long as we can tell he's making an intentional match. We will be bringing these new matching pictures to S.C. to work on them there, too.
4. Car Racers Toy: We had worked with this one as a homework item in Month 1 in Unity, and Ryan learned to use the gearshift to make the cars go.  However, when I tried to teach him Step 2 of the toy, putting the police car on the roof and dumping it in to start a car chase, Ryan got confused and kept going for the gear shift.  So, we stopped that program.  I showed it to H. to see if she had any suggestions for re-introducing Step 2 of the toy.  H. suggested positioning the toy so that the police station roof is right in front of him, and the gear shift is further away (turn it sideways). We can start by HOH putting the car on the roof, and gesturing for him to dump it in (he already knows how to tip it in). After he goes through this procedure correctly, we can turn it so he has access to the gear shift as his reinforcement.
5. Imitations and Correcting Errors: I talked about and showed H. our on-going struggle to reduce Ryan's prompt dependency, especially when it comes to him doing imitations (pat head, waving, clapping, etc.)  Basically, she agreed with what the other therapists have already suggested:  the mixed trials, doing full prompt for two and then no prompt for three, and positioning his hands before giving the instruction. However, she brought up an interesting point about something I hadn't realized. Let's say I was doing "clapping" Ryan, and he patted his head.  I always say, "Oh, that's pat head," then HOH the correct answer, saying, "THIS is clapping!"  She thinks my wording might be confusing him, since I'm verbally drawing attention to the action he wasn't supposed to do, as well as the one he's supposed to do.  She said when I'm correcting, I should only use the words for the action I want him to do. So, using the previous example, I would simply say, "Nice try, but THIS is clapping!" (while HOH'ing the appropriate action). I think that's a good point because even with Kevin, I notice when I often say "Don't do this," he misses the "don't" part. With autistic kids, it's clearer for them if you say what you want them to do.

Circle Time: I ran my first in-home circle today.  I used the same one as I did at S.C. yesterday, in the hopes the familiarity of it might settle Ryan some. It was a good thing Grandma was there to support Ryan with circle because he was getting irritated, and again, did not seem to like that I was the leader, and not sitting behind him.  Grandma learned a lot about reinforcement during circle time because Ryan needed a lot of reinforcement to keep him focused.  Like I said, he was mad because I was leading; it was weird for him to do circle at home; he also had no one other child to share the circle activities/tasks. 

I had a hard time getting circle started because I wasn't sure how to set it up at home. Also, both the opening songs we've been taught have "our classroom/our school" in them, so I wasn't sure if I should sing them that way. It was a little thing, but it kind of threw me off right at the start.  Anyway, circle went okay.  As I said, Ryan needed lots of encouragement to stay on task and to sit up nicely. He did participate by pulling off the Velcro pictures and letting Grandma HOH some song actions with him.  He also did well matching out of two choices for the pages in the "Brown Bear" book.

H.'s comment when circle was over: it was "not too shabby!"  Um, okay. I'm not sure if that was a positive or a negative. Sometimes I find her a bit hard to read.

I then asked for some suggestions as to how I could do circle time when it was just me and Ryan, since we won't always have a third person to support Ryan. H. said she likes how I often put Ryan in the rocking chair, facing me, for activities; it keeps him physically supported, focused, contained, and there's even a little room on the chair to place materials in front of him. She also suggested sitting him in one of his foam chairs or on the floor with his back against the couch, so he could have that core body support and leave his hands free to participate in circle time activities.

Purposeful Communication: I also talked to H. about how I'd like to increase Ryan's functional/purposeful communication.  I mentioned how the "making choices" program is a no-brainer  if it's between food/bottle and some totally different object.  H. said we could start offering him other things he might like as the second choice, such as his bottle and something from his reinforcer basket. We give him the item he asks for, until he indicates otherwise.

Since Ryan has mastered the "more" sign, I asked about teaching Ryan new signs.  H. said we had a bit of a decision to make: Will we use signs or PECS (Picture Exchange Communication System) for Ryan?  We have to consider the big picture: not only what will work best for Ryan, but will work best for us as a family.  Although I think PECS might be the better system, I know we've already had some difficulties with it as a family.  Our speech therapist and resource consultant from Children First had given us a few PECS to try at home a month or two before we started Unity.  They didn't work well because Ryan sometimes ignored the pictures, but mostly because Kevin wanted to play with them all the time.  Kevin kept taking the pictures off the Velcro and disappearing with them, or putting them in strange positions on the Velcro strip.

On the other hand, Ryan has done really well learning the "more" sign at S.C.  As usual, the key to Ryan is motivation:  he will sign for things he really wants.  So, H. suggested that I start teaching Ryan signs for the things he has strong motivation to ask for/really likes:  "bottle/milk," "bubbles," etc. She is going to get me the addresses for some reputable websites for learning the signs. Grandma also took a sign language course a few years back, and has a book which might help us pick up some of the signs.

Sibling Involvement Issues: Finally, I got a chance to get H.'s thoughts on how to handle Andrea and Kevin's interactions with Ryan and their attempts to be involved in his therapy.  She agreed with me that we don't want to discourage their interactions with Ryan, but we can shape things to make them more appropriate.

For example, when the kids want to give Ryan his reinforcers during programs, I might hold the reinforcer item/bin until it's time for them to present it to Ryan.  Or, if they both want to do something at the same time, they could each get 3 items (thus, 3 turns) to give him for reinforcement, and then it's the other person's turn.

Circle time, at home, could also be a great opportunity to get them involved.  Andrea, being older, might be able to help with prompting Ryan, while Kevin could be another participant in circle time activities.  Or, they could take turns being the leader for some of the circle activities while I assist Ryan.  I'm sure they'd think that was fun. :)

Finally, we talked about making up new token boards for Andrea and Kevin. Token boards are a form of positive reinforcement; they get a token for doing something properly, and when their board is filled up, they can get a special prize/treat/activity.  So, they could be receiving tokens for interacting well with Ryan, or helping with programs or circle time appropriately, etc.  They have used token boards in the past, when Kevin did his ABA (Applied Behavioural Analysis) emotional regulation program through JMCC (John McGivney Children's Centre) and TVCC (Thames Valley Children's Centre) in the fall and winter. They got tokens for playing together nicely, being good sports winning/losing, handling their anger appropriately, etc.  I think this might work for a while,  but as I saw last time, the novelty wears off. Then again, I now realize it could have been an issue of having strong enough reinforcement; if filling the token board doesn't lead to something they are really motivated for, it loses its power.

Overall, despite some awkwardness due to it being the first in-home session, I was pleased with the information I got.  It was good to have an opportunity to ask some questions that had been on my mind for awhile, but I didn't have the chance to ask in centre.

On to Easter Weekend.  I have to say, H. was generous in letting us spread out one day's worth of homework over the 4-day weekend. We can handle that. :)

Unity Day 42: Ch-Ch-Ch-Changes!

From Facebook:

"Ryan had a fussy day today but we did okay. Papa did well on his first day with us. I ran circle time. Froze up and blanked on the opening song, but pulled it together after that. LOL"

Ryan was whining/crying from the moment he woke up this morning, and just seemed a bit unsettled all day.  He had slept well, and ate well, and wasn't sick, so I'm not sure what made him so moody.

Today was Papa's first day at S.C. We got there a bit earlier than usual, so we had time to give him a tour of the main rooms and take Ryan for a wagon ride.  Ryan did excellent signing "more" for the wagon, but of course, he was mad when we had to stop and get to work!

There were so many things I wanted to explain to Papa as we were going along, but as Ryan was having a grouchy day, I was busy trying to keep him calm/engaged, so I'm not sure how well I did.  It's kind of funny; things that we're used to doing around there probably seemed strange to Papa, such as when we shut off the lights and walked out of the Yellow Room, leaving Ryan behind.  Of course, Papa's natural reaction was to turn back to grab Ryan's hand and lead him along, because he didn't know that shutting off the lights and walking away is a prompt/cue to Ryan that he needs to stand up and follow us. We would never really leave him behind!

Anyways, our day started a little later than usual. I'm not sure where everyone was! We were ready, so I had Ryan get on the Thomas ride-on and show Papa how well he could ride it across the room. Ryan still needs help getting on the toy, but he can do the rest himself.  Ryan also entertained himself with the big bead maze for awhile.  Then, L. came in and the daily routine started with L. singing "Mr. Sun" with us and Ryan, and that did make him laugh. Ryan is usually very cuddly with L., and she knows all his favourite tickle spots.

Then we moved over to the Blue Room.  I set up the "coins in the bank" program first because we haven't done that one in a few days. Overall, Ryan did pretty well. I think he got 3/5 in at a wrist prompt.  In fact, he continued to play with the toy just for fun, and he actually put one in independently!

Next we tried clapping, with two fully-prompted trials and then 3 trials with zero prompts.  It went as expected; 2 +'s, then 3-'s.   L. noticed my frustration and stepped in to try some problem-solving. We played around with a few different ideas, and then L. had a successful trial when she got Ryan's hands into position ahead of time, before the instruction was given. I tried a few that way and got only one successful attempt, but it's something that might work if Ryan was having a better emotional-regulation day.

I thought some Play Doh might be fun for Ryan, but he was kind of whiny throughout the program.  He didn't take any ownership of squishing the Play Doh balls. I was doing all of the work, HOH.  However, he did pat them independently a couple times, which is the beginning of the motion we want. 

While we were at the table, I decided we could try colouring (and also because he likes it).  I got out the marker with the special grip, and he did well trying to grasp it and push it around for at least a few seconds (with me holding the top).  He got a + on 4/5 trials.  For the last trial, he just started to swat at it and wasn't interested in trying to grip it, so I corrected him HOH and we ended on that positive.

I believe we did the pop-up toy after that.  Ryan pushed three down with a wrist prompt and one down independently.  He struggled a bit more on the pop-up switches today, and only got one (the pull-down switch) with the wrist prompt. The rest I had to HOH. 

We moved back to the Yellow Room, and there we did the animal puzzle.  Ryan took the three pieces out independently, but I faded back from HOH to a wrist prompt for him putting them back in. He actually did really well, getting 4/6 pieces in on his own with the wrist prompt. Remember, he just started this more complicated puzzle for the first time yesterday.

Then we tried matching, but in a new way:  with pictures.   L. had laminated pictures of pairs of shapes of the same colour, like two black squares and two red squares.  She put one back square picture on the floor, and showed Ryan how to put the other black square with it, to make a match. Then she put one black square on the floor next to Ryan, and HOH'ed him putting his picture of the black square on top of the one on the floor. After that, she left the one black square beside him, and handed him the other picture, and told him to match. He did! He dropped his picture on top of its match.  Next, L. put a picture of a red square on Ryan's one side and a black square on his other.  She handed him a black square, and told him to match. He did it!  Then, she switched it around and handed him a red square and asked him to match that, instead.  I believe he was confused the first time, but after HOH'ing a correction, he got the next trial right. So, it appears that matching with pictures is going to work a lot better for Ryan. L. says she'd like to get some different pictures for him, of real objects, to match.  We were matching real objects before, but the materials themselves were too distracting for him.  He still tried to mouth the pictures a bit, but they were easier to block, and wipe off easily due to the lamination. He's also more used to using laminated pictures for matching, since we do that with some of our circle activities.

Speaking of circle, it was soon time for that. It was my turn to lead for the first time today. I was ready, but got thrown a bit by Ryan's reaction to me sitting at the front as the leader, and not behind him.  Papa and L. were there to support Ryan, but he did not react well to this major change in circle routine. He cried quite a bit, and it took some work to get him focused and sitting nicely.  I asked if I should just go ahead with circle and let them deal with Ryan, and L. said yes.  But as I went to get started, the opening song completely left my brain.  It went totally blank.  I think L. could see I had stage fright, so she prompted me with, "Which one did yo want?" and she started singing "Look who came to school today . . ." After that, my brain fart dissipated; I sang and led the rest, and I did fine. Here was my circle-time line-up after that:  "5 Boys in the Bed" (sing, and pull each boy off Velcro/bed and count down as they roll over and one falls out); "Roll the Ball" (sing and roll the ball back and forth);"Twinkle Twinkle" (sing and hand actions); "Brown Bear" (kids match the laminated pictures to the ones in the story as I read); "Wheels on the Bus" (the usual song/actions, with a choice of pictures the kids can Velcro to the bus as we sing each part); "Sticky Bubble Gum" (song and actions); and the "Good-Bye Song" (song and actions).  I had also planned on doing "Bear Went Over the Mountain" (song with accompanying choice of pictures for kids to choose and hold up), but my circle was running a bit long (not a bad thing; it just happens sometimes).  Plus, during "Wheels on the  Bus," J. had to depart for an urgent washroom break, so we cut the other songs/activities down to one step and finished up.  Overall, L. carried the singing (she's got a stronger voice than me), and J. did great with his parts in the activities. Like I said, Ryan had a bit of a tough time because he wasn't used to Mommy being in front of him and leading circle, instead of behind him, supporting/prompting/reinforcing.

Snack time came, and Ryan ate/drank very slowly and dragged it out.  He was clearly getting exhausted.

After snack I set up the "push train" trial, and he did pretty good. He got 4/5 trials correct with the train on the bumpy track. He only shoved it off the track once (I'm not sure if it was due to motor control or attitude).  I put the larger toy train on the train table as his reinforcer, and it helped distract him from breaking up our 4-piece track.  It also helped that Papa was there to focus Ryan's attention on other things!

We moved to the floor to do "pat head", and Ryan got mad because I made him sit on the foam wedge. That makes him work a little harder to sit p on his own, and he was getting really tired. Plus, we weren't having success with "pat head."  I had gone back to the two trials with full prompt/3 trials with zero prompt, but I forgot to set up his hands ahead of time until L. reminded me. Still, the result was 2 +'s and 3 -'s. I really think that setting up his hand position before giving the instruction might work, but Ryan just wasn't in the mood for it today. He was more sensitive and getting frustrated easily. 

It's tough for me to see Ryan getting confused and frustrated. I can see that he wants to be successful!  This is one of the many subtle changes that we've seen in Ryan since he started Unity.  He truly gets a look a happiness/pride/smugness on his face when he knows he's accomplished something. We love it when we see that look!  On the other hand, it's heartbreaking to see when he's trying so hard to give us what we want, or to communicate, and he just can't get it out to us. 

It was only 11:00, but Ryan was getting really worn out. L. suggested I test this out by getting a toy he had mastered and seeing what he does. I got out the ball ramp.  It's a toy he has mastered and one really enjoys.  However, he started out totally apathetic with it.  He was swatting the balls with his hands, not even trying to pick them up, and fussing a bit.  I did a few HOH's to get him going, and then he slowly perked up a bit, and did a few on his own, but he was still sloppy (fumbling the balls).  L. agreed that showed Ryan had enough for today.  So, I waited till he was calm and did the toy independently a few times in a row, then we packed up and left. It was good timing because J. had spotted the ball ramp, and he wanted to play with it, so he got it all to himself. :)

So, tomorrow is our first in-home day with S.C. staff. It should be interesting. I'm sure I'll have plenty of new things to post about tomorrow.

Unity Day 41: Fun Day!

From Facebook:

"Surprise for us: the S.C. had their Easter Fun Day for the kids, and invited the Unity families to join in. Ryan loved the activities! He did great. And how nice that their celebration just happened to fall on Mommy's birthday! It was a nice break from the usual routine. :)"

Today S.C. had their Easter Fun day for the STEPS program kids.  When we asked why it was today, they explained that Friday is a holiday, Thursday is an in-home day for everyone, and Wednesday, not all the kids are there (I didn't know some were part-time). That means today was the closest to Easter for them to have their special day. It worked for me, as it's my birthday, so it was refreshing when we were invited to try doing something new and fun.

Technically, the Easter activities didn't start until 9:45, so we had 45 minutes to do our usual programming. Coincidentally, today we did our first craft with the boys, so that was something new and fun, too.   D. was our therapist for the day, but H. had prepared the materials so we could make "rain sticks": a great musical instrument/sensory toy that you can make from paper towel tubes, aluminum foil, and small pieces of rice/gravel/beans.  Ryan and J. both had a lot of fun making this craft. I helped Ryan put a twisted piece of aluminium foil in the  tube, then taped up one end (I let him smooth the tape down).  I poured in the rice and gravel, and helped Ryan tape up the other end.  Next, B. was there, and she showed Ryan a choice of stickers to use to decorate his tube. He was attracted to the sparkly ones. So, I pulled off ones he was interested in and helped him smooth them on. Then, we taped the whole thing up, and he had his "rain stick."

close-up of Ryan's "rain stick"

Next we tried "clapping," and the result was predictable. He clapped well for the first two HOH trials, then got 3 -'s as soon as we dropped the prompt.  No surprise there.

Then we tried a new puzzle. It's still a three-piece peg puzzle with big knobs for him to grab, but it is an animal puzzle, so the shapes are irregular, and much more challenging to put in their places. Ryan removed all the pieces independently just like he used to do with the other one,  but for putting them back in, I had to HOH.  As I said, it's the first day with a new puzzle, and the pieces have irregular shapes.    However, D. said to watch for that opportunity to fade my prompt back soon, like getting Ryan to the point of hovering over the right puzzle spot, and letting him attempt to manoeuvre it in by himself.

After that, I set up "push train" at the train table with the four pieces of bumpier track.  Ryan did pretty well with this; he just got a little over-energetic on a few trials and pushed the train right off the tracks. Overall, he got 3/5.  The hardest part was he didn't want his usual reinforcers, and he kept grabbing and breaking the track apart between trials.  You have to have ninja-like reflexes to keep ahead of Ryan sometimes!

Then, it was time to start the Easter Fun Day. The first thing we did was an egg hunt. They way they arranged it was perfect:  we each got a special bag and a list of 6 shapes. In each room we searched, eggs with one of the shapes on it were hidden for each of the kids to find. For example, in the Rainbow Room, enough "heart" eggs were hidden so each child could find one, etc.  After we found/collected our 6 eggs, we returned to the Rainbow Room to open them up and see the prizes inside.  This way, all the kids got the same amount of eggs and the same kind of prizes.  Ryan was a bit confused as to why we were wandering from room to room, but he soon caught on that he liked this free time to walk around. While I spotted all the eggs, I encouraged Ryan to reach for a couple and pick them up. He also helped me open them when we got back to the Rainbow Room. His favourite prizes were the sparkly Mickey Mouse stickers (Remember he liked the sparkly stickers at craft time? What a coincidence!) and the little blue light that straps on to his finger.

After that, we had our circle time, and it was L.A.'s turn to run it today. She did a good job. I give her lots of credit for being creative, and using new activities and songs.  Ryan liked it when she read some Mother Goose nursery rhymes.

Snack came next, but Ryan was too excited to focus on his food/drink.  It didn't help that they'd already set up the Blue Room for the Easter crafts, so we had the kids eating at different spots than usual. But that was okay because it got Ryan to finish snack more quickly than usual, so we could join in the Easter crafts.

The first thing we did was decorate a puzzle piece (the autism awareness symbol). I think they are going to use them to create a collage/bulletin board later. So, I got Ryan to help me press a sunshine sticker on his. Then we used a glue stick, and picked out a bunch of sparkly shapes to stick on it.  After that, I helped him, HOH, to put blue sparkles in all the bare spots. As we did this, L.A. kindly put together a little Easter basket (another craft) for us, since her husband was helping J. do his puzzle piece. Ryan was squealing and giggling throughout the craft. It was great to see how much he was enjoying it!

Then we went to another table to do the other craft, which was "planting flowers."  I put it in quotation marks because the dirt was real, but the flowers were artificial. LOL But the effect was very pretty when completed.  I helped Ryan spoon the dirt into a pre-decorated flower pot, and then helped him pick out some flowers. D. helped me cut the stems off the flowers to fit them in the pot, and then I HOH'ed with Ryan, arranging the flowers in the pot.  It went well, but I had to groan when I glanced over and caught Ryan with the spoon in his mouth: yes, the spoon we had been scooping potting soil with. And yes, his mouth had a ring of dirt around it. It was definitely a laugh/groan, "Oh, Ryan!" moment.  I took him into the kitchen and washed his face. He was fine. As the saying goes, "God made dirt, so dirt don't hurt!" [I'm not sure what their plans are for the flower pots.]

After that, we returned to the Rainbow Room, where several activities had been arranged. We started with an obstacle course of walking across things, climbing, rolling, jumping, and going through tunnels.  Well, for Ryan, we mostly just walked through the course. He stepped over one little hump, and I helped him bounce on the trampoline, but the rest we just walked through/around.  He was having fun, though, watching all the other excited kids racing through the course.  Then, we did an Easter-egg-on-a-spoon race. It wasn't exactly a race against others, just us doing our personal best. I HOH'ed Ryan holding the spoon as we walked from start to finish and back.  Ryan did pretty well; he stayed focused, and we only dropped the egg once or twice (both times Mommy's fault!).  They also had a little activity where the kids had to take a plastic Easter egg and throw it in the corresponding bin/hoop with the same colour.  I HOH'ed with Ryan. The problem was, he didn't want to let go of the eggs. He liked them. He wanted to keep the pretty eggs!

Ryan tolerated all the noise and commotion amazingly well.  He followed what the rest of the group was doing, and actually seemed to enjoy all the excited chaos! 

Ryan's scavenger hunt bag and loot; Ryan's "rain stick"; Easter basket craft L.A. put together for us

Just before 11, I could sense he was getting tired. He suddenly turned and snuggled his face into my legs. D. suggested it might be time to give him a break from the group.  So, we took him into the Yellow Room for a little peace.  Ryan was in a great mood, though. He plopped down and calmly played independently with a large bead maze. Once I felt he had rested enough, I pulled out the Thomas ride-on and coaxed him to hop on it.  Well, he started pushing it forward independently almost as soon as he got on!  We were in a smaller room, but still, he pushed himself forward all the way across the room, with ease.  I only had to stop him from rocking forward and backward once or twice, and then D. pointed out that wasn't necessary. We know he can go forward independently now. He simply enjoys the motion of rocking himself back and forth now and then. Wow: only three days with this toy, and it's going on the "mastered" list!

On this high point, we ended our day.  We both enjoyed the change of pace and had a lot of fun today. :)

Tomorrow should be interesting. Papa will be coming for his first day as support person, and I will be running circle for my first time. Wish us luck!

Unity Day 40: Monday Strikes Again!

From Facebook:

"Ryan had a case of the Mondays. I think he left his brain at home today. His gross motor skills, however, showed some great improvement. I'll take what I can get. ;p"

Most of this morning was an absolute struggle.  It felt like Ryan's brain was on vacation. He had a totally "off" start to his day.

To top it off, his reinforcers were totally ineffective today.  He didn't want anything in his basket, and he didn't want any of the usual toys he likes, either. T. pointed out that they had switched out which reinforcers were available in the cupboard, so I was hopeful we'd find something new and entertaining. No such luck.  Plus, the mini fibre-optic light he liked last week got destroyed by a well-intentioned student who tried to sanitize it. Sigh.

We tried to find a reinforcer strong enough that we knew he'd really want to work for it. So, T. brought out the sensory bin full of noodles. Did he want it? Oh, yes, he totally wanted those noodles. The problem was, I was trying to do the "clapping" trial with him, and he kept signing for "more" noodles!  The reason why this is problematic is Ryan's "more" looks an awful lot like a clap.  So, when I gave him the model and instruction to "clap," I knew he was actually doing "more." I was able to distinguish a difference for 2/5 trials. 

Plus, if you remember Ryan and noodles, they were EVERYWHERE. He was getting distracted by stray noodles that T. kept trying to scoop away from him while I tried to run the trials.

To try and avid the confusion over "clap" and "more," T. suggested I switch to the "pat head" imitation trial.  We made another change (we had also done this for "clap") in trying to fade back Ryan's prompt dependency for the imitations:  use full HOH prompts for the first two trials, then NO prompts for the last three trials.  Again, the result was 2/5.  He did, however, pat his head independently by the last trial.  However, he was really frustrated throughout the trial because he wanted that sensory bin full of noodles. He was very angry with us for withholding it until he did the trial correctly.  It was almost too strong of a reinforcer, T. said.  I agree.  Still, we ended on a positive with that independent "pat head." (Remember, though, that "positive" doesn't necessarily mean happy! Ryan was furious at us, but he was successful.)

We gave him a few minutes to cool down, and then I brought out the Play Doh program, thinking that would be fun/soothing for him.  Nope.  I got him to let me do HOH smashing the balls 3 times, but the two other times, he refused to cooperate.  He also cried through the whole activity, and kept throwing the Play Doh balls on the floor, or trying to stand up and walk away from the table. Once or twice I saw him squish a ball with his fingers, but it wasn't when I asked him to.  He jumped ahead of me in the program.  Ryan wanted to do things HIS way today.

Then I brought out "colouring," thinking he likes that one, too.  Um, it was so-so.  We had to do some tweaking again to get this program to where it works best to help Ryan accomplish what he needs to do.  This time, T. suggested that we focus on increasing the time he moves the marker with a proper grip before WE let go of the marker.  Before, I was only holding the top of the marker till he had a decent grip, and then letting go.  This time, I held the marker the whole time he pushed, as long as he had a good grip. We managed to get about 3/7 good grip-pushes with him.  I guess that's an improvement over zero good pushes with no help or several small pushes but all fully prompted.  I also moved the special rubber grip as far down the tip of the marker as I could, because Ryan kept trying to grab the marker right at the tip.

Ryan was pretty fed up with our trial-and-error trouble-shooting by this point, so I brought out another play program in the hopes it would calm him: the pop-up toy.  Overall, it seemed more like a way to relieve his aggression! As soon as I set it on the floor in front of him, he started grabbing at (and slamming down) the pop-up heads.  I think he pounded down three in a row before I even got a chance to give the instruction!  Then he lost some steam. He kept hitting the fourth one, but it wouldn't go down, so he just got frustrated. So, I stepped in and did a little HOH to get him settled again.  He got two of the easier ones to pop back open with a wrist prompt, and I did the other two HOH. 

Since he seemed to have vented some of his frustration, I thought we were safe to try matching.  It started out okay in the sense that he was cooperating, but even using the plastic elephants vs. an empty distractor bowl, he got 0/5 trials correct. Keep in mind, each time he does it incorrectly, I tell him, "Good try," and HOH the correct response with him, then immediately repeat the trial.  So, this is like ten times in a row we had done this, and he hadn't gotten one right yet. What is going on?!  We didn't even get a single trial right in Step 1? That's ridiculous. It's like he's regressing in "matching" or something. On top of that, with no correct answers, and no tangible reinforcement, he's getting frustrated again.  And he's sweeping the items and bowls off the table.  And he's trying to stand up and "escape."  Oh, my. So, we do one final trial where I HOH the whole thing (so he's guaranteed success) and we end on a "positive."  T. said we are going to try something different. She thinks Ryan might do better matching with pictures, because he usually has a decent amount of success with those activities during circle time. For example, today he got 3/4 matches right for the "Panda Bear" book at circle, when given two choices and having to pick the correct answer. Hmm.

Weekly Evaluation and Homework

Evaluation went fine, nothing unexpected. The issue of continuing to seek more reinforcers for Ryan is ongoing.  H. also asked if I had been recording data for my incidental goals at S.C. They know I do them, but they weren't sure they'd seen me recording them.  I'll admit, I usually put them off till later or sneak them in during a spare moment, but I do record them.

One thing about evaluation that was interesting was discussing what my support person(s) will be evaluated on. Really, it reflects back on how well I taught them, so it's still me being evaluated.  My support people start on Wednesday, so they only have 2 days to work on the goals, so we decided one goal would be reasonable.  I decided the focus would be on how to do programs for play goals (I figure that's a natural area of strength for a grandparent, right?), with the built-in component of reinforcement being administered properly (since it's a part of everything we do).

Homework:

1. Manding: keep an eye out for issues/concerns.
2. Play Goals:  NEW--Cause and Effect--Choose a toy with easier buttons to push/higher built-in reinforcement. (I was successful already. I chose a little computer toy and Ryan loved it, and was attempting to roll the mouse/push buttons by the end of our first session.)  Close-ended--magnetic stacking blocks--stays the same.  However, I'm adding in an attempt to divert Ryan from mouthing the blocks by giving him his chewy before I give him a block. 
3. Incidental Goals:  a) NEW--waving hi/bye-bye has been removed, and will be worked on at S.C. as an incidental there, but also as part of the "mixed" discrete trial of various imitations.  Instead, we have added "making choices":  When Ryan seems to be fussing for a bottle or food, we will begin by presenting the bottle or food paired with something completely unrelated, and asking Ryan to "choose" which one he wants (by pointing, touching, or reaching).  He gets whatever he requests. So far, tonight, it has worked well; he chose bottle/food over the other item each time.  [Eventually, the goal will be to pair pictures of similar items together and have him show us which one he wants (bottle vs. food, or even fruit vs. yogurt, etc.)]  b)The other incidental goal, "Stand up/Come with Mama" continues as before.
4. Discrete Trials: continue to choose one to do each night.  NOTE: I mentioned having difficulty doing some at home because I don't have the specialized materials they have at S.C.  I was told I can borrow the materials overnight, so long as I have them on hand for work at S.C. the next day.  That's good; I actually brought home the marker with the special grip to run the "colouring" trial at home tonight (it went so-so).

Back to Ryan

When I was done with my meetings, it was half-way through circle time. L.A. was helping Ryan at circle because her support person, her husband S., started with us today.  Ryan looked like he was having a good time with L.A. In fact, I believe he was a little irritated by the interruption my return made and L.A. going back to J., but he got over it.

He took his time during snack, and I eventually had to sneak his things away because he was dragging it out so long!

After snack, we did the shape sorter, and I turned it so he would have more of a challenge, more choices of which hole to put the pieces into.  He chose the right hole only 2/5 times, but he was doing great manipulating the pieces to get them in the holes. Some he did independently, and for some he needed a wrist prompt. The best part was seeing that he was trying very hard and was engaged in the task. His attitude was much improved compared to earlier in the morning.

Then we moved into the Rainbow Room to work on some gross motor activities, and it was like a transformation occurred in this child.  When I got out the soccer ball to "kick ball," he started kicking it before I even gave the instruction to do so.  When I got him focused, and gave him the instruction to kick the ball, he did even better than kick it. He was "tracking" it. What that means is he was watching/following where it went. One time, after my initial instruction, he kept following the ball and kicked it three times in a row, all on his own!  This is a very exciting development.

I have to add here, that last night, I did the "kick ball" trial with Ryan at home. Andrea came in and wanted to participate. I remembered D. saying Ryan would be ready to play with his brother and sister soon, since he had been kicking a ball back and forth with D. So, I had Andrea kick it to Ryan, and I instructed him to kick it back to her. His aim wasn't good, but he and Andrea kicked the ball back and forth to each other about 5 times.  That was excellent, both for kicking the ball and the social interaction.

After his success with "kick the ball," I wanted to get Ryan on the Thomas ride-on toy again.  He wasn't especially motivated to get on it at first, but once he was on, he wowed us again! I gave him the prompt to move forward by putting his one foot forward a few times; he moved forward, but I also noticed he kept rocking backward. So, I blocked the ride-on with my foot so he couldn't go backward, After a few blocks, he suddenly caught the rhythm of the proper foot movement and started propelling himself forward across the room, with no prompting!  It was just a few moves forward at first, but since he was enthusiastic and doing so well, we kept at it. By the end of our session, he independently pushed himself forward across almost the entire Rainbow Room! And it's a long room!

We decided to end the day with the great successes in gross motor skills Ryan displayed for us. :)

Unity Day 39: T.G.I.F.

From Facebook:

"Today was good at Summit Centre because it was Friday, and Fridays are shorter due to research and theory. That was about it. :p "

No, Ryan did not have a good day today, and I was going on about 4 hours of sleep, so T.G.I.F. 

He started crying as soon as we pulled into the parking spot at S.C. I turned around and said, "Seriously, Ryan? It's Friday, the easiest day of the week.  You only have to work for like, an hour, and then you get to play with the student-volunteers!"  He continued to whine as we got out of the car and walked up to the door, and then he plopped himself down on the floor and bawled as soon as we settled in the Yellow Room.

One positive is Ryan's progress on going up the stairs inside the main entrance each morning.  It's a pretty big flight of stairs.  He used to lean back on me as he tried to climb, or I would even have to lift his pant-leg up to encourage him to step up each step.  The last few days, he has been holding my one hand, and putting his other hand on the railing or wall, and going up the stairs nicely.  Hey, improvement in an incidental gross motor skill: I'll take it!

Ryan did not want to get to work today. After opening song, he wandered off to play with the Pooh piano, the bead maze, the ball, etc.  Exploring is usually a good thing, but he was totally turning his back to me and wouldn't let me participate in his play.  He did not want to acknowledge me because he knew I was going to make him work!  Eventually, after moving all the toys towards me (and thus making him mad), he turned and I pulled him over to do some programs.

We started out with "coins in the piggy bank" at a wrist prompt level, and he was struggling today. He only got 2 out of 5 coins in correctly. It felt like he was being lazy; he didn't have body control issues today, and his attitude just felt apathetic, like he didn't care. 

Then we tried "clapping, " and I noticed that he kept putting his hands behind him to prop himself up.  Well, this obviously interferes with any of our programs where I need him to use his hands to do imitations.   Since we do these face-to-face, he can't lean on me, so he leans back on his hands for support.  I noticed this yesterday, too, so today I brought this to the attention of D. He thought of something right away. He went and found a foam wedge for Ryan to sit on. I've seen these before in physiotherapy; they help the child sit up straighter and give them some support, so they don't need to lean back on their hands.  We had to take some time out to get Ryan used to sitting on the wedge, and give him reinforcement for sitting on it nicely.  While it did nothing to improve his clapping (1/5 correct--ugh), it was great for his posture, and did free up his hands for the program.

On the other hand, we had another excellent run with the chunky puzzle. He did two runs of the program (so six pieces) successfully and independently. Yay! We will move on to a more complex puzzle next week. :)

Next we moved into the Blue Room. To my surprise, Ryan did his room-to-room transitions well today. I think he was in the mood to have some freedom, so he was glad for an excuse to move from room to room. It took hardly any prompting to get him up and out today.

First I tried "stomp feet," thinking we'd better get the more difficult programs out of the way, with the mood Ryan was in. Um, yeah. We put the piano under his feet, and it looked promising; he stepped on a few keys before we even asked (although he's really supposed to wait for the verbal instruction first).  On our first attempt, he did kick his feet a bit on the keys, so we called it a +.  However, every trial after that, he either tried to kick it or wiggled his feet. D. decided that Ryan might be getting it confused with "kick ball," which he used to sit for (until yesterday).  So, the "stomp feet" program will be dropped until Ryan is consistently kicking a ball from standing. I don't know if it will make a difference; today was the first day Ryan tried to push the piano with his feet; usually, he doesn't move his feet at all for "stomp feet" unless we prompt behind the knee.  But I bow to D.'s superior knowledge in the hopes that he's right.

I tried the matching program next, and matching was a disaster today.  We didn't even get to Step 2.  He got the very first trial right on Step 1 (match the elephant with the other elephant vs. the empty bowl). However, as soon as I switched the position of the bowls, he lost his focus.  We tried it four more times, and he kept putting the elephant in the empty bowl. I would show him the correct answer and immediately follow it by the same request, but like I said, he got it wrong four times in a row.  What happened?! 

Ryan and I were both getting irritated by this point, so I decided to pull out the Play Doh program for something more fun.  He did better with this one, getting 6/8 attempts correct with HOH prompting to squish the Play Doh balls.  I, however, forgot to make up his play ball of a different colour, so he got a little impatient while I was re-rolling the balls (my bad). Despite this, he still tried to mush the Play Doh a bit with his fingers (squeeze it) and enjoyed rolling the balls off the table, so Mommy had to crawl on the floor and find them!

Then we did a kid-switch.  L.A. worked with Ryan on the latest pop-up toy, and I worked with J. on a "patterning" program. L.A. said Ryan did really well; he pushed four of the pop-ups down independently; he opened two with a forearm prompt, and two HOH. That's pretty good, considering that new pop-up toy was introduced yesterday.

I had a little more of a challenge with J. today, because I think he was feeling Ryan's Friday apathy, too.  He did his first pattern perfectly, but he got stuck on the second one, and it took up our last 4 trials.  It was also a bit different for me because J. is working on a token system for reinforcement, and this was the first time I'd used it with him.  I had to keep reminding him what he was working for, how many more tokens he needed to get, etc. I also learned about the concept of "tokening out": if by the end of a trial the child hasn't gotten enough correct to fill the token board, you can ask them to follow basic commands in order to fill up the rest of their token board quickly.  So, I asked J. to do a few things like touch his nose, point to a picture, etc.  Then his token board was filled up, and he could go play with his dinosaurs.  T. had come in to observe, and she also reminded me to keep the trials and corrections going quickly, so J. wouldn't get too frustrated or have time to lose focus. These are good things for me to learn for future reference, for when Ryan's ready to work at that level.

Next we did circle time, and both boys were kind of antsy. I was trying to get Ryan to sit on his foam wedge, but he kept trying to lean back on me; therefore, he got reinforcement for sitting nicely.

Speaking of circle time, I cashed in a bunch of Parent Points today, and H. started making up 3 new circle activities for me: one with alphabet, one with shapes, and one with colours.  I also got a copy of the "Panda Bear" book, and she's making up the matching pictures for me. 

Then we set the kids up for snack, while we went off to do research and theory. The poor new students got stuck with helping Ryan eat his yogurt. His smock, when I returned, was evidence of messy fun.  Ha-ha!  They said he did well with them, though.

Our Theory section today focused on using Differential Reinforcement to decrease (or increase) behaviour. It gets kind of confusing because there are 5 kinds of differential reinforcement called DR0, DRI, DRA, DRH and DRL.  Many people refer to them in general as DRO (Differential Reinforcement of Other Behaviours). They are all similar, but have their own slight variations which make them useful in specific situations. Here's a chart, that I found online, to summarize them.

(The DRI, DRA, and DRH samples above should all be about "Dana": author's typo.)

Source: http://www.cdd.unm.edu/autism/autism_course/modules/behavior/dr/lecture05.html

Unity Month 3

Today ends Month 2 of Unity. In Month 3, there are going to be a lot of changes. They start next week.

• Our "support people" will start coming to Unity with us each day. Gram and/or Papa will be starting with us on Wednesday. I will be training them in everything I've learned about ABA so far, so they can work with Ryan, too.
• The moms will be leading circle time at least once a week.
• Thursdays will be home days. Each week, one of the therapists will be at our home from 9 AM till about 11:30 AM to help us get ready for doing programs at home, once Unity is done.
• We'll have to create a craft for the kids to do.

Update re: Kevin in Grade 1 

In yesterday's post, I talked about my concerns regarding Kevin's transition to Grade 1, and how I wrote a letter to Kevin's teachers. I have to give them credit; they responded immediately. When I got home from Unity, there was a message on the answering machine from Kevin's principal to call her, so we could have a chat.

When I called, she was very considerate. At this time, she didn't have a lot of answers for me yet, but she said the timing of my letter was perfect. They are just in the very early stages of discussing the needs and transitions facing their special needs students for next year.  In fact, the school board's special education consultant was at their school today!  He saw my letter and was made aware of my concerns for Kevin.  The principal assured me Kevin is on their radar.  However, it won't be until closer to summer time that they will start discussing which students will be in which class, and how they will be allocating the EA's.  She suggested I call her in May/June to get more information, and perhaps set up a meeting. 

When I picked up Kevin from school, his helper Mrs. L. was at the door, and she made sure I'd heard from the principal. Then she said, "If I could stay with Kevin all the way through school, I would!" That warmed my heart. I know they have a great bond, and she'll continue to be an in-school advocate for Kevin as he moves into Grade 1  :)

Unity Day 38: Challenges and Successes

From Facebook:

"Had a mixed day with Ryan. Had some frustration (from both of us) and tears (from Ryan), but also a few shining moments, too. Can't believe we're finishing month 2 tomorrow. It's going by too quickly! There's so much more I want to do!"

The day started off with a minor irritation of showing up and finding Ryan's reinforcer basket had been dismantled. The student-volunteers were doing spring cleaning today, and when we arrived, Ryan's basket had been emptied, and the contents disinfected and put away. It's nice to have clean stuff, but it's a pain to rummage through cupboards and find all the things we've set aside especially for him over the past 2 months.  However, the credit goes to T. who quickly rectified the situation, and even managed to find the main items from Ryan's basket for us. Thanks T.!

I can't remember the order we did things in today, so I'll give you the highlights. (Although, if you've read this blog before, you know my "highlights" can be quite lengthy!)

We did some problem-solving with the colouring program today.  L. watched Ryan with the toddler markers, and saw how he wasn't taking ownership of holding them on his own.  We tried a few different things, including a regular, skinny marker; we discovered that Ryan was still putting his fingers in a decent position, but we couldn't get him to hold it for long.  L. thought maybe some kind of pencil grip might give him more of a target area to hold onto, while also making it harder for him to flick the marker away.  After several tries, we saw that this was a bit more successful. The timing of the physical prompt/assistance was tricky, though:  I had to hold the marker upright, just at the tip, and let go when Ryan got a decent grip on it.  If I let go too quickly, he dropped it or lost control; if I held on too long, he wasn't doing it independently.  When we got it just right, he made some good marks on the paper when I let go.  But getting it just right is going to take a lot more practice for both of us!

Timing of prompts also became an issue when we started working on the imitations he mixes up, like "pat head."  When we did that one today, he was only getting it right when I gave him the prompt he associates with it (block left arm).  L. said we need to fade the prompt somehow, so now I'm starting with the prompt, but stopping at just the right spot. So, now I'm blocking/shadowing his left arm as I model "pat head" and give the command, and then, as soon as he starts to raise his right hand to pat his head, I have to quit the prompt. Once again, it took ME several tries to get my prompt away at the right second.  Literally, a second made the difference as to whether I was fading back properly or not. It was frustrating, as I've never had the quickest reflexes. But I didn't feel too bad because L. had a couple missed attempts, too.

"Stomp feet," with the new stomp-on-the-piano prompt, continued to be unsuccessful.  We got 1/5 trials correct.  I even tried it at home tonight as my discrete trial homework, and got the exact same result: 1/5.  I think they need to find a different prompt for the "stomp feet" imitation; nothing we've tried has worked besides the original touch-behind-the-knees.

On the other hand, we had some "shining moments" today, too. :)

The chunky puzzle program was AMAZING. He went from needing a wrist prompt to put the pieces in to suddenly taking all three pieces, independently, and putting them into their places correctly.  He did this twice in a row.  That's 6 perfect, independent placement of shape puzzle pieces in a row. We were all shocked.  Where did that come from?!  L. said if Ryan does the same thing tomorrow, we'll move on to a more complicated puzzle. That's very exciting!

We also tried yet another new pop-up toy today. T. brought one in that had been at her house, and although it isn't as exciting as the bobble-head one, it was even easier for Ryan to push the pop-ups down and push the switches, etc. to get them back up.  His first time trying it he got two down independently, and two with a wrist prompt; he got 2 up with a wrist prompt, but the other two needed more help (HOH). That's pretty good for his first time with the toy.

I tried the "matching" program again today.  I reduced the difficulty by going back to the original activity of matching the little elephants in the bowl, and then I introduced a glove (which I thought would be boring, so he wouldn't want to play with it).  The Blue Room was quiet today, so Ryan was more focused during matching.  This combination of factors led to Ryan being more successful again.  He got 3/4 matches correct in both Step 1 and Step 2.  I was surprised and relieved to see this improvement.  L. said I did the right thing in decreasing the difficulty for a bit.  When Ryan's consistently matching successfully, I can try to increase the difficulty again.

I decided to up the ante on the "push train" trials today. I still used one train, and the plastic track, but I flipped the track over to the bumpy side.  He got his first trial incorrect because, I could tell, he was thrown off by the sensation of the train bumping under his fingers. After that, though, he got 5/6 more trials correct.  I think that was great, considering I wasn't giving him any physical prompts, and the bumpy track was more challenging for him.

Circle time and snack were a bit difficult for Ryan today.  He was pretty tired and cranky by then.  He got lots of reinforcement simply for sitting nicely and participating.

After that, we went into the Rainbow Room to do some "kick ball."  Ryan did fabulous!  From sitting, he kicked the ball every time. L. said we'll do it from standing from now on.  However, when we do it from standing, I need a second person to make sure Ryan stays in one place!  He was a runner today. More than once, I had to chase him across the room and down the hall!  Anyway, L. stayed behind Ryan and held him still while I rolled the ball to him to kick it.  At first he kept turning and trying to play with L. because he felt her behind him, but she kept her head down and wouldn't give him attention, so he'd eventually turn back to me.  Besides his attempts to play with L., he did a good job of kicking the ball from standing, too.  L. mentioned how Ryan might have fun kicking a ball back and forth with his siblings soon. That made my heart happy. :)

We ended our day with something new! Now that Ryan is staying longer at S.C., we have time to work on more items in the Rainbow Room, where most of the gross motor activities take place.  He showed an interest in a Cozy Coupe they had, so I helped him get in. The problem is, his legs are getting too long for it! They bend under too much, so it's awkward for him to push around with his feet. Also, with its closed design, the Coupe makes it difficult to do any physical prompting of Ryan's legs and feet.  However, we let him hang out in there for a while because he enjoyed it, and was rocking the car forward and backwards a bit, which was good for his leg muscles.

Meanwhile, L. had sent a student upstairs to get down an open riding toy that might be suitable for Ryan.  She came down with a Thomas the Train ride on, and I think Ryan fell in love. LOL It makes train sounds and everything.  Again, Ryan's legs were a little bit long for it, but it was way better than the Coupe. Ryan tried to get on it himself, and was able to climb off it himself.  L. showed Ryan how to move his feet forward to make it go, and he was able to do it with a physical prompt.  The prompt is taking his one foot and moving it forward; he moves the other one, and the train moves forward.  He liked it, but we decided 5 trials (5 foot moves forward) was enough because he tires easily. Coincidentally, J. is a big Thomas fan, too, and the toy was just his size, so he hopped right on and scooted around.  Then he got off and went and told Ryan, "Come on and sit down. Sit down, Ryan!" It was so sweet; J. was giving Ryan a turn, and encouraging him to get on the train!  It looks like this Thomas ride-on will be used as a gross motor goal for Ryan, and a reinforcer for J. We'll share. :)

So, we ended our day with a fun, new toy that will help Ryan slowly build up his muscles and skills. We won't have time to get up to riding a tricycle by the time Unity is done, but we can use these toys to start the ground-work for future skills.

Kevin: What Happens Next Year?

Yesterday I shared some concerns I had about Andrea.  Today, my thoughts are on Kevin.

First of all, he is getting so big! I look at him, and he looks so much older than 5 and a half years. He's getting so tall, and his face is really losing its baby features.  Plus, the big excitement in our house right now is that Kevin has his first loose tooth!  He showed us last night; we didn't know until then. And it's very loose! I'm sure the tooth fairy will be visiting him, for the first time, sometime this weekend. :)

But really, it was a message from Kevin's teachers that brought my concerns about him to the surface. They've been simmering on the back-burner for months now, but the question has been with me all year: What happens to Kevin when he starts Grade 1?

Anyway, the message from Kevin's teachers was just to say that they were keeping a record of Kevin's issues/behaviours: what happened, how often, what might have caused it, possible solutions, etc.  They will pass this record on to Kevin's Grade 1 teacher before school starts next year, so that teacher can have some idea of what to expect.  I think that's a great idea, and I really appreciate that Kevin's current teachers are doing that.  However, what got me concerned is that they also said Kevin probably won't have an Educational Assistant (EA) in his classroom next year. 

What?!

Okay, yes, Kevin is really on the high-functioning end of the autism spectrum.  But he does have special needs in the classroom. He has not had an IPRC or IEP yet, but many schools won't do those until Grade 1 because the JK and SK curriculum is so play-based. However, I know from talking to the ECE and from parent-teacher interviews that there are frequently times Kevin needs one-on-one assistance to get through a task because he becomes overwhelmed.  Sometimes, he needs help dealing with his sensory difficulties and emotional difficulties, too.  In JK and SK, there are two teachers in the room: the main classroom teacher and the ECE (Early Childhood Educator).  This year especially, Kevin has been receiving a lot of one-on-one assistance from his ECE.  Mrs. L. is fantastic with Kevin, and he clearly has become attached to her (he talks way more about Mrs. L. than his main teacher). 

In Grade 1, there won't be an ECE.  There is just the one teacher trying to deal with 20-or-so students, and I know there are a number of other students in Kevin's year with learning difficulties, etc.  (Last year, the teacher actually admitted that Kevin might not get as much priority in the classroom because they had so many children with a higher level of need!) 

Anyway, it worries me that there won't be an extra helper there for Kevin next year.  His teachers seem to believe that the more structured setting of a Grade 1 classroom will suit Kevin's learning style, and he will be more comfortable and successful there than in the JK/SK setting.  However, as a mom and his advocate, I have to voice my concerns about assuring Kevin's needs are met next year.  My first step, tonight, was writing a letter to his teachers asking for more information about what the plans are for Kevin next year, what resources will be available if problems arise, etc. 

I am trying to think positively. I would love to believe that Kevin will blossom in Grade 1 and have a comfortable classroom experience. At the same time, I have to be proactive.  This is the same kid who spent a couple days hiding under desks in the classroom because Mrs. L. was off sick, and he refused to come out.  This is also the kid who wants to quit school because he claims to have learned everything already. [Actually, he has mastered all the basic SK skills and knowledge.  His teacher showed me the sheet of what they are expected to know, and he really is beyond it all already. The teachers' focus for him is on emotional regulation and social skills now. For Kevin, with his autism, these are the worst things you could possibly make him do!]

My darling, bright, complicated boy . . . I just want the best school experience for him.

Unity Day 37: Long Morning . . . Long Day . . .

From Facebook:

"Long morning ... Let's just say the therapists were making jokes about Mommy needing a drink by about 9:45 AM. Maybe Ryan heard them because he perked up a bit after that and we made it a bit past 11:30 today. We got a lot done, but I need a nap."

Well, I did not get my drink, nor did I get my nap.  In fact, it was an extra long and busy day with Ryan not napping either, and then taking Andrea to an hour-and-a-half-long First Communion meeting in the evening, on top of all the usual afternoon/evening chores (cooking, cleaning, homework, etc.).  

Anyway, the day started out with Ryan being cranky.  He did alright when we first arrived. I tried the new tactic of taking him into the Blue Room and pulling out three items he might like to play with (as reinforcers) to see if he'd gravitate to one of them.  He did. It was a little train that has beads in it that pop around down when you move it.  So, that strategy of introducing some new reinforcer choices to Ryan worked today.

But as soon as we moved to the Yellow Room and set up to do work, he got mad.  When D. came in to do opening song, Ryan whined and made pouty faces through the whole thing. D. asked if I wanted to move to the Blue Room because Ryan was laying by the door, crying and refusing to get up and come to do programs with me. I decided that I wasn't going to let Ryan push my buttons; I said, "No, I'm not going to let him escape just because he's mad. We're staying in here."  D. was impressed, and gave me extra parent points for not giving in to Ryan's attitude.

So, I decided to try colouring because Ryan seems to enjoy that activity (I could do that much for him).  He started out well, and I was pleased. I was still HOH, and he was making some nice lines on the paper, and then I would give him the new train to play with.  However, D. wanted me to try and get Ryan to take ownership of holding the marker.  That's where things got tricky.  He would either drop the marker or flick it around on the table top.  D. thought we could try it with a regular marker, to see if that might break Ryan's habit of prompt dependency and/or playing with the marker, but he still would not hold that one, either.  D. went and discussed this issue with L., and they decided to put the colouring program on hold until the senior therapists can brainstorm together, and come up with some strategies to get Ryan to hold the marker independently.  I could tell D. was really frustrated by this because we can see Ryan enjoys colouring, but he does minimal effort to get his reinforcement.  D. jokingly suggested that we need to tape the marker to Ryan's hand.  I wonder if there is some kind of accessibility product out there that attaches to the hand, that can hold a writing utensil? I'm sure there must be, but I doubt they make it for three-year-olds. I'm also not sure it fits in with what we're trying to do here.  I don't know. I thought the colouring program was going well, but it suddenly became this huge issue we spent a bunch of time on today. 

By the time we tried all this colouring stuff, Ryan was totally mad.  We told him to "go play," and put out all kinds of toys all over the room for him, but he just sat in his chair and cried..When D. made him stand up, Ryan stood in the middle of the room and cried. Then, he kept trying to go to D. and get attention from him.  D. wanted Ryan to go explore the toys, and to be sure to not reinforce Ryan's mad behaviour, so he kept gently pushing Ryan back or ignoring him, saying, "I'm busy writing my notes."  Ryan eventually sat down by the big bead maze and played with a few beads, but not until he wiggled the door handle and tried to escape!

Once he had calmed a bit, I brought him back to sit with me and do the pop-up toy.  He was a bit whiny, but overall, he did well with the activity.  I started prompting at the forearm today, and he got two out of four closed on his own with minimal prompting.  He also popped one open independently. In total, he got 3 +'s out of 6, which is pretty good considering he was so cranky, and we were working at fading back the prompt to forearm for the first time.

Next we worked on "pat head," and it was a bit of a mess.  Ryan got 4/7 trials correct.  He was getting mad again, and confused by which action he was supposed to be doing. However, it was nice to read,  according to D.'s feedback sheet today, "Pat Head-Good job sticking with it.  Your prompt levels, reinforcement, and increasing your prompts were perfect."  So, although I felt a bit discouraged at the time, I guess I was doing things right at my end of the activity.

Then, we moved over to the Blue Room.  Well, it took a while. We went through the range of prompts, enticements, cajoling, all the way up to iPad, and nothing worked to get him moving.  We even tried saying good-bye and walking away, leaving him "alone" in the dark room, with the door open.  He just started to get mad, and D. didn't want him to get scared or so upset that it would affect his work in the Blue Room.  Eventually, we hauled him to his feet and guided him into the Blue Room. Let's just say "stand up and come with mama" got all -'s today!

In the Blue Room I started with Play Doh, in the hopes of cheering Ryan up. He actually did really well. He seemed a bit confused at first because his play ball of Play Doh was fluorescent orange, and I'm not sure he liked that colour. He kept making weird faces at it. LOL However, once we got started with the blue Play Doh balls, he liked those.  He got all +'s for letting me HOH smooshing the balls, and he even took a bit of ownership once or twice: he has learned he can squeeze the balls with his fingers and that flattens them a bit.  It's nice he's trying to figure this out a bit for himself.  I also saw him rolling the balls around and sticking his fingers in it, making fingerprints.  That independent exploration is fine (actually, a good thing) when he does it between trials, so it's not interfering with the actual program.

Next we tried "stomp feet" with him sitting on a chair, and the blue piano at his feet.  Ugh, it was not pretty. He got 1/5 trials correct, and even that one was weak.  He was totally distracted during this activity.  He kept turning around in his seat to watch and listen to other things going on in the Blue Room (it was very busy).  I tried to get his attention by calling his name, touching his face, putting the toy train by his feet, and so on. I might hold his attention for a second, but I quickly lost him again.  He would not stomp, even when D. came over to give an extra prompt like a touch on the leg.  Ryan is still totally dependent on the touch-behind-the-knee prompt. Nothing else works.  I know  this because he stomped feet just fine during circle, when we were sitting on the floor and I touched him behind the knees. His prompt dependency is really causing a road-block for us in several of our programs right now. Ugh.

I decided to move across the room to put away the Play Doh and set up "push train," and that's where the senior therapists saw my exhaustion/frustration, and started joking about mommy needing a drink. I replied that I should start carrying a discreet hip flask.  LOL  They understood that Ryan was having a rough day, and making mommy do all the work.

"Push train" went pretty well, though. Ryan was successful on 3/5 trials, and I was only setting it up and telling him to do it (verbal/visual prompts).  The only reason I recorded two trials as incorrect is because Ryan was a bit awkward on those two and knocked the train off the tracks early.  I have to expect more of him on this one now because I know he is capable of doing it perfectly. If he does it better tomorrow, I will probably increase the difficulty (add more train cars or something) on Friday.

Next we did the chunky puzzle, and he did awesome.  Taking the pieces out has been removed from the program (he does it automatically), and putting them back in is at wrist prompt. He got +'s on all six trials, and in fact, put the circle back in, independently, twice! I will definitely be fading back the prompt on this activity by the end of the week.

It was time to go to circle, and of course, getting him up and out was a challenge.  Circle time itself, though, was okay. He perked up somewhat.  He was particularly strong with "Panda Bear" today, matching the pictures with the book.  D. was giving him a choice of 2 each time, and I think he only got one wrong out of approximately 5 tries.  In D.'s words, it was "amazing." He also sat well and did some song actions today, although they were a bit hampered by his one hand holding his chewy pendant in his mouth.  He needed some chew time during circle. Hey, whatever works.

Getting Ryan to snack was another challenge. That boy did not want to transition from room to room today! D. eventually told me to get some of Ryan's snack items and bring them back to the circle room, to entice Ryan to follow me.  I picked the bottle, knowing Ryan would want that most.  I had to get right down and wave it in front of his nose a few times, but it did get him off his butt and back down to the Blue Room.

After snack, we worked on the shape sorter and he was a super star!  I was working with him at a wrist prompt level, but he put in three circle totally independently.  He also put in the other shapes well with the wrist prompt.  Triangle and square are still newer and harder for him; you have to line up the edges just right to get them in.  However, he was trying really hard to manoeuvre them in and had good success with a little wrist prompting.

Then we did "clapping" and he got 3/5 trials correct. The ones he got correct depended on me giving him a forearm/elbow prompt of the right hand, though.  Sigh. Prompt-dependency strikes again.

Next we did "coin in the piggy bank" and it was the usual. He did well with the wrist prompt, but when I tried to fade back, he didn't have the finesse to get the coin in on his own yet.  If I can't fade back by next week, I'll talk to the therapists about some options to help Ryan improve his manipulation of the coins.

Soon it was time to move into the Rainbow Room, and Ryan wouldn't budge.  D. said it was time to "pull out the big guns": yes, the wagon. He wheeled it right into the Blue Room. When Ryan tried to get in, he wheeled it out the door. Ryan got a bit mad, but D. promised him (and showed him) that if he came out the door, he could have a ride. Ryan was working his eyebrows in the most amusing expressions of disbelief and consternation, but he eventually made his way out to the wagon, and got his ride.

After the wagon ride, we did some "kick ball." We started out with him sitting in a chair, and his kicks were great. As soon as he saw the ball by his foot, he gave it a good kick. D. kicked it back to Ryan a couple times, and Ryan tried to kick it back to D.  That was good motor skills and good interaction!  Then, we tried him kicking the ball standing up. He had a bit of a hard time concentrating at first, but then did a few good kicks from standing, so it was a success.

Then I ran through the "mixed" trial of the different hand/arm actions that Ryan keeps confusing.  As usual, high 5s were fine, but everything else was muddled unless I gave him the exact prompt he associates with the given action. Grr.  On the plus side, in the middle of this muddle, I got an independent clap. That was a nice surprise.

So, it was about 11:20 by this time, and Ryan was starting to lose his energy, and show some attitude, again. D. suggested re-running one more program (an easy one), so I got out the pop-up toy again. Ryan did it with some whining,  but it was okay.

However, as I was writing up some notes in preparation for tomorrow, Ryan took off across the room and settled himself in the wagon.  Then he started to cry because he really wanted a wagon ride.  L.A. kindly offered to take Ryan and J. for a ride together. Once I got my notes done, I hopped up and followed them down the hallway.  L.A. knew our routine of pausing the wagon and waiting for Ryan to sign for "more."  I think he needed a physical prompt once or twice, but for the most part, he knew to ask for "more" as soon as the wagon stopped. I had to laugh because J. had L.A.'s iPhone and was playing a game on it while they were in the wagon, and Ryan would lean across once in a while to peek at the screen. It was too cute.

As for Mr. Ryan, he did not nap this afternoon.  The negative effect is that he was cranky most of the afternoon, but the positive is that he was asleep by about 9:30 tonight, Finally!

Thoughts on Sibling Involvement

Sorry, I know the longer the day we have the longer the entry already is, but I wanted to comment on Ryan's siblings' growing interest in being involved in his "homework" and communicating with him.

In some ways, it's a good thing.  For his incidental goals like "waving hi," Andrea is (and sometimes Kevin, too) stepping in and being the other person when I need it.  They also think it's fun to get high 5s from Ryan.  Furthermore, Andrea likes to stand by and give him his reinforcement, or even set up an activity like putting the ball by Ryan's foot and telling him to "kick the ball."  I'm pleased that they want to help.  I'm happy that they are excited about trying to communicate with Ryan.  I also think it's good for Ryan to generalize his skills with his siblings.

However, Andrea and Kevin can be a little too enthusiastic sometimes.  Kevin, for example, will jump into the program and start doing things his own way, or giving Ryan the reinforcer when it's not appropriate.  Andrea, on the other hand, tries to run programs when we don't need to be running them, or when Ryan is having a break. She thinks she knows everything because she's watched me do programs with Ryan, and even helped a bit. She also gets offended when Ryan won't respond to her ("He doesn't like me!").

Similarly, they push Ryan too far sometimes.  I know they are just excited that Ryan is starting to communicate with them on a certain level, but they can demand too much. For example, they get into high 5 competitions, where Andrea will ask Ryan for a high 5, then Kevin will, then Andrea, and they keep going to see who can get more from him. To them, that means he "likes" that person more.  Well, poor Ryan just gets overwhelmed and fed up after about 8 high 5s in a row between the same two kids. Who wouldn't? I often have to remind them to "give Ryan some space" or "give Ryan a break" or say, "Ryan's had enough for now." 

Then again, to give Ryan some credit, he does try to show them when he's had enough. He might make a mad face, or push them away, or put his head down.  The difficulty for me is teaching a 7- and 5-year-old how to read their non-verbal brother's body language. 

So, as with everything on this journey, it's a mixed blessing: I'm glad they want to interact with Ryan, but I need to figure out how to help them interact with him appropriately.  It's hard enough getting a family of neurotypical kids to interact with each other appropriately . . . LOL

Andrea: Sensory Issues?

Oh, why not go for it while my mind is running through all this. So, this one has been on my mind for some time, but the urgency of the question had increased over the past 6 months: Does Andrea have sensory issues?  

She clearly suffers from anxiety, but some of her reactions to things lately remind me a lot of the way her brothers react in certain situations. And people can have sensory processing disorders/difficulties without having autism.

Here's a list of some things I've noticed about Andrea that make me think she might have sensory processing difficulties:

• She hates the sound of pencils that scratch on the paper. We have certain pencils that totally freak her out and distract her from doing homework.
• She hates the feeling of the paper pages in paperback novels.  We have been reading some chapter books from home and she gets upset that she has to hold the pages down; she licks her thumbs until they are soaking wet to press down the pages, so it lessens the sensation of the paper on her skin.
• She gets overwhelmed when Kevin gets into his repetitive noises, and starts to scream at us to make him stop.
• When too many people are talking at once, or when someone is giving her directions/commands, she often gets overwhelmed and yells, "Okay, okay, okay, okay!"
• Slow music makes her sad, and she cries.
• She is constantly putting things in her mouth: her hair, her fingers, her headphone wire. She even asked to have a chewy like Ryan's.  Instead, I offered her a chew tube he doesn't use.
• She is totally freaked out by Daddy's "belly fur." I thought it started out as a joke, but she actually screams and gets really upset, and refuses to go near him, when he has his shirt off. (Seriously, he's an average man. His body hair isn't abnormal.)
• She has started to suck on her arm when she is anxious.  She says she does this at school.
• Her teacher mentioned she has seen Andrea bunching up the top of her shirt and sucking on it when she's getting anxious.

So, here's another thought/question:  Are these issues manifestations of Andrea's anxiety, or is Andrea having anxiety because of sensory overload? My poor girl, she's really been struggling this year.  Her teacher is very much aware of Andrea's anxiety at school (Andrea cries almost daily).  We've discussed how we're all unsure as to what to make of this.  Is this brought on by the stress of being a big sister to two little brothers with special needs?  Does Andrea have an anxiety disorder?  Does she have a sensory processing disorder? 

Who can we go to for help with these questions?  Just a year or two ago, a school social worker would've been a great resource for us. Now, they don't have them anymore.  I have been trying to research resources for primary, school-aged children with Andrea's symptoms, but I'm stumped. 

Plus, I feel awful saying this, but it's true: I just don't have the time/energy resources right now to start on a whole new journey of research/referrals/meetings/therapy for another child.  I want to help Andrea, but I'm overwhelmed.  Sadly, I often react to her outbursts with frustration or anger because I feel so helpless.  I think she understands that I do care, though, because we often talk after and apologize to each other, or explain our feelings and why we acted the way we did.

I knew motherhood would be complicated, but holy smokes . . .