Keep up the creativity

One of the hardest things as an adult working with children is to constantly challenge yourself to be creative. It's important that my students see a variety of ways to play with toys. As the adults around them it can be super challenging because the kids might only play with one toy appropriately. After about a month of playing with this one toy or even similar toys, things can get really boring. That leaves the adults with two options. The first option is to go out and buy more similar toys that way there is at least a variety of toys. The second option is to expand on the creativity of the one object. In the context of kids toys, expanding on the creative ways to engage with a toy can be super challenging. As adults, we see the toy for what it is and how we should play with it. However, it is important that children look at toys beyond their functional use. It is absolutely beautiful to watch children play with toys and that is because of their extensive imaginations. Non-typical kids often struggle with imagination and can really benefit from a new way to look at and play with a toy. Another reason why it can be really difficult for adults to be more creative is that we have seen these toys so many times. We feel like we have exhausted all creative endeavors. If you find that this is the case, combine two toys. How can the toys work together? Being creative is definitely one of the most challenging parts of working with non-typical children. However, it can be so rewarding when you see that they begin to bring more creativity to their toys.

Doing our part as the adults

The fact that little kids are just so darn cute can hinder our ability to be effective teachers. For instance, I have one client who escapes from situations when mad. Obviously this is awful when transferred into a more public setting like a mall or grocery store, so we need to practice at home. The problem with this kid is that the kid takes a lot of work to come back to work and has parents who pay attention most after escaping. It is natural as an adult to try to reason with the child and say "no, you need to come back and play with your teacher". However, this is actually a disservice to the child and parents because the parents have reinforced the child's negative behavior with attention. We call this an ABC situation. There is an antecedent (A) which is what happened immediately before the child's behavior, or the reason for the child's reaction. Following this is the child's behavior (B). You can track what kind of behavior the child exhibited. Finally, there is the consequence (C) that the adult gave the child. In the case of my client, something happened (A), the child escapes (B) and the child got attention (C). Once behavior is explained in these terms it seems pretty clear why children act the way they do. Most of the time, the hardest part as the adult is stepping back and looking at the behavior in a dry manner and be able to apply the proper consequence. Sometimes the difficulty is that you just don't know where the behavior is coming from, you don't know how to react, or -the worst- you all together forget to analyze the behavior and give in some way because the kid is just so darn cute or funny. For as much as I want to keep some of my clients, it is a disservice to them and their parents if I don't do my part to create structure and present clear consequences.

Sibling imitation power

Even though it may seem distracting to have siblings in on a session, I love having siblings participating in sessions. Multiple kids can sometimes seem overwhelming. However, if you can make some of the children leaders and give them special responsibilities, it is absolutely amazing how helpful they can be. These leader siblings act like me and my coworkers when we aren't there. The leader siblings want to be teachers, they like applying the structure to the other siblings and enjoy being helpful. The last time I had a group session, I saw the twin prompt the oldest sibling to appropriately ask to share a toy!!!
Now you might think that if you don't have older children, you might not be able to take advantage of maintaining the lessons from the therapists. This is totally not the case. If you have younger children, you can teach your younger children all of the same things you are teaching your child that is receiving therapy. For instance, I've seen infants pick up some sign language. Sometimes the infants just want to participate in the activities.
Regardless of who in the family begins to imitate either the therapist or the sibling, the family will have more consistency with better sharing and turn taking skills and look to each other more often for learning.

oh those stubborn terrible twos

The terrible twos are the terrible twos for a reason. Children are just learning about how the structure of life works. Their desires become more complex. For instance, they become picky eaters, they only like their favorite toys and are unwilling to share those toys, they are impatient. On top of all of this, two year old children do not have language complex enough to communicate their developing complex desires. What was once just crying for either the bottle, diaper change or sleep, becomes shouting and screaming and kicking and hitting and running away and even biting in the grocery store, at preschool, at the park, and sometimes even animals. However, if you are a lucky parent, this isn't always the case. For instance, my parents always tell me that my brother was a happy baby; he was docile, calm and always had a smile on his face. But that's not what this story is about. Before my brother, my parents had me, a typical "opinionated" two year old with a healthy set of lungs and quick legs. Naturally enough, my mom loves to laugh at my stories of my more "opinionated," stubborn children, like one of my current clients.

I should first note that not all of my clients are diagnosed with autism. Some of my clients have cognitive disabilities (or develop differently in regards to cognition), physical development difficulties, or flexibility issues. In most cases, the "opinionated" two year is the one with flexibility issues. As an inflexible child and sometimes an inflexible adult, I have struggled with inflexible children. Inflexible children tend to want to be in charge and play the way they want to without any interruptions. As an older version of these children, I'm prone to the same expectations. When working with a child, I expect the child to follow instructions appropriately and to be okay playing with whatever toy I think is appropriate at the time. However, the "opinionated," inflexible child doesn't normally see eye to eye with me on listening to instructions or even playing with the toys I think are most appropriate at the time. I'm sure it's not difficult to imagine the difficulty I encounter with the little versions of myself.

After nearly a year of working with children, I think I figured out how to work with inflexible children. Scenario one: the "opinionated" child gets upset when presented with a new activity. Solution: put the opinion to work. Give the child the option to make choices and select what he or she would like to do. This presents the opportunity to practice communication such as pointing, sign language, or verbalizing. I think communication is the best way to combat this inflexibility. Even if it isn't necessarily appropriate, like getting in and out of a car a thousand times or jumping on the bed or eating the 20th cookie for the day, at least it's better than an aggressive behavior and the child practices communicating. Scenario two: the "opinionated" child doesn't like sharing, nor watching someone play with a toy inappropriately according to the child. Solution: it is a variety of steps. First let the child play with all toys freely. Then see if the child will let someone else play the same activity next to the child. The following step is to see if the child will allow integrative play such as constructing a lego tower together, pretend cooking together, and putting a train track together to play trains. The last step is turn taking. In this case, someone else taking a turn for even a second can count as a turn. The point is that the child appropriately attended and engaged while someone else took a turn. Sometimes this last part can be a challenge and can seem to take a life time to achieve, but it is so exciting when it does happen. This has worked for me in the past and I hope it can work for other children.

Oops not quite

Sometimes we think our students have mastered a skill because they can produce the correct response to a stimulus. Unfortunately one of the characteristics that is important to watch for in children with autism is the ability to generalize. This means that a child might appear to have acquired a new skill. However, it is often the case that the child has learned this skill in a specific context. For example, I have one student who appeared to have mastered an imitation skill. However, this kid only mastered this skill when presented with a very narrow range of objects. The worst part is that no one noticed this until we thought the skill was mastered so now we need to go back and nearly start the program over from scratch. In this case the child is learning an association between an activity and an object instead of paying attention to the imitation stimulus. This is true of almost anything we could possibly teach children. It can be challenging to think of how to add variety to activities or make something different, but it is a way to be creative and develop a different perspective on life and learning.

So much learning

I don't think we truly appreciate how much children learn all the time. When children start to learn words, they learn fast. At 18 months a child learns 20-40 words a day. Children also learn to listen to multiple step instructions like "come here, take this, and put it in the trash". That's three steps in one. There is a lot going on there. Children also learn object permanence, which is that objects don't disappear when hidden. For example, a toy does not disappear if it is put under a blanket. Another example is covering your face with your hands and removing them in order to play peek-a-boo. So although peek-a-boo is adorable and fun it's actually a sign that a child has not reached a certain stage of development. That doesn't mean that you can't have fun playing peek-a-boo in the mean time. Children learn so much all the time. Even potty training is an example of extensive learning. Kids first learn that they need to recognize that they should go to the bathroom, then go to the bathroom. Next they need to pull down their pants and sit on the toilet for some time. (If you are currently potty training, it helps to sing a song or book to prevent boredom; some kids even laugh). The amazing thing is that we expect children to be able to do all of this at such a young age.

This is all amazing when you look at it from a neuro-typical child. However, children with autism typically don't have the same amazing milestones that typical children have. As a result, I think it is super important to break down all of these steps and to realize how much learning goes on all the time. Fortunately for me and my clients, I think the Discrete Trial Training (DTT) method really helps to break it down. Children match one object with another. Children start following instructions. Children become more flexible with behaviors. Children begin to communicate. Children learn to jump, stretch and walk up stairs. Children learn to be patient. Children learn to share experiences and even initiate sharing those experiences. Children begin to take turns and share. Children complete activities or increase focus on activities. Children learn to use silverware. Children begin to imitate. When you take the time to break down the learning process into all the little details, the learning process for a children with autism can be just as amazing, if not more rewarding. Even if it takes ten years for a child to learn to clap, that clap can mean a connection to a child. That small connection of giving a correct response one time means that we are bridging the gap between the child's world and our world. To think we could have access to the world in which every child with autism functions, the possibilities for change and creativity seem plentiful. We should all appreciate learning in all its forms.

slowing it down and focussing on the child's needs

First off, at my brother's request to sound a little more professional, I'm going to start referring to all of the kiddos as students. Kiddo is just how everyone at work refers to our clients. So here comes the professional talk.

I have one student that had some trouble focusing. This student needed to have a couple things going on at all time like a preferred activity of puzzles and the option to run over and look out the window to check out the cars driving by. After a lot of time and a variety of intervention plans, this student has really improved on the ability to focus on one task. However, the last month and a half has been a little difficult because this student and the student's family has been sick and I was on vacation for almost a month before this. Nowadays the good days are sparse because of these complications in addition to a developing toddler attitude because this student is engaging better with the surrounding environment. Yesterday was particularly tough because this student would not go through more than two trials of any program at one time. It was almost as though as soon as the student knew that we working on a program, the student would try to escape really quickly or present some sort of aggressive behavior.  Despite these difficulties, we go through most of the programs and still had a half hour left before the end of the session. For this time, we went outside and did some water coloring. Here, the student had two points of focus: the cars and water coloring. Watching cars go by still seems to relax this student. As a result of the option to focus on two preferred activities at one time, the student was able to sit calmly for 15 minutes. At times this seems like a retreat, but I hope that maybe this student just needs two activities going on at one time. It may not always be for the better, but it is something that we are working on for this student and obviously sometimes this student still needs this double focus sometimes. Personally, I know that I struggle with this. For instance, I don't like to just to focus on eating when I'm eating. I either like to watch TV, talk with other people, etc. I also can't stand silence. And although I know there are numerous studies proving that it doesn't help to have music on on while studying, I have always been guilty of that. We also drive and listen to music or talk on the phone or eat. (Be careful with the last two. I have picked up a ticket and got into a fender bender as a result of my multitasking). I guess I find the double focus to be an appropriate need or behavior if it is common among neuro-typicals. The student seemed to be a little calmer after sitting outside and water coloring. Hopefully I can be a little more pro-active for the next session and maybe give the student the opportunity to have some double focus time earlier in the session to take advantage of its calming effect.