Unity Day 56: Home Visit #4

Today, D. came to our house for the final home visit. We haven't had a chance to work with him in a while, so it was nice to see him again.  Ryan certainly seemed excited to see him; he was smiling and giggly and silly when D. arrived. I think Grandma was a bit offended because her arrival, a few minutes before, wasn't greeted with as much enthusiasm (although Ryan was happy to see her, of course!).

Today we went through a bunch of the usual programs and how they might look at home, as well as discussing some possibilities for future programs.

We started out with some "pat head," and I did the modeling and gave verbal instructions while Grandma prompted from behind Ryan.  Ryan was a little irritated because he had to move from his favourite rocking chair to work on the floor, and he kept standing up and trying to go back to the rocking chair.  D. said we could use this to our advantage, since the rocking chair is obviously strong reinforcement for Ryan.  So, Ryan got a mini-reinforcement between each trial (something to chew on, or beads, or cuddles), and then got to go to the rocking chair when he successfully finished a program.  For "pat head," Ryan was a super-star today! He got 5/5 trials correct, and the last three were barely prompted. Then, he got to rest in his rocking chair for a few minutes.

Next, we got him down again and did "clapping."  He got 5/5 on this one, too, but he needed a little more prompting and some of his responses were a bit weak.  Grandma was prompting him from the elbows.  Also, D. suggested that I model longer, so Ryan doesn't forget what I'm asking for; basically, I keep clapping until Grandma's prompt comes, and then I can stop. That's something we can fade back later, as Ryan's clapping imitation becomes stronger.

Then, I set up "bowling" for him. Today, I really noticed how much harder it is to knock down the pins on our bowling set than the one at SC.  Ryan hit the pins consistently over several attempts, but was only able to knock one down twice. Later in the visit, when D. saw the ball I was using during circle time (small but harder, rubber), he suggested I use that ball for bowling instead. It's heavier, so it will knock the pins down more easily. Still, Ryan had one great roll that knocked down two pins!  D. said we should end when he does something awesome, so he'll remember that happiness/accomplishment the next time we try the program. So, Ryan got to go to his rocking chair for a nice, long break after that.

After that, we tried "colouring," but in a slightly different fashion since we're at home. I pulled out Kevin's magnetic drawing board that all the kids like, and we used the pen on that like we would do the marker at SC. The only thing missing was a special grip (I still haven't received one). Ryan did great!  He had a good grasp and made nice, long marks on 4/5 trials.  Grandma tested him a bit, though, by adding in the component of getting Ryan to slide the bottom button in order to erase his work. Ryan was a bit frustrated by this, but D. suggested showing him his reinforcement to encourage him to work for it by pushing/pulling the eraser slide button.  Ryan did it, with help, and under some protest. ;)

We also tried the stacking toy I have here, to see how it compared to the one we did at SC yesterday.  Ryan got the ring on in 6/8 trials, but only one was at wrist prompt, and the rest Grandma had to HOH.  I was also telling D. about how Ryan hadn't tried to mouth any of them yesterday, so of course, Ryan tried to mouth every single one today. Stinker!

We did our musical shape sorter, on its side again. Ryan can independently put in the circle, but for square he needed the wrist prompt, and triangle finally needed an HOH (he was fumbling it too much). D. also suggested leaving out the star (it's the hardest shape) and doing the circle again, instead, so Ryan could end on a positive. Again, that's something we can change as Ryan gets more independent with the other shapes.

I also set up "push train" on the floor. At home, we have the grooved wooden tracks. The biggest nuisance is blocking Ryan from dismantling and chewing on the track, since that's the kind he got addicted to chewing on at SC for reinforcement.  He actually did better than I expected in terms of the tracks. Grandma and I were quick to block/move them after Ryan pushed the train, and offer him other, chewable reinforcement.  Ryan got 3/5 trials correct on the wooden track. The two incorrect ones were early derailings, and really, the track was a bit uneven and more challenging than usual.

Then, we chatted awhile about some other home toys/programs:

• Puzzles: The puzzles we have at home have more pieces and smaller pegs to grab onto than the ones Ryan is currently working with. Until he'd ready for them, D. suggested we make some modifications to the puzzle and program.  First, find a way to make the peg grips larger (Grandma took the puzzle home to Papa, and is giving him this as a project). Then, only have Ryan practice removing and replacing one piece at first. As he masters each one, we can move on to expecting him to put in more pieces.
• Car Ramp/Garage: Keep practicing with Ryan putting the car down the ramp (skill maintenance). The next step is teaching him to use the elevator on the toy. We tried this out a bit, and D. suggested starting with me modeling pushing the elevator up halfway, and Ryan pushing it the rest of the way (HOH at first). We will do the same thing for pushing the elevator back down.  Eventually, I will fade back my physical prompts so Ryan's pushing it up and down himself.
• Stairs: I mentioned how we had set up a plan with T, regarding the stairs, but I still had to get a different coloured and textured mat to put down as a visual for Ryan to STOP at the top of the stairs. When Grandma heard this, she got a great idea!  She has just renovated her kitchen.  She used to have a little green-striped mat in front of her sink, and Ryan liked to sit on it and play with the edges. She kept it, and said we could have it and use it for Ryan's STOP visual.  It's perfect because it is a totally different colour/texture from our carpet, it's just the right size, and it addresses the one question I had for D.: How do I get Ryan to sit down without a physical prompt?  Well, Ryan already liked sitting on Grandma's mat, so hopefully he'll generalize that to our house.  [Coincidentally, Gram had dropped off the rug a bit later and I had to go downstairs. When I opened the gate, Ryan walked over and I said, "STOP." He immediately stood still, then plopped down on the little rug. He then scootched to the edge of the stairs,and with my permission, carefully scootched down all the steps on his bum! It's working!] D. also suggested that we practiced the "stop and sit" with the gate up sometimes, just get him used to doing it without us right nearby. The idea is that he will learn to "stop-sit-scootch" even when we're not around, so we can leave the gate off, and he'll be safe.
• Potty Training: I felt the need to bring it up before we left SC. Personally, I don't feel Ryan is developmentally ready to begin potty training soon, and I was reassured when D. totally agreed with me.  Still, we are at the stage of future planning, so I asked what would be the way to start when the time comes.  D. said to start slowly, and just get Ryan used to sitting on the potty.  [Although I'm saying potty, Ryan's way too big for a training potty, so it will be on the toilet with some kind of special seat.] Get him to sit on the potty for seconds at a time, and give him huge reinforcement.  Slowly extend the amount of time he sits on the potty to get his reinforcement.  Eventually, he can sit on the potty for awhile with a toy/reinforcer.  From there, the body functions will come. (I also know they have some good tricks at SC to encourage actually "going," and that's something I could ask about at a consultation group when the time comes.) 

Since I didn't really have anymore questions, I decided to run a circle time to see what would happen and get any suggestions D. might have, based on his observations. Ryan, however, was getting really angry and tired. He did not want to do circle time. I thought the singing might cheer him up, but he was fighting it (mood swings: grinning one second, crying the next).  I tried to shorten the circle time by removing some activities, and doing some portions of the activities myself.  But Ryan was miserable!  What he did, he did grudgingly.  He was crying and throwing himself down a lot. It was quite the test for Grandma, who was assisting Ryan while I ran cricle. We needed to pause to wipe Ryan's nose several times from all the crying, and it was a struggle to get him to sit nicely. 

So, this led to one final question for D., after all: What do I do when Ryan gets like this during programming/circle-time activities at home?  Do I press him on? Do I stop?  D. said if Ryan's frustrated or upset, keep the reinforcement level high. He may even need to have a toy/chewy thing in his hands the entire time.  As long as this keeps him calm and attentive, it's okay. In terms of circle specifically, there are things I can control, like I tried to do today. For circle, I can decrease the amount/duration of activities, or what expectations are placed on Ryan. Grandma wondered if this might teach Ryan that if he throws a tantrum, he will get less work.  It's a good question, and one that I had way back in our first few weeks of Unity. D. said to make sure to vary which activities get changed/shortened each time this happens.  Ryan is less likely to pick up on the difference in expectations  if there is no regularity or pattern to it. 

By this time, Ryan was flopping back on Grandma with his eyes half-closed, enjoying his "milk." D. said he was okay with ending there since we'd pushed Ryan's buttons enough. Also, as this is our fourth home visit, my home issues have been addressed for now. 

Tomorrow is the last day of Unity! I am getting weepy thinking about it! This time with Ryan has been an experience I'll never forget.  Okay, I'll save the rest of my boo-hooing for tomorrow. ;)