Friday, October 31, 2008

Wordless Halloween!

Thursday, October 30, 2008

The Second Unit's Next Five Sentences and Questions (Part III)

Today, I will follow up on the introduction to the second unit of language and thoughts on RDI and the association method with the five remaining repetitive sentences and questions. To quickly recap the earlier post, I covered the first sentence (This is a/an/some _____) and question (What is this?) and the steps used to cover them.

The next sentence I taught was (I see a/an/some _____). Because Pamela had already learned the difference between the three articles (a/an/some), we did not spend any extra time on them. I wrote "see" in green to attract her attention to the new syntax. I also took pictures of Pamela pointing to the object to emphasize that she was the subject (I) and she was in the act of seeing the object. We had not worked on eye gaze at that time, and I remember finding it difficult to get her to look at the object and pose for the camera. Notice that the first two sentences I taught were declarative in nature because the speaker states something about an object. (Click the pictures for a better view.)

As before, I taught the question that goes with the sentence next: "What do you see?" and then alternate randomly between the two sentence/questions to make sure Pamela knew which sentence answered which question. We also practiced this playing games and in real life to make sure Pamela understood the context in which to apply them.

The next sentence we covered was similar to the second: I have a/an/some _____. Again, we color code the verb "have" because it is the new word of interest. I purposely had Pamela hold each object when I took these pictures to emphasize the difference between seeing and having. After we taught the question "What do you have?" we went back to alternating between the three sentence-question pairs and being sure to use all three in games and real life.

The fourth sentence we covered was similar to the second and third: I want a/an/some _____. The verb "want" is green, and I had Pamela reach out to the object of desire to emphasize the meaning of the verb. After we taught the question "What do you want?" we went back to review all four pairs and using them beyond therapy time.

Then, I switched gears and focused on names of people and characters instead of nouns "This is _____" to go with "Who is this?" I remember this "little" change threw a few curve balls, which Pamela overcame after a few weeks (yes, weeks): (1) remember when to use articles and (2) when to ask "who" versus "what" questions. Her difficulty with these minor alterations in syntax confirmed my suspicions that she had syntactic aphasia.

Pamela found the next question much easier because there were no articles to trip her up: "_____ has a/an/some _____" and "What does _____ have?" She was so used to using "I" in sentences and "you" in questions, she had no problem substituting these pronouns with the name of a person. However, she struggled a bit with "has" versus "have." To you, it may seem minor, but children with aphasia are extremely poor guessers and they usually guess wrong! So, a little difference in the last sound of a word was huge and took another week or two for her to nail.

Up until this point, all sentences and questions were in the present tense. We finally reached the first past tense one, and, believe it or not, it threw Pamela for a loop: "I saw a/an/some _____" and "What did you see?" I forget how long Pamela needed to nail the sentence and question down, but it took quite some time to remember which words went with which tense!

Last month, something interesting happened. Pamela's skeeter bites were driving her nuts. We were working on expressive imperative and declarative gestures, but she was so distracted that she stimmed up a storm AND fell back on the six repetitive sentences that she learned five years ago! Here is the clip:

Tuesday, October 28, 2008

The Second Unit of Language from an RDI Perspective (Part II)

As promised in my first post on the second unit of language, I want to share some ideas about where I think RDI dovetails with the Association Method. If I could boil RDI down into one over-arching principle, I would say the goal is to redo developmental milestones missed originally. Therefore, I believe the key to figuring when to implement the Association Method ought to flow from the development of typical children. Since many readers may be "lone rangers" (without consultants), I plan to refer to readily available documents found on line (such as Zero to Three handouts), rather than RDI stages. As you read through this post, think about your child and try to assess if the language delay is due to the overall delay or something co-occuring, above and beyond what is seen in typical autistic children. If you are dealing with garden variety autism with no extra-special language delays, maybe the answer is to keep doing RDI and reevaluate language in a few months.

Focus on Typical Development
Babies spend the first year of life becoming masters of nonverbal communication (both receptive and expressive). In the early stages of development, nonverbal trumps verbal. So, before going crazy with fifty nouns and six repetitive sentences, it makes sense to follow the path of babies if your child is nonverbal or low-verbal. Should you follow this exactly? No, every child is unique and the key is to fill in gaps. I am just attempting to give a broad outline to help you figure out where the Association Method might fit:

0-3 months - Build trust between you and your child; be a source of comfort when they are melting down; respect their need to take a break when overwhelmed; encourage times when you are both nonverbal and expressing yourself through sound, facial expressions, and body movements.

3-6 months - Continue the foundation previously built; sounds become more structured (babbles, coos, gurgles). In my opinion, this is a great time to introduce simple phonemes in a playful, unstructured manner.

6-9 months - Continue the foundation previously built; frame situations in which your child has a chance to learn by copying you; spotlight feelings in your sounds; pair common gestures with your words. In my opinion, this is a great time to continue simple phonemes, going back and forth like conversation.

9-12 months - Continue the foundation previously built; frame situations in which your child can (1) follow simple directions and (2) communicate through sounds and body; develop interaction patterns. In my opinion, this is a great time to get serious about phonemes if vocal play seems stalled.

12-15 months - Continue the foundation previously built; frame situations in which your child can (1) communicate what they want through actions, (2) point to common things you name, and (3) imitate what you do; join in and elaborate any pretend play your child starts. In my opinion, this is a great time to continue working on phonemes and make plans for the fifty nouns.

15-18 months - Continue the foundation previously built; frame situations in which your child can (1) respond to simple questions and directions through their actions, (2) react to the emotions of others, and (3) perform simple roles in household chores. In my opinion, this is a great time to get serious about the fifty nouns, if no nouns have emerged.

18-24 months - Continue the foundation previously built; frame, elaborate on, and speak declaratively about pretend play, problem solving, and testing things out; whenever your child uses nouns, add another word in response ("apple" "Want apple?") In my opinion, this is a great time to continue working on the fifty nouns.

24-30 months - Continue the foundation previously built; frame, elaborate on, and speak declaratively about pretend play, problem solving, testing things out, and interactions with another child; whenever your child puts words together, add another word in response ("want apple" "You want apple?") In my opinion, this is a great time to continue working on the fifty nouns and make plans for the six repetitive sentences and questions.

30-36 months - Continue the foundation previously built; spotlight sentences with two ideas. In my opinion, this is a great time to get serious about six repetitive sentences and questions . In time, stories in the second unit will cover developmental milestones listed in the link: personal stories (own name and characteristics of people), past tense stories (what happened yesterday), present progressive stories (acting out own stories), etc.

Focus on Cognition
Another principle to consider is that cognition (thoughts and ideas) precede communication. When Pamela was eighteen months old, she had no clue that crying was a cause producing the effect of getting what you want more quickly. Therefore, she saw so no point in learning the names of things because she saw no connection between using the name to get the object of desire faster. We started suspecting autism at two years of age (Steve's sister helped us zero in that quickly), so I took sign lessons to learn the names of nouns of things I believed Pamela wanted most: grapes, cookies, yogurt, milk, etc. Although my strategy was sound, it still took Pamela a long time to make connection between signing a word and getting what she wanted! We never had a "Helen Keller at the water pump" miracle. Once Pamela did make the connection (around age three), she quickly dropped the signs and started learning nouns at a rate of about one noun a month! We called it the word of the month! I stopped keeping a spreadsheet tracking every noun when she turned four. At that point, nouns and animal sounds came more quickly.

Applying cognition to the developmental profile above, it helps to understand the function of phonemes, nouns, and the six repetitive sentences and questions. Early in development, infants figure out how to make sounds with their mouths. After months and months of play and experimentation, the babbling, cooing, and gooing become predictable phonemes, the building blocks of words. When you are doing interactive patterns with a nonverbal child in the early stages of RDI (tossing a ball back and forth), you might want to try vocal games in which sounds are the object in the pattern. I do not think it needs to be formal and structured at first, but playful, fun, and joyful.

Once vocal play becomes easy, it makes sense to start playing around with putting two or more phonemes together in a playful manner, well before nouns enter the picture if your child is still low-verbal. At this point, you should have more opportunity for lots of variation, sound effects made from phonemes in their pretend play, imitation games with multiple phonemes, even little words when you do things together (uh-oh, oh-no, y-ay, uh-p, w-ee, ow-ch), etc. I still remember Pamela's first two spoken words when she was three years old: coo-coo (cookie) and so-see (music). If your child comes up with her own phonemes for a word, why not repeat it with joyful nonverbals to celebrate their accomplishment? From there, you might even be able to guide coo-coo into coo-kee with more back and forth sound games.

Again, cognition is the key. A child who starts coming up with their own words understands the concept of labeling nouns. A child who points to things she wants or sees is grasping the idea of a noun. A child who follows the simple direction to get her Beanie Baby understands a set of words identifying a particular noun. These are all signs of readiness to begin work with the fifty nouns. I think picking nouns with simple phonemes that are part of every day life or of special interest to the child are great ones to target at first. Meaning and context fuel the need for nouns.

Well before you consider starting the six repetitive sentences and questions, you might need to make sure cognition leads the way. If you have a new object in a group of familiar ones, does your child look curiously at the new one? Does she point with a questioning look? If so, the first question, "What is this?" will help her ask for names. When you are driving to the store, does your child observe the new restaurant that just opened up or point out a truck that made a wrong turn near a ditch. If so, "I see a/an/some _____" will serve that function. If your child requests things, then "I want a/an/some _____" will suffice. Without the desire to ask questions, share observations, or make requests, the new and improved syntax has no meaning or benefit to a child.

Focus on the Unique Child
The hardest thing about autistic children is that they are so scattered in development. Even though our RDI stage reflects the dynamic intelligence of a toddler, Pamela is working on decimals in math, reading sixth grade level books, writing at about a third grade level, and speaking like a preschooler. That is a wide range of ability! The key is to focus on those strengths and scaffold through their weaknesses.

Suppose a child's fine motor delays prevents her from doing all of the writing. Try using magnetic letters for the kinesthetic channel and figure out the reason for the delay. Pamela was very delayed in writing until we did patterning exercises to improve her bilateral coordination, worked on strengthening her fingers and pincer grasp, and figured out that she was left-handed and treated her as such! If a child has dyslexic tendencies, the Association Method may be a solution for that, too, because it falls under the same umbrella as Orton-Gillingham and the Spalding Method. So, even though reading or writing are well above the developmental level you are targetting in RDI, if the child can do these things, by all means, incorporate it into your work with the Association Method!

At first glance, the association method seems very static and drill-like. To be honest, a child with a severe language disorder that goes beyond the scope of autism may very well need some focused, drill-like work on language. It would be no different from a child with autism and cerebral palsy needing some focused, drill-like work on motor skills. However, I have embedded some RDI principles into what we do with the association method. When reading stories, I try to make sure I react in nonverbal ways. We reflect on any emotional highs or problem solving abilities of the characters. We talk about what the story reminds us of (perhaps, something that happened to us). I give Pamela much more time to think and process before she speaks, showing a warm, encouraging smile. Rather than correct syntax errors directly during oral work, I wrinkle my forehead and frown, say "What?" or "Huh?" or repeat the question, using my voice to emphasize the word giving the best syntax clue. Our Association Method work is much more fun since we started RDI as you can see in this video clip I made for the Charlotte Mason Conference in 2007.

Part III of the second unit is here!

Monday, October 27, 2008

The Second Unit of Language of the Association Method Part I

Last month, I gave an overview of the association method and a description of the first unit of language. Today, I will follow up with introducing the six repetitive sentences and questions taught at the beginning of the second unit of language. If you find you have no clue about what I am explaining, you might want to read the overview and first unit posts first! If you are dying to know more NOW, this long pdf summarizes and condenses the method. The manual itself is only $52, and, when I reflect back on all of the speech therapy materials and manuals I have bought in the past seventeen years, this book was the best investment I ever made. Without a doubt!

The minimum required vocabulary at the beginning of the second unit is fifty nouns (you will understand why soon). Children do not need to have verbs or adjectives because you cover these parts of speech later in the unit. They need to be able to read and write these nouns, but, for children delayed in fine motor, I would certainly try this method with magnetic letters!

The manual recommends doing "I see a/an/some _____" ("What do you see?") first, but I chose "This is a/an/some _____" ("What is this?") because it seemed simpler. Here is an example of teaching the latter from the manual:

Here are the official seven steps listed in the manual in my words (there are only six because one of the original seven gets dropped when you move to the second unit). I modified these steps with Pamela, but this summarizes what the manual recommends:

Activity 1:
Reading the Child's Book - The educator observes the child read the stories in her individualized book (all pictures in this blog are examples of said stories) and monitors her pace and articulation and ability to read from top to bottom and left to right.

Activity 2:
Syntax Review - The educator writes an appropriate number of sentences with the new syntax on the board (four to six or more). The child reads the sentences in three passes broken down into the reading step, the lip-reading step, and the acoustic step.

a. Reading - The educator points to each word in a sentence and the child reads it aloud. Then, the child turns around and repeats the entire sentence from memory. The child performs this step for each sentence on the board.

b. Lip-Reading - The educator reads a random sentence from the board. The child points to the sentence, reads it aloud, turns around, and repeats it from memory. The child performs this step for each sentence on the board in random order.

c. Acoustic - This is actually done in three phases. In the first phase, the child faces the board, and the educator stands behind the child (preventing any lip-reading hints). The educator points to the first sentence and reads it aloud. The child repeats the sentence. They continue reading all of the sentences in this manner in order. In the second phase, the teacher reads the first sentence without pointing and the child repeats the sentence. They continue reading the story in order. In the final phase, they continue working in a similar manner, except the teacher does not point and reads the sentences in random order.

Activity 3:
Oral Recall - The educator shows a picture of a noun, and the child says a sentence using that noun with the syntax of the week. They work through several pictures in this manner.

Activity 4:
Writing - The educator writes a story in cursive and the child copies it onto lined paper. (The manual has adaptations for children whoare still learning to write.)

Activity 5:
Written Recall - The educator gives the child a picture (or series of pictures), and the child writes her own story, using the syntax already mastered.

Activity 6:
Dictation - The educator slowly says a story, sentence by sentence, as the child writes it on paper.

Other Activities
Games - While playing games, like Go Fish and Concentration, the child and educator can practice new and old syntax. This can even work well with commercially available games, too.

Pretending to Be Teacher - The child and educator switch roles!

Daily Activities - Educators can looks for opportunities throughout the day to apply the new syntax and reinforce the syntax already learned.

I made the following modifications to suit Pamela. Because she already knew phonics, I did not teach the Northampton symbols. Because she could read chapter books, I wrote the nouns as words in the sentences and put the pictures on the question page and began sentences and questions with a capital letter. Here is the very first story we read and seeing it brings back memories for me! I applied the "seven steps" from a Charlotte Mason perspective, so I modified it from the book a bit. We focused on the sentence only at first. I believe I used to spend about a week on this sentence (some new syntax took two weeks, or longer). Notice that the first sentence taught is "This is a" which limited me to singular countable nouns that begin with a consonant. Pay attention to the color coding because you will soon see a pattern that green signals the syntax du jour. (Click the picture for a larger view.)

If you haven't already guessed, I am a principles-oriented thinker which I believe is the common element present in all three ways of thinking. I have tried to coalesce them into one (RDI, Charlotte Mason, and the Association Method). When I was processing the Association Method, I tried linking it with a Charlotte Mason point of view and, after careful reflection, realized that all I needed was a minor translation. Every day, we cycled through these steps, focused on the new syntax. The very first week we focused on "This is a" stories:
  • Read aloud (Activity 1) – Pamela reads aloud a typed story (cursive, color-coded) in her therapy book with the new syntax for the week.
  • Recitation (Activity 2) – I read a sentence from the story. Pamela repeats it while seeing the page and without seeing the page. We did do all three steps (including the three phases of the last step), but I reduced it to pure recitation after doing the Association Method for a year.
  • Oral Narration (Activity 3) – Pamela practices the new syntax during her daily conversations.
  • Copywork (Activity 4) – Pamela copies a story I type in cursive.
  • Written Narration (Activity 5) – Pamela writes her own story applying the new syntax in print.
  • Dictation (Activity 6) – I say a sentence, and Pamela writes it on paper in print.

Once Pamela mastered "This is a _____" we moved onto the question it answers: "What is this?" I believe we spent a week on the question before moving onto the next piece of syntax, the article an. While we stuck to singular countable nouns, this time we focused on nouns beginning with a vowel. Again, the color green spotlights the most important syntax is an. Because the question for this second sentence structure is the same ("What is this?"), we practiced the sentence and question side by side, both Pamela asking and answering the question.

In the next step, we combined both kinds of sentences, "This is a _____" and "This is an _____" to make sure she had mastered the difference. Because Pamela had an eye for pattern and already knew the difference between consonants and vowels, we only spent a week on this kind of story. I imagine younger or less experienced children might take longer. You have to be absolutely sure the child is able to say the syntax correctly very consistently before moving onto the next level. This looks startling easy to us native speakers, but, for kids like Pamela, still learning English as a first language, it is surprisingly difficult. I found when I pushed Pamela too fast, her syntax fell apart! Seeing that happen several times convinced me that she really did have aphasia.

I believe we spent another week on the question before moving onto the next piece of syntax, the article some which went with mass nouns. Again, the color green spotlights the most important syntax is some. Because the question for this third sentence structure is the same ("What is this?"), we practiced the sentence and question side by side, both Pamela asking and answering the question.

In the final step of teaching the first sentence and question while spotlighting the articles, a, an, and some, we combined all three kinds of sentences, "This is a _____" and "This is an _____" and "This is some _____" to make sure she had mastered the difference.

For her, the cliff notes looked like this (new in green and review in black) but remember some kids may progress more quickly or more slowly than this timeline:

Week One:
This is a _____.

Week Two:
What is this? This is a _____.

Week Three:
This is an _____. What is this?

Week Four:
What is this? This is a ______. This is an _____.

Week Five:
This is some _____. What is this? This is a ______. This is an _____.

If you are impatiently chomping at the bit, wondering if a child could ever get far progressing through syntax at such a slow rate, one structure at a time, take a peek at Pamela's latest unedited nature notebook entry she composed with no input from me and you will see how far a child with severe language issues can go when you find the right method of her!

Because this post is very meaty, I will pause here and let you digest this introduction to the second unit of language. While I have only covered one sentence and one question, the next five will flow much more quickly, now that we have gotten through the methodology of actually teaching one structure. Some of you RDI families may be thinking this is dull and deadly and down-right static. These are very valid points to consider. In Part II of the second unit, I plan to reflect on how one can view this from an RDI perspective!

Sunday, October 26, 2008

How to Avoid Getting Tied Up in Knots!

Right now, I am working on three RDI objectives: two for Pamela and one for me. Yes, my consultant keeps an objective open for me. I am your garden-variety, neurotypical parent with no major shadow traits of autism, but I still have objectives. Like many parents of autistic children, Steve and I have successfully reared a neurotypical child (our 16-yo son, David). The issue is that, with Pamela, we are having to go back, find holes in her development, and "redo" certain milestones to see if she can learn them now. The good news is that she can (which I blogged earlier in the month). To guide her through that process, I need to be very mindful of how I interact to make sure we are giving her every opportunity in this second chance. The parent objectives are geared toward making sure I am successful at guiding her.

My most recent parent objective was learning about broadband communication. In the autism world, we have become obsessed over speaking, so obsessed that we are overlooking the building blocks that support the words that we speak. Everyone knows that how you say is just as important as what you say. Your facial expression, your voice inflection, pacing, and volume, your gestures, your gaze, your space and touch, etc. can all influence what you really mean when you say what you say. If you do not believe me, go and watch a political debate. I used to believe all children in the autism spectrum could not learn to do this, but now I know some can and Pamela is one of them!

My consultant sat down with Steve and I and taught us the first few objectives. Now, we are watching e-learning modules, multimedia presentations that focus on a particular topic. When finished, we type up our answers to questions and upload them to a computer system that keeps track of all of our objectives and Pamela's objectives. Occasionally, we submit videos that demonstrate our ability to perform certain actions.

In this case, I filmed three clips of Pamela and I tying knots while waiting for the pizza to finish. I love this first one because Pamela reads my broadband communication to figure out what I am thinking! She is slowly growing more adept at reading my mind! YIPPEE!!!

In the second clip, I am trying to play around with how many different ways we can interact while tying knots on the blanket for baby Ines.

In the third clip, we start off with lots of language because we are talking about what color thread we should use for the monogram. After we start tying knots, I work on the next level of knot tying. On the first day, all she had to do was the last step: pulling the fringe after I set up the knot. In this second day of tying knots, I have her hold the set-up knot with her left hand and pull with her right hand. In the future, when we make her next blanket with overhand knots, I plan to transfer more and more steps, working from the last to first, until she can do the whole thing independently.

While I am NOT (adamantly and forcefully repeat NOT) a fan of ABA (applied behavior analysis), I am using an ABA technique called backward chaining to teach Pamela to tie knots. We also back-chain memorizing the lines of a poem, learning the last line first and the first line last. When you watch the video, notice that making a knot (a static skill) is the framework in which we work to spotlight the more important objective: learning to read one another's broadband communication. I do not let learning to tie knots override the joy of our quiet interaction while listening to lovely Lily twitter in the background. That is the quality of life I treasure in our daily interactions. I value the sweet, precious moments when we work together much more than how quickly and efficiently Pamela masters tying knots! In fact, focusing on these intangibles that are not easily measured, boxed, sorted, and analyzed keeps my statistics-oriented brain (yes, I have the degree to prove it) from getting tied up in knots!

Thursday, October 23, 2008

Out, Out, Damned Spot!

Didn't my friend Brenda do a GREAT JOB on the monogram for the blanket Pamela made for baby Ines???????

Thanks to my little helpers on the left, the spot is gone! I basically tried one, rinsed the area, tried another, rinsed again, and tried the third. HURRAY! You can bet I was relieved!

Tuesday, October 21, 2008

Do You See What I See?

We agree with our RDI consultant that Pamela's expressive imperative and declarative gestures are going to be a long-term project, so we are now working on a new objective in addition to spotlighting gestures during our daily activities. We picked something that I think Pamela can pick up quickly: my consultant always asks me to chose a simple phrase to help me be mindful and mine is Do You See What I See?

Simply put, when Pamela wants to point something out to me like a toy at the store or the truck that went off the side of the road, she needs to make sure that I am looking in the right direction! She needs to stay calm and help me redirect my focus until I am turning my attention to the same thing as her. I will work on this by looking in the right direction some times, but not all of the time. She can redirect me in many ways: pointing, bring something closer, turning it around, telling me which way to look, etc.).

If you have no clue what in the world RDI is, Laurel, a parent and RDI consultant, just launched a new blog explaining what RDI is and how to get started.

Before I update you on the baby blanket bonanza, I have two SWEET stories to share, which show the kind of progress Pamela is making in being flexible and rolling with the punches of life!

Story A - On Monday, Steve was packing for a business trip to Chile. Usually we speak in code because only Knoxville is an acceptable trip in Pamela's mind. So, we say The People's Republic of Knoxville (for trips to China) and Knoxville, SA (for trips to South America). Pamela walked in the room and asked Steve where he was going. He slipped and told her Chile. She did not freak out. It is the first time in ages she did not freak out. Then she sat on the bed and said, "I miss you!" Tissues please!!!!

Story B - Pamela has a thing about watching TV at noon until exactly one o'clock on school days. It's her little routine. Well, we dropped Steve off at the airport yesterday and took the dog to the vet, so she missed her nooner. Normally, she accepts that. But, today, time got away from me and she wanted to go shopping with me. Missing her noon date was completely unplanned on my part and unpredictable. We left the house at 11:53, and Pamela told me very calmly that tomorrow she would watch television at noon. David and I looked at each other in surprise because normally I try to shop at eleven, so we can be home by noon (or rush, rush, rush) to avoid a mini-meltdown.

I should be able to finish my blanket tomorrow. I crocheted it for my grand niece, precious baby Ines, who made her debut ten days ago, one month early, and is doing wonderfully.

I must confess a deep dark secret. I am the anti-Martha-Stewart, and my careless, flippant handling of crafts nearly botched up Pamela's Little Mermaid blanket for baby Ines. I nearly coughed up a hair ball when I noticed the fourth side of the blanket did not line up one bit! Today, I finally faced my mistakes and spent an hour rescuing the blanket, which did survive Tornado Tammy.

Here are my lessons learned:
  • Use the big picnic table outside because the kitchen table is too small, and I wouldn't want to scratch up the dining room table or hardwood floors.
  • Do not try to mix one knot tying technique with another. It seems I wanted to tie overhand knots like the former (which require five-inch strips) but only made strips long enough for the latter.
  • If there is a video, watch the whole thing! Spending three minutes on the video last week would have saved me an hour of sweat today!
  • Try to do all the cutting in one shot. Do not take it apart out of curiosity or leave it laying around all weekend and shoved into a drawer before company comes.
  • If the instructions say, "Cut all four corners first," then CUT ALL FOUR CORNERS FIRST YOU KNUCKLEHEAD!
  • If you have to go back and recut everything, tie a few knots here and there to keep it all anchored.

Friday, October 17, 2008

I Was Wrong!

Made you look!

No, actually, I was wrong about Pamela's ability to learn non-verbal communication. As a faithful subscriber to ARRI, I had read numerous articles about how difficult it was for autistic people to read and make facial expressions and perceive eye gaze direction due to differences in the amygdala and have trouble interpreting gestures due to a deficit in mirror neurons. (If you do not really know what mirror neurons are, check out this fourteen minute video--my cyber friend Poohder gave me this link and pointed out that Daniel Glaser is a lead researcher, but there's no relation that I know of). I remember listening to Eric Courschene present his findings on the attention-shifting difficulties due to difference in the cerebullum.

Not only that, I saw it with my own eyes. When Pamela took sign language classes at homeschooling co-ops when we lived in Minnesota, I saw clearly how much she struggled with picking up the nonverbal nuances like facial expressions when she signed. So, like most parents, I assumed that, because of the brain anomalies found in autism, she would never be able to learn these things, so why bother!

When I read about the possibility of Pamela learning to read and do nonverbals, I was skeptical. Afterall, she was seventeen years old--way, WAY, WAY beyond the cut-off for neural plasticity according to the experts. Sure, it took Pamela three weeks to learn to follow my eye gaze, but now she doesn't think twice about following mine or directing me with her eye gaze. She uses her eyebrows a lot now and her face no longer requires extreme emotion to register an expression. She has mastered a limited gesture vocabulary of her own, and she can read many more of mine. Our consultant remarked the other day that Pamela is showing signs that her mirror neurons are at work because she watches me so intently and learns from it.

If you want to know more about the kind of nonverbals RDI parents and professionals address, Horizons put out a great article called Nonverbal Communication: What’s it all about?

You may think that having a purely nonverbal conversation is unnatural, but it's not! The other day we were in line at the store, and it was a long line! A cashier at the other end of the checkout aisles caught my attention and, when he noticed my eye gaze was in his direction, he pointed to me and then pointed to his check-out line. Then, I pointed to myself and he nodded, so I started walking. As I got closer, he pointed to the correct aisle more deliberately and I nodded.

Pamela can have conversations like that. Last week at the store, I put a shopping basket on the conveyor belt and Pamela put five items behind it. Suddenly, she handed the cashier one item after another, being careful to match her pace with that of the cashier's. She forgot the fifth item, so the cashier pointed to it and Pamela followed the eye gaze and point, grabbed the item, and handed it to her communication partner. I just stood back and admired the whole thing! Their conversation was beautiful.

Sometimes, it may feel like you are taking a step backwards when focusing on nonverbals, instead of verbals. However, the first thing infants learn is nonverbal communication. It seems backwards to focus exclusively on verbals first with autistic children, when typically nonverbals lead to verbals. The difference is that we have to be more deliberate about teaching them to autistic children, but I am finding with Pamela that the effort is worth it.

My consultant and I agree that Pamela is making progress in using expressive gestures, and we will continue to spotlight it for a long time. As Pamela's teacher and parent, I try to balance working on verbals during school time (at least with the association method and oral narrations) with being overly nonverbal when we are not in school mode. When I can get away with it, I try to be nonverbal during school time, but that is not always feasible. The key is to be mindful of opportunities as they arise.

I have noticed Pamela is using more and more declarative language and is doing some higher level thinking. Here are some examples that may seem little to you, but are big, big advancements:
  • We usually do math in the morning but forgot. I did not pull out her math book after lunch, and she said, "You forgot math!"
  • Steve drove the radio-less red car to work today. When Pamela realized it, she ran into the house and, "Daddy drove the red car. Go in grey car!" She raised her fists and said, "Hurray!"
  • When we were in the car, I made a point to be very nonverbal and expressive. At stop lights and at the drive through, we were reacting to her talking about lions, bears, shots, claws, etc. She loved it and her face lit up. None of these were stims either--it was fresh conversation.
  • Pamela usually listens to CDs in the car. At one point, she decided to listen to the radio and told me, "FM!"
  • When we reviewed Miracles on Maple Hill, she seemed concerned about Joe being lost. With The Story of the Trapp Family Singers, she talked about how sad they were because they have to go back to Europe. A few days later when she found out they were in jail (immigration glitches at Ellis Island), Pamela was shocked!
  • When we were sitting on the rockers doing schoolwork, some birds and squirrels got noisy and Pamela commented about that.
  • A paper had flown into the bushes (unbeknownst to me). I had been looking for it while Pamela worked and, when I found it, I told her. She said, "Ew!!!" because she thought it would be dirty. She looked surprised when it was only a little wet, but not dirty.
  • One cool morning, Pamela walked in the room and said, "I'm wearing a sweater and socks." Then, we talked about how it is good to pay attention to the weather and wear a sweater and socks if it feels cold.
  • I walked out to the back porch, and Pamela was all excited about a wasp she killed with a rock. It was merely stunned so we negotiated back and forth until we decided I better finish the job.
  • I bought the complete New Testament of The Illustrated Bible: Complete New Testament from eBay. I showed it to Pamela and told her it was hers. I opened it to the first page of Matthew with the genealogy. She was okay about it--like how much can you do with a bunch of names? Then, when I turned the page and showed her the pictures and text, she loudly gasped. She was very surprised! Then she said, "Gasp!" spotlighting her surprise even more.
  • Pamela frequently asks me, "Where's great grandma?" followed by a little sign language stim for "died" and "heaven." The other day, Pamela asked me if great grandma's soul could talk to God. When I answered in the affirmative, she wanted to know what they talk about! I guess she thought, if the body was in the ground, it would be hard for a person to talk to God.
  • I was at the computer. Pamela was talking to me so I turned to give her attention. She didn't like me being low verbal so she got a little rude. I looked down and pouted and she said, "I'm sorry," and kissed me on the top of my head!
  • Pamela and David were sitting on a bench about Wal-mart while I checked out. They were at the other end of where I checked out, so I headed the cart in their direction. David was listening to his iPod and was not paying attention. Pamela saw me walking toward her and headed in my direction, but David did not. I decided not to say anything to see what she would do. She turned around and noticed David was still sitting. So she went up to him and tapped him to get his attention!

Thursday, October 16, 2008

Cutting Up a Storm!

Warning: Read my lessons learned before you attempt this project!

We made it half of the way through cutting the fringe and corners of the first baby blanket! My mother is the most fabulous quilter and now I know why I am not! I decided to scaffold this by cutting the fleece into two pieces: 48 inches long for the newborn great niece and 24 inches for Baby Alive. I am so thankful I did. It took me an hour of sweating and near tears (but no blood) to trim the cloth and cut it into two pieces. Pamela would definitely have picked up on my frustration. My hats off to all you quilters out there--I cannot hack it myself!
These are the templates for scaffolding: the square for corners, the lines for spacing, and the ruler to guide cutting.
This is how I set up cutting a corner. Many websites recommend the square template, so I am not the genius with this idea. I am the beneficiary and the messenger.
The key to any successful RDI is scaffolding, giving enough support to ensure success without smothering on one end or frustrating on the other. I thought templates would make cutting the blanket run more smoothly.
This is the set up we used to guide the rotary cutter and keep us both on track. I thought it worked pretty well. Our lines are not perfectly straight, and it would not be precise enough for quilting. That is why we are doing a no sew blanket! LOL!
Here is how the fringed looked when finished. Below you can watch the video of us in action.

Monday, October 13, 2008

Blanket Pre-Quel #2

Last Wednesday, we did our first preview of a mission to make a no-sew, reversible fleece blanket for Pamela's cousins' baby, born a month early last Friday, and doing well all things considered. On Friday, I wrote a future story (shown above) using the word will for Pamela's association method tablework (or should I say rocking-chair-work). My goal was to preview the next day's trip to Walmart to select two pieces of fleece (a pattern with a complementary pattern). On Saturday, we bought enough fleece to make a blanket for the newborn and maybe even both blanket and pillow for Baby Alive, and, as you can see below, Ariel and the color purple won. We even found a sample Hannah Montana no sew fleece blanket, already made, and Pamela's eyes lit up when she saw a blanket in real life. I hope to start working on it tomorrow since our deadline is October 24.

Previewing future activities works on episodic memory, which F.A.C.T explains as follows:
Episodic Memory
Allows us to anticipate future possibilities, and learn from past mistakes. Memories of success are stored and used to develop perseverance and resilience. Builds motivation to endure challenges. Allows us to prepare for potential future scenarios and expect future uncertainty.

Why is this important? The Pathways Treatment Center explains that autistic children tend to be very strong in storing procedural memory (details, scripts, formulas for behavior). Often autistic children will lock into static patterns in life, such as the order of aisles you take while shopping or the route you drive to the store, and flip out when you deviate from it. They pick up on verbal scripts whether taught explicitly in the form of therapy or picked up from movies and television. Those with high IQs excel in academics because they memorize facts easily.

Autistic children tend to be weak in storing episodic memory, which focuses on the whole, not the parts; the big picture, not the factual details. In this case, the brain stores information in episodes, including emotions. In RDI, we take great pains to find meaningful experiences we can share and build upon. By previewing a future experience in different ways, I am teaching her to anticipate storing a future episode.

Friday, October 10, 2008

What Stims Mean!

Not everything goes as smoothly as I hope, and Tuesday was a case in point. I wanted to give Pamela a preview of my plans for her to make "no sew" tied reversible fleece blankets. I copied a bunch of pictures off the Internet and put them on two pages for us to review. To strengthen episodic memory, it can help to spotlight various stages of an activity. My objective was two-fold: do the preview and see what gestures Pamela makes in casual conversation.

The problem was that Pamela was itchy from her skeeter bites. She was very distracted and stimming up a storm. While she used some echolalia productively and appropriately "Please stand by," "Cut," "Don't say that," and "Don't do that to me again," she blurted out some off the wall stuff: "Maizie," "Yes or no," "Director," "It's to be announced," "Big bad wolf," and "Rollercoaster." She even reverted back to the earliest syntax she first learned when we started the association method: "I saw a . . ." and "I have a . . ." It is interesting that her syntax feel apart when she felt confused.

I did see some positive things. Even thought Pamela did not want to engage, she trusted me enough to hang in there. She did use some declarative language in the midst of all that stimming. She told me, "I don't feel so good." and used "we" language when she suggested, "Let's go somewhere else." When she was confused, she said, "It's stucked," and I think she meant, "I'm stuck." She also used lots of single nouns and "this" when a word escaped her.

Her nonverbals were there, too. Pamela paid very close attention to me when I looked at her and made sounds. Sometimes, she nodded or raised her eyebrows. She caught on right away when I was using eye gaze to give her a clue about making a blanket for her babies for she asked, "What?" and then started naming things in her room. She hit her leg to show frustration when she saw the dog in the room, scolded the dog, and shifted right back to joint attention with me. She also did that when she was mad at me! I ignored her, so she tapped me for attention. She used several gestures: point, hitting her leg gently, grabbing the page to tell me to turn it, cut with her fingers when she read the instruction about cutting, and poking me. These were all natural gestures that I did not pull out of her or demand.

I had hoped she might immediately figure out my idea about making blankets for her babies. She did not. First, I pointed to the babies. That did not work. Then, I started looking at the pictures. That did not work. So, I asked, "I wonder which one baby David would like." Then she caught on.

When we read the directions and talked about what we had on hand, I had hoped she might immediately figure out shopping for cloth over the weekend. She did not. I said, "When we go shopping," and paused. She did not react, so I added, "What could we do on Saturday?" I tried sticking with declarative, but I had to ask questions because she wasn't tracking. I ended up giving lots of explanation at the very end, rather than dragging it out, because I thought it would have pushed her patience too much.

The very next day, Wednesday, we had a lovely conversation: Pamela was not itchy and was much more engaged.

I want us to have a conversation that is not an obvious RDI thing to see what gestures arise. We are talking about two emails Janet and Alyson sent to her.

Overall Impression:
Pamela struggled much less than yesterday and you could tell by her quick thinking! She followed my nonverbals well!

What Worked:
Pamela had no idea what was in my hand. She started off with one of her stims, "New York," and I went with it. I figured I could nonverbally guide her into guessing Louisiana. I was really shocked that it worked so well! :-) Immediately, she thought of the wedding. Again, she used some declarative language about her cousin, aunt, and her princess attire.

Pamela paid very close attention to me when I looked at her and made sounds. Sometimes, she nodded or raised her eyebrows. She was much more engaged with me than yesterday.

When she changed gears from wanting to bake a cake to shopping at Piggly Wiggly, I played dumb. She did follow my nonverbals and got a little annoyed with me. She grimaced once at me in frustration, so I pointed. Right away, she poked me and then adjusted my chin! I have never seen her do that. That would be expressive imperative because she is telling me not to pout!

She used the following gestures: point, pointing to herself, poking me, adjusting my chin, and slight frustration flaps. These were all natural gestures that I did not pull out of her or demand. There was one gesture that I felt I demanded: pointing to her teeth.

What Did Not Work:
She stimmed a little, "New York. Don't say no. Change it. Don't say that. Yes or no." She stimmed a lot less than yesterday!

My bottomline conclusion is to agree with something Dr. Gutstein said at a breakfast for my consultant and parents in her practice. Self-stimulation is a secondary issue, and, as the brain organizes, it usually goes away. In Pamela's case, physical discomfort or illness distracts her brain and her verbal stims increase!