She sits

Last Tuesday the supervisor adjusted the potty training program again.  Instead of sitting on my lap, she had R. sit on the toilet ten times for one second.   R. fought the first few tries but by the end, she seemed resigned to do as asked.  A new, never seen Elmo potty training sticker book helped.   I should also mention that she is sitting while wearing her pants and diaper.

She did well all week, and by Friday she was laughing when the therapist sat her on the toilet, like she found the whole thing hilarious.    This week the supervisor extended the time to five seconds.  The therapist places her on the toilet, and she has to sit independently.  We count to five.   That doesn’t seem like a long time, but it is just long enough that she has to willingly decide to sit there on her own.

I’m sure we will have to start over again once her pants and diaper are actually pulled down.  But for the first time I’m actually letting myself imagine what a diaper free life might be like.

Reading material- Art as an EI Tool for Children with Autism

Thanks to the library, I recently read the book  Art as an Early Intervention Tool for Children with Autism by Nicole Martin.   Ms. Martin has a younger brother with autism.  She was trained by a behaviorist as a young adult to work with her brother.  As an adult she is an art therapist working with people on the spectrum.

The first chapter describes autism.   If you are like me and have read tons of autism books, this chapter seems unnecessary.  She does offer good descriptions of scripting (echolalia), perseverating and stimming.   I think my favorite part from this chapter is:  Children with autism hear “no” a lot from adults; helping them find ways to express and develop their talents lets them say “yes” to themselves.

She discusses how humans seem to have a natural tendency towards making art, and reasons that there is no reason to think that people with autism would be any more or less interested in art making then their typical peers.   She also mentions that symptoms of autism such as hyper focus or tactile defensiveness, can make it appear that the individual on the spectrum is not interested.

Ms. Martin outlines what she calls basic assumptions that  she writes need to be understood before using art as an intervention tool.

The adult is not “fixing” a child’s artwork, but using art to “fix” parts of the child that can be best engaged using art

The art itself (the product) is not as important as gaining the self-discovery, experimentation, tactile tolerance and so on (the process) that is required to make it.

Skills such as imagination and creativity are worth rehabilitating in children with autism.

You must believe that creativity can be learned.

The author describes “good scribbling” (focused, contemplative, experimental, sometimes even chaotic) and “bad scribbling” (symptomatic). She provides some really useful illustrations and easy to understand descriptions of children’s art development using the theories of Victor Lowenfeld and Rhoda Kellogg.

The author gives a number of good tips to help a child with autism move beyond scribbling.  She suggests reinforcing any scribbling or attempts at art work, but to give extra praise and reinforcement to attempt that are the best, or exhibit experimentation and variety.

Visual supports are also another tip- drawing a circle or line on the page can help jumpstart a drawing.  When a child puts art tools in their mouth she suggests offering an appropriate chew item. (I can attest that this works).

She also suggests that the parent (or therapist) make art along with the child.  She offers the idea of copying what the child is doing.  I found it really useful that she says the parent should attempt to draw at the child’s level, and to model appropriate scribbling and early drawing.  She mentions that a higher skill level can fascinate and frustrate a child with autism.  This reminds me of what John Holt wrote in How Children Learn, about how children lost interest in activities in which he clearly knew more then they did.

Ms. Martin lists nine autism symptoms and the corresponding artwork characteristics.  It is an interesting way to look at it.  One of the symptoms is sensory issues and the characteristics are – use of materials for self stimulation, tactile defensiveness and art material’s impact on regulation.

She also lists six major goals for children on the spectrum that can be best addressed using art.   One of them is sensory regulation and integration.  She writes Some children on the spectrum get “stuck” in the kinesthetic feeling of using art materials and are slow to move into representational work.    Her suggestions are to become aware of a child’s reactions to different textures and to take control of art activities.  She also suggests activities that create artwork using the entire body like tracing and masks.  I would have liked to read more details about how to work with this.

The author details what she calls tools of the trade, describing paints and other art materials.  And she also gives tips for providing the optimal environment for creating art, what she calls a quality art experience.  She writes An individualized directive with least invasive prompt possible is my personal rule of thumb when working with a child with ASD.  She gives a very good and detailed description of prompt hierarchy, and shows her knowlege of ABA with suggestions for problem behaviors and reinforcements.

Reference: Art as An Early Intervention Tool for Children with Autism by Nicole Martin, (Jessica Kingsley Publishers, 2009) Pages 25, 30, 31, 41, 59, 73, 113

Echolalia is kind of cool for now

R.’s talking is about the same.  We’re hearing a few more spontaneous words.  She’s saying uh oh and oh with a variety of inflections in response to things, and we’re hearing yeah and no more often.

Mostly though she is repeating what we are saying.  In a few months I may be frustrated  with this, but now I think it is quite awesome.  It means that she will say hi and bye to people if they say it first, and she’s paying attention.   I’m discovering that there are so many kinds of games to play where I get her to repeat what I’m saying.  I’ll give her stuffed animals one by one, getting her to repeat duck or whatever.  We’re actually playing with flash cards.

E. is much sillier with her and they play these games echoing babble phrases.  He touches his forehead to hers and says “bonk” and she says bonk and they play a head bopping game.  I’ve been trying to put a stop to this game, imagining her head butting one of her class mates.   But I think I end up sounding like a control freak because they are having fun.

Right before Christmas vacation the behaviorist said she was not doing as well with two word mands, they are working on want book, want ball.   She suggested I work on it over vacation.  I did and did not have much luck with any mand that started with want, she would just repeat the last word.  She would however repeat two words for requests like lights on, socks off and that kind of thing.  I also noticed that over vacation her response seemed to be a little slower, I had to work a little harder at prompting.   I was wondering if I was seeing a regression.  Monday when she came home from school she was back to responding to a verbal prompt almost instantly and it has been that way all week.   I can’t help but wonder if this is a part of having vacations or if we could be doing something else.

She also has new sounds.  Her screaming has become more dramatic.  She has this new angry, tearless scream that is so loud and high pitched, it must get the attention of all the dogs in our neighborhood.   No one told me that her voice could get louder.   She also has a new happy sound, I guess it is really a vocal stim.  She sounds like Arnold Horshack’s little sister.   She makes this sound and runs around grinning and being mischievous.

What ever it takes

We are in the beginning stages of potty training, it is like we are in the training for potty training stage.    Starting in November, we spent several weeks just taking R. into the bathroom at the end of her daily ABA session.

The supervisor decided that the next step was to get R. to lift the lid of the toilet seat.  She wrote the program so that R. was supposed to open and close the toilet seat lid ten times in a row.   I stepped in immediately and said no way are you having her do that ten times in a row.  I mean talk about teaching a repetitive behavior.   It did not take too long for R. to master lifting the toilet seat lid once.

Sitting on the toilet is a problem for R., she does not want to do it at all.   If I want to get her out of the bathroom all I have to do is suggest she have a seat on the potty. (Maybe I should stop doing that).   The supervisor’s suggestion for the next step, is to have me sit on the toilet and put her on my lap for 30 seconds.    I did mention that this happens during R.’s ABA session.

So yesterday here I am in the bathroom sitting on the toilet with R in my lap, her male therapist watching and counting.   Counting out loud to 30 was the only way to get her to stop screaming and fighting.   To his credit, the therapist did not seem the least bit embarrassed or flustered.     I’m just going to have to get over it.

Christmas vacation is over

The bus came five minutes early this morning.  That was right on time as far as I was concerned.  R. seemed just as happy to go as I was.   I think she had a good vacation.  We had some minor meltdowns, and she’s been a little stimmy, but generally in a good mood.

We had a chance to go to a tot gym that we used to go to regularly.   She remembered as soon as we got into the parking lot and held my hand and ran into the place.   I think we probably hovered a little too closely, she did not get into much trouble at all.  She used to just run around all excited and crash into kids.  She did not crash into one person, and I even saw her stop herself so she wouldn’t knock into another child.   She spent some time following these two little girls, I’m guessing were close to her age.  They were playing with those sticks with horse heads on them, I can’t think of what they are called.  She finally worked up the courage to grab one, and as I was about to intercept one of the girls handed her one.  They had an extra.  Of course she did not know what to do with it.  But that scene could have ended with a meltdown and two girls getting bopped on the head.

She also spent quite a while in the bouncy house.  A few small boys were in there.  One of them kept knocking all the other kids over, R. included.  She thought this was hilarious, and let him knock her over many times.  She also let a small boy, probably under two crawl all over her.   Part of me kind of hates those bouncy houses.  I never know what is going to happen, and it’s not easy to go in there after her.   She really likes them, and she’s starting to learn to get out of the way so it is easier.

I got my fill of bouncy houses, we also went to a party playhouse which is basically a giant bouncy house with several levels,  slides and ball pits.   She played for a while, but then wanted a drink and had a meltdown when she could not bring her cup into the play area.  She let me put her shoes on and was fine once we got to the car.  It was getting really crowded, so I’m sure she was overstimulated.

Conquering the library

About a year and a half ago we were at a playground with one of R.’s ABA therapists during EI.  There was a library having a story time in one of the rec rooms and R. was fascinated by the singing.  She went in and only wanted to run loops around the room.   The librarian told me that if she could not sit, we had to leave.  I attempted to hold her in my lap and of course she screamed.  The librarian told us to leave.

I’ve had this irrational fear of bringing R. to the library ever since.  When she started school last March I was able to start going to the library regularly by myself.   Over the summer I started by putting her in the stroller and just walking into the library to drop off books and then leaving.  I gradually increased the time, and now I can usually take her to the library for 10-20 minutes and actually spend a little time choosing books or DVDs and then check them out.

During Christmas vacation we have been able to actually use the library as an outing.  She is happy to be wheeled around the library and then will play with the toys.  I’ve had a little problem with her screaming about books, so I’ve been careful to only let her look at one at a time, and if she screams we leave instantly.

One day we showed up at the library and story time was already in progress.   She seemed interested and happy in the stroller so we stayed.  She sat through the remainder of story time- about half an hour.  She did have her fingers in her ears the entire time, but she did not complain at all.  The rest of the day she sang Old McDonald, one of the songs they sang.

The main city library was advertising a special Christmas train display in the children’s area.  They have a very nice and large children’s area, and we’ve been talking about taking R, so we went.    There were three trains on separate tracks, Thomas the Train, the Polar Express train and the Hogwarts train.  They were in an enclosed case and there were buttons on the front to control each train.   I have to admit I was bored in about two minutes, but E. and R. spent fifteen minutes watching and pushing the buttons.   We took her to the children’s area and she actually asked to get out of the stroller.   The play area was nearly empty and she played for quite a while.   We walked around another floor of the library and R. sang read read read over and over again.  That is from the Pirates who love to read song on the Elmo and the Bookaneers DVD.

Happy New Year

I’ve been thinking back on the past year.  2010 was long and eventful.  It’s funny how things seem so different and yet also the same.  I was looking through pictures and I found two that really illustrate this for me.

Jumping at Home - Jan. 2010

Jumping at School - Oct. 2010

Another Christmas gone by

We made it through Christmas 2010.    R. doesn’t really understand the concept of wrapped presents.   I ended up opening most of them, she kept going back to the toys she already opened.  But she definitely enjoyed getting a stash of new toys, she was giggling and saying yay a lot.   She also collected everything on the dining room table, like she needed to take inventory and guard it from being taken.

She really loves these Caring Corners furniture sets.   I see a doll house in our future.   I’m really impressed with these sets, one came with a doll (Mom I guess), a bed with an attached blanket, a nightstand with a working lamp (she loves this) a cat, a stool and a book.  The doll can hold the book if it is sitting, and once I did this, R must have asked me to do it 100 more times over the last day.  The other set has a doll (the daughter), present, pinata and a table with a birthday cake on one side and you can flip it over and there’s pizza on the other side.  Each side has two little triangular pieces of cake or pizza that can snap onto the plates on the table or into the pizza or cake itself.  R. was kind of frustrated at first that these pieces did not come off completely.  But now she is used to it and seems to like to fit the slices in like a puzzle.

Ernie tries the new cake table

She also likes the Fisher Price Flip Flop Egg Drop toy.  I have to thank Shannon De Rosa for the suggestion.    R. hasn’t figured it all out yet, but she is captivated.  It is a little tricky.  You have to line the egg up with the hole for each egg, and there are three levels one has a wheel, one a push and pull lever and one turns.  You can flip it over and do it again.   At the top there is a chicken (or a duck?) that comes out when you turn a wheel.  I think this will be around our house for years.  It is good for fine motor skills, problem solving and it is kind of stimmy watching and listening to those eggs.

This wasn’t exactly a Christmas present, but I bought a small plastic cabinet with three drawers.   R. has been really into opening drawers lately, and she has a growing assortment of play food and dishes.  So I filled the drawers with the food related items and she just loves it.

I’m Stylish?

Kathleen at Kicking Kittens gave me this award.  It’s hard to imagine being stylish, so I’ll have to assume it is referring to the font I chose.  Thank you Kathleen, this is my blog’s first award.

I’m supposed to list seven things about myself, so here goes.

I like to watch Science Fiction shows and movies.  I still like to read, but I don’t as much as I used to.  I miss Battlestar Galactica and Lost.   I’ll even watch those disaster movies on SyFy.  You know the ones where the main character is a scientist who discovers the impending disaster and then manages to lose his child on the other size of a giant chasm or lava flow.  I usually start talking to the main character about half way through and telling him he better not solve everything with a nuclear bomb.  Most of the time he does and I’m kind of annoyed about it.  I do wish they would make a movie of the story When Sys Admins Ruled the Earth.

Years ago, before getting married and having a child, I played bass in a metal band.  Back in the 80’s I had big hair and clothes that don’t need describing.  But most of my band years were in a thrash metal band.  I don’t miss dealing with band members or any of that, but lately I miss playing.

I’m really bothered by one line in If You are Happy if You Know It.  It is the one – If you are happy and you know it stomp your feet.  Who stomps their feet when they are happy?  It seemed like every therapist during EI sang this song.  Now maybe it is just me, but I spend a lot of time telling my daughter things like when you are angry you can…  And this song is just confusing the issue.   Where do I write to complain?

We have a cat who is 19 and senile.   As soon as R goes to school in the morning or to bed at night, the cat is right there looking for attention.  I’m not sure the cat really understands that R. is a person.   Although this week I caught the cat meowing at R. for the first time.  R. said Hi to her, which was more pleasing to me than the cat.

I really hate weeding.  Here the weeds grow all year long.  So over the last couple of years we’ve been changing all the plants to succulents and putting in rocks.   It is really helping with the weed situation, and we hardly have to water at all.  My favorite succulent is the Aeonium.  They are so pretty and interesting to watch grow.

I started volunteering at our local Support for SN families office.  I’m just answering the phones and doing whatever admin work they throw my way.  I’m also training to become one of their Parent Mentors.    The classes are really amazing – it is a combination of special ed law and all of the individual experiences of the parents involved.   I’ve learned so much already.

I think I’m the only person on the planet who doesn’t like wine.  It tastes like rotten juice to me, and I don’t like juice either.

I get to choose three blogs to pass this award on to.  It is hard to decide, kind of like picking three chocolates out of a box.

Anybody Want a Peanut

Professor Mother Blog

Wildeman’s Words

Encouraging Communication – What’s working Part 2

Play skills are directly related to communication abilities.

One of the first things that our first ST told me was that developing play skills is crucial for early communication.   I would like to understand the hows and whys better, but I have seen that as R.’s play skills increase so does her ability to communicate.
In the beginning I felt like I should always be working on something with her.  I’d talk to her constantly, follow her around reading books, doing all kinds of things that did not hold her interest.   One afternoon I just started with what she would like to do – I chased her, and she loved it, she engaged with me and was smiling and laughing.  I realized that although it did not seem to have anything to do with encouraging her to talk, our play was a step in the right direction.

R. like many children on the spectrum only engaged in exploratory play.  She would shake, hit, throw, mouth and examine toys.  Sometimes she would line them up.  I hosted a playgroup for a typical Mom’s group before R. turned two.  I did not know about the autism yet, but I knew R. did not play like other kids.  A baby who wasn’t even walking yet crawled over to the toy box, found a car and proceeded to drive it across the carpet.   His older sister put a doll in a play stroller, flung a play purse over her arm and said she was going out.  R. spent most of the time rolling around under the dining room table.

It is hard to figure out how to play with someone who doesn’t seem to want to play with you. When that person is your child, it can be even harder.  I had to realize that any kind of interaction was the goal, and any activity that she found enjoyable was worth pursuing.  I did not need to worry about if the activity was educational or appropriate or anything else.

Activities that require me or another adult’s participation were (and are) the easiest to engage R.   We still play “baby games” like peek-a-boo, chasing, tickles and raspberries.  In the beginning one of the few sure fire ways to engage her  was to let her knock over a tower of blocks that I stacked, she would do this over and over.   Bubbles, wind up toys, even a whoopie cushion all got her attention and made her want more of the activity.  The ABA therapists are really good at coming up with their own silly games.

A couple of silly games we are playing now- R. will lead me to a computer chair with wheels , I’ll prompt her to say come, and when she wants me to sit, I’ll verbally prompt her to say sit.  She will then climb in my lap, say ready, set go and then I have to give her a chair ride.   A variation of this is that she will lead me up the stairs, I’ll prompt her to say come and then up.  She then pulls me to sit down on the top step, and I’ll prompt sit.   She’ll climb in my lap and say down- again she wants a ride.  I’ll make her say down for every step.   With games like this that are consistent, she seems to be able to say a spontaneous word for the start of a desired activity  (ABA calls this manding) more consistently.  So she will say ready set go, or down with no prompt most of the time, but the lead in words -come, sit, still require verbal prompting the majority of the time.

I keep some toys out of reach, and some are in boxes or bags that she can’t always open, so she has to ask for them.  During EI, R. had a program that was just the therapists demonstrating different things to do with toys and taking data on her interest level and attention span.   I try to come up with interesting and different things to do with her toys, so she will ask me to repeat the activity.

Floortime talks about joining in a child’s play, and this is a good way to engage R. when she is perseverating or just on her own agenda.  When we started, one of her favorite activities was to carry all of something, like blocks or stuffed animals one or two at a time from one side of the house to another.  I would get in the way and hand her the animal or whatever, and just insert myself into her game.  I would also mess up her pile, which sometimes annoyed her, but hey I got her attention.

I think the reason that children on the spectrum are limited in their play is because they literally have difficulties imagining anything else to do.   It seems to me that the repetitive nature of her play was (and is) comforting to her.   Most people have an easier time in most situations if they have some idea about what is going to happen.  Perhaps for R. it is that she can not even conceive of a unique situation until she has seen it, and often she might need to see it several times.   If I pick up R. in the kitchen and run or spin her or do something fun, she will hand lead me back to the exact same spot to repeat the activity.  It doesn’t occur to her that I could do this anywhere, until I show her.

Thinking about pretend/symbolic play it makes sense that children on the spectrum would have difficulties in this area.  Why is symbolic play so significant?  I wondered this after our diagnosis, and I’m probably not the only one.   Symbolic play is essentially how she is perceiving and reenacting her experiences.   I think that when R. did not have any symbolic play skills, she also did not have much knowledge about or ability to manipulate her environment.   As R.’s symbolic play increases so does her expressive and receptive language abilities.  I think in the wait for spoken words, I kind of forget about receptive language.  It is so amazing to get responses to things I say, that tells me that not only is she understanding me, she can imagine and conceive of a familiar situation she is not experiencing at that moment.

As an example, We went to Home Depot recently, and as soon as we pulled into the parking lot R. started to cry.  It was clear she did not want to go.  A year ago she would not have even noticed where we were until we were in the store.  She could see the store and imagine (I’m guessing here) the last time we went.  She did not cry the last time, but we had been there the day before, so I’m sure she was tired of it.  I told her that Daddy would go to Home Depot and she and I would go get a cookie at the bakery.  I repeated this a few times and she stopped crying and she even said cookie a couple of times as she climbed into the stroller.

I think it has been the most difficult to encourage pretend play as opposed to other kinds of play.  Probably because I have a tendency to over think it.   R. really liked to set up toys on the dining room table, so it seems like a natural thing to encourage her to set the table with play dishes and food and have her dolls eat and drink.  She will set the table, feed and give drinks to her dolls (mostly Elmo and company).   She will try hats on Elmo or Ernie and she is starting to try out things that aren’t actually hats.  This is a great improvement over a year ago when this kind of play was non-existent.  But her symbolic play skills are still very much in the beginning stages.    She’ll brush Ernie’s hair for a few minutes and then go on to something else.  I’m not seeing many complex scenes acted out.  It is not always easy to interpret what she means by what she is doing.  When we are out she’ll have Elmo and Ernie try out things, she’ll dangle them over the side of the shopping cart and she will be babbling in a conversational tone the entire time.

I set up different play scenarios and I try to mix up the locations and how they are set up, so she doesn’t become too fixed on one way.   I also try to jump in and make her play sessions a little longer.  She will put a doll to sleep and I’ll pick her up and make her tell R. that she doesn’t want to go to sleep.  Or when she removes the doll’s clothes I’ll have the doll complain that she is cold.  R. is becoming very receptive to me playing like this.  She smiles and is very engaged and will give me items to use to play.