Unity Day 36: Busy Morning

From Facebook:

"Had a bit of everything today at S.C.: a new student observing; weekly evaluation meeting; kid switcheroo; Ryan hyper; Ryan overtired and angry; etc. ..."

We had a new student, who will be doing a placement at S.C., observing Unity today.  We'll call her St. because I can't remember her name.

When we first arrived, we had some extra time, so I took Ryan into the Blue Room to go through the cupboards to try and find some new reinforcers. I took out a few bins of items and showed them to Ryan.  He didn't really pick out anything. I picked out a few to show him, but he only liked the mini fibre-optic lamp. After a while, he just got mad, got up, and ran off crying.  He ended up running up to St., and I think he kind of scared her because he was crying and trying to grab at her, and she didn't know what she was supposed to do. I went over and led him away from her.  It wasn't until later that we found out she'd be observing us and interacting with the boys a bit after. I wonder what she was thinking when she realized she was going to be spending the morning with "the little crying boy." LOL

We did "Itsy Bitsy Spider" for opening song. Then, L.A. went for her weekly meeting first while St. stayed and played with J. We had T. in the room, of course, so we stayed in there and did some programs until it was my turn for the weekly meeting. 

I think we started with the mix of trials involving hands and prompts, the ones Ryan has been getting confused. With prompts, he got "clap" right twice, "wave hi" 2/4 times, "high 5" right twice, and "pat floor" 1/3 times. I think he was worn out by the trials by "pat floor" and was just ready to move on to another program.  We noticed that he always gets "high 5" right because it's a different action and prompt (holding hand up to him; no physical prompt).  We'll keep doing this mix of trials each day until he starts being able to transition and differentiate from one to the next without confusion.

He was really enjoying the one new reinforcer he picked. He liked swatting at the fibre optic threads with his hands and watching them wiggle. He also liked it when I gently rubbed them on his hands/arms (they tickle!).

Next we did the "coin in the piggy bank" and he was doing great. He was independently picking up the coins and trying to put them in the slot, but he kept laying them flat, and they would slide off the pig.  So, I still had to wrist prompt him to turn them up and manoeuvre them into the slot.  Still, he's showing an effort at independence and he clearly understands where they're supposed to go, so that's great.  However, he does occasionally kick over the pig with something like contempt. He's not mad, or even irritated; he just gives it a kick and knocks it over.  I'm not sure what that's all about. LOL

Then we did colouring, and he did really well. It was still HOH with the marker, but I'm barely holding my hand over his. After we did the marker colouring, I went and got the pencil L. rigged up for us yesterday, and showed T. how Ryan likes to use a pencil after he's done with the markers, as a bit of extra reinforcement.  T. was surprised to see (and so was I!) that Ryan actually had the beginnings of a decent pencil grasp this morning; the position of his fingers when he grasped the pencil, to push it, were just about right for when he's eventually ready to try it on his own. Nice!

After that, T. got Ryan's bobble-head pop-up toy from the other room for us. I showed her how Ryan can do a lot of it independently, like pushing down some of the lids and pulling on the one thing to pop one open.  Ryan surprised us both today by figuring out that he could by-pass the flips and switches to open the pop-ups by getting a finger under the edge of the lids and prying them open!  While we're impressed by his problem-solving skills, it kind of defeated the purpose of working on his hand strength and dexterity.  T. said now that we know what Ryan can do with this toy, we should focus our program on the pop-ups/buttons he has the hardest time with.  It makes sense. The rest he can just do for fun and a sense of achievement. (I know I've said it before, but we love toys that are their own reinforcement!)

Then it was time for my weekly meeting with H. T. stayed nearby while St. played with Ryan, as I headed off to my meeting.

Homework

1. Manding: no changes.  Keep track of issues or questions.
2. Discrete Trials: no changes. Do one each night.
3. Play Goals: a) Cause and Effect--NEW--Thomas the Train Alphabet Toy; have Ryan press a letter to elicit a response OR have Ryan press a music button to elicit a sound. I will need to test this a bit to see which function he's more engaged in and which prompt level to start at.  b) Close-ended: no changes.  Fade back from wrist prompt on magnetic blocks as appropriate.
4. Incidental Goals:  no changes, but an adjustment to "wave hi/bye-bye."  As discussed in S.C. programming, this is becoming confused with other hand actions.  This week we will try removing the physical prompt, and instead, have me model the waving next to Ryan. If this does not work out over the next week, this goal will be removed from home incidentals and replaced with something new, since we are already trying to work through it with the "mixed" trials at S.C.

Evaluation

All is well, just a few notes:

1. Be careful not to let Ryan's "behaviours" affect my follow-through with a program. There's some judgment needed here, though.  If Ryan's upset or angry, I have to follow through with my expectations of Ryan for the program. However, if Ryan's "behaviours" are due to loss of control (body/emotional), then I can pause the program to comfort him and fulfill any sensory needs he might have. If I'm not certain which situation Ryan's in, I should ask the therapist for their opinion.
2. Don't rely solely on the items in his basket for reinforcement.  If they aren't effective, then switch them out. [Way ahead of you on that one; that's exactly how we started our day!]  We might try putting out a selection of two or three new things each morning, and see if Ryan gravitates to any of them.  That way, he won't get overwhelmed by choices, as he seemed to this morning. 

I also have over 200 Parent Points, and I'm not sure what to do with them! I'll have to check through my circle supplies and reinforcers to see if I can come up with any ideas by Friday (in case I want more circle items by Monday). Next week, we moms start running circle at least once a week. Eek!

Back to Ryan . . .

When I returned to the Yellow Room, Ryan was having a great time with St. He was very excited by a toy she was using with him.  I've seen it before because my in-laws have one at their house: Laugh and Learn Tool Bench. He hasn't shown particular interest in it before, but St. had him fascinated with the measuring tape.  If you pull it out and let it go, the wheel inside spins.  Ryan's cheeks were red and he was flapping away because he was so worked up over this toy.  He kept patting the tape measure to signal to St. that he wanted it again.  Finally, he managed to pull it out on his own one time! Hmm . . . we'll have to get Gram and Papa to pull that toy out the next time we come over for a visit. :)

However, T. did say that Ryan had a bit of a meltdown when I first left for my meeting, and they had to spend some time getting him calmed down.  That's why they were letting him play with the toy over and over; he seemed happy with it.

Next it was circle time. Ryan was so-so. He continues to do some of the song/activity actions (with prompts) and matching with the book, but he also needed frequent reminders to sit up nicely and pay attention (he got upset a few times).

Snack was our down-time.  Ryan enjoyed his "bubba" with half-closed eyes ("Ah, that's so good . . ."), and made only a moderate mess with his yogurt. He finished both items.

After snack, I was surprised to discover that we were finally having another opportunity to work with each other's boys.  I set up the Play Doh program for L.A., thinking that would be an easy and fun one for Ryan. From what I could tell, it started out well (I heard lots of happy praise) and then went downhill (I heard Ryan screaming) because Ryan was getting so exhausted. You see, he'd only gotten about 6.5 hours of sleep (11:30 PM to 6 AM) which is not nearly enough for a little guy like him.

My program with J. went pretty well. He needed some encouraging to head to the table with me (we brought a whole toy bin!) and we were working on, I think it was called, "serializing." Basically, J. has four pictures which show a sequence of events or items in different stages, and he has to put them in order. For example: kid climbing up a slide ladder, kid sitting at top of slide, kid sliding down, kid at bottom of slide. I mix up the four pictures a bit, and he has to put them in order. If he's correct, he gets reinforcement (his toys) right away. If not, I say, "Good try," show him the correct answer, and repeat the series until he gets it correct on his own.  He did pretty well, but I think he was getting kind of frustrated with doing the work because he picked up and crumpled the series pictures a couple times when we were done (unfortunately, they weren't laminated).  On a positive note, though, he had some success with a series featuring a full Popsicle to an empty stick, which had puzzled him before.

Since Ryan was so over-wound when I got back to him, we agreed that I should do a simple, mastered skill with him and end our day on a positive. I chose the ball ramp.  He played with it well and independently, and calmed quite a bit during the activity.  When I decided it was time to go, I had to distract him with a "high 5" to get the toy away!

In case you're wondering, he fell asleep in the car on the way home, but he woke up when I carried him in the house.:( He just fell back asleep around 2:30.  I hope he doesn't nap too long; we need to get this child back on a reasonable sleep schedule!

Side Note: Two Good Things I Forgot to Mention Before

1. On Friday, during circle time, Ryan was actually moving his head back and forth to the tune as we sang, "It's time to wave good-bye to our friends." I can't remember the last time I saw him move along with music. That was cool. I can't believe I forgot to put it in Friday's post.
2. Last night, when Daddy came home from work, I told him, "Wave hi to Ryan," to get an incidental response.  Daddy waved once and said hi. Ryan looked over at him. Daddy repeated the action and words; Ryan waved completely independently. We haven't seen that before, and he hasn't done it yet today, but it was pretty sweet to see last night. :)