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.

Easy apps for Autism

R. is actually bored with both of these apps, but she used them quite a bit for the first couple of weeks with the ipad.  I think they helped her learn how different apps work and the fact that they are simple to do made her feel confident enough to stick with it.

 

 

 

 

 

 

 

 

 

Monte Lingual 1 to 10 Lite

This review is for the Lite/free version.  There is an advertisement bar at the bottom of the screen during play.  It does not seem to get in the way.

When the app loads it says tap screen to begin.  This means R. can easily launch the program herself.  There are no ads on the opening page.

The description of the app says that they are using the  Montessori bead stair concept.  There are ten red circles on the left hand side.  Each circle is moved individually to the bar across the top of the screen.   The app is somewhat forgiving, and will pull the circle into the correct spot when you are close. You can also bounce the circles off the opposite side and they will bounce into the correct spot.  The circle makes a popping sound when you remove a circle, and a slight swishing sound if you fling it.  It makes a clicking sound when the circle is put into place.  The red circle turns a different color once it is in place and is labeled with the next number and the program says each number out loud.   Once all ten spots are filled a button pops up offering play again.  It is a bit tricky, but you can select more than one circle and count by twos or whatever.  R. is not interested in that yet.

I think learning how to move the circles helped teach R. how to manipulate the ipad.  There are really no wrong answers or moves, so it provides errorless learning.  The music turned her off initially, but once I learned how to turn it off (press the i in the upper left hand corner) she was interested in the numbers  and was able to do it herself after a while.  You can also turn off the sound effects each circle makes, and the speaking of the numbers.

 

 

 

 

 

 

 

 

 

 

 

 

ABC Alphabet by Little Sorter

This is a free app.  There are no ads.   On the first page there is a button in the lower right corner that says play.   R. tired of this app before she learned how to use the button.

Grasshopper Apps, who wrote the app, says that you can learn with sight, sound and touch. A letter is spoken for each colored letter when moved, and it can only be placed in the correct spot.   When attempting to place the letter in the wrong spot the letter bounces back and a bouncing sound is heard.  The number of letters that appear each time vary, and can be customized in the settings.   You can select a minimum and a maximum number of letters to appear from one up to six.

The authors must know all about children with autism, because there are many ways to customize this app.  There is a settings button on the front page.  You can record your own voice and customize all the game sounds -including turning them off.   There are separate settings for the intro music (we turned it off) and success sounds.

R. took to this app immediately, it was one of the first ones she could really do independently.   Sometimes she would just play with the letters to hear the sounds.  She figured out that if you try to move more than one at a time it makes strange echo-ish letter sounds.

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.

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.

What do four year olds watch?

R. has been exclusively interested in Sesame Street for so long, I kind of gave up on offering alternatives.  But lately she really gets tired of watching the same ones.  I get them from the library and Netflix, and copy the ones she likes on to the AppleTV.   She’s kind of bored of Elmo’s World, she doesn’t like the DVDs that are just a collection of Elmo’s World.   I’m starting to run out of new options for her to watch.

Now that we have the ipad and can stream Netflix, I’ve been offering some other choices.   Sometimes I think she is so used to watching Sesame Street on the television, that seeing anything else just seems wrong to her.   She is more willing to at least try some new shows on the ipad.

I tried Dora, she watched one episode and then wasn’t very interested.  I don’t understand the appeal.  Compared to Sesame Street it seems slow and boring.  And the parts that are trying to be educational seem kind of contrived and weird.  I also wonder about the Spanish words- is that confusing to a child who has language delays?

I tried the Backyardigans, Blues Clues,  a few animated movies and a dog and cat movie.  She did not like any of them.  There is one show that we discovered she will watch – The Wubbulous World of Dr. Seuss.  It is by the Jim Henson Company, so I suppose I should not be surprised.  But each episode is a real story, and fairly involved.  There’s no counting or letters, there is a little singing.   R. is choosing it herself.  She figured out how to find the Netflix icon, and will choose the show from a list of options.

I don’t mind letting her watch the show, it is cute and not too long.  I would like to encourage her to watch some of the shows and movies that other kids like, just to get her familiar with different characters and stories.   The Wubbulous World of Dr. Seuss seems kind of obscure.

I would appreciate any TV show or movie suggestions your kids like or even that you wish your kids liked.

A letter to NT Parents

I wrote this about a year ago.  I didn’t post it here before because I thought it sounded more crabby than I intended.   For autism awareness month I dusted it off, and posted it to the Mom list that inspired it.

Dear Parents

My four year old daughter has autism.  Maybe you know us.  Even if you never meet us, considering the number of people with autism is currently 1 in 110, you will meet people with autism in your lifetime.

A while ago someone on a Mom list was concerned their child had autism.   I was kind of shocked by some of the responses.  Autism is all the rage now. Really?  Do you think it is trendy and fun to have a child who does not speak?   Is it cool to know my child may never live independently?   Do you think all the children who are being diagnosed are undeserving of the services to help them?

Someone else said  Your child doesn’t have autism – he’s great! I get that you probably do think a child with autism is quite awful.   But I feel the need to tell you that I think my child is great.  Better than great actually, but I’ll spare you my gushing.

My daughter is a person, she has likes and dislikes and she also has real challenges with communication.   Sometimes she is overwhelmed by sounds and sights around her.  I do my best to keep her away from stressful situations, but I do feel like it is important for her to be able to go out into the community.   If she screams or has a meltdown I will leave with her.  But every once in a while I really need to buy milk or something that can’t wait .   Yes I know she is loud.  Please have a little patience.

You may tell me that only babies have tantrums like my daughter, and if I would just discipline her she would behave.   I don’t expect you to understand that she has had years of behavior therapy.   But I hope that you can understand that part of having autism is immature development.   In many ways, she is like a baby or a toddler in terms of her ability to communicate.

Please don’t get in my daughter’s face while she is in the stroller and tell her she is too big and too old to be in a stroller.   Not that it matters, but she’s not seven like you think.   I’m sorry your world-view is so narrow that the sight of a large child in a stroller offends you.  But it is not my problem, please deal with it on your own time.

I’m going to take my daughter to the playground, and she is not going to act like your children.   When my daughter sees your son playing with a bouncy ball, she wants to play with the ball and with him, but she doesn’t know how to ask.  She will take the ball from him as her way of asking.  I’ll be right there with her, and I’ll tell her the ball is not hers, and I’ll make her throw or roll the ball back to your son.   I’ll admit it must look strange to you, that my child can’t do something so simple as say play with me, and that I have to be so involved with her.  In my fantasies (which occasionally come true) your son would play with my daughter.  Just pass the ball back and forth a few times.  It is a public playground after all.  It is your son’s choice, and if he doesn’t want to play with my daughter, that is fine.     But please don’t give us dirty looks, drag him and your other children away, and tell them they have to stay on the opposite side of the playground from us.   You are teaching your child that it is okay to be rude to people who are different and also that they should be ignored.

My daughter enjoys watching your daughter and her friends climbing on the equipment and hanging upside down.  She also likes it when your son brings his remote control helicopter to the playground to fly.  I know she looks a little strange, her body quivers with excitement and sometimes she’ll jump up and down clapping and and saying yay.   The kids don’t mind the attention, and I keep her safely out of harms way.   Please just let her watch.

I’m not looking for pity or sympathy.  But I do hope for a little patience and understanding.   You will meet people with autism, they will be your child’s classmates and your neighbors.  Autism is not contagious, in fact studies are showing that typically developing children actually benefit from exposure to children with special needs.   I’ve seen this first hand.  It’s never to early to teach tolerance, and that is a gift that will continue to give through a person’s life.

She wants me to go away

R. is talking a bit more all the time.  Her requests are becoming more natural.   For nearly a year we had to verbally prompt each word. Last month she started saying some words if we held the item she wanted up and waited.   Now for most items we just have to wait.  At mealtime she is just speaking up and saying what she wants.  It almost feels normal.  E. and I will be talking and she’ll just interrupt with her demand.   It is just one word, but I’ll take it.

She is also self correcting herself.  She’ll say cookie, bagel, or open, cookie.   She’s saying more words in response to situations, oh no, wow and after years of me working on it – she is saying hey.  I know that sounds like a silly word to be excited about.  But I’ve been trying to get her to say hey or stop instead of crying.

Her echolalia seems to be changing slightly.  Sometimes when she echoes she changes her intonation. It is subtle, but definitely deliberate.

She is very into spending time with E., and she wants him all to herself.  She’s been saying Hey!  What you doing? When I come into the room.   If she is being nice she will hand lead me into another room.  But often she just gives me a shove.  I’ll say, you want me to go away? And she will say go away! I think this is really funny, and it doesn’t bother me at all.

I feel like I’m documenting every second of potty training.  She is up to sitting for eight seconds.  The therapists tell her she will sit for eight, and they say only the first, middle and last number.  R. counts on her own, and insisted on staying until the count of ten once and twenty another time.  Nothing happened, but she was and is happy to sit there.  I’m almost looking forward to summer so we can devote more time to this.

I do have to say that I really hate pull-ups.  They leak like crazy, and trying to do up the sides makes me feel like I’m all thumbs.   Maybe it is because I have so many years practice with diapers.

Behold the ipad

Anybody know how remove washable markers?

R. was entranced by the ipad from the moment she saw it.  At first she just watched, and seemed kind of reluctant to touch it.   It is a little confusing to teach her, because each app works slightly differently in terms of what to touch and if she should press or swipe.     It works best if I show her hand over hand, but she prefers to watch me do it, and then use my finger as a stylus at first.

I don’t have a PECS program yet.  I’m going to research it a bit before spending the money.  I don’t think we will use it as a true AAC device if her language continues to progress.   But I think it could still be useful.  I would like to find something so that I could offer choices, like breakfast options or where she wants to go.

I’m kind of amazed how much the ipad inspires her to speak.  She echoes, she labels and even a little commenting if I can count Oh no.   In just a few days, she’s already used to a bit of ipad time before dinner.  We forgot the other night because we had visitors, and she actually started saying ipad, ipad, ipad, totally unprompted and with it out of sight.

I’m going crazy downloading apps, trying to find ones that are good and that she will like.   Many of them have intro or accompanying music that she hates.      Some of the apps do have settings to turn off music and other sounds.  I have to go through the apps before I show them to her.

The free flash card app My First Words by Smart Baby is helpful to show her how to manipulate things on the ipad.  They are flash cards of objects in different categories of items (more categories are available for purchase).  Each card shows a picture, the word and the word is also spoken.  The app can be set up to automatically scroll through the cards, or manually so that the cards only advance after you touch them.  I found setting it up manually really showed her how to use the ipad.  She is really interested in the pictures and words, she will repeat them and it just looks like she is absorbing everything with such interest.  Another neat feature about this app is that you can record your own voice for each of the flash cards.

Another free app, Z is for Zebra is helping to teach her swiping/scrolling.   A screen comes up with the letters of the alphabet, and when you press one it takes you to a page with the letter in upper and lowercase and a picture of an object that starts with that letter.  You can touch each letter or the object and hear the letter or word.  I wish they actually displayed the word too.    You can also scroll through the alphabet by swiping left or right, she really liked doing this once she figured it out.   If you touch the wrong place it just goes back to the alphabet screen.  Many apps have lots of buttons that when touched accidentally take you out of the app, or other places.

iWrite words was suggested by the school’s OT.  The free version gives you the letters A,B,C  in upper and lower case, the numbers 1-9 and a few three letter words.   I upgraded this for $2.99, now we have the full alphabet, the numbers up to twenty and more words.    It displays the outline of a letter, and a little crab appears at the start point followed by numbers showing the direction to write.  You drag the crab through the numbers (connecting the dots) and the line shows up on the screen.   After the letter is completed a copy of what is drawn shows up in the upper left hand corner, and a small box with the same letter drops down so you can either tilt or drag it to a wheel that spins and the letter disappears.  It doesn’t sound very exciting, but R. loves doing this.  So each letter has  built in reinforcer.  R. usually starts using my finger, and after a few letters she will do it herself.   I wish you could select the letter or letters you want to work on instead of having to go through them in sequence.    I wonder if they will come up with some ipad-friendly stylus for handwriting practice.

Color SlapPs is a free program to practice color recognition.  You can select which colors you want as options, (I removed peach) and choose from one, two or three colors on the screen at a time.   A voice says touch brown or whatever color is next, and when brown is touched it spins and disappears.  You can choose to cycle through five or ten times, and when the round is completed two stick figure children appear and jump up and down and the sounds of cheering and applause is heard.  I’m surprised how much R. likes this, she smiles at those little figures.

The Dr. Seuss interactive book apps are amazing.  When you select read to me, the words turn red as they are being said.  R. is so fascinated.    I am too, because while she might occasionally sit through part of the ABC book, she will leave the room if I read Cat in the Hat.   On the ipad, she is fully engaged with both books.   She actually likes them better than the sample of a Sesame Street book I downloaded.  I think it is the words lighting up red that is so engaging.   Who do I have to talk to for an app for Polar Bear, Polar Bear?

She listens better than the cat

Her younger, fat cat days

When E. and I first met he had a cat.  That same cat is still alive at nineteen years old.   She’s never thought much of R.  She saw her first as a lap usurper, and then when R. started crawling I think she was scarred for life.

For the longest time, I could not help but compare R. to the cat.  She’s finally bigger than the cat!  She’s faster, and my favorite – she listens better than the cat.

The cat is in decent health, but the vet said that she has dementia.  It seems ironic somehow to me, as the parent of a child with autism to have a demented cat.   But it does explain some of her behavior.  She has kitty tantrums, meowing, howling and sometimes knocking things over.   I’ll spare you the rest.

Trying to figure out the cat’s behavior shows me how much easier even R.’s most perplexing behaviors are to deal with or understand.

Lately the cat will actually go to R. and meow at her.  I can’t imagine what she wants.  Today R. looked at the cat, listened to her incessant meowing and said stop kitty kitty.

Girls have autism too

April is Autism Awareness month.  I’d like to see more awareness that girls get autism too.  Thanks to DS Walker for the inspiration.  Some think that girls with autism are under diagnosed.  This seems likely to me, I wonder if we will see more females with autism in the coming years.  I know a few, but the boys do outnumber them.

I know that most of the therapists we have worked with, especially the ABA therapists have mostly worked with boys.   In many ways I think that works to R.’s advantage.

As she gets older R. becomes more girly, I don’t think I’m overly encouraging this.  She is naturally gravitating towards pink and purple.  When she does initiate with people she acts like a girl, she’ll smile shyly and approach quietly.  We’ve been lucky so far in preschool there have been one or two other girls in her class.  I wonder if there will come a time when she is the only girl in her class.   How will that impact her?

There are many bloggers writing about their daughters with autism.  I’ll try to mention a few of them that I read.

Autism Army Mom
DS Walker
Puzzle Piece Princess
Professor Mother
The Simile of Autism and Snowflakes

Welcome to my planet
Countering Kim Wombles
Life with Aspergers

 

Here are a couple of sites specifically for women with autism

Autism Women’s network
Girls with Autism

Since most of the reports and studies seem to only have male participants, I did a little searching for ones that featured females.

Sex differences in the evaluation and diagnosis of autism spectrum disorders among children.
CONCLUSIONS: Girls, especially those without cognitive impairment, may be formally identified at a later age than boys. This may delay referral for early intervention. Community education efforts should alert clinicians and parents to the potential of ASDs in boys and girls.

Autism Symptoms and Internalizing Psychopathology in Girls and Boys with Autism Spectrum Disorders.

Reading comprehension, word decoding and spelling among girls with ASD or AD/HD: performance and predictors.

Here are some details from a presentation given by Lori Ernsperger and Danielle Wendel, authors of: Girls Under the Umbrella of Autism Spectrum Disorders: Practical Solutions for Addressing Everyday Challenges.

Here is an interesting theory about how females are more likely to suffer from right brain caetextia than males.  They feel that this is an unrecognized type of Aspergers Syndrome.