The “Right” Fidgets

This has been a big summer for us. It is the summer we finally found fidgets that work for Beth. They were not the standard variety though. I want my money back for all the sensory balls, toys, weighted this or that, and junk I have bought over the years (if you are reading this post and think, I wonder if she tried…the answer is yes). Finally, we found two things that actually work:

1. Bead Necklaces to Reduce Flapping on Outings

Why do I care about flapping on outings? Because she flaps and looks at her hands and does not tune into her surroundings when we are out. She can’t safely cross a street or learn about her surroundings and communicate with others when she flaps and looks at her hands so often. Why does she flap?  As far as I can tell it is many reasons…happiness, anxiety (often due to noise), frustration, and boredom seem to be common triggers. Flapping in cooler weather was not an issue because coats seem to calm the flap (see http://wp.me/p2OomI-1gf). But when the coats came off in spring and summer, nothing I tried to give her or distract her with would calm the flap.

Then, while visiting Beth’s grandparents, Beth put this seed pod necklace on:

Bead pod necklace

Seed pod necklace (search for “seed pod necklace” on etsy or ebay)

I noticed she played with in instead of flapping as much. All I had to do was remind her to put it on before we left the car (she takes the necklace off and flaps and rocks out to music in the car for fun) and it was like magic. Flapping on outings was greatly reduced overall and she was able to tune into her surroundings. But soon Beth started to put the necklace in her mouth, bite on it, and rub it across her teeth. Since I was worried about Beth damaging her teeth, I went on a hunt for an alternative.

I tried some silicone necklaces that are worn by moms and used as a nursing focus tool and/or teething option for their babies (food grade silicone, for example…http://www.amazon.com/Sassy-Baby-Beads%C2%AE-Silicone-Teething/dp/B00JT0DCJS/ref=sr_1_5?ie=UTF8&qid=1441192857&sr=8-5&keywords=nursing+necklaces+sassy). She did not like the single pendant version (which is similar to autism chewelry) and the beaded necklace was too big and heavy.

Nursing Mother Silicone Bead Necklace

Nursing Mother / Teething Silicone Bead Necklace

It seemed Beth preferred smaller lightweight beads. I found 9mm food grade silicone beads (on etsy, ebay, amazon, just type in “9 mm silicone beads”) and sometimes added something bigger at the bottom of the necklace. I used these sets to make her necklaces: http://www.amazon.com/dp/B00U6XXW60/ref=wl_it_dp_o_pC_nS_ttl?_encoding=UTF8&colid=31MEQ0C8W2TBH&coliid=I1C4Z3NY21VMVQ and http://www.amazon.com/gp/product/B00OXIBKP4/ref=s9_dcbhz_bw_d54_g201_i2_ps). These work very well for her, and they are stylish too! Note the necklace is most effective when it is long enough so that Beth doesn’t have to raise her hands up much to use it. I like the safety pop away clasps that came with the kit I bought -I just tied a simple knot on each half of the clasp and popped it together (here is a close up of the clasp, separate string and clasp link: http://www.amazon.com/dp/B00ZQ66DKY/ref=wl_it_dp_o_pC_S_ttl?_encoding=UTF8&colid=31MEQ0C8W2TBH&coliid=I2CP4OHA679GI3). The clasp does not come apart easily, so even when she pulls on it it doesn’t break. I noticed the beads tend to tangle in Beth’s hair in the back, so I left beads off the upper portion of the necklace.

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2. Window Gel Clings for Desk Work

Beth LOVES gel clings like these: http://www.amazon.com/s/ref=nb_sb_noss_2?url=search-alias%3Daps&field-keywords=window+gel+clings . She loves getting new ones, their stickiness, their oily smell (ewww), and, unfortunately, she loves to rip them apart. Because she rips them, I got stuck on the idea that we should limit them and use them only as a reward for work. But she got very frustrated during work when I told her she would have wait for the gel clings, so eventually I gave in and let her keep the gel clings with her at the table. And just like that, the key to getting her to sit at the table for long periods of time was found. Sure we have gel clings all over the place and I am forever on the hunt for gel cling deals (CVS, Target, Jo-Ann Fabrics, ebay, craft stores are the best places to find good deals, especially at end of season). But who cares. It helps her sit happily and work for long periods of times without stress (when she is writing, I have her hold a gel cling in her left hand and it is surprisingly not distracting). Here is our “first day of first grade” pic, with gel clings all over the place.

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I guess the upshot is this. Observe your child and she/he will lead you to the best fidget. Also, tread carefully when trying to use a sensory item as a “reward.”  With the gel clings it actually backfired and made her less focused. It wasn’t a reward, it was a sensory tool she needed to use WHILE she worked.

The Answer to the Category Problem

I have written about categories (also known as classes) long ago. For a fairly comprehensive list of categories, see here: http://wp.me/p2OomI-Ia. What a pain categories have been for Beth. What a pain they have been for both of us!  Basically, teaching categories usually involves sorting activities, which is hard for Beth. We tried everything, including various apps (see this somewhat outdated post: http://wp.me/p2OomI-Iq) and these hands-on approaches:

 

 

 

 

Montessori cards with mats, http://www.montessoriprintshop.com/

Montessori cards with mats, http://www.montessoriprintshop.com/

But after all the effort above, Beth still struggled. The answer finally came from the Montessori book I am using (David-Gettman, Basic Montessori, http://www.amazon.com/Basic-Montessori-Learning-Activities-Under-Fives/dp/0312018649/ref=sr_1_1?s=books&ie=UTF8&qid=1431948690&sr=1-1&keywords=Montessori+basic). In it, after the children have explored the cards for a very long time and the categories and items within the categories have been fully discussed, the author suggested the children should sort the cards using overall category cards with general pictures of the categories including text. Specifically, he suggested the items within the category should be slipped underneath the main category card. But slipping things underneath a main card would be a nightmare for Beth. She likes to see the items, and messes with cards until they are lined up just so. But his suggestion changed my thinking. It is a great idea for kids like Beth who hyper focus on the details of each card to put the main category card as the focus. I had to remove the motor planning step of placing the sub cards under the main card, so I simply adapted the strategy by taping the category cards (category cards made from google images) to the tops of boxes:

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The category item cards shown above were a combination of cards from the various kits I amassed and print outs from Montessori Print Shop (http://www.montessoriprintshop.com/). During sorting, I have Beth read and speak to keep her focus. For example, Beth will say things like “the zebra lives at the zoo, the cow lives at the farm, the sheep goes with the farm” as she is sorting. There is no chance to hyper focus on the items within a category or mess with them trying to place and arrange them perfectly because she just drops the cards in the boxes and they quickly disappear. Of course this requires great familiarity with the categories to begin with, through natural exposure and reading books. For instance, we read zoo and farm books for 2 weeks before attempting the sorting and we have visited zoos and farms for years. That is the way it should be and, in my opinion, the category sorting should not be a tool to learn the categories. It should only be a tool to learn the subtle differences between known categories, to stop and make choices between categories, to firm up known categories, and/or to practice speech. Unfortunately in the day and age of drilling kids, the important “familiarity step” often gets bypassed and we go straight to sorting. As a parent who tried this approach for years, trust me when I say this is not the way to go. Especially for kids who already have trouble with sorting due to motor planning issues, crossing midline problems, visual scanning problems, and/or hyper focus on parts to exclusion of the whole.

Reading Adventures on the Spectrum

It was a rocky road to reading, but last night Beth was all smiles while reading sight word books with me. I wanted to pinch myself. She is reading and she likes it! Wooooohoooooo! How did we get here?  Glad you asked. Here is my video blog on our reading adventures (and misadventures):

What Made Beth Stumble While Reading

-Not having appropriate set-up while reading (needs book upright, appropriate seating or lying down while I hold the book up for her, see this post for details http://wp.me/p2OomI-14s)

-Fancy font (like “a” and “g” instead of plain font that looks like a hand written letters)

-Small font

-Words too close together

-Using just her eyes to guide her reading (she needs her finger to help guide her eyes)

-Multiple lines of text

-Long sessions (visual scanning is hard work and short sessions are a must)

-Working on the same books over and over (leads to guessing and stuck expressive language)

Products That Worked for Beth

-Sight word readers that addressed all the above stumbling blocks.  The best books for her were the Lakeshore Learning non-fiction readers because they had engaging pictures and little pictures for the harder words, which reduces frustration (Lakeshore sight word books, level 1, non-fiction , Lakeshore sight word books, level 2, non-fiction ).  These other sets are also good: Scholastic sight word readers and Harcourt Trophies K readers .

-Weekly Flashcard reviews. We used these: Sight word flash cards

Samples of Beth Reading:

 

 

 

 

Sequencing is a …

XXXXX. You fill in the blank (hint, it rhymes with witch).

Not that sequencing is a bad thing per se, it has just been a huge struggle for Beth. Sequencing with pictures is important, because it is a great tool for teaching basic story telling, which helps with conversation and reading comprehension, and it is also useful for teaching steps in a process (i.e. “how” things are done). Beth’s difficulties with visual attention, visual motor planning, gross motor planning, working memory, expressive language, inference from pictures, and impulsivity means we were stuck in basic 3-step sequencing for months with essentially no progress. We kept plugging away at it though and we finally have a process that works. Below I give my advice and examples of how we do 3-step sequencing based on some hard lessons learned. I hope this will be of help to others who are struggling with basic sequencing.

1. Ditch the store-bought sets and make sequences that are meaningful to the child. After I tried and failed with about 5 ready-made sequencing sets, I resorted to taking my own pictures of my child doing every-day tasks. The payoff was immediate. I suggest choosing sequences that the child is very, very familiar with and asking what he/she sees in the pictures before you use them for sequencing. If the child doesn’t understand what a picture is trying to represent (the inference), then re-take the picture to correct the inference, ditch the set, or save the set for later. Remember, in the beginning the goal is to work on the sequence in and of itself. Here is a list of common basic sequences and pictures of a few sets we use:

  • Favorite foods/drinks (e.g., peel banana, eat banana, throw away peel; open yogurt, get spoon, eat yogurt; open water, pour water, drink water)
  • Favorite activities (e.g., open bubbles, get wand, blow bubbles)
  • Going to familiar places (e.g., get in the car, Mommy or Daddy drives, we got to [familiar place])
  • Familiar processes (e.g., go into store, get shopping cart, pay; unlock door, open door, walk outside; open car door, get in the car seat, Mommy or Daddy drives)
  • Beginning, middle, end of favorite books or videos
  • Daily living tasks (e.g., put on pants, put on socks, put on shoes; put toothpaste on toothbrush, brush teeth, rinse; go potty, get toilet paper, flush; turn on water, get soap, wash hands; turn on water, take a bath, dry with towel)
Sequence 1: Open yogurt, get a spoon, eat yogurt; Sequence 2: Open bubbles, get wand, blow bubbles

Top sequence: open yogurt, get a spoon, eat yogurt; Bottom sequence: open bubbles, get wand, blow bubbles

Top Sequence: get in the car, Daddy drives, go to Subway; Bottom sequence: Put toothpaste on toothbrush, brush teeth, rinse

2. Address visual attention challenges. Beth gets easily distracted and has trouble with looking on a flat table-top surface for extended periods of time. Typical solutions for increasing visual attention include the use of slant boards and easels. We address some activities through a slant board, but I have found an easel is better for tougher tasks. As shown in the video below, for sequencing we use a magnetic white board table top easel, and I attach magnetic tape on the back of the laminated pictures (you can use clear contact paper or a laminator).
3. Address motor planning challenges. If motor planning is an issue, find a motor plan that works for sequencing and stick to it (and tell all therapists and teachers to use the same motor plan). You will see in the video below we went with boxes for placement and we place the pictures above or below the boxes on an easel.
4. For visual scanning or impulsivity problems, guide the child to slow down and look at all the pictures first.  I have learned a great deal from watching where Beth’s eye gaze is directed, and have noted her getting fixated on certain pictures, stopping mid-scan, not looking before she grabs a picture, etc. To be successful with this task, the child must examine all the pictures first. I usually use a verbal prompt (I say look at the pictures, or if she is really distracted I tell her to look at each picture) and often use a sweeping motion with my hand.  I am very careful to avoid guiding her to the answer with my hand (I stop randomly while sweeping/pointing and randomize placement of pictures).
5. Start with a sequence the child knows and model the task. I use A, B, C and 1, 2, 3 in the beginning of each session to remind Beth what we are doing (shown in video below). For completely new sequences I model the set several times before I expect her to sequence the cards independently.
6. Keep the guiding language consistent at first, then expand to more complex and varied language. I started with saying “What do you first?” (she places first ), “And then?” (she places second), “And then?” (she places third picture). But after a while I realized sequencing is a great opportunity for language expansion once Beth gets the process for a particular set of cards. Then I started varying the language and asking longer phrases. Here are some ideas:

  • “How do you [insert main sequence idea]?  First…then…, then…”
  • “What do you need to do when you want to [insert activity]?  First…then….then….”
  • “Let’s put these in order. First…, next…, last…”
  • “Let’s talk about the story (for books or video screen shots). In the beginning…, in the middle…, at the end…”

7. Reward appropriately and give breaks. You will see in the video we got lucky and only used scented stickers for this round of sequencing, but I keep the reward high for this demanding task. We have used mints, gum, gel clings on the light table, a promise to go outside, and many other things to keep Beth motivated. The video below is a particularly long session for her and in general I give her more frequent breaks. Some days she is just not into the task, so we tray again later or do the task another day.
8. Once 3-step sequencing with custom cards is mastered, consider moving to store-bought sets to expand learning and language. You can work on what the boy, girl, or group is doing in the pictures (work on he is..,  she is.., they are…), teach new processes, find gaps in knowledge, and get ideas for new activities you can do together. For example, if a set of sequence cards shows making lemonade and the child does not understand the sequence due to lack of experience with the process, make lemonade together.
9. Most importantly, observe carefully and think outside the box. Despite Beth’s expressive language delays, she chose to talk during the sequencing activity.  It definitely surprised me, but now I understand that using expressive language slowed her down and helped her with task focus and working memory.  I believe in following my child’s lead in general, but it is especially important during challenging teaching tasks.

Yes, I Get Down Too.

On my blog, I try to focus on the positive as much as I can. I prefer to write about the good things or the solutions we have found. But the truth is I feel crappy lately. I am finding it hard to bounce back like usual. Let’s see, I wonder why I have been feeling this way. Maybe it has something to do with what has been going on the last few months…

  • 9 evaluations for Kindergarten.  It really, really sucked. Enough said.
  • All the statements about “self-stim” and “very low” this or that on the evaluations.  Yes, I knew it, but having it shoved in my face is not a picnic.
  • We pushed hard for inclusion, thought we had some inclusion put in place at the start of school, only to have the district back pedal on it.  I just signed the damn IEP anyway…fine, who knows, maybe a slow transition to typical K inclusion for parts of the day are best. We asked to meet 2 weeks after school starts to argue about it then, because it was clear the team just wanted to get on with their summer vacation. Anyway, Beth’s teacher has not been hired, and that probably matters more than the inclusion plan right now. Which brings me to the next stress point…
  • Talking to the professionals at the school did not make me feel better. I tried to explain my kid’s autism and her unique learning/visual scanning/motor planning issues to everyone during the eval process and when I toured the school. I got confused looks most of the time. The exception was the speech therapist, but I just learned she will not be at the school next year. Add to that, I have not met Beth’s teacher yet because she has not been hired. I will get to meet her the week before school starts. All I can do is pray that Beth’s mystery teacher is a champion collaborator who wants to hear all I have learned while teaching Beth the last 2 years.
  • Going to PT and OT therapy up to 3 times a week, only to have them discover what I have already discovered. It was clear in the evaluations everyone thought Beth needed more PT/OT, so we started up again with those therapies (30+ min drive each way, so 5-6 hours of time a week).  While I have learned a few nifty approaches, those aha moments are dying out and she is not progressing any faster than when I worked with her on my own. But I am sticking with OT/PT longer this time, on the off-chance it makes a difference and because Beth loves the gym part of it. Also, I learned through the school eval process it is good to have outside professionals involved to back me up and document things. Sad, but true.
  • Being an aid to my kid at camp and classes is great, but I hate to watch her struggle.  Being an aid to my kid has been a phenomenal experience and I don’t regret it. But it is still hard to stuff the feelings down sometimes when your kid is so obviously delayed and very different from other kids.  Stuffing those feelings is zapping my energy and while I think going to camp is probably one of the best things I have ever done for her, I can’t wait for it to be over. Only 8 more days over 3 weeks to go…yes I am counting down the days.
  • The public is getting to me. Beth often stands out now when we go places. As I wrote before (http://wp.me/p2OomI-1gf), warmer weather means she can’t wear her coat now and so there is more flapping. Plus Beth is really, really big for her age, so she looks older than 6 and people try to converse with her more now. Add to that a myriad of sensory seeking and processing difficulties outdoors and in new indoor environments and she looks much less connected when we are out verses at home. The public just doesn’t know what to do with all that, and they tend to say the wrong things, look away, disengage, feel uncomfortable, over analyze, etc. Again, I don’t blame them, and I do what I can to explain and facilitate their interactions with Beth, but it can get me down sometimes.

I am sure I am missing something above, but you get the picture. Last night I decided it was time to do something about my foul mood. After camp is done (mid-July) we are getting the heck out-of-town. I canceled most summer activities and we will head to places with water to re-group and decompress.  Beth and I both deserve some fun after that last few months we have had.

Beth Throwing Heavy Rocks in Her Stream

Beth’s New Hobby…Throwing Heavy Rocks in a Stream Near Our House

 

Autism Can Be Identified Earlier, Which Means?

A couple of days ago, I posted this article (http://www.healthcanal.com/genetics-birth-defects/48756-autism-signs-can-be-identified-earlier-than-formerly-thought-study-suggests.html) on my Facebook wall and it has been bugging me ever since. We can identify autism early and then what?  Throw a bunch of services at a 2-year-old child and hope something sticks?  It seems like prioritization is necessary, but no one wants to prioritize.

If you go onto the CDC website (http://www.cdc.gov/ncbddd/autism/treatment.html), it states early intervention is important and references one article about preschool education (technically early intervention is before preschool) and another article with an educational committee’s recommendation. The committee recommendation document is over 300 pages long (http://www.nap.edu/catalog.php?record_id=10017) and the upshot is in this paragraph taken from the executive summary:

The committee recommends that educational services begin as soon as a child is suspected of having an autistic spectrum disorder. Those services should include a minimum of 25 hours a week, 12 months a year, in which the child is engaged in systematically planned, and developmentally appropriate educational activity toward identified objectives. What constitutes these hours, however, will vary according to a child’s chronological age, developmental level, specific strengths and weaknesses, and family needs.

So, do a bunch of therapy, throw the kitchen sink at a kid as young as possible, but we don’t really know which kids will respond and how well they will respond and what therapy is appropriate? And then there is line in the report:

Personnel preparation remains one of the weakest elements of effective programming for children with autistic spectrum disorders and their families.

Great, so throw a bunch of therapy at kids as young as possible, but chances are a good portion of your team will not be appropriately trained. It is enough to make a new autism parent want to cry.

My daughter Beth, who is now almost 6, was about 2.75 when she was diagnosed, and she had some OT (Occupational Therapy) and psychological support from 2.75 to 3, then started intensive therapy (ABA[Applied Behavioral Analysis], speech therapy, OT, and PT [Physical Therapy]) at age 3. Things did not go well in her early intervention and preschool program, so it is really hard to imagine that starting intensive therapy at age 2 with the same program would have made a world of difference. I will admit that from 2-2.5 she was still rather calm and had fewer stims and preoccupations. Maybe that is why it is best to start early, because you can teach more in that period and there will be a strong foundation for further work.  Given that consideration and what I know now about my child’s challenges, I would say that the following services at home would have been most helpful to Beth from age 2-3: 1. Play therapy like Floortime or a parent-oriented behavioral approach like the Denver Model, 2. A focus on body movement and motor planning, with an OT very knowledgable in treatment for dyspraxia, and 3. Language work (receptive and verbal) with a speech therapist using a Floortime approach.  But that is looking back and that is just what I think is right for my kid and our family. I have no idea what I would suggest to another parent who has a newly diagnosed 2-year-old child with autism. 

It would be great to have recommendations from an Autism Therapy Prioritization Committee* specifically geared towards 2-3 year olds, where they describe particular profiles of kids at that age who have autism and what therapies would most likely help. It would also be helpful if a prioritization committee would bite the bullet and chose which ABA programs and which developmental charts are best for 2-3 year olds diagnosed with autism. In addition, it would help to know which play-based models and certifications are recommended, so that parents can ask about those certifications when they are choosing therapists (many speech, OT, and ABA therapist hold these additional certifications). I doubt we will see this type of advice any time soon. And in the meantime, parents with young children who have been diagnosed with autism have the overwhelming task of deciding what therapies to do and which therapists to hire (or fight for through the school system). My heart aches for these parents and I believe the experts have a responsibility to prioritize and further clarify early intervention recommendations.

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*My name for my imaginary committee

Never Say Never

I never thought I would be writing this. We are back to ABA (Applied Behavioral Analysis). Whoa. Wha? Me? The mom who said a hundred times “ABA just didn’t work for us”?  If you are anti-ABA try to read on. If you are pro-ABA stop pumping your fist already and read on 😉

For those who are new to the method, I attached a definition of ABA that I found on the BACB (behaviorist certification) site below.* As I understand it from my experience, ABA therapy for young kids basically means setting goals, measuring progress, and rewarding for doing work toward the goal. The reward can be anything (e.g., edible, play, iPad, sensory break). Generally, negative behaviors are ignored. I have never had much of an issue with the overall concept of ABA, but the devil is in the details of the ABA plan and the talent and experience of the ABA therapists. Being a top-notch ABA therapist to young children who need to work on verbal, academic, play, social, and fine/gross motor skills is a tall order. There can be hundred of goals to work on and they are all detailed in developmental maps (http://www.marksundberg.com/vb-mapp.htm , http://www.partingtonbehavioranalysts.com/page/ablls-r-25.htmlhttp://www.amazon.com/Denver-Curriculum-Checklist-Children-Autism/dp/1606236334/ref=pd_bxgy_b_img_z), but it is hard to determine how to prioritize goals, when a child is ready for goals, when a child has truly mastered a concept (without holes in logic and without forgetting what they have mastered later), and how to teach something to a child who may have a very different perspective of the world than his/her teacher. Also, a good ABA therapist will be skilled in relationship therapies like Floortime (http://www.stanleygreenspan.com/) and RDI (https://www.rdiconnect.com/pages/home.aspx), and will use a child’s interests to meet goals. It is not an easy job by any stretch of the imagination, which is probably why there are people, like me, who have had bad experiences.

ABA did not work out for us when Beth had intensive ABA therapy from 3 to 4 years old. I saw basically no progress with an increase in negative behaviors (aggression, sleeping issues, increased stress). The therapists were able to get Beth to be in a typical preschool classroom (With an ABA-trained aid who fed her squirts of glycerin on her hand, which she licked off as a reward for just being there. Glycerin? Long story there.). In the end it was clear Beth only cared about the reward and was not really tuning into the classroom. Occasionally when music was involved she seemed to have fun. So, we took a very long break from ABA and did Floortime and standard teaching methods at home. I wanted to see if Beth could do things without the edible rewards and if her language could progress with more natural methods like Floortime. Soon we added a speech therapist, because it was clear I could not do it alone and not with just Floortime. Over a year’s time with the Floortime approach, speech therapy, and standard teaching methods, Beth was really initiating with her body (by getting into everything around the house) and verbally (rapid requesting for things she wanted). But slowly, ABA sneaked back into the picture. And when I tried it this time, it worked better than before and I finally understood why people support ABA. When it comes to autism and therapies, never say never is my motto now.

Rewards for Work

To say that Beth and I struggled trying to do schoolwork in our homeschool is an understatement. It was tough to get her to work for a couple of minutes without rewards. Often she would get very upset before we could complete the task. With no other option, and despite my loathing of edible rewards, ABA made a comeback with me introducing rewards for schoolwork. I worked very hard to find a range of rewards, and over time we have a nice set of both edible and non-edible rewards (examples include peppermints, mint floss, blowing bubbles, iPad time, batting a balloon around, and a break in her room where she usually jumps on the bed). Why the need for such high reinforcement for just 5-10 min of school or language work? In short, it is incredibly difficult for her to focus on the task (due to competing sensory interests), coordinate her body and language, and sit still. I always thought if we got the work level right or made the task extremely fun it would not take an additional reward, but I tried everything and I still had to use the “additional” rewards.

The additional rewards worked, but Beth reached the point of rapid requesting for items and we had a new problem. She would bug me constantly for the reward because she finally had the words. My friend used a token board with her son and it worked wonders, so I decided to make one to space out her rewards and teach her to wait. I believe it works great for Beth because it gives her a sense of time and how long she needs to wait in a visual representation.

Token Board (front). I tell Beth  moves 1 penny into a small box after doing some work and after 4 pennies are earned (moved into the small boxes) she gets the reward in the large  box.

Token Board (front). Beth moves 1 penny into a small box after doing some work and after 4 pennies are earned (i.e. moved into the small boxes) she gets the reward in the large box. Velcro is used for attachment of rewards and coins (Side note: I rotate pennies, nickles, quarters, and dimes so that Beth is learning the coin names too).

Token Board (back). Reward choices are on the back of the board and after Beth chooses her reward, I move it to big box in the front of the board.

Token Board (back). Reward choices are on the back of the board and after Beth chooses her reward, I move it to big box on the front of the board.

I try to focus on the positive and be happy we are able to use rewards effectively now. But I can’t help but wonder what would have happened had a variety of rewards and a token board been used in Beth’s previous ABA program. She was so hyper-focused on the glycerin reward and her verbal requesting was so sparse it seems like an obvious missed opportunity. But maybe Beth just needed time to mature before she accepted other rewards and a token board. We’ll never know.

Flashcards & Developmental Maps

I can’t remember why, but about 4-5 months ago, Beth and I pulled out some simple I Spy books that she had when she was 2 (http://www.amazon.com/Spy-Little-Toys-Jean-Marzollo/dp/0545220963/ref=pd_sim_b_11?ie=UTF8&refRID=05MWP470F164HA9XWE4P). I remember she used to point at some items before autism really became evident at just before age 3, but she really couldn’t attend to the book or point to them at all when we tried it again recently. To make a long story short, after a visit to an ophthalmologist and a diagnosis of Oculomotor Apraxia (not the most severe kind, thank God), I became aware of how truly difficult visual scanning and discrimination is for Beth. The ophthalmologist told me she most likely will grow out of it, and to make things as easier on her as possible. He suggested a distraction free work space, picture books that were not too busy, and a book holder for reading (http://www.amazon.com/Portable-Reading-Document-Holder-adjustable/dp/B005IV6U0U/ref=sr_1_1?s=office-products&ie=UTF8&qid=1395155629&sr=1-1).  I also have Beth use a slant board for writing and doing activities, because scanning a flat surface is more challenging than on the slant board.

In addition to the visual issues,  I realized Beth had a terrible time initiating pointing. For awhile I had to nudge her elbow and rest her hand on the table in front of the I Spy book, and occasionally had to sweep my hand across the book to get her attention and help her to point. Over time she is doing much better with pointing to things in books. I remember we had great difficulty in the previous ABA program with pointing to flashcards. She used to pick up the cards or brush her hand across them instead of pointing. I suspected then that she was actually getting some of them wrong when she knew the answers. Now that we worked through her motor issues with pointing I can say that was definitely the case. No wonder she was frustrated.

The experience with the I Spy books got me thinking that maybe the ABA flashcards I thought she hated were not such a bad idea after all. I had asked the ABA therapists why flashcards were necessary for her sessions but I did not get a good answer. Now I know if you get the right flashcards, they can be very useful, especially for kids with visual scanning and discrimination problems (the flashcards should not be so big that it requires a lot of scanning, not so small that it is hard to discriminate the picture, and a white background is best….unfortunately we did not have the right flashcards in the previous ABA program). Put simply, flashcards are visually easier to scan to find the answer to a question. Also, flashcards give a visual grid of choices when you are working on language goals, which if the scanning issues have been addressed, reduces frustration.

So, I stopped thinking of flashcards as the enemy and went back to our old developmental map from her previous ABA Program, the VB-Mapp (http://www.amazon.com/VB-MAPP-Behavior-Milestones-Assessment-Placement/dp/0981835627/ref=sr_1_1?s=books&ie=UTF8&qid=1395157949&sr=1-1&keywords=vb+mapp). With the help of Beth’s speech therapist and the VB-Mapp to set goals, we did a lot of receptive work (pointing to answers) and expressive language work with flashcards and Beth has gained a lot of skills.

I definitely have a lot of issues with the VB-Mapp and I would suggest ignoring the first list entirely and going with the second more detailed list. For some reason some of the secondary tasks on the second list within the book don’t quite align with the main goals they are associated with, and yet the secondary goals are very important for children like Beth who need every step taught. My biggest beef with the VB-Mapp is a part that states that children should respond in a certain amount of time (it is called fluency). Or else, what?  The therapists gave her the answers, that is what (errorless learning is what the therapists called it). I think the theory goes that we should give answers to reduce frustration, and some therapists say that the children are just in a habit of not answering and they need to answer faster. This frustrated Beth to no end. I know she had something in her head that wanted to come out, but she just couldn’t get it out when she was 3. I argued with the therapists to give her more time (because she often did answer if given enough time) and we struck some sort of compromise. But her “amount of time to answer” and her ability to answer at all was very inconsistent back then. Now she can answer fast, and all I can say is that over time, her processing of language and ability to speak an answer has gotten faster without ABA.

When we stopped ABA the first time, we gave Beth a lot of choices, asked her what she wanted and what she saw, and worked on receptive directions tirelessly. We worked with a great speech therapist who is very good at Floortime. One day we noticed Beth’s receptive language was way up, later we noticed she was singing, then later more spoken words started coming out. Then we tried ABA again and it seems to work. So, maybe she just wasn’t ready to speak when we did ABA from 3-4 and now she is (?)  Which is the frustrating thing about ABA. You have the map, you have the method, but you have no idea how to prioritize or teach each individual kid. And you definitely have problems deciding when a kid is ready to attack a goal. Like I said. Being an ABA therapist is a tough job.

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Definition of Behavioral Analysis (taken from http://www.bacb.com/index.php?page=2): “Briefly, professionals in applied behavior analysis engage in the specific and comprehensive use of principles of learning, including operant and respondent conditioning, in order to address behavioral needs of widely varying individuals in diverse settings. Examples of these applications include: building the skills and achievements of children in school settings; enhancing the development, abilities, and choices of children and adults with different kinds of disabilities; and augmenting the performance and satisfaction of employees in organizations and businesses.”