Planning for the future

What does it mean to look toward the future? I feel it is so important for people to at least be thinking about the future and what they would like to see not only for themselves, but for their children as well. In the schools we tend to only look one year down the road. Why is that?

This point has been driven home to me several times this week and I felt like this would be the perfect time to write about planning. This seems to be the time of year when schools and families start thinking toward the next year. This can also be the time when problems start to crop up as we go through that long stretch between Christmas and spring break. This being said, I find it very helpful to at least think about long range when making plans for kids in the school system. I think parents should be encouraged to at least think a little bit about where they would like to see their children in the future.

Well in at least two instances this week I have been told by superiors that this is not a good thing. Parents aren't ready to think about this. They are too new to the diagnosis of autism and the special education system. Well if not now, when?

Having some type of long term goal helps in establishing the short term goals we want for our children. I know as a school district employee it helps me to make short term goals if I know what the long term expectation is.

It has been a very frustrating week for me. I hope that the parents that read this blog take this information and at least think about what they would like for their children in the future. One of my favorite things about the RDI program is the mission previews we do with families in the very first appointment. I think this gives all of us a sense of direction. Does this mean that these plans or thoughts can't change along the way? No way it just gives a direction to drive our car in.

So take a few minutes this week and put some mission previews together (what do you want for your child 2 years from now, 5 years from now, 10 years from now). I think having this helps us not only to see where we are going, but all of the progress we make along the way. We all have thoughts about our own future why not have some for our children?

Talk to you next week,
Erin

Creative/Flexible Thinking

I can't believe that I've already covered 4 of the 5 core deficits! (self awareness, episodic memory, appraisal/dynamic analysis and experience sharing) The time goes by fast! The final core deficit is creative/flexible thinking. Quite often this is the core deficit that most people can identify and say "ah, yes" autism and flexible thinking certainly go hand in hand.

The core deficit of creative/flexible thinking is the idea that a person comes upon a problem (a change in what is expected) and is able to come up with a creative way to solve the problem. They are able to be flexible and come up with a solution. I've had families share with me that they don't think their child has a problem with flexible thinking. They tell me "He is able to go with the flow of the day. I can drive different routes to different places and he is just fine." This same family ran a little test and every day switched seats at the dining room table. The first night, not a big deal, the second some resistance and by the third time it happened, outright refusal to change seats. Not so flexible after all. Many times a child can appear flexible, but if you know your child's coping mechanisms you may figure out that they are not coping as well as you thought. Many times you will notice when there is a change in routine these coping mechanisms show themselves in full force. Some will fall to the ground in a full out temper tantrum, others will get silly, while others will start scripting or using delayed echolalia etc.

A great way to help not so flexible thinkers to become more flexible is to present challenges that they can be successful in solving. As they feel more competent in successfully solving a challenge, the more they will approach moments of uncertainty or challenge with less anxiety and more willingness to work through it. It really is amazing to watch our kids work through challenges and come out feeling so great about themselves. Those who are brought through a challenge with the right amount of support quickly become much more flexible in their thinking.

Imagine entering the working world and not being able to be creative or flexible with a problem. We would run into problems immediately in any job! Challenges arise all day every day and it's essential to learn to work through these moments with creativity and flexibility!

Until next week!
Michelle

Critical or Not?

Last week I wrote about the need to prioritizing treatment needs from the perspective of knowing what needs to be treated, placing treatment in an appropriate context in the life of a family, and using an approach that treats foundational issues as priorities. There is one more thing I would like to address in this arena, and that is how to determine treatment priorities from a developmental perspective. To place this discussion in context I’d like you to consider the following:

Joe gets in a bad car accident and ends up with a variety of major and minor injuries. He has a brain bleed, a collapsed lung, broken ribs, a leg broken in 2 places, and a sprained wrist. When he arrives at the hospital the doctors immediately call in specialists to address the most critical issues - the brain bleed and breathing problems. He is in surgery for hours, but survives and begins the process of healing in his brain and lung. Once he is stable and out of surgery the orthopedic surgeon comes onto the scene and puts pins in his leg so the bones can heal properly. He then begins the process of healing his leg bones in a cast. The doctor doing rounds comes in the next day and decides that the course of treatment for the broken ribs and sprained wrist is rest and allowing the body to heal those things over time.

This progression of treatment makes sense. Joe’s doctors prioritized the needs of their patient according to what was most life threatening and then worked there way to other issues from there, each time making a decision about what was the next most pressing issue to treat. It wouldn’t make sense to any of us if upon entry to the hospital the doctors had put a cast on Joe’s leg first; or wrapped an ace bandage on his wrist; or wrapped his head in bandages to stop the bleeding without doing surgery. No! When it comes to a situation like this is seems very obvious what to treat first, second, etc. down the line.

When it comes to treating children on the spectrum, however, we have historically gotten our priorities backwards – treating things first that are best left to later, and very often not treating the main problem(s) at all. Consider the child who presents with the core deficits of autism (which means problems in experience-sharing communication, dynamic analysis, episodic memory, self-awareness, and flexible thinking), speech articulation problems, academic delays, and self-stimulatory behaviors. Very often it’s the more obvious and tangible things that get treated first. The child might be placed in speech therapy for the articulation problems, tutoring or discrete trial training to learn academic skills, and sensory therapy or behavioral therapy to address the stimming behaviors. The problem with this treatment approach is that it is the equivalent of treating Joe’s sprained wrist first when he has a brain bleed and a collapsed lung! It’s not that those things aren’t important to address – it’s that they are not the MOST important things to address first.

If we were to prioritize treatment for a person with autism in a way that makes sense we would treat the foundational developmental issues that contribute to the core deficits of autism first. Obviously if there were significant behaviors, feeding problems, etc. that were at a critical level we would work on those first or at the same time as starting work on developmental foundations. This process would entail beginning to establish the developmental foundations for interpersonal engagement and relating between parents and child. Once those foundations of development were begun we would reassess the remaining needs to determine what still required treatment. In many cases there are issues that fall by the wayside when we begin to treat the most pressing developmental foundations first. What also often happens is that as adults we re-prioritize what is critical in terms of treatment, and issues that seemed critical before become not so critical as children begin to progress developmentally. By looking at the problems that are still present once developmental foundations begin to come together we can determine what to treat next. It doesn’t make any sense to treat speech articulation problems when a child has no developmental foundations for using their speech to engage in real communication! It doesn’t make any sense to teach a child to read words or do math facts when they don’t have the developmental foundations to think about what they are doing and apply it in their lives! We have to think about what makes sense and understand the process of child development enough to know that teaching things out of context doesn’t make sense. We have to look beyond trying to fix a tangible problem that we can easily see or assess (Johnny doesn’t say any words. Susie flaps her hands. Tommy doesn’t know his alphabet. Lily doesn’t know how to play with other kids.) and look at whether the child has developmental foundations to make working on those things meaningful. If not then we must start with developing those foundations. To do anything else just doesn’t make sense!

Where are you in the process of sorting out what is important and not important for you and your child to work on? What are critical priorities and what aren’t? Are you spending a lot of time, energy, and money wrapping sprained ankles instead of treating the major problems? I hope some of you feel great having read this post, knowing that you are treating the critical areas now and leaving less critical problems until later!

Until next week,
Nicole

What's HOT (Horizons Occupational Therapy)

A friend laughing, water lapping against the shore, someone singing in tune, birds chirping; these are sounds that are pleasing to my ears. What about the loud vibrations of a stereo in someones car, the humming sounds of the florescent lights above your head, the furnace running, the toilet flushing, the humming of the computer, a baby crying, someone sneezing, a siren blaring; these can be disturbing to different people. There are many sounds that go unnoticed that effect us on a daily basis.
Think about people who appear to to distracted in a busy environment. Do they have a glazed look on their face, are they holding their ears, not following conversations, becoming upset for no apparent reason? Many of us can filter out various sounds and continue on with our work, while many others have difficulty filtering out all the extra noises that each of us get bombarded with. This is auditory processing.
Some sounds are found to help by using certain types of music. Classical music can help people to focus and attend to task, help with academics, communication, engagement, and body organization. While other types of music with rhythm can help with body movement, timing, rhythm, sequencing, postural organization, and emotional responses. Sounds of nature can help with body awareness, and can make a person feel calm and relaxed.
Even the very loud base booming music coming from the car stereos, may help a person feel more grounded, to help them focus.
It is important to remember that sounds that you may enjoy, may be very difficult for someone else. Also, be aware of the background noises that could be effecting your feelings and emotions.
Moods can change very quickly with an unknown background sound, or by seeking out various sounds. People can experience joy, happiness, sadness, anger, frustration...and many more just by the sounds they hear.
Sarah OT

Buttprints???

Ok - while working on a project I came across this quote and literally laughed out loud at my desk. I'm glad no clients were around, or they might have thought I'd lost it. I found this quote to be full of visual images - I hope you enjoy it.

You can't make footprints in the sands of time

if you're sitting on your butt.

And who wants to make buttprints

in the sands of time?

- Bob Moawad

Have a great weekend! Enjoy!

Betsy

【Ｕ】 加工 (Processing)

Processing is the topic for this week. I have had a lot of time to think about this over the course of the past week and have come to realize that I take processing for granted so often that I wonder just how much the students I work with really miss on a day to day basis. If we really stop and think about processing and the great deal of effort it takes it is a wonder that we are able to have such rapid fire exchanges.

For our children on the spectrum this rapid fire process is much slower. For many what would take a neuro-typical child 5 seconds to process might take a child on the spectrum upwards of 30-60 seconds and then they may not even process the whole message. For others it may take as many as 5 minutes and for those in the extreme it may be as long as 20 minutes. Now think about that in the context of our ever changing world and especially in the context of school.

Now I’m not putting down schools as there is a ton of information that needs to be taught in a day, but would a little processing time hurt anyone? Have you ever been in a classroom when the teacher is asking questions? The scenario usually goes something like this – The teacher asks a question and within 5-10 seconds he/she is calling on a student to answer. Now if you are a slow processor will you ever get a chance to answer or will your answer most often be wrong if you by some chance just randomly get called upon. Interestingly enough it isn’t just our students on the spectrum that need more processing time. Even the children who are quick to answer may actually come up with more thoughtful answers given a little more time to think and process. Interestingly I have been reading a book about creative intelligence lately and processing time is directly tied to a person’s ability to respond creatively. The thing is that those people who are slow processor may actually have some of the most creative answers/solutions to questions/problems if given the chance to respond.

I work with several children both at school and at Horizons that are very slow processors. You can “see” the wheels turning in some kids it is that slow. Since I have been thinking a lot more about processing lately I have really been trying to slow myself down and consciously give these children the time they need to process what I have said. You would be amazed at the results. They do actually know what you want them to do or they can come up with a thoughtful response to my comments.

Think about how frustrating it must be to always be several steps behind. It is no wonder that our children’s responses often don’t seem to make sense or that they retreat into echolalia. Hey I know the rules are that when someone asks me a question I need to give a response whether it makes sense or not and I need to hurry because they aren’t going to wait. I can also use echolalia as a way to cope with not being able to process rapidly and then they will just give up and not ask me anything else.

Now there is what I would call “good” echolalia and we all do it from time to time. We all use “good” echolalia to help us process we might just not do it out loud. You can tell the difference. The difference is in the quality of good echolalia and it is being used to help process what has just been said. You don’t have to admit it to anyone but yourself, but you know you do this. We often call this self-talk and it is our brains way of making sense of the world. The amazing thing is that I see children on the spectrum’s processing speed increase as they begin to use this type of processing. So modeling self-talk not only helps with self awareness, but also with processing.

So how do we help our children with processing? Slow down, slow down, slow down. Give your child time to process. A good way to do this is to slowly count to ten in your head after making a comment to give your child time to process what you have said. If they don’t respond after this you can try a prompt. My challenge to you over the next week is to try slowing down and providing some processing time. I think you’ll be surprised at the responses you get.

Talk to you next week,
Erin

The House is On Fire! (prioritizing treatment needs)

I recently had a parent refer to the many needs of her daughter in this way: “It’s like there are three floors of the house burning – where do you start and which level do you fight the fire on first? As I am a fan of visual imagery and metaphors, I’d like to use this as the springboard for this post on priorities in treatment. Keep in mind that I know absolutely nothing about fighting fires, so please no comments about the logistics of real firefighting in relation to my metaphor!

When a child has autism there are many areas of need to consider. The pervasive nature of the diagnosis leaves little unscathed in terms of development and functioning. The extent to which each area of need is impacted varies, but it’s safe to say that all children on the spectrum are affected by their autism in numerous areas. There are the communication problems, the social interaction problems, the restricted behaviors, rigid thinking, etc. that come from having the core deficits of autism. Then, for many kids on the spectrum, there are the co-occurring problems to address, such as impulsivity, feeding problems, sensory processing problems, motor deficits, academic problems, etc. The list can go on and on depending on the child and it can, indeed, feel like all three floors of the house are burning.

Once you have identified the condition(s) that require treatment, the question becomes what to treat, when to treat it, and how to treat it. There are some options to consider:
• If all three floors are burning there may be a tendency to decide to try to throw a lot of water on everything in an effort to put the entire fire out at once. I have seen parents do this and the result is generally unfortunate for everyone involved. What ends up happening is that the parents get completely overwhelmed with trying to address everything at once with comprehending a bunch of different therapies, driving all over the place to get to therapies, having all kinds of people in the home, paying for everything, etc. Trying to treat everything at once is a recipe for burned out parents and burned out kids. It’s also a recipe for a burned down house because by throwing water at the whole fire at once you will not be able to concentrate enough in one area to make a real dent in the fire. You might keep the fire from spreading, and you might reduce the flames a little on each level, but the fire itself will keep on burning on every level.
• One could also decide to concentrate water on the area that seems to be the most obvious – the top of the house where the flames are shooting out. This can be thought of as the approach of treating the most obvious problems first – my child isn’t talking, doesn’t look at me, doesn’t know how to make friends, and/or doesn’t behave normally so we’re going to treat those things. That seems like a logical plan on the surface, but the problem is that it is the equivalent of putting out the fire from the top floor first. You might save the top floor, but there is no foundation to hold it up so what you end up with is part of a house that is salvaged, but can’t support itself. This is what happens when we choose a skill-based approach to treatment that does not focus on core developmental issues that need to be addressed in autism.
• A third approach is to concentrate efforts on the base of the house first by putting out the fire there, and then working your way up to the higher levels of the house. This approach is the equivalent of working on the foundational developmental skills, abilities, and milestones that must be achieved in order for a child to make long-term developmental progress. It can be a difficult choice to make because it feels like the things that are most obvious are not being treated right away. It can feel like too much of the fire is allowed to burn while efforts are concentrated on one area at the base. However, this is the choice that must be made for long-term gain. It is in focusing on the core deficit areas of autism in developmentally appropriate and specifically targeted ways that we move forward.

As parents and professionals we have to recognize that there is only so much “water” to go around – only so many hours in the day, energy to expend, knowledge that can be absorbed, money that can be spent...the list goes on. I’d like to propose the idea that it is not necessarily about getting more water, it is about how that water is used.
• It is about understanding exactly what needs to be treated and prioritizing those needs so that a treatment plan is developed to work in everyone’s best interest, without extending beyond resources that aren’t there.
• It is about understanding that by treating foundational developmental issues many other problems begin to fall away. By taking a bottom-up approach we address areas of development that snowball and create change across the board in the way a child thinks, communicates, and behaves.
• It is about prioritizing family health above all else and recognizing that if the needs of everyone in the family unit are sacrificed in the name of doing “more” to treat autism, then in the end everything will be lost.
• It is about knowing how to make the most of the time, energy, and finances you can in targeting the core issues of the child’s disability.
• It is not about running around to try anything and everything, and making yourself, your child, and everyone around you crazy, tired, cranky, and broke in the process. That helps no one in the end.

Next week I’d like to extend this discussion to the specifics of prioritizing needs from a developmental standpoint. But for now, think about how you are prioritizing the needs of your child. Are you able to rest assured that you are targeting what needs to be targeted for now, and that everything else needs to be left for later? Do you have a strategy that is allowing you to put out the fire from the source instead of blindly aiming water at the obvious flames? Do you have a good balance in your family where autism is one part of what you focus on as a family, and not the thing that takes up everyone’s time, energy, and finances? These things are critical to consider, and good to do a gut check on every now and then.

Until next week,
Nicole