A reason to behave

R. had a couple of bad days at school with hitting, but Thursday and Friday were behavior free.

It is getting much better at home too.   I’m making a real effort to use positive language and avoid saying no and don’t.

We are also all reacting to the behavior in the same way – we block her from hitting, and ignore her – no words or eye contact.

I think the biggest difference is that when she does hit, she is able to snap out of it quicker.  Even a few days ago it was like she was caught up in this cycle of having to complete the hitting behavior before she could do anything else.

It makes me really think about how much her behavior is dependent upon those around her.   That’s the case for all of us really.

Maybe I’ll never know exactly why she decided hitting is a good way to show her displeasure, although it seems like a logical reaction.   But I do know that how we reacted just made her want to do it more.   Our behavior was actually reinforcing to her, even if in the moment it seemed at least to me that we were both unhappy.

I think that a parenting lesson I am learning is that I should strive to remove any power struggles that arise.   This does not mean that she should be able to do whatever she wants.  But it does mean that I have to give her a reason to do what I ask, especially if it goes against her own desires.

I don’t think that she stopped hitting because I told her to, she stopped because she did not have much reason to do it anymore.   I do think that we are lucky that the solution has been relatively simple so far.

Behavior is back in town

I kind of knew that when they said she had no behavior issues at our IEP meeting last month that it was just a matter of time.  Now we have some new behavior issues.

Just last week she started to hit E. and I when we tell her to stop doing something.  Sometimes she will say R. no in a snotty voice and then she will try to hit us in the face.

She is really insistent about it too.  When I stop her from hitting me, she will get really mad and cry and follow me around until she can get in a smack.  She wants to hit our faces, she is tall enough that she can just about reach mine, but she has to pull E. down to reach his face.

She did it for the first time in school, she smacked an aide in the face.  Of course it had to happen during the time she was mainstreamed.  The teacher said that it has been going perfectly up until today.

She has also been running away at school.  Once she ran off when they were walking from the bus, and she ran from the cafeteria towards the SDC Kindergarten class.  The teacher said she got a look in there (it is right across from her classroom) and has been obsessed with gaining access since.

We discussed it with the behaviorist.   Regarding the hitting, we are going to make sure that we stop her before she hits us.  We will try not to use words like no or don’t, and phrase our requests in a positive way.   We are also going to say nothing when she is trying to hit us, so it does not become a power struggle.

They are going to work on teaching her to respond to the word stop, which I know she can do, just not consistently.   I asked if she could have a chance to explore the kindergarden class, to just get it out of her system.  She is very curious about new things.   They are also going to work on having her ask to leave the group.

R. was really prickly last week, and still is but not as much this week.  I was wondering if she was getting sick or if there was some cause for the changes.  This all started last week.

I also wondered if it is a developmental thing.  Maybe she is just becoming really aware that we are telling her what to do, even nagging from her perspective.   There was a time when she did not listen at all because she did not have the receptive language.  When she had the receptive language she began to follow instructions.  Maybe now that she has been doing that a while she is thinking about it more.

I know that hitting is not appropriate behavior, but I can’t help but be amused at her reaction after the fact.

I think that the running away at school is similar.  I’ve noticed when we go to the zoo recently that R. really seems to know her way around and she is asking to explore areas we have not seen.   (Usually because there is no stroller access, and she is walking holding my hand).

Maybe she never really noticed there was a classroom across the hall, or had the ability to think about how to get there when she was in another part of the building.

I certainly hope this is just a phase.

The many gifts of the ipad

There are so many things that R. has learned that can at least be partially attributed to the ipad.

She started to point purposefully after she learned to use it.  I’m sure the ipad is not the sole reason, but it seems to have helped.

Her receptive language has increased and it seems like she is picking up words (especially labels) faster and with less trouble generalizing.   I know that school and the techniques the ABA therapists are using deserve the most credit.  But I also know that the ipad is helping to reinforce these words -pun intended.

I think it also has helped with her auditory processing, she is pronouncing some words better.  I suspect it is because of apps like Bob Books, where she can hear the phonetic letter sound as many times as she wants.  She is touching the letter, seeing it and hearing a sound.

I have posted about how her youtube video selections seem to mirror what is happening in her life.   She will finish with her ABA session where they were working on the prepositions on top and under and go to youtube on the ipad and find Sesame Street videos that are teaching the same concepts.

She has stopped playing with her spit on the window (big hooray for that one!).  I really think it is because she can get that same sensation from the ipad.

She is writing letters, numbers and shapes.  She asks me to show her how to draw things -shapes and letters.   Of course they do this in school, and I give her teacher plenty of credit for helping to teach her these skills.  But I think that the ipad helped her focus in a way she could not before, and those positive experiences give her confidence and motivation.

She doesn’t have to to it all the time, but she will share the ipad with a friend, and even negotiate turn taking.   I never thought about the ipad as something that she could do with a peer, silly me.  They seem to do it themselves quite naturally.

 

September Meeting

We had our monthly ABA meeting at the school with the teacher this month.   We set the date for the IEP meeting that will determine the type of kindergarten placement for the beginning of November.   That seems so close.

I was hoping to have an IEP meeting this month to update some goals.  But since we have so many meetings and IEPs, the teacher and I agreed that I would email her the goals we discussed and she would update it.

Most of the goals I want updated are simple enough.  R. has mastered recognition of the alphabet, numbers 1-10 and the prewriting goals.   She is actually writing some letters in class.   I asked for more writing goals – tracing more complicated shapes, copying shapes and writing the alphabet and her name.

I also asked to increase the numbers to 20.  I know she knows them, I wonder if I should have gone up to 30.

R. is talking more in class, asking for things and labeling all sorts of items.  We discussed that she does not always make sure she has someone’s attention before asking for something and then gets frustrated.  The teacher had been working on getting her to tap her on the shoulder and say her name before requesting.

She has a goal about responding to someone else by making eye contact and orienting her body towards the speaker.  So I suggested that we make an actual goal that she would get someone’s attention before requesting something.

R. has also been refusing to wear a smock for water play and painting.  She used to wear one, but for some reason will not do so.  I asked for a goal for wearing a smock during these activities and then to put it on herself.  It seems like a weird goal, but I think that it will help her in a few ways if she would agree to wear it.

Only Say Hi if You Mean It

ABA has been working on some sort of greeting program since R. started therapy over two years ago.  The ABA provider during EI tried different techniques.  They taught R. to do a high five and used that as a greeting for a while.  It did not transform into a natural wave as they were hoping, but it did help with imitation programs later and it is a social thing to do with someone.

Then they took photos of each therapist and enlarged them so they were a little larger than the size of an adult head.  They cut them out and laminated them and attached them to large popsicle sticks.   I guess the idea was that they would hold one up and she would wave at it.  It did not work, but she loved all the faces.  She would gather them all up and arrange them in a circle around  herself.   It was funny, all the therapists were uninhibited in their play and interactions with R., but those faces on sticks made them all uncomfortable.

By the time she started preschool she would say bye to the therapists, but only when they were at the door.  It was like they had to really mean it.  Our current ABA providers did not put any emphasis on a greeting program at first.  At our last team meeting with the teacher before summer started, everyone seemed to say that she would say hi or bye when someone said it to her.    The ABA supervisor said they would do an actual greetings program.  I told them about our previous experiences, and suggested they keep it natural.

At first they only ran the program when a second therapist or the supervisor or behaviorist was there.  The second person would go outside R.’s door, knock and enter and R. is supposed to say hi.  She did this fairly well, although after the second time she seemed to lose interest.

About a month ago they started doing the program with just one therapist, but not every day.   It seemed like it was going okay.  Sometimes R. would play along and say bye, see you later when they walked out, making into a game.   But in the last week they have been doing it every day.  I think they are trying to master it out.  And for some reason she will not say hi consistently.  I think it is because it does not feel natural.  Why should she say hi to someone who has been sitting with her for the past hour?

The supervisor went to observe the classroom this week.  R. walked up to her and said hi.

Summer – 30 Minutes at a Time

Elmo has wheels

I found this skateboard/scooter thing at a garage sale, and it seems to satisfy R.’s new craving for wheels.   She calls it a bicycle.  She won’t actually ride it yet, but she is having fun.

We have been doing what I’ll call official potty training for four weeks – since summer school ended.  I put her in underwear when we are home and take her to sit on the toilet every half an hour.    It is going well from the perspective that she is compliant about sitting, and when I say time to go potty, she will usually get up and go right into the bathroom.    She has only had one success so far, and she put her fingers in her ears when she heard herself peeing.

She can go a long time between peeing.   So after it has been an hour or so, I reduce the amount of time between trips to the bathroom.   It makes the day feel kind of endless, so I’ve been trying to make the best of our five minutes.  We still look at books, but that is not as exciting now that we are in there so often.  I’m letting her put stickers on the bathroom wall while she sits, and I moved a small TV table into the bathroom.    We are using it for coloring and drawing, doing sticker books playing with legos and anything else I can find.  I’m trying to teach her to play memory type games – the ones with cards you flip over to make pairs.

At first it seemed like she was intentionally going right after sitting on the toilet.  She did not give any indication that she noticed she was wet.   But she stopped doing that, and it seems like she is becoming more aware.  In the last couple of days she has actually said something either after or while she is peeing.  The other day she was sitting at the table and she jumped up and said wow.  She had peed, and after she had new clothes on she kept going back to look at the wet spot on the chair.  This afternoon she said oh, and grabbed herself.  I asked her if she had to pee, and told her to pee in the bathroom.  She ran in, but it was too late.

When she has an accident, I take her into the bathroom and have her sit on the toilet and help her get changed.   I don’t have her sit for the full five minutes.   Everything we are doing is based on the the advice from the behaviorist.  She had ABA sessions for the past three weeks (this is the last week until school starts), and I’ve been having her go sit multiple times during the session.

I realize that this is going to take a long time.  I remind myself that every time I get frustrated waiting for R. to do something particular, just when I’ve nearly given up, she gets it.

Words, they are coming

R. is having her first real language explosion.  This is the first time in her whole life I feel like I can’t quite keep track of all the new things she is saying.   Her language is still a far cry from a typical four year old, but for us it is amazing and wonderful.

Mostly she is speaking in 1-2 words requesting (manding) things.  She will spontaneously say what she wants, and if we don’t respond right away she will repeat herself over and over again, and then point at the item and give me a determined look.  She is doing a lot less hand leading, it is like she realized she can get us to do what she wants with her other methods.

It is so interesting to me, I’ve been working for years now on increasing the exchanges (circles of communication) between R. and I.   For so long it was mostly gestures and facial expressions that we were exchanging, I guess I thought that when talking was the main method of communicating, it would decrease the number of circles of communication- because talking is so much more efficient, and R. is not able to really converse yet.   But I’m finding that while it is certainly more efficient to have R. talk to me, we are actually closing way more circles of communication during our exchanges.  She looks at me to see if I am paying attention when she speaks, she keeps looking back at me to see if I respond.

She is also doing a lot more labeling, she hardly did that at all before.  It seems like anytime she sees something she recognizes she labels it and seems so pleased with herself.   We were at the playground and some adults were riding bikes just outside the fence.  She said bicycle, bicycle clear as could be and ran to follow them.

R. does not seem to have the same problems with over generalizing that she did a few months ago.  I think the behaviorist was correct to say that increasing R.’s receptive language would help her generalizing abilities.   Sometimes she comes up with the wrong word for something, but it is different, I can usually get her to say the right word with repetition.  But I do have to figure out what she means first.  She was asking for peacock, so I showed her pictures.   Later, I gave her some peas to eat (she likes to eat them frozen out of the bag) and she got all excited saying peacock peacock.   I only had to model the word pea a few times until she started asking for pea instead of peacock.  I also don’t think she exactly understand what it means when someone says ow.  She bopped me on the head with a toy, and then rubbed my head and said ow R.

Just a quick update

Summer vacation is here.   Friday we went to R.s classroom for an end of the year party.  The teacher made a slide show of all the pictures she took all year and showed it to all of us.  The kids liked watching it, but I think they liked the cupcakes more.

We also had our monthly ABA team meeting this week.  We decided to wait until after summer school to start all day potty training.  I’ll admit I kind of pushed for the delay after thinking about it a bit.  We have taken such a slow approach to potty training – we started in November, and she is just now up to sitting for two and half minutes.   It hasn’t even been a week at that length of time.  She was so aversive to sitting at first, and progress has been pretty easy lately.  I think it is worth waiting a few weeks and using that time to gradually work up to the five minutes like we have been doing.

R. never pointed.  In the past year she started pointing at things in books and naming them, and she also started using my finger to point.   Now she is pointing on her own.  Not all the time, but enough to be incredibly useful.  It kind of looks like she’s acting on a stage, her whole body is invested in the pointing motion and she gives me an expression that seems to say -hey I’m pointing pay attention.

Yesterday R. said to me Want chicken.  She won’t each chicken in any form, I could not think of a toy, so I just repeated it back to her with a questioning tone.  Want chicken? Then she said, Want chicken!  Bock bock! So I bocked like a chicken.  What a strange thing to ask for….

Summer of potty training

School ends next week, it seems too soon.   Summer school (ESY) starts two weeks later, it is at a different school.  We will have the same teacher, so that puts my mind at ease.   ESY starts on a Thursday, and they extended the day by fifteen minutes.  I’m guessing that must be some crazy math to limit the number of days of school.

It looks like we will be spending the summer working on actual potty training.  R. can pull her pants and the dreaded pull-up up and down.  She started doing this independently, and she’s quite proud of herself.  I have to thank the ABA supervisor for pushing this.  It has been tedious.  R. has to pull her pants and pull up down and then sit on the toilet for sixty seconds four times in a row.  They started with a full prompt and reduced the prompt in my opinion quicker than usual.  Last week she started doing it all on her own.  They tell her pull your pants down, and then she does.

I never realized just how complicated pulling your pants up can be, we could show her the pulling part, but she figured out on her own that she has to wiggle her butt a bit to get the pants over the pull-up.   I’ve been trying to let her pull her pants up and down on her own, and even when we are in a hurry she “helps”.  She’s trying out her skill on her own, I find her pulling her pajama pants up and down in bed and she is trying to remove pillowcases from pillows.

Today the behaviorist increased the amount of time she is sitting on the toilet to two and a half minutes.   She has not peed on the potty yet, she seems to go in between attempts.  It is kind of obvious that she is holding it.

They want me to start during the two weeks between the end of school and ESY.  I’m supposed to put her in underwear all the time when we are home, and have her sit on the toilet for five minutes every thirty minutes.

We still have to work out the reinforcers.  I have candy saved for when she actually goes (hopefully she will eat it and it won’t get stale first).  We have been giving her reinforcers after she sits.  I’m using some special books she likes and a light up wand.  The behaviorist says that when we go to actual potty training we should not reinforce her for sitting without peeing.   I want to start offering her the books while she sits.  Five minutes is a long time.

A Behavior plan for the ipad

R. is still requesting the ipad, by saying ipad when it is out of sight.  This skill seems to be generalizing, because she is starting to tell me what she wants for other things when she grabs my hand, as opposed to waiting to say it until she leads me to it.

We’re running into some behavior issues regarding the ipad.  I know we need to be consistent so we don’t create a monster.

Issue 1:   She wants all ipad all the time

She is getting kind of obsessed with it, she demands it as soon as she gets up and throughout the day.  I know that she gets this way, fixated on something new and then the novelty wears off.  So I am humoring her a bit, and letting her use it a bit more than I would like.

Set limits for use – times of day and length of use session
I don’t want to go so far as to set a schedule, but I think having specific times of day that we use the ipad, will help with setting limits.   I also make sure she doesn’t spend hours at a time using it.

Give warning with a specific cue for end of ipad time. Offer transitioning help – music on ipad, new activity.
I’ve been giving her warnings, telling her when whatever she is doing is finished we are all done with ipad.   She usually protests, so I will turn on Pandora and tell her only music on the ipad, and I’ll put it out of reach.  It really is best if I have another activity planned and ready, even just coloring or going out.

Be consistent and firm and acknowledge but do not react to her emotional outbursts.
When I’ve decided it is a “no ipad time” I have to make sure not to give in to her pleading. She has never verbally begged like this before, and it is so hard to say no.   She will cry sometimes and get very angry.   At first I was not sure how to react, and she totally picks up on this.  She’ll scream louder once she senses my indecision.  If I am firm and consistent, she gets over it a lot quicker.

Issue 2:   She wants to pick her own apps and they are usually a video or an app she gets stimmy with.

She is not allowed total control of the ipad.  She should say all done when finished with an activity.
We have to totally take charge of the ipad the majority of the time.  We select which apps she plays with, and insist she do at least a part of the activity.   She’ll press the button to exit the app, I’ll stop her until she completes the activity, and then I’ll get her to say All done before going on to something else.

Use preferred activities as a reward.  Tell her first this and then that.
It is usually obvious what she would like to select, so I’ll tell her first do a puzzle and then you can play with the fish pond.   When she spends a long time doing “educational apps”, I’ll let her play around and do what ever she wants for a little while, even it seems stimmy.

Don’t treat the ipad like a drilling machine.  Explore all the different possibilities.
I do try to find things to do that match her mood.  After a day at school and then therapy, she doesn’t always want to write letters in iwrite or anything like that.  But I can usually find something that requires some engagement and interaction on her part, even looking at her photo album, and having me name her classmates and other people in the pics.

Allow her some free time.
We let her do what she likes with the ipad for a little while before dinner.

Issue 3: She wants to use my finger instead of her own to operate the ipad. She has a short attention span at times.

I think these two issues are related, because the more successful she is with an activity, the longer she wants to do it.

Use the easiest apps.
Some apps require less precision than others.  The puzzle pieces go into place if you are in the general vicinity, even iwrite is somewhat forgiving about the lines.   We need to use the easiest apps when prompting her to use her own finger.

Start by letting her use the method she is comfortable with and then physically prompt her to use her own finger.
It seems to go easiest if I allow her to use my finger a couple of times and then say R. do and I’ll physically take her finger and make her do it.   Sometimes she argues and wrestles her hand away, but if I’m insistent she will comply.  I usually have to hold her finger a couple of times, and then I can back off to just putting my hand on her arm.  With some apps she’ll usually go on for a while on her own, but with others she’ll do it on her own for a few times and then I have to go back to letting her use my finger and start over again.  When she can do an activity all on her own she gets so excited and pleased with herself, and she wants to continue doing it.

Have her ask for use of someone’s finger.
I’m going to prompt her to say help, each time she wants to use my finger.  I hope that will eventually help her realize that use of someone else’s finger is not automatic.