AUT-2B-HOME IN CAROLINA ~ Teaching our twenty-five-year-old daughter with autism and aphasia, who is still learning about God, the world, and its people with a little help from Charlotte Mason
Today, a gorgeous sunny day with a bit of a breeze going, Pamela, David, and I met up with the entire Jamberry and Habeeb crew (Sly, Jman, SB3). The only one missing in action was Steve, who was helping out Tammy's brother with a favor. The next time, Jamberry and her boys--all four--will stay with us so that we can talk without Pamela and Jman looking for an escape hatch from the chatty mommas (actually, they were both VERY patient). I loved holding SB3 and got to see the gamut of his emotions: placid, sleepy, hungry, poopy, and giggly. Yep, I saw him laugh, and he was sooooo cute.
I enjoyed talking to Jamberry and Habeeb, fellow boat schoolers. How often can you talk about the Dark Ages, going over the wall, getting fried, Storm Brother's ice cream, Annapolis' version of the Ho Chi Minh trail, women's glee club, itchy wool uniforms, peacoats, overcoats, and reefers? See what I mean! You don't have a clue what any of that means. Not even Steve, the 16-week wonder, knows what some of it means.
Before moving onto my dog, I wanted to address Penny's comment from Monday's post, asking if Bob's Red Mill withdrew their oats a few months back because of gluten contamination. I was not too worried because Pamela showed no signs of a reaction to the cookies or eating an entire bowl of oatmeal for breakfast. I emailed the company and, within 24 hours, they replied,
Our Gluten Free Oat products were withdrawn from the market for a few months because of a bad flavor and odor profile caused by the way they were processed. Our supplier has since updated their processing procedures and we now have a limited supply of Gluten-Free Steel Cut Oats.
Now, onto Loa, the GF/CF dog (the fawn colored one on the right) . . . ever since we moved to Carolina, we have struggled off and on with major skin problems. The first thing we treated was fleas, something unknown to her when we lived in Colorado, Alaska, and Minnesota. We got the fleas under control, but she continued to have unpredictable breakouts, which we thought might have been fleas. We got very aggressive with weekly flea shampoos and bimonthly treatments, but no change. The only thing that ever cleared her up were antibiotics and steroid shots, unhealthy for her in the long run. We even did the protocol recommended by the vet: Omega 3 oil, Benadryl, weekly baths with a special creme rinse, hot spray for new open sores, and dog food for sensitive skin. Even our most dedicated efforts failed. He finally told u$ Loa may re$pond to low-allergenic pre$cription diet.
Fortunately, what I learned with Pamela helped. At first, we tried Hills Prescription Dietcanned z/d dog food. The vet prescribed antibiotics, but no steroids, so we could see the effect of the food sooner. She did very well for a week, so we bought more of the same plus Royal Canin'sPotato and Duck dry dogfood. For two days, I caught Loa gnawing on rawhide and she had another breakout. Rawhide may cause allergic reactions, so we only let the healthy-as-a-horse dog chew them.
We started alternating between the two foods as a hedge against further food allergies. She got better and finished off the antibiotics. Last weekend, we ran out of Benadryl, and she had another breakout. I began to suspect the canned stuff, mainly because it had corn starch. I bought more Benadryl, so now we are doing the med and the corn-free potato and duck dogfood. If she stays clear for a week, then I test her with the canned dogfood with the corn starch for a test. I could go on and on with the variations I will have to do to isolate the culprit. Most of you know the process because you have done it with your autistic children. Happy, happy, joy, joy!
After we checked out, Pamela and I were in the parking lot, walking to the car. We bumped into an acquaintance of mine and her little three-year-old boy. He attends my very short, in-the-spirit-of-Charlotte Mason music lesson for preschoolers every Sunday. He loves the drum and plays with a very steady rhythm. I told him that I missed him last Sunday, and his mother told me he had a stomach virus. Then, the coolest thing happened:
Pamela overheard the conversation and said rather stridently, "You're not sick!"
In my typical declarative response, I pointed to the boy and said, "He was sick on Sunday. But, you're not sick."
We reached their car and were winding up our conversation. Then, Pamela turned to me, pointed to him, and asked, "How does the boy feel?"
I told her, "I don't know. You could ask him a 'How do' question?" I scaffolded her syntax because I wanted her to succeed in this interaction with a total stranger (she has never met this little boy).
She looked at him, pointed, and asked, "How do you feel?"
Then, he looked up at her and said, "Fine!"
Then, his mom prompted him to say thanks, so Pamela thanked him. LOL. But, then when he waved good-bye to her, she waved back and said, "Bye!"
The First Layer
Working with Pamela feels like peeling back the layers of an onion sometimes. Last month, we agreed with our consultant to continue working on expressive gestures as a long-term project and to start working on a short-term objective like calling joint attention. Initially, I summarized this short-term objective in this way:
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.
My objective was to focus on experience sharing by focusing on being together more than the activity itself. We are solidifying experience sharing before transferring more responsibility to Pamela in calling joint attention.
Pamela can share experiences beautifully on her terms. Tuesday, she came up to me with a crocheted scarf that a friend gave to her and asked, "What's this?" I said, "A warm scarf." She said, "No, it's a long tail." I looked and she had the other end sticking out of the back of her pants. I spotlighted my delight nonverbally and through comments about her pretty tail.
A little bit later, she came up to me and talked about her bee sting on her finger from last spring. I buzzed and pretended to sting her with my pincer grasp. She laughed. Then, I kissed it to make it better.
The Third Layer
Sometimes, Pamela becomes very static or verbally stims. In Monday's cookie video, Pamela went back to thoughts of salad several times. It might have been because I have not fed her in this manner in years, making it a very uncertain situation for her. Uncertainty may be the reason why she falls back on static conversations or verbal stimming. Our consultant remembered another child who struggled with uncertainty in the same way. She suggested I figure out what situations cause Pamela to go static and then work on helping her discover that uncertainty is not a bad thing. We are not even sure this is a formal objective, but we still need to address it!
Schedule
Pamela does not mind living in an unknown state of mind when it comes to do with the plan of the day. Years ago we used to have "I don't know" days to help reduce her dependence on a routine or schedule. Today, she will say, "It's to be announced," when I tell her I don't know exactly when something will happen.
New Way of Doing Things?
Pamela has a hard time when we are doing something deviating from what she generally expects. It is not that I have to be rigid, but, when something catches her by surprise, I see more static responses. The day she struggled to speak because of skeeter bites, I threw her off because I was sitting on the bed and talking to her. I hardly ever do that. When I followed her in the yard on Tuesday, simply to find opportunities for experience sharing, she got very mad at me. Wednesday, at Walmart, we explored some very cute Christmas shirts with lights. The problem is that I am not a shopper, so this was very unexpected behavior to her! She went back to her static statements ("I want Coke!"), much like she went back to her static, "I want salad!" when we ate cookies on Monday. Sharing experience lasts about forty-five seconds before her brain cannot handle the uncertainty any longer. It feels like an annoying pop-up ad that you can click off, but mysteriously appears a minute later.
Pamela is getting used to the shopping forays. Yesterday, Pamela completely adjusted to the idea of me and her exploring a section of Walmart. She had a moment or two of frustration and then went with the flow the moment she spotted Hannah Montana accessories. We flitted from Hannah to Christmas jewelry to generic jewelry: her "I want chips" popup add only happened once or twice.
Unknown Objects? Pamela has no problems with not knowing what a hidden object is. I tested it out twice. I put a toy spider in my pocket and said mysteriously, "I have something in my pocket." Pamela asked a couple of questions and I gave her a few blank "I don't know" answers. She went right back to her school work. We received a book for her in the mail, and she had no problem waiting to find out what it was. She had only three book popup ads with a lot of time in between.
Phone Calls?
Pamela MUST know who is on the phone when they call. If I ignore her, she will bug me with, "Answer me." I do not get many phone calls, so I have not been able to assess if she goes static. I hope you can live with the uncertainty!
Where Are We Going?
I am fairly certain this is an area where she needs certainty. Pamela's sense of direction is so keen that her "Where are we going?" popup ad happens as sooon as I make a wrong turn. One of the things I will have to work into our periods of uncertainty is finding ways to drive somewhere without telling her exactly where. I anticipate lots of popup ads! LOL!
The Fourth Layer Friday, I reflected on what a fellow RDI mom has written on trust. Now, Pamela trusts me in most situations. Perhaps, that trust is shaken when I behave in unpredictable ways. Maybe, I compensate too much and, when I don't, she goes static. This friend discussed how when she first started RDI her goal was to coexist in the same room without making any demands. So, I borrowed her idea and applied it to the yard since Pamela got riled up at me the other day.
As predicted, Pamela grew very angry and obnoxious. She was furious when I announced we were going to go out because it was "after school hours"--an unpredictable time. I decided to push this, but then, once we hit the yard, I LEFT HER ALONE. I figured I needed to win her trust, so I did my own exploration and she did hers. After about five minutes, she was near me doing her own thing. I saw a dead vine branch hanging from the tree top, and I grabbed it because I know she has a thing for sticks. I began pulling it. She was very interested and joined me. First I pulled, then she pulled, and we pulled together. We moved to different locations to test the best direction for bringing it down. Her face flushed with joy at our success. I left her alone to play with the very long branch because I wanted to end on a positive note.
In this video, I strung together pictures to give you an idea of how our explorations went on this beautiful fall day.
Cream the first four ingredients (wet ones). Beat in eggs. Combine the next five ingredients (dry ones). Gradually add the dry ingredients to the creamed mixture and beat (not heat) until just blended. Stir in chips and nuts. Drop by spoon. Bake at 375 degrees for nine to eleven minutes.
My objective was to focus on experience sharing by focusing on being together more than the activity itself. We are solidifying experience sharing before transferring more responsibility to Pamela in calling joint attention. While baking cookies together, I learned thing: focusing on little unexpected things and spotlighting them rather than the procedure.
In the first two videos, the camera angle looks awkward, but I really wanted to capture our facial expressions and sharing. In the first one, I capitalized on unscripted things. I have been trying to capture Pamela's "magic finger" (a "problem-solving technique" for her). She does her "magic" at 3 minutes 50 seconds!
My two favorite moments were when we discovered a mistake in the recipe and talked about how to correct it and when Pamela learned to scoop cookie dough with spoons. You can see on her face that she was in the moment here and not agenda-driven. I loved Pamela's smile of pride when she learned something new (handling two spoons).
In the final clip, we are enjoying cookies. The problem is that Pamela had made a salad and wanted to eat that salad, dog gone it! You can see how she goes back to something static--salad--because this activity has no procedure. I slowed down the pace by feeding her and myself, which allowed her to relax--you can see how for a good forty-five seconds she was in the moment.
I have been seeking opportunities to experience share. Pamela came into the house with a beautiful red fall leaf, and we talked about it. She went outside, and I followed her after she had five minutes on her own. I was hoping to capitalize on that moment, but I failed. She got real static and tried to get me on her verbal calendar train, but I refused. We walked around the yard, but it was a bust because she focused on calendars and started sputtering at me when I didn't join her.
I pouted and walked in the house. She knew I looked upset (deep down inside, I was mildly amused), so she followed me. I looked at the floor sadly, so she put her hands on my upper arms and kissed my forehead. She said, "I apologize." I looked up and told her a forgave her and kissed her on the cheek. We agreed to explore the backyard tomorrow. I love how she read my emotion and tried to repair it.
There are two big things I discovered:
When *I* am unsure of what to do, I talk too much. I talk to cover up my uncertainty.
When *Pamela* is uncertain, she falls back on static conversations or verbal stimming.
With reference to adult outcomes, we do know some things and we shouldn't be all that impressed . . .
It is not an overstatement to say that adaptive behavior competencies will get you through times of no academic skills better than academic skills will get you through times of no adaptive behavior competencies.
This speaker did cite the 2004 Howlin study that Dr. Gustein uses as well as two I do not remember seeing (Green (2000) and Cederlund (2008)). He mentions several statistics like those spotlighted by Dr. Gutstein as well:
In a group of 20 adolescentes with Asperger syndrom, Green, et all (2000) found that despite a mean IQ of 92 only half were independent in most basic self care skills including brushing teeth, showering, etc. None were considered by their parents as capable of engaging in leisure activities.
Howlin, et all (2004) surveyed 68 adults with autism with an IQ of above 50 and found a majority (58%) were rated as having poor or very poor outcomes. With regards to employment status they found
8 were competitively employed
1 was self-employed earning less than a living wage
14 worked in supported, sheltered or volunteer employment
42 had "programs" or chores through their residential provider.
Cederlund, et all (2008) followed 70 males with Asperger Syndrome (AS) and 70 males with autism more than 5 years after their initial Dx. The results indicated that while 27% of the AS group presented with "good" outcomes, 26% had a "very restricted life, with no occupation/activity, and no friends." Outcomes were considerably worse for this with an autism diagnosis.
He came to similar conclusions as Dr. Gutstein. IQ does not predict the ability to stay employed, keep friends, and live independently. In his talks, Dr. Gutstein goes further to say that neither language nor success in school predicts employment, friendship, and independence for autism-spectrum adults. So, who is the mystery speaker? Dr. Peter Gerhardt. Unfortunately, his conclusions, I fear, will produce more of the same . . .
Before I go any further, I must be completely honest. I am not a fan of ABA; I have a personal bias against ABA. In spite of all of the "evidence" (and I am a statistics hound, having earned my bachelor's degree in mathematics and master's degree in operations research), I am not impressed.
Why? Because, as these studies point out, success in school (a static system) and high IQ (a static ability) does not address dynamic intelligence, which is required for sustained employment, relationships, and independence. ABA targets static skills (learning procedures, thinking in the box, memorizing information, reacting to a prompt in a predictable way, etc.). In fact, Dr. Gerhardt points out, "in supporting adolescents and adults, there are times where previously accepted 'prompt hierarchies' may have to be modified." His answer? Prompting a la bluetooth. Hmmm . . . I am being flippant, I know--Dr. Gerhardt's presentation is full of all kinds of ideas to make an ABA parent's heart sing. However, having seen Pamela master developmental milestones that have enabled her to learn all kinds of life skills in the past 18 months--milestones I thought impossible for autistic people, I want more than direct-prompt-driven behavior.
What I like about RDI is that direct prompting (imperative teaching) is the absolute last resort for teaching problem-solving and thinking outside of the box. RDI acknowledges that the great strength of autistic children is static learning. Pamela learned her calendar skills (knowing the day of the week given the month, day, and year) through her eye for patterns, a static ability. Rather than developing that part of the brain even more, I find it more beneficial to develop the area where she is weak: dynamic thinking. It is slower and not as exciting as ABA, but I think in the long run will pay off for us!
I am not trying to bash ABA here, but to draw some clear distinctions between the two. Remediating autism means giving the child a second chance to do over what they missed the first time around. It means looking at the typical developmental profile of a typical child and letting them try to master those missing gaps. That is why ABA looks great at first because children pick up all of these wonderful static skills very quickly and you become the miracle worker. BUT, they have no idea what to do when things change or something unexpected happens. Static is easy for them, so why spend time focusing on what comes naturally? That is why you have so many highly intelligent autistic people with degrees who cannot hold down a job.
Not only that, the parents/therapists doing ABA have to engage in a completely different manner. In ABA, you expect the child to give an immediate response--in RDI, you are told to wait up to 45 seconds to allow the child to process and think. In ABA, you give the command in the same way every time. With RDI, when the child is on a roll and feeling competent in the situation (there are no commands or prompts), you add variation for which you have no prompt or target response. If they are able to go with the flow, you keep adding variations. If they freak out, you help them recover, get them going with the flow again, and challenge with a different variation. With ABA, everything is focused on verbal communication. With RDI, you are trying to be as nonverbal as you can because that is what most of our kids missed during their infant and toddler years.
If I boiled it down to one comparison, I think an ABA child is expected to do, but an RDI child is allowed to discover. P.S. Here's more food for thought: an article called Reaching an Autistic Teen about a school started by the father of a spectrum teenager that employs Greenspan's ideas. I like this explanation of developmental theory (which is what RDI is too) on page 4:
I begin to picture the brain metaphorically as a tangled ball of Christmas lights. When you plug it in, there are strands that light up perfectly and there are dark zones where a single burned-out bulb has caused a line to go out. If the bulb for Exchanging-Smiles-With-Mother doesn’t light up, then Empathy won't be kindled farther along the strand, or Playfulness, or Theory of Mind (the insight that other people have different thoughts from yours). The electrical current won't reach the social-skill set, the communication skills, creativity, humor or abstract thinking.
I think RDI is less-child driven and tries to balance between parents and children more. I am inspired that it is the PARENT of a spectrum child (a father, no less) who started and runs the school. Very neat!
In September, I wrote a post about dynamic thinking and Greg Tang's Math Appeal, which we finished two weeks ago. Why dynamic thinking? Pamela thrives in static situations: predictable, expected, orderly, and sequential. She has a keen eye for patterns and details as a result and has no problems learning anything that has a logical procedure with very little ambiguity.
When you think about how many of us teach children math, we tend to do it in very static ways. According to his biography,
Greg Tang was tutoring math in his daughter's class when he noticed something interesting about the dominoes they were using. Each white dot had a pencil mark on it, which meant the children had been counting them one at a time. Mr. Tang taught them to look for patterns instead, and to add and subtract groups of dots in order to calculate the dominoes' value quickly. From there, he developed a new method of teaching arithmetic in a visual and spontaneous way. His method teaches both computational and problem-solving skills, and is so fun and challenging that children forget they are learning math! He believes that all kids are capable of doing well in math, and he has a mission to make math a natural part of every child's life.
The other day I was checking David's statistics problems by hand and something about static thinking hit me. Math is not his favorite subject, so he prefers sticking to procedure. He put his number in order and then added them. As I studied the number, I noticed that, by ordering them slightly differently, you could line them up nicely in easy to add groups. Of course, when I pointed it out to him, he rolled his eyes and told me that was too complicated and he would rather add them up the hard way! LOL! Maybe, this sort of thinking only appeals to geeks like me!
Lately, Pamela has shown some signs of dynamic thinking in math. She has been counting down the days to Daylights Savings Time. By noon today, she had already reset the kitchen clocks in anticipation of the big event. She told me we are now living in Houston time (my sister lives near Houston, and my parents are visiting her right now). I ought to be thankful that Pamela is a flexible enough thinker not to wait until exactly two in the morning to make the switch! But, that is all static stuff.
We were talking about whether we add or subtract an hour. Pamela told me subtract without hesitation. Then, I reflected on a verbal way of remembering the time change, "Yeah. I always remember fall back, spring ahead."
Pamela gave me her nonverbal image, "No! Leaves!"
I spotlighted her idea, "That's right! The leaves fall off the trees in fall."
She added, "Just like subtraction!"
Then, I said, "The leaves grow back in spring. Just like addition!"
That is a very cool way to remember and I would love to know of any other person on the planet who shares that image. What I love about it is that, instead of some rigid mnemonic, she came up with an unforgettable idea, rich in meaning and context.
But, wait there's more! The other day, I noticed that Pamela diverged from the way that I taught her to borrow and carry. Instead of writing the number to carry above the top digit or crossing out the number from which you borrow, she rewrites the digits to be changed. There is absolutely nothing wrong with coming up with your own way of doing math, as long as it is logical and correct!
Next on the agenda for encouraging mathematical thinking are more books by Greg Tang. Although they cover skills Pamela mastered years ago, I am doing a "redo" in the true spirt of RDI. Think about the math she learned procedurally in more dynamic ways: Grapes Of Math Math for All Seasons Math Fables Too
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:
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.
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!
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!
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!
Today, a gorgeous sunny day with a bit of a breeze going, Pamela, David, and I met up with the entire Jamberry and Habeeb crew (Sly, Jman, SB3). The only one missing in action was Steve, who was helping out Tammy's brother with a favor. The next time, Jamberry and her boys--all four--will stay with us so that we can talk without Pamela and Jman looking for an escape hatch from the chatty mommas (actually, they were both VERY patient). I loved holding SB3 and got to see the gamut of his emotions: placid, sleepy, hungry, poopy, and giggly. Yep, I saw him laugh, and he was sooooo cute.
Before moving onto my dog, I wanted to address Penny's comment from Monday's post, asking if Bob's Red Mill withdrew their oats a few months back because of gluten contamination. I was not too worried because Pamela showed no signs of a reaction to the cookies or eating an entire bowl of oatmeal for breakfast. I emailed the company and, within 24 hours, they replied,
