Looking to youtube for inspiration

R. really likes to watch videos on youtube on the ipad.   She can pick videos from her history, the favorites or subscriptions. (I subscribed to Sesame Street.)  She also seems to remember how to find particular videos by looking at the choices that come up when a video is chosen.  It looks like she is just watching a video for a second and then going on to another one, but it usually means she is looking for something.

When she started summer school at a different school she kept watching this video about riding the bus 40 blocks from home.   When we started potty training she was finding all these Elmo potty videos.  She does tend to like to watch a video over and over, not for an hour, but five or six times.

I’ve been trying to see how I can work with her interest in these videos.  The obvious way is to sing the songs.  She does like this, and will sing along and request that I sing them now.  She also likes it when I change the words and add her name.  She never seemed to notice before.

R. likes counting videos, for a while she was watching ones with Count and his counting organ.   I started using her Count doll to count things and this is now a regular game.  Mostly she wants me to count the pieces of her play birthday cake.  I have to hold up the Count doll and have him count and touch each piece, and I can’t forget the ah ah ah at the end either.   She is starting to do it herself, so we can take turns.

Another video she watches often is an old Sesame Street cartoon – Number 9 martian cutie.   The artwork is simple enough I actually managed to draw it and boy was R. impressed.    She asks me to draw it over and over.  I will only draw one part at a time, she has to tell me to continue.  She usually taps me and then I prompt the word. Since the martian has nine hairs, eyes and other parts we are closing dozens of circles every time I draw one.  She also likes it when I hold her hand and draw it with her.   I’ve been backing off and getting her to at least draw the hair and arms (just lines) with just a prompt at her elbow.  She is so proud of herself.

If that crafting gene I’ve been waiting for all my life ever kicks in, maybe I can think of some way to make the martian in 3D with glue and stuff.

Her favorite dvd right now is Elmo’s Christmas Countdown.  She’s been watching this video from that dvd of two actors from the Soprano’s playing Bert and Ernie.   I tried acting out the videos with her Bert and Ernie dolls, but she was a little too entertained by sticking things in my ear.  I don’t think I should encourage that.

I found a stuffed gingerbread man and woman a relative gave her a while back, so I’ve been playing you’ve got a gingerbread man on your (or my) head.  It is usually good for some laughs, but it doesn’t keep her engaged as long as drawing martians.

I think her favorite part is when they yell gingerbread man, because I hear her saying that and she loves it when I say it.    I dug out some Christmas books and we look through them and yell gingerbread man when we find one.   I also printed out gingerbread men from the web and placed them around the house.  She doesn’t quite get the idea of hunting for them, but she enjoys finding them and yelling gingerbread man with me.   I should try drawing them with her, but I think I’d need a stencil or something.

Any easy crafty suggestions are welcome.

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.

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.

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.

Encouraging Communication-What’s working Part 1

Find an alternative communication method.
We used PECS (Picture Exchange Communication System) with R.  We were fortunate that our ABA provider made all the icons and set up the binders.  We used a combination of the standard icons and actual photographs.  We started hand over hand and offered preferred items.    In the beginning the therapists would put her trampoline against the wall and she would have to hand over the icon for the trampoline to get them to put it down so she could play with it.   We keep two PECS books around the house,  one for food and the other for activities.  R. does not use them as much as she used to, I think she really understands it is easier to be prompted to say the word than retrieve the icon, but she will occasionally go back to them and bring us one of the cards.

Sign language is another option.  R. did not have the imitation skills when we began, so this really was not a good fit for us.  I have met other children with ASD who are as adept with signing as R. is with PECS.  One advantage to signing is that you don’t have to bring your PECS book everywhere and keep track of all of those icons.

Our former program director would talk about PECS enabling R. to learn the power of communication. It really is not possible to physically prompt a child to speak, but both of these methods can be physically prompted.  The advantage of being able to physically prompt the correct response, in ABA speak is errorless learning.  The prompt level will be gradually decreased.  When R. started using PECS the prompt was to hand over hand help her remove the icon and hand it over.   After a while the only prompt she needed was for us to show her the PECS book.

Several family members asked me if R.’s using PECS was going to delay her ability to speak.  They were concerned that it appeared easy for her, and she would become reliant upon the method.  I think PECS is what enabled R. to get to the point she is now with speaking.   She was not at the developmental point to be able to access language, but she was able to be taught how to communicate.  NT infants and toddlers in the pre-verbal stage are becoming experts at non-verbal communication,  R. needed to develop these skills before she could speak.  PECS enabled her to have the benefit of being able to communicate at her developmental level.

The ipad and other devices will be opening up new worlds in alternative communication for children on the spectrum.

Don’t reward crying/tantrums

Crying and tantrums are a form of communication.   They were R.’s main method when we started on this journey.  ABA was very helpful in teaching me that I should not give her what she wants when she cries, I should prompt her to communicate her wants.  I wrote about this a few months ago. I’ve read discussions on different ASD boards that describe this method as not acknowledging or ignoring crying/tantrums, and I think this is an incorrect interpretation.   Crying should be acknowledged for what it is, a complaint.  The message I want to send R. is that, I hear you, you are upset, but if you want whatever it is you have to say a word or give me an icon.  Crying may get my attention, but only communication is going to get you what you want.
At this point I can usually prompt R. to say a word if she is crying for something she wants.  This actually happens rarely, because most of the time she will start with a gestural communication (hand leading) and then will either say or be prompted to say what she wants.  But sometimes she can’t have what she wants, or she has to wait and then she will cry.  This is probably more accurately described as a complaint, she usually has no tears and there is babble and sometimes words among the yells.  I also try to explain why she can’t have what she wants and offer an alternative.  So if she’s crying because she’s impatient for the popcorn to finish in the microwave, I can show her the bag that is popping, the countdown timer and say we have to wait.   It’s always harder if it is something she can’t have, but it is getting so much better.  So if she is crying because she wants to go outside, I can tell her it is too late to go out and offer something else to do.  I’m still in awe every time this works.

Consider that communication is more than just words.
Shortly after we started ABA, R. began hand leading.  I realize now this is quite common among children with ASD.  At the time it seemed quite amazing, and now it is so much a part of how she communicates.  Prior to any gestural communication it seemed her only method of communicating was by crying or with a look or expression .   The first programs that ABA started with were what they called anticipation games.  They would do something she liked – tickles, spins, bubbles… and then wait for her to look at them to repeat it.    It wasn’t long before she would gesture by grabbing their hand to continue the activity.     These play activities taught R. that people could do fun things if she communicated.

In the book The Special Needs Child by Dr. Stanley Greenspan, he writes about closing circles of communication.   If I tickle her and she looked at me to continue, that would be one circle of communication.  I really liked this concept because it gave me a sense of actually doing something using skills she already had.    It still feels like a game to see if I can get her to close just another circle or two.   Floortime lite Mama writes about Floortime as a lifestyle, and that is how we do things around here.

Wonderful, wonderful trampoline

We were lucky that our former speech therapist found a trampoline on her street. None of her other families needed it so she gave it to us. It really helped during her long days of in home therapy. She had an outlet for her energy and the jumping helps to regulate her senses. I never thought about all the different ways that a trampoline could be used until one became part of our household.

Of course she can jump on a trampoline. She can jump barefoot, wearing shoes and socks, or just socks or even fuzzy socks. She can land on her feet, crash onto her knees or bottom. She’s not ready for hopping or fancy footwork, but sometimes I’ll catch her leaving toys on the trampoline and jumping around them. Sometimes she likes it if we hold her hands while she jumps -she gets even stronger stimulation. I will put a fuzzy body pillow on the trampoline and she will crash onto it. She came up with the idea of piling up all her stuffed animals on it and then crashing and rolling.

The therapists always called this game popcorn. We will place small toys on the trampoline and bounce them from underneath. She loves this, especially when the pieces go high and fly off onto the floor. She will collect them all and set them up in the middle of the trampoline, even standing them up if it is possible. We have used rubber ducks, small plastic animals, little people, letters, legos, pegs – almost anything will work. I always say ready set or one, two and she will fill in go or three. She’s starting to say all three words when she wants me to do it again.

When we were first teaching R. to use PECS, we would put the trampoline up against the wall and leave the trampoline icon where she could reach it. She really wanted to play on it so this worked really well.

We also use the trampoline as a table/platform. She will set up her dishes and cups on the trampoline although lately she prefers the dining room table. She will bring toys and sit on the trampoline on her own to play. It is also a great place to bounce balls and test the bounce-ability of objects. We also roll balls, spin tops and send cars racing across it.

The evolution of fake snoring

Some relatives were visiting over Christmas last year and they have kids near R.’s age.  I can’t even remember the context, but the older boy pretended to sleep, complete with fake snoring a couple of times.   After they were gone R. started doing it!  She would lie down on the floor and snore and kind of grin.   She did it once in a while, but it wasn’t predictable and I couldn’t get her to do it by playing with her dolls or stuffed animals.

One day I told her I was very tired and faked a dramatic stretch and yawn, and abruptly “fell asleep”, snoring loudly with my head on her shoulder.  Of course she pushed me away and I sat up dramatically saying Ooooh you woke me up.  After just a couple of times she started pulling my head down to do it again.    This became a regular game to play.  Shortly after we started playing the game, we were shopping in Target.  R. is happily sitting in the cart and she starts making snoring sounds.  I’ll admit, I kind of ignored her, wanting to finish shopping.  She persisted in snoring and started pulling my head down.  So there I was taking a “nap” while walking through the store.

Lately I’ve been seeing her incorporating the snoring into different but similar games.  She acts out the game with her stuffed animals.  She puts her dolls to “sleep” on a blanket and invites me to come and sleep, really she wants me to snore.  But we can play the snoring game and then I can wake up each of the dolls and she’ll put them back to sleep.  She will snore when she lies down on the floor, and sometimes it means she is genuinely tired and other times she wants me to “wake her up” .