Just the other day we were invited over for dinner at my parents, there were other guests too. Since Y is in the habit of getting over excited at seeing other people, her best activity is to sit everyone down and then count them, so I was trying to keep her in my parents room with her favourite cartoon channel turned on. The dinner was served and again in an attempt to keep her inside I took the meal into the room. She somehow managed to go outside and sat on the dinner table with everyone else and remained seated until her meal was finished. I was surprised to witness this show of good behavior from her. This and some other significant changes in her behavior and preferences have made me realize that my daughter is growing up!
Lately I have been asked the question: ‘what were my daughter’s symptoms when she was first diagnosed? What therapies did she get? From where? How did her symptoms improve? How did I help her? Etc... So very quickly I would talk about this journey through the therapies!
In the last post I discussed about Point 0: ‘the before diagnosis Y’. Today let’s start with Point 1: the point at which we started noticing the Autism cues and from where her therapies started.
Point 1: Symptoms right after PDD-NOS diagnosis.
Y was 4 years old when therapies started. She had the following Autism Symptoms:
- No eye contact
- Zero attention and sitting spans
- No communication
- Finger pointing only
- Poor motor skills
- No spoon holding
- Lining up objects
- Laughing meaninglessly
- Teeth grinding
- Hand flapping when excited
- Teeth clenching when anxious
- Throwing objects and creating a mess
So with all these symptoms we took her to AFIRM -Armed Forces Institute of Rehabilitation Medicine- where she got Occupational therapy twice a week for 30minutes. The OT used to fix her in a high chair. Following is the list of activities she used to do there:
- Making a tower through blocks
- Learning the use of spoon to eat lunch
- Threading beads
- Lacing through holes
These things made her eye contact and the attention and sitting span a wee better. But since the therapies were only twice a week the improvement was very slow. We then found AREIC -Ali Rafay Early Intervention Center. It was like a school providing all the therapies under a single roof for three hours, five days a week. Her three hours were divided in an hour of OT of which fifteen minutes were dedicated to sensory room to calm the child down from any sensory overload he/she might be experiencing, an hour of Work (table top activities based on Applied Behavior Analysis (ABA) technique. Fifteen minutes of circle time, fifteen minutes of snack time, fifteen minutes of speech therapy, and fifteen minutes of play time. Every child had a picture schedule for all these activities which was set every day by the child before leaving for home so that he/she knew the schedule/routine for the next day. The routine remained the same for all days. Everyday, after completing each activity the picture was removed and placed in the pouch to represent that activity is finished (no more of it). Some parents use the picture schedule for home too to avoid meltdowns resulting from unexpected changes in the routine.
Y has a good receptive memory and she learns very fast. At the time she was enrolled in AREIC she already knew her ABCs, Numbers, Basic shapes and Colors, maximum body parts, basic animals, a few fruits and vegetables. So when her Work Schedule was made by the Head Teacher it included things like:
- Associations cards(e.g. toothbrush with toothpaste, ball with bat, socks with feet, gloves with hands etc) . Learning was done by matching the cards correctly.
- Sorting (e.g. sorting bathroom and kitchen objects). In this activity the kid is asked to insert kitchen related cards through the kitchen slot, and bathroom related cards through the bathroom slot). A parent can easily design this activity at home using a shoe box and pictures related to the thing you want your child to learn. Sorting can be done to differentiate between colors, shapes, fruits and veggies. The options are unlimited
- Matching activity which involved matching similar pictures
- A puzzle (starting from an easy one and then increasing the difficulty levels as the child progresses
- Writing on white board with a marker. This is a good starting point to develop pincer grip. Kids love to write on white boards. You can start with connecting two or three dots. Y started from there too
- A picture story on any social subject
- Then there was this book. What is it ? What color? It helped her to answer questions. Y has always been quick to generalize whatever she learned. Soon after we started that book she started picking up Radom objects at home and would ask me what is it, indicating that she wanted to play this game with me. She always answered correctly.
The Occupational Therapist assesses every child and based on individual needs makes an OT plan. So the OT included things like:
- Threading beads
- Making a tower
- Cutting a paper
- Soft vs hard
- Wet vs dry
- Writing on sand
The gross motor activities included:
- Walking on a path with different hurdles several times
- Tread mill
- Trampoline jumping
- Pulling a sand bag
- Immitation by asking the child to immitate you while you point at different body parts and immitate various actions
Then there were ADLs (Activities of Daily Living) which started off with hand washing, teeth brushing, opening and closing of taps. Wearing and taking off of a T-shirt, shoes, socks, pants, brushing hair, applying lotion etc.
As Y kept on achieving an activity, next was added like this things went on moving in the forward direction.
The purpose of an hour of Work , which was divided by several breaks of course -you can’t expect any child to keep seated for one whole hour- was to increase sitting, attention and concentration spans which did become better. As long as Y is kept busy in a new activity she can remain seated. The second she gets bored , nothing can bring back her interest in that particular activity. The trick to increase eye contact is to sit opposite the child and be at the same level as him/her so that when you are showing him/her pictures it’s at the direct eye level. Other trick is to give precise, understandable and direct commands which a child can easily follow. Since the processing of ASD children is relatively slow giving then a long ambiguous command confuses them. For example, Y come over here, open the tap, wash your hands … is a long command involving multiple steps. When marking this activity as a hit or a miss, you would always end up marking it as a miss because the child was unable to follow such a command. So breK it down in multiple short and easy steps and then evaluate each step individually. Y come over here is one command, open tap second command, pick up soap fourth command, apply soap fifth command, wash hands sixth command, close tap seventh command. This break down depends on your child’s ability to follow commands. I started Y with such a large break down and now I only have to say Y wash your hands and all the steps are covered in this single command.
Newly diagnosed kids who are either non-verbal or having no previous learning experience or both are first taught pointing.
Soon Y was started on a proper syllabus and then shifted to a Remedial class room.
If you are taking your child to a facility then the specialists there will design your child’s work plan. But researching the web you can design easy to use DIY activities at home for your child using the materials and toys already available at home or easily available in the local market.
The key is patience. These things take time. My daughter took little time in learning orally but still struggles when it comes to motor skills. She can still not cut with scissors perfectly, she didn’t learn to tie laces or buttoning because her muscles are weak. Some kids I know are too good in gross and fine motors but academically they struggle. So the point is everyone is fighting their own battle, what we can do is learn through sharing.
Now after all these therapies I can only say that we might have moved from Point1 to Point 2, but not any further than that. Still a long way to go.
The post is already very long. If anyone wants me to elaborate on anything further or want me to write about any other topic so please leave a comment.
Until then Adios !
Disclaimer: The ideas and experiences presented in this post are specific to my personal experience of working with my daughter and should in no way be termed as professional advice!