Wednesday, February 28, 2007

Presenting Prepositions: Weeks One and Two

We finished personal description stories in January and started introducing prepositional syntax in preparation for preposition round-up stories (page 15) last month.

For several weeks, we have been practicing the concept of prepositions in Pamela's speech therapy program (the association method). I chose to make it very practical by focusing upon highways. Highways? Yes, highways! Autistic children often develop unusual interests, and, right now, many of Pamela's conversations revolve around the different highways in our area. She knows more than one route to take to different towns and often asks us to take one highway to a city and take another highway on the trip home. She enjoys studying maps of our state to learn new connections. Her syntax was never quite right in these conversations about road trips. One way to get plenty (I mean PLENTY) of practice with prepositions is to teach the ones used most in her conversations. My favorite technique is practicing language through her most cherished (euphemism for perseverative) topics because we are guaranteed to have many opportunities to apply new syntax.

Pamela understands prepositions, so my goal the first week was to introduce the syntax of prepositions in sentences associated with map activities. The first day we talked about our town, and the next three days we covered different towns where relatives she has visited live. We ended the week with an imaginary road trip pictured below. I focused on prepositional phrases with proper nouns to avoid the need for articles like a, an, and the:
"at [street address]"
"on [street name]"
"in [city/county/state/country name]"
"near [another city/county/state/country name]"
"between [two cities/counties/states/countries]"
"near Interstate/United States Route/South Carolina Highway [number]"
"to [city/county/state/country name]"

To increase her enjoyment of the stories, I included maps and icons for all the kinds of major roads (interstate, routes, and highways). Pamela loved these therapy stories and enjoyed her introduction to prepositions. The second week we introduced where. Because Steve and I have the same pet peeve (ending questions and sentences with a preposition), I bit the bullet and introduced questions beginning with prepositions: "In what. . .", "On what. . .", "Near what. . .", "To what. . .", and "Between what. . ."

Pamela looked forward to speech therapy every day because it helped her learn to discuss one of her favorite topics. Incorporating an autistic person's interests is like that spoonful of sugar Mary Poppins sneaks into her medicine. And, this "sugar" causes no cavities and does not cost a dime!

Saturday, February 24, 2007

How to Organize Free-Thinkers!

One of my favorite resources for homeschooling is the book, The Way They Learn, by Cynthia Tobias. When I started figuring out all the learning styles in my family, it helped me become a better wife and parent.

David is definitely a concrete-random thinker, abstract-random in second place, with a kinesthetic memory style. He is a blend of Ralph Moody of Little Britches (concrete random) and Anne of Green Gables (abstract random). He tends to perceive concretely (real world, practical, things) and randomly (sees rules as guidelines and schedules as straightjackets) as indicated in this online questionnaire for this model of learning styles.

Inventive. . . Independent. . . Problem Solver. . . Discovering. . . Seeing possibilites. . . Experimenting. . . Creating

Look at what are considered weaknesses for a highly concrete random person, which spells disaster when trying to knock out the subjects required on a transcript for entrance into college:
Restrictions and limitations
Formal reports
Re-doing anything once it’s done
Keeping detailed records
Showing how they got an answer
Choosing only one answer
Having no options

In fact, some concrete-random or abstract-random thinkers who are highly kinesthetic get diagnosed as ADHD in traditional schools where their strengths cause problems in the classroom. If you have a child like this, you may want to read another Cynthia Tobias book, You Can't Make Me. When authority figures fail to appreciate, much less see these strengths, kids can become burnt out with school and troublemakers at home:
Inspire others to take action
See many options and solutions
Contribute unusual and creative ideas
Visualize the future
Often a different way to do things
Accept many different types of people
Think fast on their feet
Take risks

Now that David is a freshman in high school, I need him to learn to work on his own without *ahem* nagging from me. One factor in my favor is that he plans to attend college and major in history. Thus, he knows he must do well enough in math (his least favorite subject) to score decently on the SAT. I have also explained to him that homeschool laws require me to cover very specific subjects, regardless of whether or not he is interested. He does buy into these requirements.

Rather than come up with a system I think he ought to use (afterall, that is the whole thing--sequentials like me think we can fix randoms by inventing systems that work for sequentials), I decided to let him brainstorm. He likes the computer, so I had him type up things he wants to accomplish every day. Then we added school habits, personal hygiene, and house chores to it. We estimated how much time different activities ought to take (and know this may need adjustment--but, as he likes to experiment, that possibility is up his alley). We wrote up some guidelines, not rules. He would rather pick and choose the order of getting things done, so schedules and organized lists are too boring. We agreed upon these ideas:
Use the timer to stay on track.
If time is left, convert to computer time.
Computer time can be saved; he chooses when to use it to play.
If an activity takes too long, make it up evenings and weekends.
If the same activity takes too long, do it in Mom's presence.
Discuss if we need a time adjustment.
He chooses a room to work unless he dawdles or makes many errors.
For now, put each time block on a post-it note.
Time self and bag the note when done.

My job is to inspect and gently ask, "So what are you doing now?" We brainstormed the system on Monday and implemented it on Tuesday. The past four days of homeschooling have been more trouble-free than usual with much more accomplished than usual. Four days does not a habit make, but David remarked on Thursday, "Mom, that system of mine works great!" He has taken ownership of his system, which is promising!

Friday, February 23, 2007

Teddy's First Birthday

Pamela is amazing! Yesterday morning, she walked in the kitchen and studied the drawer where I store her gluten-free, casein-free baking mixes reserved for special occasions. She said, "I want a cake." When I promised to bake one, Pamela excitedly bolted out of the kitchen.

A few minutes later, she came back with a teddy bear given to her by her Oma about a year ago. Pamela announced, "Teddy is one year old. I want a candle."

How could I refuse the chance to indulge the desire for pretend play? Since I was planning a shopping trip anyway, I asked, "Pamela, would you like me to pick up some ice cream and sorbet when I go shopping?" She answered in the affirmative, of course.

After we finished our routine for the day, we headed to Wal-Mart and made an exciting discovery! They carry Van's Gluten-Free Waffles, Alexia Food's Gluten-Free Waffle Fries, and Turtle Mountain's Organic So Delicious Chocolate Velvet Dairy-Free Frozen Dessert. Pamela and I high-fived each other and Snoopy-danced down the frozen food aisle. Wal-Mart's selection will never compare to that of Earth Fare with Pamela's special foods, but I might be able to spread out our bi-monthly trips to the health food store an hour from home!

After dinner, we celebrated Teddy's first birthday. I was so glad that my dislike of baking did not kick in when Pamela quietly asked for an impromptu cake earlier in the morning. A grouchy "No!" on my part could have halted the whole experience. By taking her request in good humor and letting masterly inactivity be my guide, I followed her whim down a delightful rabbit trail, illustrating what Charlotte described,
The next element in the attitude of masterly inactivity is good humour––frank, cordial, natural, good humour. This is quite a different thing from overmuch complacency, and a general giving-in to all the children's whims. The one is the outcome of strength, the other of weakness, and children are very quick to see the difference. 'Oh, mother, may we go blackberrying this afternoon, instead of lessons?' The masterly and the abject 'yes' are quite different notes. The first makes the holiday doubly a delight; the second produces a restless desire to gain some other easy victory.

Wednesday, February 21, 2007

Masterly Inactivity and some Autism Therapies

Years before I became acquainted with Charlotte Mason's philosophy of education, many of her ideas made sense to me. Back in 1994, when I was teaching Pamela skills and academics through Discrete Trials Training, I balked at drilling play skills as outlined in Chapter 12 of The Me Book. I thought, "Play is play. If you have to teach a child to play, then play becomes work." Charlotte Mason had written something eerily similar a hundred years before my time, "There is a little danger in these days of much educational effort that children's play should be crowded out, or, what is from our present point of view the same thing, should be prescribed for and arranged until there is no more freedom of choice about play than that about work."

Breaking down pretend play into a series of teachable steps seemed too contrived and controlling. Pretend play is an outward response to the mysterious inner life of a child. Charlotte Mason wrote,
There is an idea afloat that children require to be taught to play––to play at being little fishes and lambs and butterflies. No doubt they enjoy these games which are made for them, but there is a serious danger. In this matter the child who goes too much on crutches never learns to walk; he who is most played with by his elders has little power of inventing plays for himself; and so he misses that education which comes to him when allowed to go his own way.

Although I was not familiar with Charlotte's concept of "masterly inactivity", I waited to see what would happen. My passivity toward pretend play lasted for two years! In the spring of 1996, Pamela began what appeared to be a bizarre ritual. During her free time, she plopped herself in the same spot near the nightstand in my bedroom. She always held a yellow Duplo window and a small baby blanket. I drew the line in the carpet after she added the vacuum cleaner to her odd circle of friends! Because I was so curious about what she meant by her odd routine, I stepped aside and let her be. After about a month, spontaneous language blossomed, and she began to say, "Blankie!" and "Loudmouth!" These exclamations lifted the veil to the mystery: Pamela had taught herself to pretend play, imitating The Brave Little Toaster, her favorite movie! Incidentally, our vacuum cleaner was a Kirby, and an orange reading lamp and clock radio sat on our nightstand!

Pamela had not only figured out pretend play by using concrete objects, she also understood symbolic play, substituting the Lego Duplo for the toaster! She continued her forays into the world of pretend play, jumping off the top bunk wearing a blue dress (imagining Alice tumbling down into wonderland). She did the same in a Pocahontas outfit, imagining the canoe going down the waterfall. The following Christmas she put a Choosy Baby All Gone doll on her wish list. As soon as we pulled the doll out of the box, Pamela began to feed her baby like any doting mother. She started telling me what she wanted to be for Halloween and asking for Barbie dolls, which she truly played with like any other little girl. Her younger brother taught her to cross swords with him. What Pamela needed was not me teaching her how to play but time and, in my humble opinion, a gluten-free, casein-free diet. Charlotte Mason thought time, not adult intervention, was a key ingredient to play too, "Boys and girls must have time to invent episodes, carry on adventures, live heroic lives, lay sieges and carry forts, even if the fortress be an old armchair; and in these affairs the elders must neither meddle nor make."

My second experience with restraining myself was when Pamela began cutting up her beaver Beanie Baby named Bucky. One day, while I was processing email, Pamela waltzed up to me with Bucky and asked, "What animal?"

Distracted, I replied, "A beaver."

After Pamela vehemently exclaimed "No! That's not a beaver!" I inspected it closely and noticed she had ripped off the beaver's teeth.

Pamela was a walking encyclopedia of animal names, so I had no idea what she expected me to say. I turned the tables on her and asked, "So, what animal is it?"

She smiled and announced, "Squirrel." I think she enjoyed teasing me with her little prank for, the next day, she came back with a tailless squirrel and asked, "What animal?"

I said the first thing that popped in my head, "A chipmunk."

She danced away happily because I nailed that one. With a tied score, she headed back to her room, where she spent several minutes contemplating how to best me with a new animal. Finally, she skipped up to me with the Beanie Baby formerly known as Bucky scrounged up into a squat and its muzzle pushed into its face. I was clueless this time and begged her for an answer. She smiled, "Frog!"

"Wise passivity" allowed me to witness Pamela's creativity and imagination in action. Had I intervened and stopped her from mutilating any more of her toys, I would have missed a golden opportunity to see her mind in action. Doing less with Pamela through masterly activity allowed her to do more! Except for snipping Barbie's locks, this was the one and only time she ever maimed one of her toys. Pamela never became a toy serial killer due to my lack of action. Charlotte Mason observed,
But the fussy parent, the anxious parent, the parent who explains overmuch, who commands overmuch, who excuses overmuch, who restrains overmuch, who interferes overmuch, even the parent who is with the children overmuch, does away with dignity and simplicity of that relationship which, like all the best and most delicate things in life, suffer by being asserted or defended.
My third encounter involved Pamela allowing a television show to get in the way of her schoolwork. The minute Blues Clues debuted back in 1996, Pamela was hooked! I was a bit miffed when she demanded stridently to watch this half-hour show twice a day. While she lacked the oral language to explain why, I stepped aside and bowed to her wishes because the show seemed important to her. I decided to file paperwork, do the dishes, or zip out some emails while an episode aired.

By the end of one month, I was glad I caved! Steve and his clues mesmerized Pamela so much that she began to fill pages and pages and pages of clues. Drawing like her hero improved her handwriting just as much as my carefully conceived writing plans. Charlotte Mason encourages parents and teachers to permit personal initiative in their students' work,
In their work, too, we are too apt to interfere with children. We all know the delight with which any scope for personal initiative is hailed, the pleasure children take in doing anything which they may do their own way; anything, in fact, which allows room for skill of hand, play of fancy, or development of thought. With our present theories of education it seems that we cannot give much scope for personal initiative. There is so much task-work to be done, so many things that must be, not learned, but learned about, that it is only now and then a child gets the chance to produce himself in his work. But let us use such opportunities as come in our way.
Encouraging children who show personal initiative does not preempt a parent's authority, Charlotte writes,
Authority is neither harsh nor indulgent. She is gentle and easy to be entreated in all matters immaterial, just because she is immovable in matters of real importance; for these, there is always a fixed principle. It does not, for example, rest with parents and teachers to dally with questions affecting either the health or the duty of their children. They have no authority to allow to children in indulgences––in too many sweetmeats, for example––or in habits which are prejudicial to health; nor to let them off from any plain duty of obedience, courtesy, reverence, or work.
She assumes parents have established a series of habits that accomplish schoolwork with time left in the day for children to direct themselves. Every school day, Pamela is in the habit of reading and narrating living books; language arts through copywork, studied dictation and recitation; math lessons; speech therapy; self-care (including fixing her own breakfast); and keeping her room tidy. Pamela understands why she ought to maintain a special diet. My tool box of autism techniques allows me to be "gentle and easy" rather than "harsh or indulgent": Discrete Trials Teaching to clarify confusing academics, Social Stories™ to explain sticky situations, Sensory Integration to promote calmness, etc. When she was younger, we scheduled Pamela for Auditory Integration Training to help her manage noise with less stress. We try to live up to one of Charlotte's mottoes, "Education is an atmosphere, a discipline, and a life."

I could list example after example of masterly inactivity, but I will close with my favorite. During Auditory Integration Training, Pamela overcame her fear of escalators, but was still terrified of elevators. She would throw major tantrums if we tried to force her to ride one. We decided not to push the point. We figured it is not a health issue because taking the stairs is great exercise. Near every elevator, you can find a flight of steps. We applied masterly inactivity on this issue and waited for ten barren years for it to bear fruit.

Unbeknownst to us, Pamela's attitude began to soften by watching the elevator scenes in Toy Story 2. We lived in Alaska at the time and, because the island lacked the fell beasts, she lacked the opportunity to test her courage. When we moved to Minnesota, we began going to the library several times a week. The library was large enough to house three floors and an elevator for the carts. One day, we approached the stairs, located next to the elevator. Pamela commented, "Elevator, just like Toy Story 2."

Sensing that Pamela's love of all things Disney might be at work here, I asked her, "Would you like to push the button?"

"Yes," she replied and Pamela hesitantly walked up to the door and pushed the button. She stood there for a while.

I didn't want to rush her, so I said, "Would you like to ride the elevator some day?"


"What day would you like to try?" That was followed by a long pause.

I clarified, "Would you like to ride the elevator today?"

"Yes." Not only did Pamela get on the elevator, but she actually rode it. She was extremely nervous, but she did not scream or cry. She was so frightened when she stepped on that elevator; her body quaked! However, she faced it on her own terms and in her own time. Her effort and her resolve led her to that elevator.

After she survived her first trip on an elevator in ten years, her smile was so big. Her pride in accomplishing such a big feat showed on her face. Ever since that day, Pamela has had no issues with elevators. Pamela's initiative throughout the years strengthened her ability to choose to face a major challenge in her life. Charlotte's reflections on initiative describes what we have witnessed ourselves,
The child who is good because he must be so, loses in power of initiative more than he gains in seemly behaviour. Every time a child feels that he chooses to obey of his own accord, his power of initiative is strengthened. The bearing-rein may not be used. When it occurs to a child to reflect on his behaviour, he should have that sense of liberty which makes good behaviour appear to him a matter of his preference and choice.

Tuesday, February 20, 2007

When is DTT Unreasonable? When Social Stories Eliminate a Behavior!

I am like-minded with the ABA proponents who see the benefits of Social Stories™. Several ABA sites (even those that ignore sensory and diet issues) plug Carol Gray's Social Stories™. Polyxo, a site with detailed information on ABA and DTT, describe how they implement Social Stories™. Even the Association for Science in Autism Treatment reviewed Social Stories™ favorably with the caveat that they be used in conjunction with ABA.

Carol Gray explains Social Stories™ at her site:
A Social Story™ describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format. The goal of a Social Story™ is to share accurate social information in a patient and reassuring manner that is easily understood by its audience. Half of all Social Stories™ developed should affirm something that an individual does well. Although the goal of a Story™ should never be to change the individual’s behavior, that individual’s improved understanding of events and expectations may lead to more effective responses.
What most impresses me about her stories is that Carol deeply respects autistic people. She recognizes sensory integration issues. She takes bullying so seriously, she wrote a guide devoted to the topic with practical activities for children to confront bullying. She seeks to balance the social equation by helping us better understand people with autism through the process of writing Social Stories™ and helping the child understand a situation better and possibly respond more appropriately. One of my favorite quotes from her site is,
While people with ASD appear to sit alone at the top of the social teeter-totter, the blame for their lack of success or frequent struggles does not lie solely with them. People on the “other end of the teeter-totter” can do much to promote social success for all participants in an interaction, even those with ASD.
Rather than explain Social Stories™, I can tell you what they are not. They are not long lists of rules that make you as shaky as a caffeine addict early in the morning! They are not carved-in-stone commandments cleverly cloaked in a story. They try to include very few directive sentences and couch them with words like, "I will try to" or "It is a good idea to."

The best way to learn how to write them is to go to the source! Her workshops are great, and, if unable to attend one, her video is the next best thing. She has some free tips on getting started, but the current guidelines are available in a PDF file costing only $7 (a bargain compared to the price tag of other therapies). Her two books with collections of Social Stories™ provide shells that helped me get started, but I really did not understand the process until I attended a workshop. The Social Stories™ Quarterly are full of great ideas.

Why I favor Social Stories™ over DTT for behavior is that they dovetail beautifully with Charlotte Mason's principles of education and belief in masterly activity. In her fourth principle of education, she warns about heavy reliance upon direct influence,
These principles are limited by the respect due to the personality of children, which must not be encroached upon whether by the direct use of fear or love, suggestion or influence, or by undue play upon any one natural desire.
The point of a Social Story™ is to provide information, not change behaviors. Through this process, the autistic person and storywriter learn more about the situation and their perspectives. While the autistic person might accept the ideas in the story and respond differently, he is free to reject these suggestions because he lacks enough information or the story aimed at the wrong issue. Carol Gray trusts people with autism to make appropriate choices when armed with greater insight. In her nineteenth principle, Charlotte writes,
Therefore, children should be taught, as they become mature enough to understand such teaching, that the chief responsibility which rests on them as persons is the acceptance or rejection of ideas. To help them in this choice we give them principles of conduct, and a wide range of the knowledge fitted to them. These principles should save children from some of the loose thinking and heedless action which cause most of us to live at a lower level than we need.
Social Stories™ are kindred spirits to Charlotte's concept of masterly activity, for she preferred a thoughtful and purposeful letting alone over heavy-handed dominance:
We try to dominate them too much, even when we fail to govern, and we are unable to perceive that wise and purposeful letting alone is the best part of education.

Last spring, a need arose for a Social Story™ when Pamela started growing angry at rehearsals for a church musical. Whenever we had to repeat a song or skipped around in the book, she grew increasingly upset. I suspected she thought rehearsal ended when we finished the last song in the book. Skipping around and repeating songs confused her expectations of when rehearsals would end. I imagined the problem might be solved if she focused on time instead.

I thought it might improve her understanding by explaining the difference between rehearsals and a performance. I wanted to explain the different parts in a chorus and how one part might want to review a few lines. Pamela and I usually sing soprano together, but as there were no men at first, I helped her brother learn tenor. To make her smile, I put the names of her favorite songs in the story. This is what I wrote:

“Celebrate Life!” is a musical. Our church can do this musical on Sunday, June 11, 2006. On the night of the musical, the singers can sing all the songs in order. After the organ music, they can sing the first song, “Prepare a Way for the Lord.” Then they can sing the second song, “The Truth Shall Make You Free.” They can sing all the songs until the last one, “Prayer for Peace.” Organ music is at the end. That night, the singers can sing the songs in the right order from beginning to end.

A choir has four groups of singers. Each group has their own notes. They follow their own line of music. The high voices are called sopranos and altos. Mom and I have soprano voices. Mom thinks I have a pretty voice. The audience thinks I have a sweet smile. The low voices are tenor and bass. David has a tenor voice. Mom can help David with his tenor part during practice. Mom can sing the soprano part with me on June 11.

The singers can practice on Sundays and Wednesdays. Another word for practice is rehearsal. Pastor Debra is the director. In rehearsal, the director picks different songs. Sometimes, Pastor Debra follows a different order from the book. That is okay. Sometimes, the singers need to practice one song two or three times. That is okay. Sometimes she has a group like the altos or tenors practice their part alone. Sometimes the sopranos practice alone. This can help each part learn the correct notes. That is okay too.

Going in a different order can be frustrating. Repeating a song can be frustrating. I can bring a watch to check the time. Mom will try to tell me what time rehearsal will be finished. When I get frustrated, I can check the watch. Then I can figure out how many minutes are left. If I need a break, I will try to say, “I want a break.” It is okay to take a short break.

This story solved the problem! Within a few rehearsals, Pamela's outbursts decreased. I did not write a story when we started doing two thirty-minute performances in a row at one rehearsal. That was too much for Pamela. Because she had only ten days to learn choreography for the last song, I told her that it was okay to take a break, but she needed to come back to the stage for the last song. She appeared like clockwork, just as we had agreed!

Monday, February 19, 2007

When is DTT Unreasonable? When AIT Eliminates a Behavior!

I am surprised when some try to deny the sensory aspects of autism. On this pro-ABA website, the author writes, "Autism is probably not...
A "sensory disorder," or a dysfunction of any specific sense (hearing, balance, vision, and so on). Exaggerated responses (fear, anxiety) to normal sensory stimuli are very common, but the response is probably not simply a normal response to an exaggerated or distorted sensation. (There may be a disorder in how sensory information is processed, but it is not likely as simple as "too loud" or "not clear.")
I am stunned! Pamela had several very specific auditory sensitivities that harmed her quality of life. She still has some, but she is now able to avoid sensory overload by covering her ears, leaving the room, or using calming techniques. I think back to the time Pamela could hear the box-crushing machine at the back of the grocery store and refused to enter the room. Another time she complained about bees in our apartment: the fluorescent lights in the hallway were on the blink, and I had to open the door to figure out that. I am convinced her hearing is more acute than mine is!

These comments do not square with eyewitness reports of autistic people themselves. In one interview, Temple Grandin describes her altered hearing as a child:
My hearing is like having a sound amplifier set on maximum loudness. My ears are like a microphone that picks up and amplifies sound. I have two choices: 1) turn my ears on and get deluged with sound or 2) shut my ears off. Mother told me that sometimes I acted like I was deaf. Hearing tests indicated that my hearing was normal. I can't modulate incoming auditory stimulation.
Here is how she describes her hearing today:
I am unable to talk on the telephone in a noisy office or airport. If I try to screen out the background noise, I also screen out the voice on the telephone. Autistic people with more severe auditory processing problems are unable to hear a conversation in a relatively quiet hotel lobby.
Thomas McKean is an adult with autism who describes his hearing in this way:
Also due to an operation in my right ear when I was very young, I am losing hearing in one ear. And so the frequencies of each ear have different sensitivities. So sometimes when I hear one thing coming into both ears, it sounds like two separate sounds and my brain tries to separate them. This is confusing because you can't separate only one sound. Add to that the natural hypersensitivity to noise that people with autism have. So I am deaf to some tones, hypersensitive to others. Processing audio is very difficult for me to do. I have learned though that it appears to be necessary so I do the best I can and I am still trying to learn ways to do it better.
He did undergo auditory integration training (AIT) and experienced mixed results. The AIT worked wonders for a few months, and then his hypersensitive hearing returned:
It has been many years since my ears have been normal, until now. I had forgotten what a pleasant experience it was to be able to hear like everyone else. I do not know what caused it to go back to where it was, perhaps think it was just meant to be. Auditory training works, but like all things, it does not work for everyone.
He concludes:
I am now convinced that auditory training does indeed have beneficial effects for many individuals. It is NOT an experience I wish to repeat, but the end results may justify the means if the procedure is done correctly.
What Thomas tells parents to do is exactly what we have done with Pamela. He is absolutely right for these tips have worked wonders for Pamela:
I have noticed over the years, and I have no scientific data to back this up, it is merely an observation of one seasoned advocate, that there is a correlation between auditory dysfunction and violent behavior in the person with autism. If your child is acting violent (for no apparent reason), check the environment. It may be something you don't even hear yourself, like fluorescent lights. Take them someplace quiet and calm so they can get themselves together. Other sensory bombardment causes the same reaction, but I have noticed that auditory problems are the worst.
Thomas describes what he perceives during sensory overload caused by a trip to a very large mall:
I vaguely remember the car ride back to the apartment. All visual input was reduced to geometric shapes - clouds and fogs - mere shadows of substance. Color had no meaning and ceased to exist. My voice was completely gone. My world had become a hideous black and white distortion of reality. All auditory input was magnified in volume and echoed very painfully in my ears. Everything my hands and feet touched felt like flames. When we arrived, I collapsed in the bedroom and started crying for the first time in many years.
Once again, I find Thomas's recommendations in addressing sensory overload to be exactly what has worked for Pamela. He finds tactile input from a friend; Pamela responds to deep pressure hugs. He needs people to follow his cues; when Pamela tells us she needs to stay home, we respect her wishes and give her down time. He seeks a quiet place in the environment; Pamela craves the same thing! Darkness comforts him; we used to throw Pamela's big, navy blue blanket (her trusty companion for the past ten years) over her head to calm her. Because Pamela has responded so well to these tactics, she has not needed medication, which was another solution Thomas suggests.

Donna Williams has posted several articles about the sensory issues she faces. What she writes fits how Pamela communicated when young. Now, her stored lines make more sense, thanks to the association method:
My senses and perception were chaotic, fragmented and constantly shifting and fluctuating and the ability to understand things with meaning was so delayed I looked like I wasn't 'on line' but also like someone very behaviorally and emotionally disturbed. I stored huge strings of sound patterns and sang and chattered to myself most of the time, often in stored lines, jingles and adverts.
Since extreme ABA proponents deny the validity of distorted sensory perception faced by people with autism, they do not see the point of attempting to change the environment and teach children calming tactics. They refuse to try sensory -based strategies because they believe the child perceives the world the same way as everyone, but reacts in an exaggerated manner (high anxiety and extreme fear).

Back in January 1993, I read The Sound of a Miracle, and we decided to try auditory integration training (AIT), a mechanical means of achieving an improvement in auditory discrimination through an intensive form of music therapy. The AIT Institute describes it in this manner:
AIT is an educational intervention that efficiently retrains a disorganized auditory system. Auditory Integration Training (Berard AIT) is a scientific method of retraining the ear to listen and to process sounds in a more normal manner, without distortions and delays. While no guarantees can be made, Berard AIT is documented to have profound positive effects on many different types of individuals.
I contacted Louisiana's first person qualified as an AIT practitioner, Susan Boudreaux (we became friends and still keep in touch by email on a regular basis to this day). The first opening we could make was in June 1993. With Pamela's birthday coming up in March 1993, I decided to "test" AIT by trying to desensitize Pamela to candles for, like Georgie Stehli, Pamela could not blow candles on her birthday cake. I tested her and found that she could blow things like bubbles and paint out of a straw (to make bubble pictures). She could even blow an unlit candle!

A few weeks before her birthday, I placed an unlit candle at the end of the kitchen table. Pamela remained calm and relaxed. The moment I lit the candle, she covered her ears with her hands, tilted her head sideways, and hummed to tune out the candle's flickering noise. She did learn to blow from across the table. The closer I pushed the candle to her end of the table, the worse her performance became. No amount of bribes or comfort could encourage her to blow once the candle was too close for comfort. This was before I understood the principles of DTT for I read Let Me Hear Your Voice a year later, but I did make a concerted, daily effort to train her to tolerate one lit candle. When her fourth birthday rolled around, she still refused to blow out her candles.

That June, Pamela spent two weeks undergoing AIT using the original Berard audiokinetrons. During the training, something astounding happened. Elevators and escalators instilled panic and high anxiety in Pamela. At malls, we had to veer as far away as possible from these dreaded beasts, or Pamela would throw herself on the floor and tantrum. When we could not avoid straying too close, I would calmly repeat my mantra, "No elevator! No escalator! No elevator! No escalator! . . ." I had absolutely no intention of testing AIT at the mall because her reaction was so visceral and so public. We went to the mall, and I did the usual mantra. Suddenly, Pamela jerked my hand and pulled me toward the escalator. She rode it with no hint of fear! I asked her if she wanted to ride the elevator, but she flatly refused and I did not want to blow it. We toured several escalators that day for fun, and Pamela never had another problem with any.

We noticed subtle changes in Pamela. She no longer left the room when I vacuumed the house. She tolerated hand dryers in public bathrooms. She no longer hummed when we crossed bridges with grating. She could sit through a car wash without clawing into the upholstery. All of these things improved her quality of life because she was able to do more things with less fear.

The most exciting change happened in August 1993. Her little brother David celebrated his first birthday. Unlike his sister, he was king of the power nap and fell asleep during his own birthday party. Steve's family attended the party and we already had the cake and candle, so we decided to light it anyway. To our great surprise, Pamela walked right up to that cake without any prompting and blew out the candle. Everyone there had seen Pamela grimace and hum at her last birthday party. There was not a dry eye in the house.

AIT has more published studies than sensory integration. One blind study found that AIT reduced problem behaviors, while another blind study saw significant improvements in auditory problems and aberrant behavior. Some of the research includes non-blind studies too. While one site emphasizes a recent study that failed to show the benefits of AIT, the AIT Institute summarizes twenty-eight clinical studies (not all blind/placebo controlled) in this manner:
Twenty-three reports concluded that Auditory Integration Training benefits various population subgroups, three studies claim to show no benefit (or no benefit over that seen in a control group), and two studies reported rather ambiguous or contradictory results. Considering the great difficulties in both providing a credible placebo treatment and assessing improvement in the subject populations, these results are quite encouraging. The balance of the evidence clearly favors Auditory Integration Training as a useful intervention, especially in autism.
One thing to keep in mind when contemplating any therapy is the cost versus benefits. One problem with AIT is there is no guarantee it will help. Trying to predict what child will see positive changes in behavior is impossible. The average dollar cost of twenty Berard AIT sessions ranges from $1,200 to $1,500 in the United States, and the investment of time is a total of ten hours (two half-hour sessions per day, spread out over a two-week period). Parents considering AIT must be willing to lose up to ten hours and up to $1,500 and see no benefits. The possible benefit is a reduction in challenging behaviors related to auditory hypersensitivities and some improvements in auditory processing and speech (which we also witnessed with Pamela). AIT can be done in conjunction with other therapies like ABA!

The Cambridge Center for Behavior Studies has performed cost-benefit analysis for ABA. They focus upon four skill domains (language, social, adaptive, and academic), but ignore sensory sensitivities, emotional relatedness, and biomedical issues. The longest, best-documented study (Lovaas, 1987; McEachin, Smith, and Lovaas 1993) found that forty-seven percent of the children were able to function independently and successfully in regular classrooms. Another forty percent improved substantially, but still needed specialized intervention. Ten percent made minimal gains and continued to need intensive intervention. The best outcomes in studies on ABA require at least thirty hours per week year around for two to three years, starting before age six. They estimated the average annual cost of these programs to be $33,000 per child, meaning a total of $99,000.

We did not have the advantages of parents today in that ABA did not become mainstream until Pamela was past the magical age of six. I am not sure how we would have approached the idea of having therapists in our home, day in and day out, year round, for three years! However, Sonya Shafer handled ABA with her daughter Hannah in ways that makes sense to me. She has some fascinating insights on the gaps she found in ABA:
We discovered that the ABA therapy we had been using focused on the areas not affected by autism. This is in no way to say that ABA is useless; quite the contrary! ABA is useful for teaching facts, procedures, and absolutes to developmentally delayed children. We intend to continue using it for those aspects of Hannah’s learning.
In closing, autism is complicated. There are no easy answers or easy choices. The best thing parents can do is to get as much information as possible and make informed decisions, taking into account the profile of children likely to improve with a therapy, the costs, the risks, the benefits, the research, and recommendations of people with autism, other parents, and professionals. Our children have the greatest chance of improving their quality of life when we see our children as people and address the unique challenges they face. We can only do the best we can with the time, money, and energy we have.

Thursday, February 15, 2007

When is DTT Unreasonable? When SI Techniques Eliminate a Behavior!

Sensory Integration (SI) techniques have very few studies, and I cannot argue with the conclusion, “There exist so few studies that conclusions cannot be drawn.” However, some comments from extreme ABA proponents that exaggerate the claims of SI therapists push my buttons,
Those who promise that autism can be cured or ameliorated substantially with a pill, a vitamin, a diet, some sensory stimulation, some exercises for the ears or eyes or brain, or some play time with their parents or typical children find a large and eager market for their services and products.
I have yet to read SI material promising to cure autism and what I usually find are conservative descriptions like these, “Our goal is to improve quality of life for persons with sensory processing disorders” or “Our vision is to . . . improve the quality of life for children, adolescents, and adults with Sensory Processing Disorder.”

Designing experiments for a complicated treatment protocol like SI is not easy. No two children receive the exact same treatment because the role of the therapist is to develop a profile of the sensory needs and challenges of each individual child. A child with gravitational insecurity would be terrified when placed on a swing, but a craver of vestibular stimulation might turn into a chatterbox after a good swing! Sensory stimulation for the sake of sensory stimulation is not the point of sensory integration. Therapists target specific sensory stimulation to children who show a specific sensory profile.

A properly designed experiment would compare apples to apples: rather than study randomly selected autistic children, researchers need to study randomly selected autistic children who crave vestibular stimulation for a swing study. A researcher would not give reading glasses to all children to test how effective glasses are. Only children who needed glasses should be studied with glasses that match their unique vision profile. This analogy applies to sensory integration.

What also bothers me is the complete lack of concern about very real sensory differences that make life difficult for autistic people. Almost every single autobiography written by an adult with autism discusses sensory sensitivities, and some experienced problems integrating sensory input. Tactile defensiveness led Temple Grandin to develop her own squeeze machine that calmed her and helped her overcome her oversensitivity to touch.

Parents can implement sensory integration techniques in conjunction with other therapies and at a reasonable cost. I attended a three-day workshop on sensory integration, and Nancy Kashman graciously consulted with me when I had questions. Several inexpensive books can help a parent on a shoestring budget go far: The Sensory Connection, The Out-of-Sync Child, and The Out-of-Sync Child Has Fun. That combined with online resources and consultation with therapists open to the parent administering a carefully designed sensory diet at home can reduce costs. Parents can make their own squeeze machine, platform swing, weighted vests, etc. and find alternatives at discount stores.

Autistic children can fall into the habit of tantrums because their sensory systems are easily overloaded. Charlotte Mason recommended strategies for strong-willed children one hundred years ago similar to our approach: (1) stay alert to the warning systems of meltdown and take steps to prevent it, (2) teach Pamela to be self-aware and allow her to self-manage this issue, and (3) find ways to calm her down if she blew her stack. Like the researcher in this study, we began to look for the sensory integration techniques that maintained calmness to allow Pamela to keep learning and doing activities she enjoyed. We also sought techniques (antecedents) that helped her recover from tantrums quickly (behavior) to prevent her from being put in time out and further isolated from social activities (consequences).

When Pamela first entered a homeschooling co-op that lasted six hours one day a week, she had meltdowns several times a day. I volunteered to set up the K-2 class and had the flexibility to make it autism friendly. We taught two subjects every half hour that varied between challenging and easy classes. I wrote a schedule on the chalkboard to help her transition. I functioned as her aide to keep her on task. When I saw signs of frustration and ignored them or tried to redirect her, she would meltdown.

I never saw consistent antecedents, but tight muscles and looks of frustration alerted me to take precautions against pending meltdown. I decided to relax her with SI techniques. I walked with her in the hallway while she still had self-control. Then I spun her and gave her several deep pressure hugs. It usually only required five minutes for her muscles to relax before she could head back to class without tantrums. Consistently, calming techniques (antecedent) produced calmness (behavior) and allowed her to stay mainstreamed with typical peers (consequences). Over the months, she needed fewer and fewer sessions in the hallway. By the end of three years, she could last an entire day without incident. I could leave her unattended for sign language and art classes (two one-hour periods) to go teach other classes!

Another way to prevent tantrums was to respect her sensory needs. I did not take her on field trips that featured loud noise, such as the tour of a fire engine. On a tour of a grocery store, Pamela flatly refused to go in the back of the store where they stored packaged food. Her language was so limited, she could not tell me why, but she was ready to tantrum if I forced her through the door. This was highly unusual behavior. I asked one of the mothers to take David with them, and Pamela and I waited at the meat counter. When they returned, some friends cleared up the mystery. One of the rooms had these monstrous, very loud box-crushing machines that boys loved and mothers hated! They all wished they could have stayed behind with Pamela. This convinced them to believe my stories of Pamela's bionic hearing.

Occasionally, tantrums were unavoidable! Ten minutes before church, we were at the front of the sanctuary, getting ready for choir. The director flipped on the new mike system, and Pamela went berserk. She ran the Indy 500 around the altar, covering her ears and humming loudly. I asked the director to shut down the sound system and grabbed Pamela. In a split second, I decided not to haul her off by brute force because I wanted to teach her to calm herself and graciously leave a troubling situation. So, with bewildered eyes watching me, I plopped her on the steps and rocked her and firmly hugged her. In a few minutes, she stood up and quietly walked out with me. Over the years, I saw a clear pattern between vestibular stimulation and deep pressure as the antecedents to produce calm behavior, even after a tantrum, which had the consequence of learning how to recover after a meltdown.

The good news is that therapists, parents, and teachers can blend ABA and SI! Temple Grandin has reported that many parents find DTT more effective when combining with swinging on a platform swing or deep pressure tactics. A child can easily respond during ABA sessions while wearing a weighted vested, stuffed shirt, or stuffed pants. A child can practice letter recognition by pulling wooden puzzle pieces out of a plastic tub of dry beans and rice and naming each letter. Encourage the child to draw letters (or numbers) in shaving cream, fingerpaint, sand, or pudding and name them. A child can don a swimsuit and practice naming magnetic letters (or numbers) in the tub while surrounded by the deep pressure of water. He can wrap himself in a weighted blanket and name objects or flashcards displayed by the therapist. She can sit on a cheap big ball or jump on a mini-trampoline and count the number of bounces.

A therapist can track the data and see if the child performs differently with or without SI techniques. In fact, if extreme ABA proponents really believe that SI is hogwash, they have nothing to fear by incorporating sensory strategies into their sessions. If they are right, they have proved their point. If they are wrong, then the child can progress even faster. That sounds like a win-win to me!

Monday, February 12, 2007

When is DTT Unreasonable? When Diet Eliminates a Behavior!

When Pamela was five, only two books on Applied Behavioral Analysis (ABA) were accessible, and I bought them both: Let Me Hear Your Voice and The “Me” Book! We lived in Louisiana at the time, and ABA therapists were nonexistent in our area. I ran a Mommy ABA program, and Pamela learned her preschool academics very quickly (colors, shapes, numbers, letters, adjectives, verbs, etc.). I still find Discrete Trials Teaching (DTT) useful when Pamela struggles to learn a new concept.

Some ABA proponents pooh-pooh dietary interventions because "the lack of scientific evidence that casein and gluten cause autism is concerning" or "few if any conclusive, valid studies have been performed on them." They leave out many important points.

First, look up diet at the free online index of the Autism Research Review International, and you will find scientific studies on diet and autism. Unfortunately, these studies do not meet the golden standard of being double blind, placebo-controlled. That would require a group of autistic children to go on the gluten-free, casein-free diet. The researchers would have to split the group in half, randomly selected, and all would be given pills. Half would receive gluten/casein-laced pills, while the other half would receive non-allergenic pills. No one involved in evaluating the children, including parents, would know which children are truly free of gluten and casein. How many parents are willing to go through the hassle of a diet, not knowing if they are giving their child the troublesome ingredients?

Second, dietary intervention has helped tremendously with what appeared to be a major behavioral problem. From the ages of two through four, Pamela slept only four hours a night. She had night sweats, tossed and turned, gagged when stressed, and ground her teeth. She did have a history of food allergies (we had her skin-tested at eighteen months of age because her health was so poor). We had eliminated foods for which she tested positive: almonds and eggs. We thought it wise to search for connections between food and behavior. I split up her foods into four day cycles, trying to keep related food (i.e., rhubarb and buckwheat are related) on the same day. Miraculously, all of her sleep issues disappeared on all but one day! Through trial and error, we traced it back to apple products. Pamela lived for apples, applesauce, and apple juice. She was so sensitive that Thanksgiving sweet potatoes mashed with apple juice for liquid made her suddenly pull an all nighter after two months of normal sleeping patterns! In fact, every time she had a major disruption of her sleep cycle, we were able to trace it back to apples. Every time. That may not meet the golden standard for all autistic children, but it did in my sample size of one child!

Third, let us analyze that one situation using behavioral terms. The antecedent (apples in any form) causes a behavior (insomnia), and the consequences are a foggy child with foggy parents. The behaviorist would develop an elaborate program of antecedents designed at getting Pamela to stay in bed and try to sleep backed up by positive reinforcements (or negative ones) to encourage that behavior. Would it not be easier to eliminate the source of the problem, apples? Mr. William Ahearn would have advised me that children like Pamela “will not benefit from dietary restrictions of any kind unless they also have a food allergy or intolerance.” Her skin testing for apples revealed absolutely no food allergy or intolerance!

Fourth, the apple connection was not a lucky fluke. Removing gluten and casein from her diet solved other behavioral problems. After years of failing at potty training, Pamela established bladder control within two weeks of starting this diet. She was out of daytime diapers within two months. The issue was that the morphine in the gluten and casein was masking her ability to sense a full bladder. The typical antecedent for a child to go to the bathroom (a sense of fullness) was not present! This was not simply coincidence for one of the signs of eating gluten and casein was losing bladder control. In one instance, Pamela snuck half a biscuit at a family reunion. When someone told me of her offence, I predicted to my relatives that the next day she would be irritable, develop a rash, and wet herself--behaviors not displayed in the past couple of days at the reunion. All three predictions came true the next day. Once again, Pamela had no response to wheat (gluten) or milk (casein) to the skin testing done on her, but the behavioral connection was predictable and avoidable.

Finally, how can one ever determine that specific foods are antecedents to problem behaviors if one rules out them from the beginning? What ever happened to scientific curiosity and inquiry? One can still stay cloaked in the mantle of the scientific method and investigate a possible link between diet and behavior. Using the scientific method, why not form a hypothesis "Apples causes Pamela to have insomnia" and develop a study to test it? Dad can give Pamela apples (or the placebo of pears) on randomly selected days, secretly without Mom's knowledge. Then Mom can measure how long she sleeps and the wetness of her sheets. Is that not the scientific method in action?

I am sure that some scientifically minded types me write me off as some airheaded, bubble brain. I earned my degree in operations research (statistics) at the Naval Postgraduate School, and I do understand a thing or two about the scientific method and statistical research!

P.S. Mr. Ahearn expressed concern eliminating specific foods for children already self-limiting food choices. What he does not realize is that removing addictive (morphine-laced) foods allows children to expand their food choices down the road. In our travels, Pamela has tasted and enjoyed a wide variety of food: pickled octopus, salmon, raw oysters, sushi, quinoa noodles, fried yucca, baked plaintain, pupusas with curtido, chiramoya sorbet, collard greens, etc. Rather than bake with a few related foods (wheat, oats, barley, and rye), the flours I use are made from sorghum, rice, garbanzo beans, fava beans, tapioca, potato, soy, corn, amaranth, quinoa, corn, and buckwheat. What say you?

Another P.S. All of you Charlotte Mason homeschoolers are probably wondering what this has to do with masterly inactivity. In her books, she liked to juxtapose contrasting ideas and then poke holes in those she rejected. I am emulating her approach in outlining my principles of education as they apply to a person with autism.

Sunday, February 11, 2007

Discrete Trial Teaching within Reason

Thanks to a comment by Mama Squirrel on an earlier blog post, I experienced an epiphany in my thinking about autism and Charlotte Mason's concept of masterly inactivity, which we are discussing at the CM Series email list. Before I can adequately explain it (in a post down the road), I need to outline my principles. Why? Unlike Pamela who is a concrete sequential thinker, I am abstract sequential and enjoying researching options, thinking through ideas, and figuring out how they relate to my principles. So, please bear with me all of you concrete and random readers!

I have found Discrete Trial Teaching useful when kept within bounds. DTT is a technique used to teach a wide variety of skills to everything from animals to people following the principles of behaviorism. Today, therapists trained in Applied Behavioral Analysis teach autistic children using methods far more sophisticated and humane than Pavlov's dog. By humane, I mean that ABA practitioners have developed ways to avoid the aversives originally used in early ABA trials with autistic children.

Here is what I like about DTT: breaking skills and tasks into the smaller steps, teaching each step until mastered, and providing lots of repetition. The word discrete means that you teach the steps in order with a distinct beginning, middle, and end. The word trial means that you repeat the steps a certain number of times per session. Part of the process involves identifying the antecedents (events, prompts, or stimuli to start the skill or task), behavior (the steps you are trying to accomplish), and consequences (feedback to let the child know if correct or incorrect).

This week Pamela needed some DTT because she did not catch on at all to her math lesson that introduced introduce inequalities like ≤ and ≥ and the language that goes with it. The first step I took was to find her baseline: what she had mastered. I found that she was able to go from back and forth from words to graphs to mathematical symbols without a struggle for simple inequalities. This meant she remembered material learned previously:
My number is seven. N=7
I have less/fewer than 10. N<10
It is greater/more than 13. N>13

I checked to see her comprehension of phrases like X or more/greater, X or less/fewer, greater/more than or equal to X, and less/fewer than or equal to X. She did not see the connection between the key words and the need to use the symbols ≤ and ≥. As her math book had not previously covered this material, I was not worried. However, the author assumed the student would immediately see the connection. Pamela did not.

Here is my strategy to teach this next week via DTT.

1. Teach her to match index cards with ≤ and ≥ to the mathematical expressions < + = for and > + = for .

2. Teach her to match index cards with the new information. The symbol ≥ goes with X or more/greater and greater/more than or equal to X. The symbol ≤ goes with X or less/fewer and less/fewer than or equal to X.

3. Make cards for the matches already mastered. The symbol > goes with greater/more than and the symbol < goes with fewer/less than. Make sure she can distinguish what symbol ≤, ≥, <, and > goes with what language.

What are my ABC's? The antecedent is the pile of index cards with information. The behavior is to match the cards correctly. The consequence will be for me to show Pamela the correct match if wrong and encourage her if right. I will teach her step one until she masters it. Then I will teach step two and, once mastered, step three.

Pamela is advanced enough in mathematical understanding that once she learns what math symbols goes with what language, I think she will easily make the leap to translating from language to number sentences and vice versa. If not, I will use DTT to teach this process. I suspect that making graphs will require more DTT.

Thursday, February 08, 2007

A Snapshot of a Century

Pamela spent some time the other day writing up the calendar sheets to the right (click the picture for an even larger view). About three years ago, she started researching calendars on the Internet and memorized dates visually. She has the fourteen basic calendars memorized: leap years starting on seven different days of the week and common years starting on seven different days of the week. She knows the pattern for leap years, even obscure facts like the beginning of every century (1600, 1700, 1800, 1900, 2000) are not leap years, except for those divisible by 400! Unlike the savants who mathematically calculate calendars, Pamela sees them in her head and accesses the information like you would by turning pages in a book and looking it up. The animals are based on the Chinese astrological signs.

One of my favorite resources for homeschooling is the book, The Way They Learn, by Cynthia Tobias. When I started figuring out all the learning styles in my family, it helped me become a better wife and parent.

Pamela is definitely a concrete-sequential thinker like many autistic people. This picture is a great illustration of the strengths of someone who is concrete (real world, practical, things) and sequential (orderly, structured, plan-oriented) as indicated in this online questionnaire for this model of learning styles.

Organized . . . Perfectionistic . . . Precise . . . Memorize . . . Hard-working . . . Practicing . . . Completing work

Look at what are considered weaknesses for a highly concrete sequential person, which dovetails with what we see in autism:
Working in groups
Discussions that seem to have no specific point

Working in an unorganized environment

Following incomplete or unclear directions

Working with unpredictable people

Dealing with abstract ideas

Demands to "use your imagination"

Questions with no right or wrong answers