A little this...a little that

Catching up from the weekend....
Katie has developed into a wonderful swimmer over the last 4 days! Once she felt in control under the water, she has excelled rapidly. She glides both on her stomach and her back across the pool. She swims underwater and comes up for breaths. She is learning how to use her arms to stroke. She jumps in without someone catching her and actually loves it now.

John's last day of Early Start is tomorrow! He will move into the START program next week.

On Friday, John has an evaluation with Foothill Presbyterian Hospital for Occupational Therapy/Sensory Integration (finally!!!)

Now for today...

John had speech today, but instead, they began his START evaluation. Step One is to evaluate his play to see at what level he is "playing' at. The idea here is that autistic children tend to take everyday objects and use them in different ways, instead of the intended use.

So, Tonyia gave John a baby doll, hair brush, bar of soap, bottle, and toothbrush. He started by brushing her teeth. Although, at first, he picked up the bottle and the toothbrush, which looked odd, but then he used the bottle as the toothpaste and then proceeded to brush her teeth. He then grabbed the brush and brushed her hair. Tonyia asked John to give her a bath and he used the soap on her legs. She then took off the babies clothes and put foam soap on the baby's tummy and John grabbed a tissue and cleaned the baby. Tonyia then assisted John in dressing the baby and John brushed her hair again, pretty hard. Tonyia told John the baby was crying and gave him the tissue to wipe her eyes. John wiped away the tears and picked up a cup out of Tonyia's bin. He grabbed the bottle and "poured" something in the cup and took a drink himself and then gave some to the baby.

Tonyia set up a house with a bed, sofa, TV with DVD player, table, chairs, and a slide with a ladder. She then gave John a boy, girl, and later, a mom. He laid the mom on the ground. He had the girl sit on the couch. He then took the TV into his hands and played with it for a long time... there was a "pretend" DVD that went in and out of a hole in the TV and he kept putting it in. Tonyia eventually took it away from him. He then took the boy and had him climb the stairs and slide down the slide. Then he asked for bubbles.

He played with cars, play dough, and bubbles and it was time to go home.

John had another session of Neurofeedback today. We are on session number 20. The first 20 minutes is spent on the part of the brain that controls sleep and impulse control. John was so quiet and calm. The next 20 minutes made John a little agitated, as it has the last few sessions. They added an element that helps with motivation. Today, we decided that it may be too much for John. We are going to eliminate that protocol from the training and add 10 minutes to each of the other protocols. The last protocol is training the part of the brain that deals with social/emotional responses.

Things I've noticed since beginning Neurofeedback:

• biting of skin stopped
  
• chewing of shirt stopped
• doesn't drag his toes anymore while walking
• Achieving goals rapidly at Casa Colina
• Speech improving
  
• Falls asleep easier
  

Now, I'm not saying Neurofeedback alone has contributed to these things. John is working hard and there are a lot of PEOPLE helping John, but I am beginning to believe that Neurofeedback is enabling him to be present for learning and helping with behavior. The goal of Neurofeedback is to calm the brain down enough to teach it how to self-regulate itself. Through brain self regulation, the nervous system no longer feels under threat. The body is able to think beyond itself and begin to "take the blinders off", seeing the world around them. When we feel under threat, we naturally get "tunnel vision". When our brains cannot self regulate, we will operate as if we are "under attack", manifesting itself in ADD, ADHD, migraine headaches, some Autistic behavior, sensory issues, pain in the body, etc. Through self-regulation, the brain is able to calm itself and the outward symptoms disappear.

Good Days and Bad Days

With any child, there are good days and bad days. Everything on Monday seemed to lead to what I am now calling a bad day. It started with John's refusal to eat his eggs. Katie came with us to Early Start Pre-School on Monday morning. All John wanted to do was "check his schedule" and skip all the activities that the schedule told him to do.

I think John is getting bored with all of the "un"scheduled activities in this class. Mom sure is getting bored with it! Sometimes it feels like we are trying to "pass the time" until John gets his one-on-one work time with the teacher. Some of the other activities, which include Imaginary Play, Outside Time, and Gross Motor skills are led by the parent or caretaker of each child.

Imaginary Play involves a play kitchen, which doesn't always have the food, pots, pans, and plates. There are only so many things you can do---open the microwave, put the corn in the refrigerator, wash the dishes, etc. The girls play the kitchen well. John will attend for a few minutes, but usually is ready to move on to other things. I don't blame him. He did really well last week, washing dishes in the sink, putting them in a bin that he called the dishwasher, putting them away, putting food on the plates, and starting the process over. But, this Monday, he didn't want to play with the Kitchen. SO, I let him go outside.

Outside time includes riding bikes, wagon rides, playground equipment, a play house, etc. John usually will fit everything in to his scheduled 20 minutes. About 2 weeks ago, John discovered the swing. Well, on Monday, the swing wasn't set up. So, he busied himself with running back and forth between the playground side and the bike side. Katie couldn't keep up. She just wanted to sit and play. At first, I kept making her join us. Finally, I gave up and let her have fun on the playground equipment without my immediate supervision. She's old enough now for me to just check back and forth. It's hard having them both at class. John doesn't like it when I give Katie any attention at "Ja's Skool".

Circle Time, Fine Motor skills, and Table Time are led by the therapists. Circle time went fine and Katie got to participate, which made her happy. Fine Motor Skills was an activity where the kids got to put their hands in the glue to stick fish, crabs, and sharks in the sea (a big poster hanging on the wall) and then finger painting their sea creatures. Although John wanted his hands in the glue and the paint, he was more interested in going to the "ba-oom to wah ans" (bathroom to wash hands).

Washing his hands has become a big thing these days because John is close to being completely potty trained!!!! He decided that Katie wore underwear and so should he, so he refused to wear pullups and diapers. Two potty accidents taught him to tell us he needed to use the bathroom and from there, we've progressed quite nicely. Even now if he starts to have an accident, he can stop it and tell me he's going to have an "acdent", while grabbing his crouch! He has 4 stickers this week for pooping on the potty seat. Now, this is very rare for a child with John's issues to be potty trained. It was something I wasn't ready for, but John made sure this was something he learned. Again, an example of his 'scattered level of skills'.

I digress, back to Monday and the "bad day". Work time was especially hard. He didn't want to look at the teacher and she was having to constantly remind him to "check his eyes". With his eye contact issues, they have him make sure that he tells the person what he wants by looking at them. So, if he wants the school bus to "go", he has to say "go" by looking at the person that will push it to him. Some days this is easy and some days this is hard. Monday was hard.

After school, we went home for lunch and a nap so we could go to speech class. Our next door neighbor came over to babysit Katie and she brought movies. John didn't want to go to speech class anymore. Leaving was a battle. Once we got to class with Tonyia, we started the eye contact battle again. He did everything he could not to look at her ---turned around, closed his eyes, put his head down, yawned a lot, kept pointing out the clock, etc. She worked him hard for the first 25 minutes, but she told me we were going to stop because she thought he needed to move around. We went into the START gym and he played in the ball pit and swung on the swing. He didn't want to do much in the gym either. He kept pointing out the clock.

After speech, we went to the second session of Neurofeedback. Well, John didn't want them to hook up the EEG monitor. He cried, squirmed, kicked, and got very upset. I told them that I was taking him home. It was a bad day and forcing him to do it would have been torture for him and me. So, we went in the elevator to go down to the first floor.

We got stuck in the elevator for 25 minutes! We were going from the second to the first floor. It got stuck between floors. Before we got in the elevator John was crying. Getting stuck was the best thing that happened to him all day. I had apple juice with us and he drank that, danced around, pushed buttons, and kept squealing in delight, "elvater!" The best part was when the firemen let us out and showed him the fire truck.

The family then went to get dinner at Rubio's, where Katie vomited in the trash can outside before we ate. She continued with the flu all night long.

Monday was a bad day.

Casa Colina: Early Start Pre-School & Speech Therapy

One of the first forms of early intervention that John received was an Early Start Pre-School class at Casa Colina in Pomona, California. The Early Start class is focused on developing the goal areas of gross motor, fine motor, sensory, communication, cognition, socialization/play and self-help. Children work individually and in groups with their parents and child therapy instructors as they rotate through a series of activity centers.

John attends the class two times a week for 2-and-a-half hours each time. Upon arriving, John must find his picture and place it on his schedule. After completion of each activity, he is instructed to "check his schedule". Using a laminated paper with a check mark on the front and piece of velcro on the back, John takes it to his schedule hanging on a wall. He places the 'check' next to the first activity, which is dipicted in a photo. The first activity is to 'wash hands'. John takes the photo to the sink, places it in a folder and proceeds to wash his hands. He is given a second 'check' to take to his schedule.

The next photo announces that its "circle time". John takes the photo and finds a square to sit on with the other children. He hands the photo to the teacher, announcing that he is ready for "Circle Time". The teacher shows the children a board that has pictures that represent different songs they can sing. Each child, in turn, chooses the song that everyone will sing. A picture of raindrops represents the first verse of the song "if all the raindrops". After the group sings the song, the child who picked the song is given a "prop" for that song. A rain stick is given for "If All the Raindrops". The child watches it fall and then is instructed to turn it over and watch again. They then must hand it over to the next child sitting next to them. After the prop makes it's way around the circle, the next child picks the song they want. John's favorites are "Boom Boom Ain't It Great to Be", where he can play the beat on the drum, "Wheels on the Bus", and "If All the Raindrops". He doesn't sing much at school, which is surprising because he does at home, but he loves the pantomime gestures and passing each of the props.

The schedule order is then different for each child, but each will have time outside on the playground, project time at the table, imaginary play, work time, and gross motor skills activities.

We have learned, through Outside time, that John loves the swing. He could swing for the whole 20 minutes. I started going through counting and alphabet games while we swing. He loves to talk and verbalize while swinging. (more on this in a later blog).

I have never let John play with glue or scissors up to this point because I just felt that he wasn't ready. Well, a kid is never going to learn if you don't teach him! So, he's learning to cut with scissors and squeeze out the glue. He loves the glue and the first week called it "gluke", but has already corrected himself and says it just right! Already, he has made a shaker, 2 caterpillars, a texture book, and a flag. He wanted to glue paper with the glue side up, but he learned quickly that his hands get messy that way and paper won't stick.

He has a 20-minute one-on-one work session where individual goals are set and then worked on to meet. John sorts colors and shapes, does animal puzzles, strings beads, blows bubbles, plays with Mr. Potato Head, and various other activities to strengthen his skills in each of the developmental areas. How they play with him is the key to his success' thus far. John came in to this program very impulsive. If a teacher held two objects, one in each hand, asking for him to pick the red one, John would reach for both without listening to her directions. By the second session, they had him waiting, looking at each one and then choosing. His first reaction is definitely impulsive, but slowing him down is the key. He has a very busy brain, which is easily distracted. He learned the "clean up" song really fast and he says and signs "all done" pretty quickly after starting a task. The therapists are really good at making him do it "one more time" and "we will be all done". I think he enjoys cleaning up and finishing more than anything else, but he is learning so much.

In addition to his early start classes, he attends 2 hours of speech therapy a week. Speech therapy is play based therapy that works on his language skills. They use a reward system (for John it's bubbles) to get him to say his words. They play with cars, Play Dough, flash cards, balls, etc. while concentrating on his verbal skills. John loves coming to "school", but speech therapy wears him out. About 30 minutes into a session, John becomes distracted and begins to look around and "space out". This is the most important time to keep going --trying to increase his attention span.

We've been in the program for 6 weeks and he has improved so much! I can't believe the changes we have seen both at home and in the classroom. He tested at a 6-9 month age level for language 2 months ago. Last week, they told me his language has already gone up to 17-18 months age range.

Things we've noticed:

• He sits during circle time
• John never sits still and the first day, I chased him around the room, leading him back to his square and having to hold him in my lap
• By the third class, I was able to sit behind him
• He has poor posture, which I never noticed before because he would never sit still; he sits leaning back on his hands or slumped over his knees
• His language is controlled
• There is intent behind his words; he communicates to have needs met
• "all done" and "more" have helped us understand when he is ready to do something
• he points to objects and tells us what they are
• He is engaging
• The inability to engage, which he showed during his Regional Center testing, is one huge part of the Autism diagnosis
• He is able to follow direction
• He is able to get my attention and tell me about an object or what he wants
• There is a 'give' and 'take' in play with him
• His attention is increasing
• Work wears him out
• John yawns about 10 minutes into every work session
  
• John gets tired after school
• John tends to have melt downs when he is tired

Goals we are working on:

• Building towers with blocks
• Increase attention
• Completing tasks
• Articulation in Speech
• Jumping from 2 feet
• Decrease impulsiveness
• Stringing multiple beads
• Blowing bubbles

This has been the best experience so far. I can't believe his progress in the little time he's been attending Casa Colina. I can't wait to see what the next few months brings us.