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Tuesday, March 06, 2007

Handy Hint number 3

A few years ago my boys did not 'play.' To the untutored eye, my own, it was easy to think that they were playing, but repetitive movements of toys in mechanical or unusual manners, didn't really make the mark.

They were also incapable of doing anything without prompting. An example of this would be when my older son was being tested, as part of his initial evaluation for autism. He was given a school worksheet to complete that was well within his capabilities, but no pencil with which to write. He sat in front of the table looking at the worksheet but did not ask for a pencil. I don't know if he could have asked specifically for a pencil back then. He experienced many a long hour with very few words, an element of the non-verbal. He might have asked for help or intimated his need by gesture, by neither occured. At that time, if anything, a missing pencil would have most likely have manifested itself in a meltdown.

Similarly, if he ever finished a task, he would not initiate the next step, what is sometimes referred to as inertia. He would not 'tell' me that he was finished, merely remain static, roll off his chair or wander off. There was no joint attention.

Had I been at home I would have prompted him, but the 'tester' had given me strict orders not to interfere. It made me realize, reluctantly, how I constantly intercepted, coached and tried to anticipate or forestall stumbling blocks. Instead of using those opportunities to seduce them into speech, I was making the situation worse. I had chosen the 'meltdown free' easy road. I stole their motivation to speak. Why should they bother when they could get what they wanted faster by other means?

In addition, choices, regardless of whether they were preferred or loathed, were a long standing obstacle.

Lastly, independence, even for a few minutes was well out of reach.

This combination of what the experts call 'deficits' left me in a dilemma, what to do and how?

So many of the recommended therapies, be that RDI,[Relationship Development Intervention] Floortime or ABA, [Applied Behaviour Analysis] had an built in flaw, namely, the one-on-one pre-requisit. One of me, two of them. I did try, but it was unsatisfactory because somebody was always left to 'float.' The nub of the difficulty was my inability to find anything constructive to occupy the other child whilst focusing one on one with a single child. Their abilities and disabilities were so different that I could see the sense in concentrating on the one-on-one principle.

If I spent 45 minutes with one, rolling a ball back and forth on the floor between us, engaged, with giggles, some words and prompts, I knew that somebody else was busy examining air particles in the family room.

I needed to find a way to keep one child occupied.

At that time we used PECS, [Picture Exchange Communication System,] small cards with icons. I made a lot of them myself because the standard ones often provoked meltdowns because they had some 'fault.' Faults included line drawings of faces and teddy bears. Both were certain triggers to cause meltdowns.

I decided that if I could teach each boy to spend some period of time working independently, this would allow me to concentrate on the other one.

I bought a binder for each of them and put half a dozen stiff pages in each. They found it difficult to turn 'thin' pages. I Velcroed two PECS to each page. They could choose between two toys or activities, such as lacing cards [tough on the fine motor skills and so less preferred] or magnet play. I made sure that they were on different 'tasks' from each other to avoid meltdowns, triggered by competition or uncomplimentary comparisons. Each page presented two choices, so I could engineer who was doing what, stagger the difficulty level and engineer that the less preferred tasks had a small chance to grab someone's attention.

Each page had a pocket at the bottom. When the task was completed or attempted they could remove it from the page and drop it in the pocket. Frequently this simple act helps reinforce the positive.

All the activities were arranged on the floor for easy access in the right sequence to help build independence. The PEC icon matched each toy to help them make the link between the page and the real thing.

The last page showed that it was snack time. Initially progress was very slow and we stumbled at each and every stage. The goal was to lead them to a point where they only needed spend a few minutes on each page, but in theory, they would be 'done' after 20 minutes to half an hour. A visual timer helped with this so they could see that it wouldn't be forever.

I can't remember now how many months it took before we were headed in the right direction, but gradually they managed to at least attempt the tasks. As they progressed, I added little 'conversation' bubbles to help prompt them to make comments, both to me - 'I'm done' and to each other, 'great job.' I know how artificial it sounds, but imposing a period structure on their chaotic world helped calm them considerably. It also gave them a sense of achievement, accomplishment and helped boost their fragile self esteem.

They knew that once they had done their 'work' they would be given time to revert to their preferred perseverances, a fair trade off.

It was a plan that eventually paid off, although I would add one word of warning for anyone as clueless as myself. If someone learns a new activity in the company his brother, it may well take any number of additional months to break the association, where the activity itself become intertwined with the link of your brother's presence.

I would mention in passing, that whilst I complain and moan about the frequent, explosive tantrums that they both have, it is only in the last couple of years that I've realized that I was the one who taught them to do this. My reaction to the meltdowns was to placate, offer solutions, fix it and fast. Every time I did this, many times an hour, I reinforced the behaviour that I was trying to eradicate. I didn't give them options to solve the problem for themselves, such as speaking. But back to where we were.

I would try to do this every day whilst my daughter was at school. She would sometimes join us if I drifted behind schedule later in the day. I imagine that if you have a typically developing child too, that this technique could be adapted to include them.

I know this won't be a good fit for many people, but for me and mine, it was great, especially for me, because I had peace of mind. I knew that we were all together doing something constructive at the same time, rather than paying the heavy, psychological price, of someone spinning their wheels elsewhere.

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