She has questions

For over a year now R. will occasionally take my finger and use it to point at something. She seems to be asking what the item is, so I tell her. It was random for a long time, she would do it once every couple of weeks.

A couple of months ago she started asking every day who particular muppets were on one of her favorite Sesame Street videos – A Celebration of Me Grover. Most of the muppets were just generic nameless characters. At about the same time she started to open Safari on the ipad and ask for Elmo. If you search for Elmo in Google and select images there are tons of pics of her favorite red monster.

It didn’t take long before she asked me to look up other Sesame Street characters and it became a new activity-her asking me to search for something and then looking at the pictures.

She’s also started watching some different shows-only on the ipad, but I’ll take it. She came to me with each show-– Backyardigans, Wonderpets–– nearly every single kiddie show and wanted me to name each character and look it up in Google.  I prompted her to use her own finger and say Who is it. This has become a favorite activity, so she picked it up quickly.

Now she’ll come up to me all the time, point at the picture and say Who is it. And then I have to look the character up in Google. I’ve learned all kind of names. I now know that Caillou’s mother’s name is Doris. How fascinating that she even wondered about that. She was upset that the boy in the cat in the hat has no name. And I’m amazed that she figured that out, I never even noticed.

She has been very into Sid the Science Kid, and one of his phrases is I have a question. R. repeats this, sometimes out of context but often she’ll walk up to me and say either I have a question or just question. And then she will ask a question!

An example of an exchange:

She walks up to me and says Question.

Me: Oh you have a question? What’s your question?

She tugs on my hand and says Come.

I remove my hand from hers (I’m working on trying to remove her touching me from her communication.) and say OK, I’ll come with you. I follow her to the stairs where she has a bunch of stuffed animals lined up.

She points at one and says Who this?

I say That’s a cow.

She walks away, retrieves the ipad, opens up Safari and points at the Google search window and says That’s a cow.

I search for cow pictures for her to look at.

The teacher suggested that I have her type in her search requests, even hand over hand. Sometimes she’s impatient, but after weeks of doing this it seems like she can spell some of her favorite searches on her own, I’m just sort of holding her arm for moral support.

 

 

The many gifts of the ipad

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

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

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

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

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

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

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

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

 

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.

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.

Showing her how rewarding life can be

One of the reasons that people seem to get down on ABA, is the use of reinforcers.  I’ve heard it equated to animal training.   There is some truth to that analogy, and I’ve learned that is not such a horrible thing.

When we started ABA during early intervention, the program director spent a lot of time asking me and working with R. to determine what she really liked.  At the time, it honestly wasn’t much.  Other than balls or bubbles, she had a few stuffed animals she liked.  She liked watching Sesame Street, but Elmo and friends weren’t BFFs yet.   Naturally they wanted to use food items, and I bristled at this, but I compromised, and asked that they not use her meal time food as a reinforcer, only snacks and treat.  As worried as I was, the food reinforcers actually did not work that well.  She would quickly tire of whatever it was, and she was not always hungry.  She had sessions for 5-6 hours a day at that time.  If every therapist offered her snacks, there was no way she could eat it all.

The Program Director asked about using videos on the therapist’s Iphones as a reinforcer.  I said my only concern was that R. might be more interested in watching videos and cry when they were not available.   The PD said that if they were that motivating, they would do the trick.

The videos actually worked great.  R. was really motivated to watch them, and she quickly learned that she was expected to do something before she could watch one.  That sounds really simple, but there are really several things that the consistent use of a reinforcer taught her, even at that early stage.

  • There are things she wants that an adult has to provide
  • Her actions are directly responsible for getting her desires met
  • If she pays attention to an adult’s requests, and complies with them, she will learn the actions required to get what she wants.
  • She can wait for things she wants, even for a short time.

I know that there are some parents who think that children are praised, rewarded and bribed too much, granted these are generally NT parents.   So what is the difference between a bribe and a reinforcer?   The way I see it, a reinforcer rewards desired behavior after it is done.  A bribe rewards a behavior whether it is desirable or not before it is finished.

A good example is crying.  If R is crying and I know some gummies will make her happy, if I give her the gummies while she is still crying I am bribing her to stop crying.  I am also teaching her that the way to get gummies is to cry.   If I show her the gummies, and  get her to stop crying and say gummies and then give then to her, I am reinforcing her use of words.  I’m teaching her that yes I know what she wants to make her happy, but she has to use words to get it.  Crying doesn’t work.

Now R. is really in touch with the fact that she is expected to do something to get her requests met.  She is primed, waiting for a prompt to tell her what to do.  We have to be careful to wait to see if she will say the word spontaneously.  Sometimes I’ll tap the item, which is a mistake because she will copy my tapping, thinking that is the response I’m looking for.  Slowly but surely we are hearing more spontaneous words.

I think that we all respond to reinforcers and even bribes all the time without thinking about it.  It is really necessary to analyze all of the ways that we are reinforcing her behavior even if it is unintentional.   I gave R. a piece of colored chalk and a chalkboard and she scribbled for a while until the chalk broke.  She brought me the pieces, I assume she wanted me to put them back together.  I gave her another piece of chalk.  She broke the next one, brought me the pieces and I gave her a new piece.  I was watching her and the first two times it seemed like it was an accident that she broke the chalk, it broke while she was scribbling.  But the third time, she scribbled for a bit, and then intentionally broke the chalk in half and came to me for another piece.  Even though I had her say chalk each time, she had quickly come to the conclusion that breaking the chalk was the key to getting another piece.

I suppose that someone who is anti-ABA could argue that the faulty methodology behind ABA’s teaching has led my daughter to make incorrect generalizations.  But I really think that this is a reflection of how R. tends to generalize things.  She does not make the same connections that I would.  Her vision of cause and effect is limited, but with repetition and experience her skill in this area gets better and more functional.

Now she has the ability to understand first this and then that, as long as we are talking about something she understands.   This is really useful.  There are many opportunities to tell her if you do this, then you get that.   I am working on getting her to wait for me when she requests something.  She always wants me to drop everything and comply with HER request.  I’ll tell her first I’m going to have a sip of my coffee, then I’ll get you a cookie.

I also find that when she needs to do something new or different that she is aversive to,  if I explain it simply and give specific perimeters like counting- do this for a count of five, she is much more compliant.

Some people ask if ABA is constantly rewarding for desired behaviors, does the child spend the rest of her life looking for a reward for every task completed?   ABA does actually have a system of fading reinforcers and using a hierarchy of more and less motivating items depending upon the difficulty of task.    I’ve also found that while the therapists still use toys and food reinforcers, they also sing songs and do all kinds of silly games with R. that she likes.   She asks for these activities, so it is like her reinforcer is doubly rewarding – she is rewarded for completing her task, and she is motivated to do something social.

I don’t see R. becoming like a trained dog, looking to perform tricks for treats.  It’s more like she’s a social being in training.  She’s making her own study and practice (with our help) of how rewarding just the act of socializing is, and how crucial engaging with others is is to getting her needs met.   She’s also learning that while the world is filled with many unknowns,  there are also plenty of great things.

And another meeting

We had our monthly ABA team meeting yesterday.  R.’s teacher wanted to come with us, so we picked them up at school.   R. seemed to want to show me around the room, she kept bringing me over to different things.

She brought me over to the toy area, pulled out a play phone and held it up to my ear.  I think this is quite amazing because I’ve been trying to figure out how to teach her about the telephone.  Every time I call someone and get them to talk to her she looks at the phone as if it should have a screen, and usually hands it back.

The temporary classroom is smaller than their other room, there is no sink or bathroom.   The teacher said that they started taking the kids to the cafeteria for lunch and it is going really well.

The supervisor and one of the therapists were out sick, and the behaviorist had not seen the new IEP (yet to be signed, because I just got the final copy today.).  So there were a lot of things that did not get covered, but it was good to have the teacher’s input.

We talked even more about the manding progam, and moving beyond the word want and noun, to play, drink eat and more specific verbs.  It seemed to me like we were worrying the same bone as last month.  But the teacher and behaviorist were able to talk about the reasoning in detail, and I think that helped everyone.   The behaviorist wanted to make sure that enough time had been spent on one word mands, in case R. was thinking two word mands are just one long word.  She had the teacher and I list words we hear spontaneously, and thought there were enough to proceed.

The behaviorist said she observed during recess recently.  R. was playing a drum with some other girls (in the gen-ed glass)  She saw the behaviorist and approached her,  obviously recognizing her and showed her the drum.

The teacher said that she is teaching R. to tap her on the shoulder and say her name instead of tugging on her hand when they are seated together.  I saw this in action several times,  R. tapped the teacher on the shoulder and said her name!

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.