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. :)