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 We tried everything, including various apps (see this somewhat outdated post: http://wp.me/p2OomI-Iq) and these hands-on approaches: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.

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Adventures with Montessori and Autism: Color Box 2 and Beginner Dressing Frames

Color Box 2

The first two color boxes in Montessori are used for color matching and identification (1). Beth knew the colors in color box 1 well, so I started with color box 2, which contains the colors in color box 1 plus other colors. Beth knew most of the colors in color box 2 at the start of this work, but sometimes confused brown, gray, and black. As always, the problem wasn’t so much the overall goal, matching the colors and color identification, it was the building process used with the color tiles during the activity. The book I am following wanted Beth to randomize the color tiles and then build columns, as show in this video:

The problem was that Beth hates randomizing the color tiles and is driven to line the pairs up horizontally (I believe due to an autistic tendency and/or motor planning impairment and/or hyper focus on a part of the material instead of looking at the whole process).  I got a lot of comments after stating similar randomization and lining up issues with the pink tower in a previous post, and I think I was somewhat misunderstood in my intentions. I don’t care if Beth prefers lining things up and she can do that if she wants to most of the time (although she doesn’t choose to line things up unless I ask her to do these types of activities). The problem is Beth is so limited in the number of motor plans she makes, her tendency to line things up and continue initial motor plans is preventing her from experiencing new motor plans. I am trying to help her with her motor planning, so I believe it is worth encouraging her to create different patterns to expand her motor planning abilities. Also, Beth’s tendency to make a long line of the color tiles horizontally caused her to lose her place and make errors. So clearly her tendency to line the color tiles in one long line is at odds with accomplishing the goal of making color matches. Here we go again…I had to create another work around.

I took two approaches to having Beth make independent color matches.  In the first approach, I lined up half of the set in one long line, randomized the other matching half within the box, then had her match in a two-row format. She did this task easily. In this video I show her using this method and she demonstrated that she knows the colors in the color box (we did not have to do a full 3 stage language lesson, since she was already close to knowing all the colors and she quickly sorted out her confusion with brown, gray, and black):

In the second approach, I taped pieces of material in a two-column format to poster board (the same material I used to make her pink tower, brown stair, and red rod mats, so she knew she was supposed to build on that material). I still had to randomize the color tiles before she started, but this modified “strip mat” allowed her to create a series of color matches on her own in columns, which brought her closer to the original Montessori process. She was so stuck on continuing to make the first column that she would replace tiles at the bottom with new ones or try to crowd other tiles onto the mat at the bottom.  I prompted her to make the new column by pointing to the top and stated that the first column was “full” so she had to start a new one. Here is a video of her using the strip mat with color box 2 where she was able to motor plan the activity without prompting, and a close up of the strip mat layout:

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With the strip mat, going from one column to the next still requires occasional prompting to start the next column. But she knows her colors well, can create color matches from the tiles, and seems to understand making columns, so we will move on and occasionally circle back to color box 2. The next step with color tiles is a complex one…using color box 3 to make a light to dark flower-shaped creation on the floor. Oh my.

Beginning Dressing Frames

The book I am using said start with the “simple” dressing frames for period 1. The problem was that all of the dressing frames were hard for Beth at first. We ended up starting with the big button, velcro, snaps, and zipper frames because they seemed the most applicable to her life (big buttons and snaps on her rain coats, velcro on her shoes, a zipper on her jacket). I wasn’t super picky about technique, as tasks like these are hard enough for her as it is without demanding perfection. After a lot of demonstration, encouragement, and flat out begging her to keep trying, her hand use really took off after she mastered a few frames. Most notably, I noticed an improvement in pincer grasp and thumb use. I didn’t even have time to write this post before she had already mastered a few more frames and was well on her way to mastering 7 frames. Also, I was surprised how well the activities transferred to the real clothes on her body (with the exception of the snaps, because she figured out she could just press down with her thumb to snap the dressing frame snaps). Here is a video of Beth doing a few of the “simple” dressing frames:

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(1) This will be a quick and poorly edited series because things are happening fast and I just want to write it all down. My daughter is almost 7 years old and we are starting the Montessori program from the beginning using this book, you tube videos, and common sense alterations. We homeschool and do other standard K activities. Montessori is an attempt to fill in developmental gaps and increase independence. See this fellow blogger’s post on the division of the work into periods as outlined in David Gettman’s book: http://thehometeacher.org/2009/03/sequencing-your-activities-more-on-montessori.html. We are starting with period 1 activities (taken from the book), with adjustments of course:

Period One

  1. Practical Activities – pouring beans between two jugs, opening and closing containers; buttoning; buckling; other simple dressing frames; carrying and laying out floor and table mats; saying please and thank you; carrying a tray; lifting, carrying, and putting down a chair, sitting down and getting up from a chair at a table; climbing up and down stairs; walking on the line; folding, hanging clothes on a hook;  brushing hair; dusting
  2. Sensorial – Cylinder blocks; pink tower; box 1 of the color tablets; presentation tray of the geometric cabinet; sensitizing the fingers; touch boards; presentation of Geometric solids; stereognostic bags presentation
  3. Language – Classified pictures exercises; speech stages – I Spy; book corner and library
  4. Math – none
  5. Culture – land and water presentation

Period Two

  1. Practical- pouring water from a jug, medium difficulty dressing frames, simple braiding, setting table, polishing surfaces, washing hands, washing cloths, scrubbing a table top, sweeping sawdust, brushing clothes, folding clothes, hanging clothes on a hanger, handling a book, scissors exchange, greeting people, kindness to visitors, being silent
  2. Sensorial- advanced cylinder blocks exercises, brown stair, red rods, boxes 2 and 3 of color tablets, geometric cabinet exercises 1-4, binomial cube, blindfold, tactile tablets, stereognostic bags exercises, sorting grains, sound boxes, preliminary presentation of bells, three stage lessons and the names of Sensorial qualities
  3. Language- classified picture exercises 3 and 4, stage 4 of I Spy, exercise 1 of single letter sandpaper letters, metal insets, frequent speech questioning
  4. Math- none
  5. Culture- Land and water exercises, first maps, places classified pictures, preliminary work for classification by leaf.

Adventures with Montessori and Autism: The Pink Tower, Brown Stair, and Red Rods

The Pink Tower

The pink tower is classic Montessori. It looks easy…just arrange the solid wooden blocks from big to small and make a tower. The goals are to improve fine motor control, develop visual discrimination and scanning of volumes, and gain an understanding of big versus small. There are many tall tower cardboard nesting block sets in stores and we had a set of those when Beth was younger. The problem was that Beth would only nest them and she absolutely refused to build a tower. This is one example of Beth’s “motor planning holes.” Maybe Beth’s rigidity caused her eventual motor planning limitations, or an underlying motor limitation plus the rigidity led to a further motor development issue. Even today I am not clear on what happened. But the good news (from a new motor planning perspective) is that the pink tower blocks are solid, and Beth’s only choice it to build a tower with them instead of nesting them.

The traditional approach for building a pink tower is described in the book I am using (1) and shown in this video:

The first step in the process is understanding the tower through taking it apart. Then the blocks are supposed to be placed in random fashion on the mat, so the child can use visual scanning to find the biggest, next biggest, and so on. To not randomize the blocks misses a key developmental step. But Beth insisted that she must order the blocks in a line when she placed them on the table, and telling her to “mix them up” or “just put them anywhere” didn’t help her randomize the placement. This is not Beth being stubborn…it is her inherent autistic tendency. Many kids on the spectrum are driven to line things up and order by size. One approach I used was to mix the blocks up after the fact, as shown in this video (this is an exceptionally “perfect” effort by Beth, she makes the occasional error):

After Beth had taken apart the tower many times and understood it, I used a basket storage approach that allowed Beth total independence. I put a mat on top of the blocks in the basket…this was a prompt to place the mat first before beginning the work. The mat size, slightly larger than the largest square, gave Beth a visual cue to help remind her she was to build a tower instead of line up the blocks. Beth still tended to order the blocks when she put them back in the basket, but I just randomized them at the end of the morning work so they were ready for the next session. Here is a picture of the basket/mat and a video of Beth working using the basket system independently:

Pink Tower in Basket

Pink Tower Blocks in Basket

The Brown Stair

The brown stair is used to make a horizontal step pattern, and later used to teach the concept of thick versus thin. I used the same basket approach with the brown stair as I did with the pink tower. Since Beth is driven to line things up, building the brown stair was very natural and easy for her. Here is a picture of the stair blocks in the basket and a video of Beth building the brown stair:

Brown Stair in Basket

Brown Stair Blocks in Basket

The Red Rods

The red rods are used to teach long versus short, and later alternating red/blue pattern rods that are the same sizes as the red rods are used for introductory counting. The red rods are too big to be placed in a basket, so I bought a stand on eBay which worked well. Surprisingly she tends to put them back randomly into the stand. Beth was good at finding the “next longest” or “next tallest” rod, and only makes the occasional error, but placing the first rod on the mat in the right position (upper left corner) proved to be very difficult. For now I am placing the first rod for her and reinforcing the lining up on the left side, which is also hard for her. Any time Beth has to work to create a boundary in empty space it is a challenge due to working memory problems, focusing on a part instead of a whole, and general motor planning issues. Here is a video of her completing the red rod pattern and a picture of the finished red rod pattern:

Red Rods

Red Rods

 

When to Move On…

Deciding when to move on is tougher for me than figuring out accommodations. The goal with these Montessori activities is to teach the concepts while refining motor control. But Beth’s movement is much different from a child without special needs, so getting every detail right (doing everything quietly, perfectly flowing movements) is not my biggest concern. I think I need to strike a right balance…expose her to motor plans she may have missed, allow the occasional mistake, and accept imperfection so we can move onto the language lessons she desperately needs to understand the world and communicate better with others. I am calling the pink tower, brown stair, and red rod building good enough to start the language lessons, and we are working on big/little and large/small with the pink tower, thick/thin with the brown stair, long/short and tall/short with the red rods. It is unfortunate that “large” and “little” begin with the same letter and are total opposites, because this tends to confuse Beth as she relies heavily on initial sounds to figure out words. It is the same with long and little…both start with l and are the opposite ideas (which one is the longest? Not the littlest, the longest). It will take us awhile to sort through this language issue, but the pink tower, brown stair, and red rods are exceptional teaching materials for these concepts.

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(1) This will be a quick and poorly edited series because things are happening fast and I just want to write it all down. My daughter is almost 7 years old and we are starting the Montessori program from the beginning using this book, you tube videos, and common sense alterations. We homeschool and do other standard K activities. Montessori is an attempt to fill in developmental gaps and increase independence. See this fellow blogger’s post on the division of the work into periods as outlined in David Gettman’s book: http://thehometeacher.org/2009/03/sequencing-your-activities-more-on-montessori.html. We are starting with period 1 activities (taken from the book), with adjustments of course:

Period One

  1. Practical Activities – pouring beans between two jugs, opening and closing containers; buttoning; buckling; other simple dressing frames; carrying and laying out floor and table mats; saying please and thank you; carrying a tray; lifting, carrying, and putting down a chair, sitting down and getting up from a chair at a table; climbing up and down stairs; walking on the line; folding, hanging clothes on a hook;  brushing hair; dusting
  2. Sensorial – Cylinder blocks; pink tower; box 1 of the color tablets; presentation tray of the geometric cabinet; sensitizing the fingers; touch boards; presentation of Geometric solids; stereognostic bags presentation
  3. Language – Classified pictures exercises; speech stages – I Spy; book corner and library
  4. Math – none
  5. Culture – land and water presentation

Period Two

  1. Practical- pouring water from a jug, medium difficulty dressing frames, simple braiding, setting table, polishing surfaces, washing hands, washing cloths, scrubbing a table top, sweeping sawdust, brushing clothes, folding clothes, hanging clothes on a hanger, handling a book, scissors exchange, greeting people, kindness to visitors, being silent
  2. Sensorial- advanced cylinder blocks exercises, brown stair, red rods, boxes 2 and 3 of color tablets, geometric cabinet exercises 1-4, binomial cube, blindfold, tactile tablets, stereognostic bags exercises, sorting grains, sound boxes, preliminary presentation of bells, three stage lessons and the names of Sensorial qualities
  3. Language- classified picture exercises 3 and 4, stage 4 of I Spy, exercise 1 of single letter sandpaper letters, metal insets, frequent speech questioning
  4. Math- none
  5. Culture- Land and water exercises, first maps, places classified pictures, preliminary work for classification by leaf.

montessori book

 

Adventures with Montessori and Autism: Pouring Beans

Beginning Our Montessori Journey

Clearly this will not be the typical jaunt through Montessoriland (See end note below [1] for info on Montessori and the book we are following). Beth has autism with very significant stims, attention issues, motor planning core deficits, language impairment, and she is almost 7 years old (Montessori is usually started at age 2 or 3).  In Montessori, natural motivation is key, as is independence, but I am sure I will be doing more guiding than typical in Montessori. Maybe even some, gasp!, correction of errors. It is simply not possible to just demonstrate something a few times and have kiddo catch on and sometimes I have to directly instruct her to get around stims and other hurdles. Adjustments will be made, but not too much, because I want her to improve her non-verbal observation and processing skills and gain independence. It is a delicate balancing act. The beauty of Montessori as it relates to Beth’s autism is its focus on the senses and working on senses in isolation, visual scanning practice, practical work, and simple distraction-free materials. It is a good fit for Beth, but perhaps something she was not ready for when she was younger. I read somewhere that special needs kids often start the process later and it is “not easy.” Ha! We are all about doing things that are not easy. Bring it on!

Bean Pouring

We tried several Montessori activities over the past month and pouring beans is the most motivating thus far. When we first started I thought…easy peasy…this will be quick. Wrong. The crossing of midline, cocking of the wrist, maintaining eyes on work, scanning and picking up the beans. It is not simple at all for Beth.

But she has made great gains. Yes, I did have to directly tell her to cross midline and turn that jug on her left side (and not just non-verbally model as is typically done in Montessori). Beth has gone through years of not crossing midline very much and is in a firm habit of not using her hands in certain ways. Also, she has grown to rely on verbal cuing, so I used the minimal amount I could and chalked it up to reasonable accommodation. We skipped the typical small tray but we should have used it…it would have made placement more obvious. No this is not as perfect, as smooth, and focused as a typical kid doing Montessori. But she crossed midline 4o times a day for weeks, she moved from insisting on standing to working at the table, she learned to tilt her head to see what she was doing, she learned she must look and use her hands at the same time for the best outcome. I am calling this good enough, and time to move on. But I will leave the bean pouring jugs out as an activity because she loves it so. The klink of the beans on the ceramic and the pouring sound…there is just something about it.

Video I found helpful:

Beth pouring beans:

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(1) This will be a quick and poorly edited series because things are happening fast and I just want to write it all down. My daughter is almost 7 years old and we are starting the Montessori program from the beginning using this book, you tube videos, and common sense alterations. We homeschool and do other standard K activities. Montessori is an attempt to fill in developmental gaps and increase independence. See this fellow blogger’s post on the division of the work into periods as outlined in David Gettman’s book: http://thehometeacher.org/2009/03/sequencing-your-activities-more-on-montessori.html. We are starting with period 1 activities (taken from the book), with adjustments of course:

Period One

  1. Practical Activities – pouring beans between two jugs, opening and closing containers; buttoning; buckling; other simple dressing frames; carrying and laying out floor and table mats; saying please and thank you; carrying a tray; lifting, carrying, and putting down a chair, sitting down and getting up from a chair at a table; climbing up and down stairs; walking on the line; folding, hanging clothes on a hook;  brushing hair; dusting

  2. Sensorial – Cylinder blocks; pink tower; box 1 of the color tablets; presentation tray of the geometric cabinet; sensitizing the fingers; touch boards; presentation of Geometric solids; stereognostic bags presentation

  3. Language – Classified pictures exercises; speech stages – I Spy; book corner and library

  4. Math – none

  5. Culture – land and water presentation

montessori book

 

What We Have Here is a Charlie Foxtrot

I have been sitting here staring at my computer screen, trying to think of what to say about our public school experience and why we are returning to homeschooling. Do I go off on how, as in my child’s early and intermediate intervention experiences, we once again had the problem of various team members thinking in silos when managing my daughter’s case? Maybe I should be kinder and say, she does have many co-morbid conditions and it is complex, so she is a challenging case and it is just easier for her to learn at home from one person who knows her whole history? But every time I sit down at the computer, one word pops into my head and will not leave, so I just looked up the exact definition for creative inspiration:

Clusterfuck (urban dictionary definition): Military term for an operation in which multiple things have gone wrong. Related to “SNAFU” (Situation Normal, All Fucked Up”) and “FUBAR” (Fucked Up Beyond All Repair).

In radio communication or polite conversation (i.e. with a very senior officer with whom you have no prior experience) the term “clusterfuck” will often be replaced by the NATO phonetic acronym “Charlie Foxtrot.”
Example: By the time the artillery came in the enemy was already on top of us. It was a total clusterfuck.
Okay, to be polite, I will say we had a Charlie Foxtrot. I tried my best to help guide them, but there was no leadership for my daughter’s case – no one person at the school that could understand all my kid’s challenges, problem solve to work around her issues, and simultaneously figure out her strengths. Thinking and working in silos led to an unsolvable mess, or at least a mess that could not be solved for a very long time (and not without expensive advocates and/or lawyers, with uncertain outcomes and a lot of unnecessary stress). Meanwhile my daughter’s development kept sliding downward and the clock was ticking.
In short, these are the negatives of the experience:
  1. I learned that our team thought they knew how to engage autism, but they are totally untrained for the “difficult to engage” child. I know they are not qualified because we have hired high-priced consultants and therapists who are masters at Floortime (no dear person at our first IEP meeting who thought she was a Floortime expert, it is not working on the floor, it is a method for engaging a child that requires you put your adult agenda aside [sort of, because you still have to have a firm grasp of development and keep goals in the back of your mind to gently expand the child] and it does require formal training). Orienting my child and helping her tune into her surroundings and other children was missing when I observed. There seemed to be the underlying assumption that she was very difficult to engage and there was nothing to be done about it. During 4 hours of observation during education week, I saw many missed “communication bids” from staff that could have led to an engagement. My offers to make custom visuals of favorite stories and send in motivating materials were brushed aside.
  2. My kid was getting less socialization in school than out of school. When I observed Beth at school she seemed disconnected. She was not being helped to tune into others and engage and “social group” is once a week. Need I say more? She got more out of going on play dates, to play centers, and going on community outings when we homeschooled.
  3. I now get why the “presume competence” crowd is totally pissed off. It is because the assumption in our school is that the goal is to catch up to peers in totality, and when you have a child with extreme uneven development in motor planning, fine motor, expressive language, play, physical capabilities and academics, he/she is basically written off as incapable. For example, staff simply cannot wrap their head around a child who can do academics, but only if given the right motor planning and expressive language supports. I am aware that my child cannot motor plan for shit, but we are working on it and she is making slow progress. So I begged the school in the beginning, please don’t let her die of boredom working on the same concepts over and over…fix the motor plan and expressive language used for academics so she can progress and work on different motor plans in occupational therapy and language issues in speech therapy. It seems simple, but I couldn’t get anyone to consistently fix the motor plans and language constructs due to the number of people involved.
  4. If you have a child with co-morbid issues like dyspraxia, visuomotor problems, low tone, and anxiety, it is hard for staff to remember how to support him/her. I would look up after trying to explain my child for the 50th time and see the familiar stare of deer in headlights. So the need for accommodations like elevating work, right table height, simplified layout, using her finger to guide her reading, working on the lower part of an easel, special prompting to help her move her body, etc. was lost on most staff.  Also, My child could not sit at school, but she can sit at home, so how can she reach her academic potential? Part of it was the totally unsupported seating at school, which was only resolved when I brought in our own chair from home because the mammoth system moved so slow. But also I think she was overstimulated and stressed. So while Beth was not totally flipping out in school now (yeah! progress from the old days!) she was still anxious. Which brings me to my next point.
  5. The final nail in the coffin was the behavioral report. I love that these reports like to “note” possible sources of “behavior” from parents, suggest OT assessments, admit history of anxiety, but in the end, our children are treated not as human beings with feelings, but children to be controlled by static “if child does this, then do that” formulas that a behaviorist can hand over to staff. I cannot live with that. I agree that Beth’s stimming can get in the way of learning and engagement is a problem, but I want to work with Beth to help her help herself. I want staff to own up to their end of the engagement problem and be trained to better engage her. I want staff to try to understand what she is thinking and why she is doing what she is doing when she is stimming. Otherwise, stopping “stimming behaviors” in a blind fashion will lead to worse behaviors and a child who feels powerless and misunderstood. When “behaviors” occur, I want all staff trained to see my child as a whole, and combine child psychology, behavioral strategies, OT techniques, and sensory strategies to help her. But that is just not the way the system works and I am not sure if it is a training issue as much as it is a mindset.

And these are the positives of the experience:

  1. I had an awesome home behaviorist and she had some good ideas. I will miss her. She encouraged me to weave intraverbal goals into play and throughout the day and that will be a big effort going forward.
  2. I learned we need to work harder on engagement and we need to work through some of the stim issues.
  3. Let’s just say my confidence in my homeschooling abilities is up. Way up.

Beginning Math Adventures on the Spectrum

I remember a little over 2 years ago when I started homeschooling Beth, I couldn’t wait to jump in and start working on math. She liked numbers. She even liked counting. I loved math. I even had experience in my college days, where I worked as a math tutor for adults who had learning disabilities. How hard could it be?

Boy was I in for a surprise. Teaching Beth math was harder than teaching Beth to read (see my previous post on reading here: http://wp.me/p2OomI-1jf) due to motor planning and visual scanning challenges and a puzzling prosody issue that sabotaged counting.

Rather than rehash the millions of things that failed, I am going to focus on what I finally figured out after endless hours of trial and error. This is not all-inclusive or it would be a very long post, but shown below are some of the methods and materials I used to help Beth achieve early math goals.

Counting and Number Recognition

I used a pocket chart for beginning counting because the numbers are bigger and easier to point to and are organized neatly in rows and the information is presented near eye level and vertically, which reduces the motor planning and visual scanning demand. After hours and hours of lightly touching her hand so that she would move over to the next number and coordinate counting with pointing and endlessly prompting her to find the beginning of the next row, this is where we are:

I would say the above is an exceptionally good clip. She usually makes the occasional coordination error moving from one number to the next or moving down to the next row, but for the most part she’s got it. So that means she knows her numbers 1-40, right?

Wrong. A few months ago I isolated the numbers using flashcards and realized she had a huge problem. She could not recognize numbers past 10 reliably. She tended to look at part of the number (e.g., would say “2” if she saw “12”) or had trouble visual scanning and reading a number from left to right (e.g., would say “21” if she saw “12”). In addition, we had some expressive language problems (or rigid stuck thinking problems?) with the teens, because she so wanted 11 and 12 to be “one-teen” and “two-teen.” Finally we had the problem if I worked on teens only or 20-29 only, for example, she would get stuck on what we just worked on and make a lot of expressive language errors. It was a mess. So while it looked as if she knew how to read numbers 1-40, she actually memorized the pattern on the pocket chart and was probably just looking at the last digit while she was reading off the numbers.

To address these issues, we used tactile cards (like sand paper cards, but softer texture http://www.amazon.com/Carson-Dellosa-Education-Textured-Touch/dp/B00D5T3EFQ/ref=sr_1_5?ie=UTF8&qid=1412284331&sr=8-5&keywords=1+to+30+tactile+cards) and I had her trace the numbers and say the names out loud. Also we practiced with flash cards or by reading random numbers from the pocket chart, and I had her drag her finger from left to right, much as we do with reading, to help her visually scan the numbers from left to right. For Beth, it is best to work on many numbers at once (at the very least 1-30) to prevent stuck expressive language and to review often (we do at least a weekly review). We have made a lot of progress, but as you can see from this video she still gets tripped up sometimes:

 

Counting to a Specified Number

The kid just would not stop counting! I would say, “count to 4” and she would blow by 4 and continue on. I tried everything…holding stop signs, hand signals to stop, putting my finger on her lips, having her say “stop” or “shhhhh” after she reached the last number. Nothing worked…for YEARS. Then one day about a month ago I was so frustrated I started jumping up and down like a mad woman and being obnoxious about the way I counted. And…she stopped on the right number. It was miraculous. But why?

It turns out my kid has a prosody problem…she says all her numbers with the same tone and emphasis usually. Now try doing that yourself right now (no really reader, do this)…count to any number and try to keep your voice exactly the same even on the number you are supposed to stop at. It is hard to stop, isn’t it?  I think it is simply Beth cannot do naturally what most of us can do…inflect her voice on the number where she is supposed to stop counting. Here is a good example where I am holding up cards with numbers on it:

Now we are moving towards counting with counters and stopping. For years I thought she just wanted to fill out ten frames due to some sort of compulsion, but now we are making progress if we work on emphasizing the last number. Here is a video with a magnetic ten frame set  (http://www.amazon.com/Learning-Resources-Giant-Magnetic-Ten-Frame/dp/B00AQURHDW/ref=sr_1_1?ie=UTF8&qid=1412289533&sr=8-1&keywords=magnetic+ten+frame) and although you cannot see it in the video, there were 10 counters on the table and she stopped counting on her own:

 

Number Ordering

We tried number ordering exercises with the pocket chart, but even that was too much visual scanning and motor planning for Beth. My friend introduced me to these Lakeshore Learning puzzles for sequencing numbers and letters (http://www.lakeshorelearning.com/product/productDet.jsp?productItemID=1%2C689%2C949%2C371%2C917%2C742&ASSORTMENT%3C%3East_id=1408474395181113&bmUID=1412289161487 , http://www.lakeshorelearning.com/product/productDet.jsp?productItemID=1%2C689%2C949%2C371%2C928%2C517&ASSORTMENT%3C%3East_id=1408474395181113&bmUID=1412290502035,  http://www.lakeshorelearning.com/product/productDet.jsp?productItemID=1%2C689%2C949%2C371%2C920%2C724&ASSORTMENT%3C%3East_id=1408474395181113&bmUID=1412289197133 , http://www.lakeshorelearning.com/product/productDet.jsp?productItemID=1%2C689%2C949%2C371%2C920%2C723&ASSORTMENT%3C%3East_id=1408474395181113&bmUID=1412289211002). I was skeptical Beth would be able to do it, but because the motor plan is so easy (all work is 2D, just slide the pieces into place), it was a success. It was nice to know that she can order numbers after all with the right accommodation. In case you are wondering if she is just making the picture…no she isn’t. She doesn’t even look at the picture until the end so it is more like a reward. Referring to a picture while putting pieces of a puzzle together is still very hard for her, even after doing puzzles with her for endless hours.

 

Patterning

I am not familiar with the research supporting the need for it, but completing patterns is a common goal on IEPs. I guess it is some indicator of logic ability. Beth failed the patterning portion of the IQ testing for K, because the tester wanted Beth to pattern on a blank piece of paper (she needs at least boxes drawn in for placement), Beth wasn’t interested in the materials, and expressive language issues got in the way.

I have found that she absolutely must have boxes on paper or containers for placement and using very familiar favorite items that she has heard receptively in videos many times is helpful. It is crucial for her to say the items out load and to point to keep her focus and to keep track of where she is. It also helps Beth focus if she is guided to build the initial pattern. It is still hard for her, but it is possible with these accommodations. With more effort, I have been able to get her to pattern non-preferred things like colors and shapes, but getting that expressive language out is a lot harder for her. This Lakeshore Learning Patterning Tray works great (http://www.lakeshorelearning.com/product/productDet.jsp?productItemID=1%2C689%2C949%2C371%2C897%2C952&ASSORTMENT%3C%3East_id=1408474395181113&bmUID=1412287383169) for patterning manipulatives. I put her patterning tray on her slant board, which helps ease the visual scanning demand and helps with visual attention. In the videos below I used party confetti with her favorite Sesame Street characters and Halloween erasers from the dollar stores (she has a favorite Halloween video with ghost, bat, witch, pumpkin, etc so those words are easy for her). The erasers are great because they are thick and easier to pick up.  These videos show us working through AB patterning, ABC patterning, and missing items within a pattern:

 

Worksheets (Finally!)

This past summer we moved away from manipulatives and tried the first chapter of Go Math. Go Math is an example of curriculum that has a very nice layout for kids like Beth…not a lot on a page, clear boundaries between sections, and ten frame boxes for counting.  Accommodations would still need to be made if this program was used due to Beth’s language and motor planning/visual scanning challenges. For example, the word problems are too hard for her due to language issues, she would need magnetic counters because she uses a slant board and the counters were sliding everywhere, she would need to circle things rather than fill in or draw squares, she would need to use plain counter blocks instead of snap together blocks, sometimes I have to block off certain sections of the worksheets to help her focus, and I often use a sweeping motion over choices to help her visually scan. Counting with her finger by pointing and then picking up the pencil to write in numbers was a motor planning nightmare. So I prompted her to not put down the pencil and circle items to count them instead. When she writes numbers I try to give her a pass on writing…if it is legible at all I accept it because she tends to get frustrated with handwriting corrections. Here is a clip of a Go Math page:

 

 

 

 

 

 

 

 

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.”