From Facebook:
"Ryan was so hyper today! It was hard to get him to focus. At least he was mostly happy. He also independently signed "more" at least 4 times and said "Mamaaa" spontaneously ... twice. :)"
Well, we are at the complete opposite end of the emotional spectrum with Ryan today. He was happy and hyper!
The morning started out fairly routinely, with Ryan requesting a ride up and down the hallway in the wagon. He was tapping the wagon to ask for more when I stopped, but I was forearm prompting him to sign "more." When I stopped the wagon after one round, he refused to get out. He tried the tapping more again, but I prompted him to do the sign "more" to get more wagon ride. Now that we know he understands and can do the sign, nothing comes free anymore! He has to ask for it.
Today we were working with L., and B. was observing and assisting. We started off with trying some colouring. Since we started it yesterday with D., L. really wanted to see it. Although he was attentive and making an effort, Ryan was having a hard time grasping even the chunky markers today. So, L. suggested a slight adjustment: we hold the marker, but Ryan has to push our hand to make the mark on the paper. This way, it's building on skills he already has, like push a train or push a car. This actually worked well. Ryan pushed L.'s hand 3 or 4 times and made some nice marks on the paper when we verbally prompted him to "colour." This may be where we have to start, and we can try for more independence as he gets better fine motor control.
Next we did some work with the chunky puzzle. He was awesome taking the pieces out by himself (he loves that part), but he's even improving on putting them in. With the adjusted forearm prompt D. implemented yesterday, Ryan was trying really hard to put the pieces in the puzzle all by himself! I was just guiding his arm a bit to help him wiggle the pieces into place. Again, that's a fine motor control issue. Right now, L. explained, we are just pleased he's paying attention to the puzzle and understands that the pieces get taken out and put back in.
We also tried some "stomp feet." It took Ryan a few tries, with L. modeling and me holding Ryan's leg up at the knee, but we eventually got some good little pats of the foot out of him. I wouldn't call it "stomps" yet; it's more like he taps the floor with his foot.
Then we worked on matching. This is where Ryan suddenly got really hyper. He did match the elephant with the elephant, but he was kind of flinging the elephant at the bowl. We could tell he was going in the right direction, but his hands were getting really flappy (flapping hands is a very common form of stimming in autism). Ryan flaps his hands a lot when he's excited. We're not sure what it was about those bowls and matching items that got Ryan all excited, but he flapped like I've never seen him flap at Summit Centre before! Anyway, we tried some different forms of matching today, like a ring in one bowl and a stuffed animal in the other. It usually took two or three tries before Ryan could match the new items. So, he hasn't generalized the skill yet, but the more we practice, the more he's understanding it. By the end of that program, he was flapping and flinging the items so wildly it was hard to tell what was intentional and whether he was making the correct choices. L. decided to end the activity on the last one he got right.
I mentioned to L. about how we'd had such a rough day yesterday, and how nice it was to see Ryan so excited today, although it was kind of interfering with our work. L. made a good point then: Ryan's excited flapping is at the total opposite end of the emotional spectrum from yesterday's tantrums, but they are both extremes. When Ryan's extremely mad or extremely happy, it's hard for him to control his body, and it interferes with learning. So really, even though he's excited, it's just as difficult to get him focused as when he tantrums. I saw that a few times today, when Ryan was flapping so much he couldn't hold onto an item we needed him to hold, or he was throwing objects where they needed to go instead of placing them nicely, so it made his motor control decrease even more than usual.
Here's where it got interesting. We told Ryan to "Go play," and instead, he independently signed "more" for the matching items! We were baffled and excited at the same time. The independent signing of "more" was fabulous, but we have no idea what it was about the matching bowls that excited Ryan so much today. However, we got at least two more spontaneous signs for "more" when he was playing with the matching items. I thought it was sweet when I looked over and L. was wiping some happy tears away! I love how the S.C. staff is as thrilled as we are with our children's accomplishments.
Ryan's surprises for us weren't over yet, though. As he was playing with the matching bowls, he suddenly said, "Mamaaaa . . ." clear as a bell! Ryan sometimes babbles "mum-mum-mum" when he's really upset, but I haven't heard a clear "Mama" since he was about a year old. I think I was kind of in shock. He got a big hug and some tickles, but it didn't register with me emotionally until we got home.
After the matching he was pretty wound up, so L. suggested I take Ryan for a walk down the hall. He needed to get that extra energy and excitement out of his system! As we wandered down the hall, he suddenly babbled, "Mama, mama, maaaaaa . . ." again. I was kind of dazed. I think I just patted his head and said, "Yes, nice saying mama." LOL
Back in the Yellow Room, we tried some more puzzle and shape sorting. He did really well with both of those; I was guiding him from the forearm, and he was trying to place the pieces. He pushed a few of the shapes in independently, after I guided them with him! However, Ryan's reinforcement for the shape sorter today was that he wanted pull off the lid and fling the other pieces around. Well, whatever works. I would loosen the lid slightly and let him pull it off, and then he would fling out a bunch of the shapes.
He started getting a little too silly again, so we tried some of the old skills like playing piano, giving high 5s, and patting the floor. He did all these with us modeling and verbal prompts. Then, Ryan got distracted by the bead maze. He knows how to play with that, as we have one at home. L. wanted to see if Ryan could "disengage" (in other words, switch focus) on his own from the bead maze to another activity. This went so-so. He was really into the bead maze this morning. L. also wanted to try an alternative to the ring stacker because Ryan has been having trouble holding and placing these (his fingers block the hole in the ring, so it's harder to get over the post). Instead, L. brought out a piggy bank toy where you insert large, toy coins (it's about attention and coordination, so the same skills as the ring stacker). She tried to get Ryan to stop playing with the bead maze to put a coin in the bank. He was having trouble taking his focus off the bead maze, and even tried to put the coins in the maze! So, we changed strategies and took a portable bead maze and used that as the reinforcer for after Ryan put a coin in the bank. (By the way, the original "coins" had been replaced by Play Doh container lids; that's resourcefulness! They are the perfect size and easy to hold.) We HOH'ed or wrist prompted Ryan to put a coin in the piggy bank, and then he got to play with the mini bead maze. This worked well.
Next, it was time for circle. Ryan, however, decided to assert his will and plop his butt down just outside the door of the Yellow Room. He wasn't moving. We tried to entice him with the mini bead maze, but he wouldn't stand up for it. At least he wasn't crying, but he was being stubborn! L. remembered how we used the Thomas videos from yesterday to motivate Ryan, so she went and got her iPhone. Ryan stood up on his own just as she returned, but Thomas videos helped guide Ryan to the Red Room for circle, and to get him to sit down for circle when we got to the room. Circle was different today because we had no other participants! J. is still away, and the STEPS children were on a different schedule than us. I don't think Ryan liked it because he had to do all the work (no other friend to take turns/share the workload). However, he did some nice story matching, and good attempts (with prompts) at block stacking, hand clapping, and feet stomping (actions in our songs). Meanwhile, his reinforcement for his extra effort was snippets of Thomas videos. I think that kept him going, so we made it through circle with no major issues.
Then it was time for Friday research and theory. It was nice when Dr. G. gave me some praise for all the great things she's been hearing about the way I've been working with Ryan, but I was a bit embarrassed. I'm not sure I deserved all that praise, but she made me take ownership of it. :) Anyway, theory focused on factors affecting the effectiveness of reinforcers and also conditioned reinforcement (things we learn to like, and how they must be backed up; i.e. a token board is only useful if we get something we want when we fill it up).
I think I'm really understanding this positive reinforcement stuff (no, "stuff" is not a tecnhical term). Today, Ryan wasn't interested in his usual go-to reinforcers, so I dumped out his basket and said, "Pick something! What do you want today?" He tried a few things and discarded them. As I mentioned earlier, his reinforcers today were things I didn't expect, like the matching materials, going for a walk, and the bead maze. This shows how true it is that reinforcers change, lose power, regain power, and might be the last thing you'd expect. Paying attention to Ryan and following his lead (where appropriate) often leads us to the items/situations that work best for him.
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