I suspect that Dar’s home therapist reads or at least has read this blog, though we’ve never spoken about it. Why? Well, somehow she knew “Dar Mar rock star” – could she have invented it? Well, she IS marvelously inventive and a tremendous help in Dar’s life. And I certainly don’t mind her reading it, or why would I have it be public? (By the way HI YOU!!) Here are notes of hers…she is nice enough to provide us little summary reports at the end of the week which look a little something like this:
Dar was a little grumpier this week. He is using screaming as an attempt to evade work. I have been granting him more breaks but only after he’s calmed down/been redirected and is complying with instructions so that he doesn’t connect his tantrum behavior as a way to escape tasks. One instance of head-hitting, two attempts @ biting (1 to me, 1 to self) this week. Dar is still having a difficult time attending to some of the cards @ the table so Kim and I talked about trying a different presentation @ eye level on a board so I’ll order materials for that next week.
Mastered: Fine motor imitation – “squeeze tweezers closed” w/left hand
Pretend play – “cook food in Elmo microwave” D put food inside, closes door and presses a start button (I present micro w/door ajar)
What to practice: cont. w/PECs – use “I want strip” on top of book w/2 preferred item icons if D chooses an icon (but doesn’t want it) let’s prompt him to vocally say “no” (ask him “do you want this?”) and then correct him w/pointing to desired icon so he is using pecs endessly.
Started out a little rough as Dar wasn’t tolerating more than 10-15 min of work at a time. Moving session downstairs helped keep Dar calmer and more focused. He is also showing more proficiency in using his PEC icon for “break” this week J Dar also really enjoyed when I have him a little foot massage (right foot only – left seemed sensitive/too ticklish) – seemed to really relax him
Mastered: echoic – “puh” (reintroduced target)
Pointing – @ desired item 2-3 ft away on the ground
What to practice:
- PECS w/”I want _____” icon on front w/2-3 highly preferred item icons
- Yes/no responses – let’s teach this endlessly and prompt him (gesture – shaking head yes/no – if he still responds incorrectly go in for a verbal and gesture prompt)
- 3D identification of brother (as this fell out of maintenance)
Today (Friday) I decided to remove the “work/break” icons from session. I am noticing Dar is expecting work after a break and even screaming when breaks were granted (instead of hearing it as a relief it seems like he was seeing as precursor to work). Thus, I did grant him breaks but didn’t call it that, I just stopped placing demands on him for a few min and just played/left him alone if he walked away from me. Will continue this next week and will see if the frequency of screaming declines.
Mastered: *Tact (label): Goat (“go”)
*Manding: “Yes” (“gah”) when asked “Do you want ____/this?”
[He is using it appropriately for the most part and is a bit inconsistent w/”no” do let’s be sure to prompt this by shaking our head (“gesture prompt”)]
*Fine motor imitation – “pick up puffball w/tweezers” (right hand)
What to practice: Yes/no responses
Prompting D to mand “play” (“pay”) for physical play. He LOVED getting slide/pushed around on his beanbag chair today!
I think it’s safe to say that transitioning session downstairs and removing the “first/then” board has been beneficial for Dar’s work @ home. Screaming has greatly reduced and Dar’s now tolerating longer durations of work J This week Dar is also starting to independently request “play” during ssn (really enjoying chase games, blanket play and being lifted for hops). Let’s continue to vary the play we provide to create more opportunities for Dar to want to ask for it. Noticed 2 instances of spitting (juice) out of mouth and spilling it on himself and spitting on floor (see below).
- Echoic – “shh” (reintro target)
- Tact/label – brother (reintro) (buh-buh) this fell out of maintenance but D remastered it in just a few days J
- Pretend play – “blow on cup like it’s hot” “let’s pretend the cup is too hot” and D blows into cup
And sometimes I take it a step further and ask D to pretend to drink from the cup now that it’s “cooled off”
What to practice: 1) if D spits his juice on self or floot, let’s direct him to get a towel and hand-over-hand have him clean himself and the floor and then toss out paper towel. Let’s give no response except direction if this occurs.
2) Play, play, play! Let’s prompt him with this until he becomes independent w/the mand.