Well, today Tony’s current activities have been put on hold until Monday. His program book is being re-evaluated/modified so Tony played a lot. He bounced with the therapist on his exercise ball. Tony also rolled back and forth across it (which he really loves). Tony swinged and looked at the cat and his reflection. The therapist pointed to the cat and repeated “cat”. The same was done with his name. We used a mirror on the wall and the therapist said “Tony” a lot. Therapist ran and jumped with Tony and he said “jump”. We also did “tickle” again.
When Tony wanted his cup he was showed the picture, which he carried, and was given his cup with the word “cup” said to him. This was done with his blocks, too. He was shown the pic and the object, then the therapist said “block” to him. Tony waved and said “bye, bye” today bc he was really tired and rubbing his eyes but the therapist kept him moving with re-direction.
Later Tony’s OT arrived and Tony cried for a short while but then saw the Leap Frog table and became mesmerized with it. From there the OT was able to get Tony to stack blocks. He also made sounds as if he were trying to count along with the OT from 1-10. Later the OT went through pictures in a magazine with him, flipping quickly the pages, labeling the different objects. If she didn’t point to and say an object then Tony flipped back and pointed to it. Once the OT said it then it was okay to move to the next page. Tony also looked at/pressed the buttons on a toy with lights (which also vibrated) with the OT. He spun in a chair as the OT counted fast and he bounced on his ball while the OT counted once more. The OT is really working on the numbers with Tony and he seems to be getting it. Tony was very cooperative and really working hard with the OT. From now on, the ABA are also going to incorporate the numbers 1-10, the hand-over-hand pointing (with heavy pressure), and stacking blocks using the different sized (rather than the same that Tony’s been doing) blocks in his therapy. Today Tony received a ton of physical stimulation/floor exercise despite being so tired. Very good (and exhausting) day!

Today started out with Tony being completely out of sorts due to the fact that he had eaten something containing gluten. He was super hyper, anxious and seemed irritable. Marlaina took him upstairs for a nap and he slept for a few hours. I was actually going to leave since I waited around for a little over 2 hours…but I was really glad that I stayed because Tony did some really cool stuff after he woke up. We warmed into playtime playing with the “big ball” as I rolled him back and forth on it for awhile. He watched the Wiggles, had a sandwich, and then he decided he wanted Marlaina to play his wooden recorder. She blew into it and Tony reacted with a giggle and then he tried to blow. With this in mind I asked Marlaina for bubbles to work on blowing. I started blowing the bubbles in front of him and before I could even say the word Tony had volunteered the word “bu-bble”!!! How cool is that!? It was even cooler because both Anton and Marlaina were there! I repeated blowing the bubbles and Tony repeated the phrase several times. Totally worth staying for, right? Tony continued to work well in therapy as we started playing with the shape sorter Megan brought (great idea by the way). He really concentrated on getting the shapes to fit and did a couple on his own. Tony even began sticking his hand into the bin to retrieve the pieces.I think Tony had an awesome day in therapy…I think being well rested has a lot to do with it.

When I arrived today, Tony was asleep…I guess Elizabeth wore him out! We decided that early afternoon is not a good time for him. I have been coming at 1:00, but I’m going to start coming in the morning. Today, Chelsea (my supervisor) came with me to meed the family I talk about so often! Tony woke up towards the end of my visit and played for a little while. I brought him out a shape sorter that I thought he would like. It has a lot of different components that challenge cognitive, fine motor, and sensory skills. He was a little hesitant to play with it, but I left it with them in the hopes that mom and dad can get him to play with it when no one else is around. Tony was in a pretty good mood when he woke up and played pretty easily!

On a side note, I love all the picture symbols that you guys have created! Tony seems to really be responding to everything really well. Keep up the good work!

Tony was a little tired/restless this morning at 9:30am. Therapist had been arriving at 10am but came in earlier to get in more therapy. Tony immediately began peeling stickers and placing them in the designated squares (therapist pointed to the squares and then sometimes used hand-over-hand to get him started). The stickers were partially peeled and Tony peeled the rest. After a couple of stickers though Tony went to play with something else. He jumped from toy to toy for a half hour but settled down some and was able to peel more stickers. Tony really enjoys this activity and the verbal praise is a strong motivator for him. He also made a lot of eye contact, watching the therapist’s facial expressions during positve reinforcement.
Tony was still reluctant to pour things. Therapist used wooden food, clothes pins, blocks and poured them in baskets, soft containers, a bucket, and measuring cups. Tony poured with hand-over-hand and did it once by himself with verbal and visual prompts. But he will walk away from the activity or push the objects to the ground. He is simply not interested in this but therapist will continue to try different objects/containers. Tony looked at his mirror today and waved at it. Therapist pointed to his reflection and repeated “Tony”. Also, Tony jumped on his trampoline a lot while saying “jump”. The therapist would either place him on the trampoline (sometimes as redirection) or Tony would climb on it himself. Tony didn’t swing today because he didn’t want to do this unless his mom came outside with him. His mom is trying to say no to Tony more.
Tony used the sign “tickle” a few times today and he was shown his pics for “cup” and “food” during lunch. Later in the day the therapist showed Tony the pic for “cup” and Tony ran around looking for it until the therapist gave it to him. He immediately took the cup and drank. The therapist also took Tony’s hand to make the sign for “food” while he had a sandwhich. Only once today did he attempt it (at the end) but he used two hands and pointed them at his mouth. Tony lined up blocks on the floor with the therapist starting it and he threw rings onto a post (ring toss-which was tried many times during the session until he did it at the end). Tony then put the ring on his head and wore it for a while (his other therapy had him doing this so it carried over). It was a slow start today but Tony focused more as the session went on, even though he was still moving around the room a lot. All in all, today was an okay day.

Today seemed to be a very good day for Tony. I believe that the
mental transition to being home all day instead of at the office is
finally almost complete for him.

He is starting to use his picture symbols for cup, chips, and
sandwich occasionally and he is definitely communicating with us
(even though it’s still not verbal). We are also excited that later
in the week we will be receiving a shipment from kinnikinnick.com of
some wonderful new gluten and casein free bread type products for
Tony. This should really excite him. Unfortunately, not everything we
need is available at Whole Foods, but luckily we have the internet to
fill-in the blank spaces. He is still engrossed in his food magazines
and I bought him a couple of new ones. Honestly, I was simply getting
tired of looking at the same Saveur day after day. We are starting to
try to use the magazines as rewards or calming items instead of
allowing him access to them at all times.

In the past couple of days, Tony has also began sitting on the sofa
by himself for extended periods of time. Until recently, sitting
still for more than one minute never really happened. Now, he has
taken a space for himself on the sofa and seems to “place” himself
there to relax and look at his magazines or watch one of his PBS
shows. I have photos that I will hopefully post soon….

The weekend also went quite well considering that we completely
removed him from his normal environment for a whole day on Saturday
to visit Anton’s parents in Beaufort. Of course, he did get over-
stimulated at times and he did have several meltdowns. He also
refused to take a nap. BUT, on a good note, he slept well on Saturday
night (even though he didn’t get to bed until 9:30 which is quite a
bit later than he has been going down). Sunday was sort of a recovery
day for us all and it was quite relaxing even though I had an awful
headache all day.

Tomorrow, we have both speech and OT. Speech will be at 10am tomorrow
instead of 1pm, but hopefully this won’t throw things off. Anton and
I decided that ABA on top of speech and OT was a bit overwhelming for
Tony, so we have decided for the time being to not have ABA on
Tuesdays. Last week after speech he was exhausted and actually slept
through the time for ABA. Poor Whitney waited around for him to wake,
but he never did. I am pretty sure that even if he had been awake
that he wouldn’t have cooperated. Hopefully, at some point we will be
able to add ABA back into his Tuesday schedule. For the time being
though, I think we’ll just let Tony tell us when he’s had “enough”!

Today Tony jumped right into peeling stickers w/and w/out assistance. He was really focused on this activity and enjoyed doing it. Later in the session Tony also placed stickers in squares in a grid. He did this first with visual cues-watching the therapist place the stickers in the squares, and then on his own. At first he didn’t want the stickers on his notebook and would peel them off but was later okay with this. Tony really liked the verbal praise and this encouraged him to peel more on his own (praising himself verbally as he did it). Tony did a great job getting the stickers into the squares the majority of the time. He also stacked blocks once when the therapist started stacking first. He didn’t stack them later but grabbed all his yellow blocks before his tv show (that he’s seen before) started talking about the color yellow.
Tony was less receptive to pouring. He would do the task if constantly prompted and with hand-over-hand but he really didn’t want to do this. The therapist said “Tony, blocks” with the cups in her hands but Tony made a light whiney sound and shook his head “no”. Different objects were used for pouring-clothespins, wooden foods, blocks. Tony responded best to the wooden foods, pouring them a couple of times from the cup to the food basket. Tony swinged today for a little while but needed his mom present (or he’d get upset). During swing time he signed and said “tickle”, so the therapist tickled him. When Tony was hungry he took his mom’s hand and led her to the high chair. The therapist showed him his pictures of “cup” and “food” and said the words as handing him the objects while he was eating. Tony paid attention to this and held the “cup” picture beside his sippy cup.
Tony responded to the therapist saying in a deadpan tone and shaking her head “no”. Sometimes he would stop an activity and other times he would become upset but he did understand it. The therapist would try to redirect him to something else. When Tony wanted something he would say in a cheerful voice “yeah!” If he couldn’t have/do something he was redirected after saying and nodding to him “no”. Tony had good attention today and was receptive to the therapist. At 12:30pm Tony looked at the therapist, waved and said “byebye” then took his mom’s hand. He went upstairs to his room.

Ok, so I know this is being posted a little late…but I’ve been out of town and away from a computer for a while! It sounds like Thursday and Friday went great and I am so glad to hear it! Tony did really well for me when I was at the house for Special Instruction. I brought out a “talk tube” (that’s what I like to call it, I’m not sure what it’s really called!) and he loved it. We tried to get him to talk into one end and hold the other up to his ear, but he didn’t really like that! He did like to push and pull it to hear the noise it made. As always, he did well grabbing mom or dad’s hand to request assistance…one of his many strengths!

From the Service Coordination aspect of my involvement, we have had to reapply for TEFRA Medicaid, due to an error by Medicaid! Marlaina and Anton, I received the sign card back saying that they received the application that I sent last week…so that’s good news! I still have not heard back from Dr. O’Dell’s office, but I have been gone for a while, so I will try again today. Once we obtain TEFRA, we are going to request that Tony be placed on the critical list for the MR/RD Waiver due to concerns over his safety and the sanity of his parents! 🙂 Right now, Tony is #770 on the waiting list and we would like for him to be bumped up…obviously! I just finished a fabulous book called “A Real Boy,” about Autism. The mother who writes it talks about everything from diagnosis to IEPs and the school system as well as ABA therapy. It’s really an excellent book!

Just on a side note, I am so pleased with everyone that is involved in Tony’s development. Tony could not ask for better therapists, advocates, and caregivers. Marlaina and Anton, I hope you know what a wonderful job you are doing with Tony. You guys are his biggest strength! If I can be of help to any of you, please give me a call! 805-5835 ext. 423. See you all soon!

Megan

Just a quick note to everyone….

So far, this seems to be working fairly well. Please make sure when
you post that you verify that the date and time are correct on the
post before you publish it. It really will be easier for us to look
back in the future if we can go quickly to a certain day and time.

Also, please make sure that you read not only the posts, but also the
comments. I know Jodi has already began commenting with EXTREMELY
helpful suggestions… So, don’t miss the comments!

Thanks guys!
Marlaina

Well, today was mostly unproductive. Tony had a very short attention span and it was difficult to get him to complete an activity. If there was something that Tony wanted to do already then I could get him to pour something to complete the task. Or I could get him to peel a sticker but he didn’t want to put it on paper. He became frustrated when the stickers wouldn’t come off of his fingers. He did do the objectives a couple of times w/out hand over hand but that was it. There were short, random moments of success but I never had Tony’s undivided attention. He was probably tired the entire session and he was also really hungry. Tony grabbed my and mom’s hand to lead him to something he wanted. He was prompted verbally, visually, and with hand over hand to use the sign for eat but didn’t do it on his own today. He grabbed his mom’s hand barely after noon bc he wanted to take a nap.

Tony did well today as we continued work with the stickers and the pitchers. Before we started with the stickers he played with his new magazine and his new blocks and then started with the stickers to make it seem more like another game to play during his playtime. I layed his purple notebook out flat for him and as he started to look at the blank pages I initiated modeling of putting the stickers on the paper. As I did this, I would say in a sing-song voice “On the paper” and would say this as I slowly put a sticker on the page. After about 10 trials of this I extended my hand out to Tony for him to try as I repeated the phrase. He started to push my hand with the sticker in it down towards the page (I guess he was prompting me here!) and I praised him verbally. After this I gave Tony a sticker saying “On the paper” and he actually stuck it right on! I reinforced him with verbal praise and tickles. He did about 6 more stickers all by himself, he did have some difficulty pulling them off but nontheless he did a great job! After the stickers we played with crayons but he liked to arrange them side-by-side more than anything. At one point he desperately wanted to be in the kitchen (where Anton was cooking) and actually sat on the carpet on the floor with his hands around his chest when I was trying to get him back into the play area. When I finally got him out of the kitchen I went back to the stickers and the notebook. He was this time very reluctant to stick any on the page, but wanted to peel them off. We still need to continue more work on this as well as the pitcher pouring task but all in all it was a good day for Tony because I felt he really made an effort and concentrated.