Unity Day 51: Home Visit #3

From Facebook:

Wednesday (would have been Unity Day 50): "So sick . . . guess I overdid it the past few days. Plus Ryan was up partying (and then crying) all night. So, no Unity for us today. Sigh. :("

Today: "Spent the whole home visit wiping my drippy nose and racing to get more tissues. Then the therapist offered to leave early because I looked so wiped out. How embarrassing. :p"

Even though I'm still pretty sick, I figured we could handle a home visit today.  Grandma joined us, and T. was our visiting therapist again.

We started out by discussing some of the toys we'd tried for the first time last week, the giraffe popper and the bowling game.  Ryan hasn't tried to push down on the giraffe's head independently since that day; I always have to HOH or position his hand on it, then really pull down on his arm (I'm doing all the work.)  With bowling, he's had some good days when he's interested, and some days where he was totally unmotivated.  Here are T.'s suggestions:

• Giraffe Push-Down: Put Ryan's hand on the giraffe's head, and my finger on the giraffe's ear. Push down that way, so Ryan has less sensation of me pushing on his hand (less physical prompt).  Try to fade back my hand on the giraffe.
• Bowling: My judgement call as to what is acceptable. So far, I have been expecting him to knock down one of two pins.  T. said we might accept a hit (but not knock over) of a pin, and just give a little less reinforcement. We also noticed that Ryan has a good roll/throw sometimes, but misses the pins.  T. suggested putting up more pins in a straight row, about a foot away from his feet, so he has a larger target to hit.  We tried this, and he did have more success.

Next, T. actually brought up some future work we might do with Ryan regarding safety going down the stairs. This is something I've had on my mind for awhile (getting rid of the safety gate!), and it was also something Ryan was working on with his physiotherapist from Children First just before we started at Summit Centre.

• The idea is to to Ryan to STOP at the top of the stairs, sit down, and scootch down them on his bum--for now. (Grandma's already been trying to teach him this at her house.)
• We need decide on a visual to use for Ryan to teach him STOP at the top of any stairs. Then, we need to work on the command to "sit down" again.  He can scootch down on his bum, but sometimes he needs a physical prompt to remind him how. He also tries to stand up sometimes on his way down, but he's not physically ready for that yet. 
• T. tried to see what Ryan would do if we left the gate open (with her on the stairs for safety, of course). He eventually went over and did attempt to take a step down. She stopped him by holding up her hand and saying, "Stop."  It took a while for us to get him to "sit down" (finally had to do it physically).  He started to go down on his bum when she encouraged him, but needed some physical prompting to keep moving. He also tried to stand up in the middle of the stairs a few times, and she had to remind him to "sit down" and come down "on your bum!"

Then, I mentioned how we had got Ryan a rocking horse toy for his birthday, thinking he'd love it (he loves rocking, right?), but he's terrified of it!  Whenever I try to put him on, he gets nervous and upset.  I think he'd like it if he got over his fear and realized it's fun! 

• T. mentioned his fear is likely due to feeling a lack of security. It has no back support, and it does tilt back and forth, so maybe he needs more body support with it.  She suggested that we put the horse sideways against the couch, and that someone has their chest to his back when he's riding, to give him more of a feeling of security.
• She also said to use a very strong positive reinforcer when he's sitting on the horse. For example, we got out his container of dried noodles and let him run his fingers through it as we praised him for how nicely he was sitting on the horsey.
• Also, we want to keep the experience positive. Therefore, as soon as he shows signs of getting anxious, we let him get off the horse.
• We tried these steps 2 or 3 times while T. was here, and Ryan was a little more relaxed each time we put him on the horse. He was on it up to 15 seconds the last time, with no signs of anxiety. She said eventually we can fade back the physical support and the reinforcement, and start rocking it.

After that, we talked about the ABLLS. It was good to get a chance to go through all the skills I had questions about scoring, or if I wasn't sure I'd scored them properly.  In the end, there were a few changes, but mostly for the positive.  The only one I took away (put back to "0") was under writing, "Can he make marks on a paper?" The idea is a short line, holding a marker. I had said "yes," but really, he still needs the help of someone holding the top of the marker, so he can't do it independently. Like T. said, though, he's SO close to this, that she bets he'll be doing it in a few weeks.  There were a couple of other skills that I had already scored "0" that he should have within a few weeks. On the positive side, there were a few skills I hadn't scored because I wasn't sure, and they ended up being given a 1, which means they are skills Ryan has gained.  These were in the social skills, and fine motor skills areas, mainly. So, the pictures I posted the other day of the ABLLS have changed a little, but the overall, "Look at all the gains (orange colour) he has made!" remains the same. :)

Next, we talked about something from last week's home visit, using the new "milk" sign.  It hasn't gone very smoothly so far. It's hard for me to sign the sign, hold up the bottle, and help Ryan (HOH) form the sign, by myself. 

• T. suggested this would work better when 2 people are around.  Hmm. That doesn't happen much lately! But anyway, the idea is one person holds the bottle of milk and models the sign for milk, while the other person stands behind him and folds his hand in the "milk" sign.
• We might accept even him just closing his hand once at first, and slowly shape it up to the full, proper sign.
• We may have to block his other hand, so he's not tempted to confuse it with other signs he's learned, like "more."
• To give him more opportunities to ask for "milk," put small amounts of milk in the bottle at a time, so he'll be motivated to ask for more "milk." Have more milk nearby to avoid frustration (and maybe add to his motivation?).
• Remember, it took him a few weeks to master "more." It will take time for him to get "milk," too. We've just started.

Finally, I asked T. about beginning speech sounds.  Yes, we are focusing on signing right now, but Ryan does make a few little speech approximations: ahhhh, ba, buh, ya, ga, muh, mum, heee, aaayeeee, and mmm are the most common ones.  Grandma mentioned in the car the other day, "If you can make that sound, you can say Grandma!"  From talking to the therapists at S.C., I know it's more complicated than that, but I do wonder if I should be encouraging Ryan's speech sounds more. So, I asked T. what I can/should be doing. Basically, it's what I've been doing already:

• Always pair signs with words.
• Encourage/respond to any speech-like sounds Ryan makes. Give lots of praise ("I like your talking!"). Imitate back to him. 
• Set aside specific play times to focus on speech (don't do it during other programs).  Use sounds I know he has to build on to make words, like "buh" or "bah" for "ball" or "balloon."

So, that was about it for our visit today. As I mentioned in the Facebook blurb, T. could tell I was a mess today (constant tissues and drippy nose), and she was fine with ending the visit a bit early.