Observing motor group and recess

We went to R.’s school today to observe motor group and recess.  She was excited that we drove her and went into her classroom.

The motor group happens once a week and it is run by an OT and a PT.  It is only half an hour but they do many things.  They started by sitting in a circle and passing a ball back and forth.  They did yoga poses, R. was mostly resistant.  Which did not surprise me, but I have seen her doing some of those poses at home.  Then the kids sat on scooter boards and had to cross the room and match a colored bean bag to a colored mat.  R. can actually do this now, she was aversive to the scooter board at the beginning of the school year.   Next was an obstacle course which included jumping on a trampoline, rolling down a wedge mat, climbing an A frame ladder (something else she would not do at the beginning of the year), walking a low balance beam and throwing bean bags into a hoop.

As if that wasn’t enough, they did fine motor tasks at a table.  Each of the kids seemed to be working on different things.  R. had to use tongs to pick up tiny discs that the OT was holding in different positions, and then she had to put the discs into a cup that the OT kept moving.   She did this really well.  I definitely got the impression R. likes the fine motor portion of motor group best.

Then we went with them to recess.  I watched her line up with her back against the wall with the other kids when instructed. She held on to the teacher’s rope thing with her classmates to walk to the school playground.   She was super excited to have us with her, she was jumping up and down and smiling, and she dragged me all over the playground, showing me around I guess.

There’s a typical preschool at the school, and a steady stream of classes came in and out.  All the teachers seemed to know each other and all the kids, which was nice.
She was a little overwhelmed when there were lots of rowdy kids running around her, but she was also really interested in them – running away and coming back for another look.  She wanted to join a group of typical kids and one of her classmates playing ball in a circle with their teacher.  So I sat with her and helped her play.  She stayed with it for almost ten minutes.   She really wanted to play at the water table, but the rule is that the kids have to wear a smock and she will not wear one.  She did not cry, it was obvious she is familiar with the rules.

The teacher said she is going to work on creating and teaching R. and other students specific play scripts to use with the typical kids.   I think that sounds like a good idea.  I hate to generalize like this, but it really seemed like most of the typical kids would do anything the teachers suggest if it is fun and gave them some attention.

Made it through the IEP meeting

I survived R.’s second annual IEP meeting.   I don’t have a copy of the final IEP yet, they are still working on it.  The meeting lasted two and a half hours, the time flew by until the last 30 minutes or so.

The most exciting thing to me is that R. is now going to be getting OT.   In addition to the class fine/gross motor group, she will get individual therapy – 30 minutes a week.  Our school district works on what they call a 3:1 delivery model for direct therapies like OT and ST.  This means that the students get therapy three weeks a month and the therapists work on consultations and preparation.   I was expecting to maybe get just the 30 minutes of consultation.  I still have to decipher the OT assessment, I’m sure I’ll write more on this.

Currently R. gets ST twice a week, once individual and once in group.  She is not taken out of class, and at this point I do not want her to be removed.  The ST works with her individually in the classroom.  The ST said that to work on R.’s turn taking and peer related goals she would bring another student into the individual session.  It sounded to me like she wanted to change the IEP to be twice a week of group therapy.  I told her that I did not have a problem with her doing what she described, but I did not want to change the wording in the IEP.  I said that next year I might want R. to be removed from class for ST, and this would leave things in place for that.   She gave me the strangest smile and agreed.

Last year at our first IEP I really fought for that individual session.  At this point I think it probably is better for R. to have peers involved in ST.   I don’t want that written into the IEP, because I don’t know that it will be the best way in the future.  At least I have that option to push for the individual session to be one on one if it seems necessary.

R.’s ABA was continued at the same level of hours until her next annual IEP.   Last year they gave her six months of ABA with a required addendum IEP meeting to renew.  I did not think they would reduce hours or discontinue service, but you never know.  It is a relief to not have to worry about that for a year.

This is the first IEP meeting where everyone who attended really knew R.  Even the general ed teacher knew R.   She did not stay for the entire time (I gave permission for her to leave, technically I could have refused, but there was no reason to.).  She did give some input about activities that could be done on the playground to help with turn taking and peer related goals.

Everyone was positive and had a lot to say about progress.  When she started preschool last March she was non-verbal and reliant upon PECS.  She was not compliant, was aversive to a visual schedule (despite using one at home).  While she is not talking as much at school as at home, she is definitely able to repeat words and has some spontaneous speech.  She complies with simple instructions, she will stop doing something or take her hands off.   She uses the visual schedule, can pick her name out and transition from activity to activity.

The teacher, gen ed teacher, OT and ST all said that R. really enjoys being with the other kids in her class and in the other classes.  The OT said she thinks R. prefers to do activities with her classmates than one on one with her.

I actually learned some things R. can do at school that I have not seen at home – she hangs up her backpack and jacket after removing them.  (I’ve only seen the removing.)  She can wipe a table with a cloth.  That gives me so many possibilities, starting with window washing this afternoon!

She can pick her name out of a field of ten, and the OT thinks she can write the letters in her name with assistance.   They added goals related to handwriting, letter, number and symbol recognition, and one to one correspondence.  Basically all the academic goals I thought should be added.   I asked about a counting goal and they said they thought she could count and they did not see a need for a goal regarding she could already do.

They did make the change to make the goal I wrote about into two goals.  One goal for initiating with peers and another for adults.  I also asked them to add the qualification in a familiar situation, so that if this gets mastered we can track if she can do this in a unique situation.   I also asked about a waiting goal and the teacher said that from her perspective she was happy with R.’s ability to wait.  She described how R. would line up against the wall with the other students and look at books while waiting.

She made progress on all of her goals except drinking from a straw and using utensils.   The OT really wants to work on using a fork.   I suggested that they we try using the fork as a play utensil, picking up putty or something she knows she does not have to eat.

I also saw the new temporary classroom.  The teacher said that R. transitioned to the new room without a problem.   It is smaller, they had to put the class trampoline in the hallway, much to the delight of students in all the other classes.

Fun and changes at preschool

R.’s teacher has been able to get some new items for the class using Donor’s Choose.  A light table is one new addition.  I’m surprised how much fun the kids have.  R. made the design on the table, whatever it is.

There is construction going on at R.’s school.  Her classroom is being renovated so on Monday the class will be in a different classroom for two to three months.  I was able to see the classroom while it was still inhabited by another teacher and class (who knows where they are going).  It is smaller and darker than R’s old classroom, and it has two doors.   The teacher assured me that she would have alarms on the doors, like she had with the one door they had before.   She is very good at getting what she needs, but I know the move is stressing her out.

The classrooms are old at the school.  I’m told it has been forty years since the last renovation.  I’m glad that they will eventually get brand new classrooms, but it bugs me that the teacher has to be bothered with a move twice in one school year, I know it must take her energy and attention away from teaching.

I went in and helped with packing up some of the classroom, and I’ve offered any other assistance she might need.   I’m sure it is going to be a tough time on Monday morning, getting all of the kids to go to a new classroom.  I can imagine R. pulling and yelling to go to the place she has gone every morning for almost a year.

January ABA team meeting

We had our monthly meeting today with the ABA team.  One of my concerns is that R. is over generalizing the mand, want book.  She is saying want book for nearly everything she wants.   The supervisor thought that this was typical for R, and she’s right. R. does have a tendency to over generalize specific mands when they are first learned.  She also said that they are working on an object identification program that will help R. increase her vocabulary, and this should help.

R. will come to me and say want book, while she hand leads me to what she wants, which is rarely a book.  If she wants a cookie, I’ll say want cookie and she will only repeat the word cookie.  I know it is common for children with autism to repeat just the last word.  I do find I can get R. to repeat two word requests when they don’t contain the word want.

We discussed this for quite a while.   They suggested that when she says want book, we should give her a book, even if we know that is not what she wants.  Then when she refuses the book we should prompt her to say the correct mand.  We decided that we should limit our use of want, okay I pushed for this, but it wasn’t hard to get them to agree.    So instead of want cookie, I’ll say eat cookie, instead of want water I’ll say drink water, instead of want open, I’ll say open door.    They modified their mand program so they will work on eat cookie, play ball and want doll.

R. has started saying Hi spontaneously, mostly to inanimate objects.    She was cold so I put a sweater on her, she looked at it and said Hi, with the most joyous, glad to see you tone.  She said Hi to the water in her shower, to the box of cookies, to the new straw I put in her cup, always with that pleased as can be tone in her voice.   The behaviorist and supervisor thought this was a little weird, but cute.  The therapists said they thought it was typical behavior for  an early talker.

They are increasing R.’s sitting on the toilet to twenty seconds, up from ten seconds this week and last.  Her pants are still on while she is sitting.  We discussed the fact that she needs to sit for the entire twenty seconds with out any prompting.  They are giving her a reinforcer after sitting, and they wondered if they should give her the reinforcer while sitting.  I said that I would like to keep reinforcing her after sitting, until we get to her sitting with her pants down.   Then when we switch to pulling her pants down, she’ll also have the addition of a reinforcer while she is sitting.  They agreed.

R. has been doing jigsaw puzzles with the image on the background, so it is really matching.  They are going to start doing the same puzzles without the background.  I’ve been doing a jigsaw puzzle with her lately with no background, and she is starting to get it.   I think she has memorized the picture, but that is okay, at least she finds it interesting.   She’s bored with her insert puzzles, so I’m looking for other activities like that.  It’s like it needs to be a little challenging, but not too easy or difficult.

They are working on a new tracing program.  R. is supposed to trace a dotted horizontal line.  She needs a little bit of a prompt but she seems to like doing this.   I know she likes to have me hold her hand and we do dot to dots or write the alphabet.  The behaviorist wants me to stop doing that until she gets further along in this program.   It bugs me a little, but I do get where she is coming from.  We’ll do more coloring.

I finally asked about being provided a list, even a short one of activities that we could do with R. on days off and sick days.  She seems to be bored and looking for more to do on those days.   They said they could give me a list of the programs that were on maintenance, and seemed to think it was a good suggestion.

One of our therapists is leaving, Friday is his last day.   It happens all the time, but it always makes me a little sad, and he says he is too.  R. really loves him, I hear them both laughing throughout their sessions.

Gearing up for the annual IEP meeting

I confirmed the date for R’s annual IEP meeting.  We had an addendum IEP in October,  but this will be the first IEP with all of the current team present.  At next year’s  annual IEP meeting the decision will be made regarding kindergarten placement.  I feel kind of pressured to make sure that as many skills that she could possibly attain in regards to that transition are included now as opposed to then.

R.’s teacher and the general education preschool teacher have made changes to add mainstreaming and reverse mainstreaming opportunities during specific parts of the school day.  They are already integrated for all of their recess time.   Currently on her IEP, in the notes section, detailing the placement, it says there are opportunities for mainstreaming and reverse mainstreaming per teacher discretion.  I’m thinking of adding a specific goal related to mainstreaming, but I haven’t converted my thoughts into IEP-speak yet.

One of the things I’m learning from the classes I am taking is how to look at goals and see if they are attainable and measurable.  There’s a goal on R.’s IEP, under Developmental Skills R. will initiate with familiar adults or peers using appropriate eye gaze, body position, gestures or words as implemented by the Special education teacher, SPED staff, parents. It seems to me now, that initiating with adults and initiating with peers should be two separate goals.  The way the goal reads now, they may tell me that she has made 50% progress on this goal, meaning that 5 out of 10 times she initiated with an adult or a peer.  I know she initiates with adults at school and home, but with peers she rarely does so. If they are two separate goals the team will have to address and track her initiating with adults and peers separately.   She will have twice the programming and I’ll get twice the data.

Many of the goals in the Developmental Skills section are really pre-learning skills.  I’m sure she hasn’t mastered all of them, but I know from conversations with R.’s teacher that she is in agreement that we will be adding actual educational goals.   I would like to add a goal to this section about waiting.  I do realize that goals need to be individual, but I found this goal on the internet to at least get the idea started.   Will be able to follow an adult’s request to wait for her turn given materials to manipulate during the waiting period for two minutes. I’d also like to add a goal about playing with toys appropriately, and possibly a second one relating to playground equipment.

I’m searching for a book on this topic, suggestions are welcome.  But for now I found a simple article that outlines preschool IEP goals that is helpful.  I’m sure that I will be writing more about this.

Happy Thanksgiving

What a difference a day makes

Wednesday’s note from Teacher- R. had a difficult day.  She fixated on two puppets a duck and an alligator.

Thursday’s note-   R. imitated the gen ed kids (read neuro-typical) at recess, running, laughing and stopping and going.  Took the class to the market on our walk and bought tomatoes and potatoes.

We survived the pumpkin patch

This horse was her favorite thing

Well we did it, we survived the class field trip to the pumpkin patch.  It went way better than I imagined it would.   She walked three blocks to the street car stop, happily holding one of our hands.  She started to cry when we stopped to wait for the street car.  It was a bit chaotic, there were about 12 other special day class kids and their teachers, aids and parents, and they were older and larger.  She wanted me to pick her up, which I managed to avoid with a  hug and the new secret weapon.

Elmo has some competition now

The street car was very crowded, and R. started to cry once we were on board.  We were surrounded by a lot of people who mostly managed to disappear once they got a good look at all of us.  Seats magically appeared and I plopped R. into one.  She sat the whole time.  It sounds so silly to be so happy about this considering she takes a bus to and from school every day.  But on the school bus she has a seat belt.

Then we walked four blocks to the pumpkin patch.  That is definitely her world record for walking and hand holding.   She was really happy, walking with a little spring in her step and making her giraffe dance.   She started to cry and wanted me to pick her up a couple times when we first arrived at the pumpkin patch.  But I managed to get out of it with more hugs and rocking her.  It was very crowded, there were many school groups.  We stood in line for the hay ride, but the teacher wisely decided it wasn’t going to be possible to wait.  So we had 45 minutes to wander around a pumpkin patch.

R. was not impressed with the pumpkins.  Her teacher tried to get her to pick a pumpkin, but she put back every one she was handed.  I wonder if she thought it was just a whole bunch of vegetables.  Her teacher also told us that she and another boy in class  do not get along.  They bother each other on purpose.  They are both sensitive to being touched and of course they touch each other.  She said that she has to keep them apart during circle time.  This little boy was lining pumpkins up at the entrance of a hay bale tunnel and R. came along and put every one back.

I think her favorite part was a wooden horse in a tree.  I’m not sure what the point is of having a horse in a tree.  I looked around for a headless rider, but did not find one.   I found a quiet spot and sat with her and gave her a snack and then it was time to go.  The teacher has us go back on a bus which was a shorter walk.  It was standing room only so I found a place to stand.  R. sat down on a man’s lap!   He was a young tough looking guy, but he smiled and gave up his seat.  She sat like a bus riding veteran and walked back to the school like it was the easiest thing in the world.

Week of meetings

Tuesday we had an addendum IEP meeting to continue R’s ABA services.   When she had her initial evaluation with the SDs ABA provider they were not happy with our former provider’s programming, data taking and they felt that R. could have made more progress if the program direction was better.   So for her initial IEP they approved six months with a provision to review.

They approved continuation of the ABA, which I thought they would, but you never know.  They also took some time to add in additional goals.   The teacher asked for a behavior plan for when R is chewing on books (more of a problem lately).  She said that she had been taking away the book and offering a chewy toy, but she felt that we should be modeling appropriate behavior with the book instead of taking it away.   The ABA supervisor set up a behavior plan that says, when she chews on a book to stop her, get her to spit out anything in her mouth (she actually cooperates with this, she knows she should not chew on a book)  and then get her to look at the book properly, once she does this give her a chewy toy.   I guess this means that I’ll actually have to buy some of those chewy toys.

I asked about self-help skills, and they added IEP goals for removing her jacket, independent hand washing, and nose blowing.  They also added goals for drinking from a straw and an open cup.  She uses a straw cup with a soft straw all the time, but she won’t drink from a regular hard straw or even a juice box.  I know she knows how to drink from an open cup but she thinks it is more fun to dump it.

We discussed potty training, it is on her IEP.  I know she is not ready yet, but I was looking for advice regarding the first goal which is R. letting us know when she needs a diaper change.   The teacher suggested having R. wear underwear underneath her diaper to see if she would try to take it off or let us know when she’s wet.   I’m going to have to find Elmo underwear.

We also had our monthly ABA team meeting this week.  We used to have the meeting at the school, but now we have it at their offices (they are part of the SD, in one of the administrative buildings).  R. actually really likes going, they have fun toys and she seems to find it amusing to have us all sitting in one room.

The behaviorist said that based on her observations that R. had decent play skills.  She had decided not to add any additional play skill programs.  But the teacher said that R. is not showing any of these play skills at school, even though they have similar toys.  So  the behaviorist is adding a symbolic play program using Little People that she has at home and school in hopes that she will begin to generalize.

We discussed the other additions to the IEP and went over the programs.    They had a jack in the box among the toys in the room and R. was very interested.  I don’t think she has ever seen one before.  She did not like the music it played and would turn the crank and then cover her ears.  After awhile she figured out how to open the top without using the crank.  The behaviorist asked if we wanted them to address her putting her fingers in her ears.  I said that I did not.  It is something new that she is doing, so it could be a phase.  And I think that if she is bothered by sounds, putting her fingers in her ears is a great improvement over screaming or crying.

No more zombie hands

ABAs imitation programs have been really challenging for R.  At first she really did not have much of an ability to imitate at all.  In the last 6 months or so I’ve noticed that she will imitate something that is of interest to her.  If I’m doing something with one of her toys she will copy me.  The behaviorist told me that this meant she had the ability to imitate, but that it was not yet under instructional control.

When we started with the school’s ABA program, they started with the same gross motor imitation (GMI) program that the EI ABA provider used.  They said do this and clapped their hands.  When she did not clap they would take her hands and clap them for her.   R. seemed to understand that she was expected to do something and she would just hold out her hands.  She did this with the EI ABA also.  This is a result of over prompting.  The authors of The Verbal Behavior Approach call this zombie hands, and that seems so appropriate.   Our EI ABA provider did not adjust the prompt level often enough.  Of course I did not realize this until I did a bit of research and by then it was time for the preschool transition.   Our current behaviorist clearly knew what she was seeing, and instructed the therapists to delay the prompt and gradually they were able to remove it.  The behaviorist and supervisor adjusted the prompt level several times a week, they really stayed on top of it.   R. is going to master not just one but several GMI programs soon.