Therapist Posts


Mands: 18

What a lovely, sunny day! Just kidding. Today was rainy and gray, very yucky. The awful weather had an ill effect: Tony’s mood could go from happy-go-lucky to quite frustrated in a heartbeat. In the morning we tried some new messless fingerpaints – they were a hit. We also colored and played with play dough. Tony loves taking objects, usually magnets, and pressing them into the play dough to create an impression. We usually say the name of the object out loud after he has done this; ‘square,’ ‘circle,’ ‘Steve,’ and ‘notebook.’ Tony really wanted to go for a walk, but it was raining and very wet so it just wasn’t a great idea. He was totally bummed that we stayed inside. We played with some new dominoes and a clear human figure with neon interior organs which are removeable with the exception of the yellow brain. We briefly played with the pretend food and he is pretty good at saying ‘sushi.’ Good job Whitney and Tony!

Once he was finished with speech therapy we knew he needed a break so we let him watch an episode of Blue’s Clues. But not before we solved a more pressing issue: Tony manded “eat” very clearly, yet everything he had and everything Marlaina added was not ‘it’ none of it was what he wanted to eat. Then, in a breakthrough communication, he said “Car, Eat.” Immediately we knew: Chick-Fil-A french fries was what he had in mind! And that is what he got.

After Blue’s Clues we did go for a walk, but it was very short. He wanted to go in the bus or the car, then he wanted to jump in the puddles. I was trying to avoid the puddles and wouldn’t open the car doors when he said ‘aben.’ Needless to say, he was growing increasingly upset with the whole situation, with his tiredness beginning to show. Marlaina decided it was naptime.

MANDS = 28

Today when I walked in, Tony was in his chair munching on a bagel watching Blue’s Clues. After a few minutes, Tony manded “all done” and he immediately manded for “walk.” I took him out the door and prompted him to say “open door”. I still have to prompt with a bridge to get him to say both words. I’ll say, “What should we do?” and Tony says “open” (then I pause to see if he’ll say door without a prompt) If he doesn’t say it, I’ll ask, “What should we open?” Tony then makes an approximation to saying “door.” I then reinforce by saying, “Yes, OPEN DOOR!” In the book I have been counting this as an approximation.

Outside Tony was very energetic and running around as usual. His speed is really amazing! After chasing him around the back for a while and letting him explore the rocks near a yard, I started in on the motor imitations. I feel like he is more receptive to the motor imitations outside.

After running around for a little bit longer, we headed inside to get down to business. It seems that Parker’s art projects have really had an effect on on Tony! He was manding for “OPEN” and then I waited and said, “What do you want?” Then Tony said “UP!” as he was reaching for me to lift him. After I picked him up, Tony started to reach for his crayons and said, “crayy”. He then wanted to reach for his watercolor paint set. I then prompted him to mand for “paint” which he did after the second time I asked him with an echoic prompt. Parker, have you been using this or did he just pick up on it? Either way, he loves all the arts and crafts activities!

After about 10 minutes of painting using our fingers (and sometimes brushes) Jill arrived for speech. Tony had what sounded like a great session, giggling the whole way through. When he was finished he decided it was time to have a break and a show before going back to work. After a few chips, Tony manded for walk again. I took him out for a quick one and he headed straight for the car giving the “car” mand. I tried to explain to him that we couldn’t go. He seemed to understand because he turned around to the bus and asked me to “open” the door (I guess he thought trying another vehicle might work). Instead of leaving, Tony and I played peek-a-boo in the bus and I even slipped in some of the new intraverbals while we were playing.

When we came back inside Tony was reluctant to get back to work and instead manded again for “walk”. At this point, Marlaina was on to him and grabbed her keys for a quick run to Chick-Fil-A for some reinforcers (the waffle fries of course). He was elated that we were taking him when I was putting him in his car seat…giggling and singing in fact. He was clearly excited that we had understood his request for “car.”

After a few fries, I took him into his room again to work more. Even though it was 2:00 by this time, Tony still seemed engaged with what we were working on. We sang a few songs, played with play-dough (which by the way he is really getting good at manding for) and we also did a lot of tacting different food items. Tony was actually saying “sushi” this afternoon!

After so much hard work and focusing, Tony started getting tired close to 3:00. Tony manded for “walk” which I reinforced again. We played in the bus again, singing the wheels on the bus until Tony put his head down. I asked him “Tony, is it time for night-night?” and Tony responded by making the snoring sound.

So after a long day of school, Tony retired. I haven’t posted as ABA since last week so I felt like I had a good sense of the degree of change with Tony. He seems much more calm and his mands seem to have stepped up significantly in the past week. I’m really excited to see how specific Tony gets with asking for what he wants now. Today he went from “open” to “up” and then said,”crayon”. It’s absolutely phenomenal!

Mands: 11

Tony started his day off with a cup and a waffle in bed at 8:30. First he manded for his ‘cup,’ then ‘eat,’ then he made an approximation for waffle. So when I arrived he was ready to go into his room and get down to business. The TV was on and an commercial was on with a telephone number listed on the bottom of the screen. Tony walked up to the screen, touched a number and tacted it while he pointed ‘three,’ ‘five,’ ‘eight,’ and so on. He didn’t tact every one, just the ones he wanted to. Most impressive!

He was ready to learn, first we colored. While he was scribbling I too scribbled. I scribbled with each of the colors we are working on and asked “What color is this?” He did well tacting these. Then he remembered the fun he’d had yesterday painting. He apparently saw the fingerpaints up high on the shelf. He raised his hands up in the air and said ‘aben!’ I said “What do you want, do you want up?” He said ‘up,’ so I lifted him. At this point I did not know yet what it was that he wanted. We looked in the giraffe, compartment by compartment. Each thing he pointed to I pulled out and asked if it was what he wanted. He pushed them away repeatedly and seemed to be getting mildly perturbed. Finally he pointed to the shelves and we got what he wanted – the blue finger paint. I had him tact the color of the paint.

We had some success with animal and animal sound tacts by using the magnets while he was already enthralled with the magnets. We were really cock-a doodle dooooooooing well and really getting into the baaaaaa, baaaaa of the sheep – tons of fun. We definitely need a wolf, coyote, bassett hound, or werewolf because I think he probably has a real talent for howling too! Maybe we can get him copies of “Werewolves of London” and “Hey There Little Red Riding Hood,” you know, for educational purposes, of course. We also managed to work on body parts with the Potatoheads. I had to use some hand over hand, but at least he wasn’t pushing Potatohead away this time. Another interesting thing we did was make giant versions of the letters of his name with pipe cleaners. I’m letting him call them sticks, by the way. He easily tacted the letters and I’m pretty positive he knows T O N Y is Tony, his name.

I brought the dolls with us on our walk because they have been feeling left out lately. I didn’t get any motor imitation out of him other than hand over hand, except for ‘jump!’ The only thing he wanted to do with the dolls was throw them, then bury them in a leaf pile and have them pop up. We did some running, jumping, stomping, and his new favorite: shuffling! He tacted ‘leaves’ on a bush, then made an approximation for ‘flowers’ as he pulled some azaleas off a bush, crumpled them up and threw them on the ground. Not what I would do with a flower, but he is a two year old boy and I guess that’s probably what they usually do with flowers.

When we got home he started getting a little whiny. Anton said it just means he wants something and we just need to figure out what it is . . .it was food. Anton made him some chicken and waffles, I put him in his chair and found an episode of Blue’s Clues. After the show we went into his room. Since we’d had a very productive morning, I let him take it easy so he would still be receptive when Jill arrived. We did some watercolor painting and jumping on his trampoline and he was very excited when someone came to the door and it was really Jill this time!

Tony had a great day today! He was full of energy from the second I walked in right up until 3:oo in the afternoon! He was happy almost all of this time with only a few brief encounters with frustration or other negative emotions. We went outside for two relatively long walks, played with most of his new toys, watched Blue’s Clues, ate, and somewhere in there he managed to fit in an OT session with Lane. Big Day!

Good thing I started off the day with lots of sugar, it gave me the boost I needed to keep up with the running, jumping, throwing, stomping, singing, painting, and coloring! During our first walk I let Tony be the leader (most of the time.) He led us down the sidewalk to the left of the house to the passageway into the courtyard. In the passageway he picked up a stick and tacted ‘tik,’ then he said ‘wa-deh’ I thought he meant water, and my suspicion was confirmed later on. He started torward the pond, so I redirected him and he was fine with the new direction. We went into the courtyard and ran around for a while. He was loving it! It was a beautiful sunny day. We jumped, stomped, and shuffled our feet, then it was off to the rocks.

Within the courtyard there is a small corner full of whitish rocks which Tony loves. He likes to sit down in the rocks, pick them up, throw them, put them in the hole in the bottom of a basketball goal near the corner, feel handfulls of rocks in his hands and let them fall onto the other rocks. Actually, this is what assured me that his earlier wa-deh was in fact ‘water.’ When we first got to the corner and Tony was standing in the rocks, I asked him “What are those?” He happily and confidently responded ‘wokk!’ I reinforced his correct tact with some praise, then he picked up a rock, said ‘waaaok,’ then ‘wa-deh,’ walked directly to the hole in the bottom of the basketball goal (which happens to be full of H2O,) and promptly put the rock into it. He repeated this process numerous times before I decided it was time to move on. Another interesting thing Tony did with rocks on our walk was bang a large rock against different surfaces and revel in the different sounds he produced.

As Tony acquainted himself with his new toys he took an enthusiastic liking to the karaoke/piano book. His parents knew this toy would be one of his favorites. It is very good for our purposes, as it has the music for Old MacDonald – animal noises and sounds, The Wheels on the Bus – one of our intraverbals, the Alphabet Song, and other catchy tunes which I’m sure will be uiseful for some reason or another, even if it is just entertainment. He liked the new planes, trains and automobiles beads, the plastic animals, and the new books too. He went on a book binge. After we opened his new small velcro-closure box of books and took the books out of the box and put them back in a few times, he started the binge.

A book binge is an interesting activity Tony has added to his daily regimen. It consists of pulling the majority of his books out one at a time, flipping through them, and making a messy pile of them on the floor for someone to ‘clee clee.’ He has added a new step to his book binges: now he makes an approximation for ‘the end’ as he closes each book. It is very cute!

Despite his less than typical night of zzz’s, Tony actually had a great session. He is getting more consistent with two-word combos (relying more on gesture than verbal models). “open box”, “give ____”, “all done ____” are ones that I’ve consistently targeted during our sessions. I’ve also noticed a huge improvement in comprehension skills, especially with regards to following 1 & 2 step directives given some gestural assistance, i.e. “get the ball and put it in the bag” with me pointing to the ball and then the bag. See you Thursday around 1.

Here’s to a better night’s slumber and no addictive late night tv!

Mands: 9

Very short blog; very short working time. After Tony’s wonderfully animated late night his mood was very fragile. In addition to sleep deprivation the grass cutters were out in full force with their loud equipment. At first all was well and we went into his room to do some work while Anton and Marlaina ran some errands. We got through the intraverbals while Tony sat on his trampoline with some bowling pins. He did very well with these and seems be on his way to mastering the new additions! He wanted to escape into the living room and manded for me to open the door.

We briefly explored the living room before he manded for a walk. I put on his socks and shoes and he became very impatient while I grabbed the clicker and my flashcards. His parents returned from their trip and that added to the confusion and made Tony reluctant to go on his walk. His unhappy mood was in full swing until I picked him up and started running very quickly and stopping abrubtly. This was fun for him and we finished our walk with Tony in a good mood.

When we got home and went back into his room, his mood quickly regressed to crankiness. Marlaina decided we should let him watch some Blue’s Clues in order to preserve as much learning energy as possible for Jill’s impending visit.

Today is Tuesday, March 14th…and my story begins…

So after watching a fascinating program on the History Channel about Comets last night (I didn’t realize it was a 2-hour show until I was already hooked), I trundled upstairs to bed at a very, very late hour. Walking up the stairs, I heard music coming from Tony’s room, and then realized he was awake and having a conversation with his musical (talking) frog. I listened at his door for a moment, and realized that he was fully awake. I decided to go in with a fresh cup of milk and change his diaper.

Tony was VERY talkative, and excited to see me (he said “hi dada” over and over until I picked him up) and so without any delay I settled him on the floor for a quick change. Afterwards, I laid him back down in his bed, and he immediately grabbed his turtle and said “ni-ni” and laid his turtle on its back and started making snoring sounds (for the turtle). He then said in his own distinctive way “wake up” and propped his turtle back up, and then started making him dance and jump, saying “jump, jump, jump!”

It was obvious that Tony wanted to discuss the finer points of his turtle’s active nightlife…at 2:30 in the morning.

So, we continued to pretend play. This is an extremely important development for Tony, since prior to his diagnosis, diet change, and therapy, he didn’t seem to have the ability (or desire) to pretend play with any object. In just a short 7 months we’ve seen Tony go from just obsessively fiddling with parts of toys (spinning wheels, lining up blocks, flipping pages back and forth without really paying attention to the pages themselves) to actively and appropriately playing with toys.

Back to Tony’s turtle…he now wanted to demonstrate the proper care and feeding of his plush little friend, and promptly put the cup of milk to the turtle’s mouth, and said “eat” and then “mouth” together. He did this a few times, and then decided that I obviously needed a lesson in turtle anatomy, and we went over the various body parts like “nose, mouth, eyes, hair, feet and paw.” (Yes, to answer your question, this turtle DOES in fact have paws!) I also asked Tony to “kiss” and he did this a number of times, either kissing his turtle directly, or blowing an air kiss with his hand and making the “mmm-whah” sound to imitate my kiss.

This continued for a little while, until I tried getting Tony to “sleep.” He pretended to be sleeping, and turned his head and closed his eyes and started snoring…then said, “wake up” and opened his eyes and sat upright. We did this for about 5 more minutes, until Tony decided that playing peek-a-boo from behind his turtle would be a fantastic game to play. So Tony covered his face with the turtle until I asked, “Where’s Tony” and then he’d move the turtle from his face and say something close to “I’m right here.” We did this for quite some time, until I trued to again suggest that it was time to go back to sleep. He was somewhat receptive to this, and pretended to sleep, and then wake up again. He was actively rubbing his eyes, so I knew he was tired…but he really seemed to need to communicate and connect with me…so I stayed a little longer in his room rubbing his head (he loves that) and just sort of softly speaking to him about what a wonderful conversationalist he was, and how proud I was of his accomplishments and that I knew inside his head he had HUGE stories to tell and was rapidly figuring out how to convey all of this to the world around him.

I left his room around 3 a.m., and he was quiet for a little while…and then Marlaina and I heard him start back up with his tall tales. Apparently his turtle is a very good listener. These stories…actually, I think he was trying to teach his turtle the new things he’s learned…continued until almost 4 a.m., and Tony slept for a few hours and woke back up with the same energy he had in the middle of the night.

I can only surmise that Tony’s brain is going through a period of intense development (to match his rapid physical growth) and he’s just mentally active and alert and reveling in his ability to finally tell his story. Since one of Autism’s hallmarks is a marked inability to facilitate communication, the fact that Tony is actively reaching out to communicate to/with us is so vitally important, that if he chooses to engage us in the middle of the night, so be it. There is never a bad time to talk to Tony!

Tony’s musical interest is still very high. He often will sit in his bed when it is naptime playing his toy piano and humming along. He’s more often than not on key, which is pretty amazing. He loves all forms of music that he hears during his NOGGIN and PBS programs, and will look at me when a song is playing and bop his head to the music and try and sing whatever song he hears. He is pretty obsessed with Blue’s Clues, but what 2-year old isn’t?

We watched Tim Burton’s Nightmare Before Xmas two weekends ago and he absolutely LOVED it. I don’t think I’ve ever seen any two-year old sit still through any movie. We watched the DVD again the next night, and he was still enthralled. Of course, with a musical score by Oingo-Boingo’s incredibly talented Danny Elfman, this only proves that Tony has terrific musical taste. He also really enjoyed HAIR!, and Wizard of Oz. Interestingly enough, he does NOT like Michael Crawford’s version of Phantom, but loved the film adaptation of the musical. Tony does NOT like country music as a rule, and much more prefers classic rock, hippie rock, and singers like Billy Joel, Jimmy Buffet, Elvis Costello, Joe Jackson, and Van Morrison. Do not even attempt to force him to listen to a “hair band” because he’ll have none of it!

Tony has a morning ritual that is pretty funny, that I need to mention for posterity. Since Marlaina wakes up before me (I often work later into the evening) she and Tony bathe first, and then Tony excitedly bursts into our bedroom to wake me up. He is very demanding in this respect. His day MUST start off with a visit to wake up his dad…and after he’s made sure that I “wake up” he will finally allow Marlaina to get him dressed and ready for his day. Whether or not this is part of his ritual, or just a genuine desire to see me in the morning is subject to interpretation. It feels more like a desire, though…since he has a definite need to make sure I am awake before he continues his day. It is pretty funny, though, in the sense that every morning begins with a Seussian homage to “Hop on Pop.”

Literally.

(I imagine there are far worse ways to wake up and start your day…)

This past weekend we managed once again to visit my parents in Beaufort (there was a fund raiser for the Democrats) and while the oyster roast wasn’t really Tony cup of tea, after retiring back to the Bay Street house Tony found his groove running around the front yard and climbing up and down the stairs of the big wraparound porch. This kind of physical exercise is so important to his well being…He always seems to be more relaxed after releasing so much energy.

Tony’s diet still consists mostly of chicken and potatoes and spicy bean chips…but since he gets an abundance of vitamin and Omega 3/6 supplements, I’m not overly concerned about his food intake. For certain, Tony bears little resemblance to the multitudes of overweight 2/3 year-olds we see about the area. He is broad shouldered, very solid, and has no belly.

Ok…so if this sounds a little rambling, I apologize. Lack of quality sleep last night is playing into all of this. Hopefully anyone reading this can take away useful information!

Onwards and upwards, Tony!

Love,
Dad

MANDS = 14 (I only counted during the morning for about a half hour)

Today was an excellent day with Tony. I was eager to see how Tony would respond to some of the recent changes we made. I didn’t come early enough to try the food today but we did get through almost everything else. We used the talking mic toy to practice the new intraverbals which Tony really enjoyed. He’s already making approximations to “music” and “Tony.”

We took several long walks outside today and we did a lot of motor imitation. He was responding better today than he has for the past few weeks. He also really enjoyed the dolls today which he has had little interest in lately. We did some new imitations like “flip” with the dolls and “shake.” Tony also made the dolls dance and hug together.

We also practiced a lot with colors today. I did work receptively and also asked Tony to tact different colors. This is the activity I see the most benefit from with the new data collection. I think he’s finally starting to understand the “SD” better of “What color is this?” (I didn’t get green as a response as much).

I used a book full of animal pictures in it to go over tacting animals and sounds. We decided to switch away from using the sound-making animal puzzle (we think he’s getting satiated with it). I believe I see animal puppets in the near future…

So today was a good day with Tony. I think the glutens are finally tapering off!!! Hooorray!

Today we all went on a lovely field trip to Beaufort to see Tony’s grandparents and also to support the Beaufort County Democrats. The club held an oyster roast on Lady’s Island that we all enjoyed…to a degree. Tony ran around most of the time and was thrilled at all the excitement going on. Being on an island with lots of people also presents its own dangers… a large grill, picnic tables to climb under, big kids, and of course the nearby water. Needless to say I literally spent my time chasing Tony around in circles as he socialized with other guests, ate his waffles (even sharing his food by leaving it in the neighboring chairs), and played with leaves and his Cookie Monster doll.

We were at the roast for only a short time before we all realized we were being eaten by little black bugs (sand gnats perhaps). In addition to the itchiness we were all sufffering from, the oysters also seemed to be somewhat under-cooked. Hepatitis is never a good thing you know. We all packed up and headed over to Grandma’s house for a rest in the shade and a bug-free zone. Tony absolutely loved being in the front yard running around the porch and up and down the steps. I honestly struggled to keep up with him!

After a good visit, Tony was exhausted and we headed back to Charleston. Tony had a great time and really seemed to enjoy being outdoors all day.

Today was our day to meet with Jay again to review the program and Tony’s progress. Jay also brought along his associate, Terry to the meeting. Unfortunately Parker could not join us because she had to go out of town suddenly. During the meeting we discussed the data collection and Jay suggested we change from the cold probe data to collecting data on each trial. This will give us all a better idea of Tony’s abilities and weaknesses.

In addition to changing the data collection, we also added a few intraverbals including ‘we ride in a “car,”‘ ‘we listen to music,” and “your name is “Tony.”‘ For mands, we added “roll ball” and also different food items (chips, chicken, waffle). Jay explained how to present the food items in a set of three or four with two or three preferred and one non-preferred food item (we will start with presenting only two though). We will only put a small taste of each food on his tray at a time to avoid satiation. The idea is that Tony will choose his favorite food out of the group and will have to mand for more using the name of the food.

Everything else in the program is staying as it is for now. I’m excited to start on working on the food. Tony learned how to say “pasta” in one sitting, so hopefully learning others will be just as easy for him.

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