Meeting With Cheri

What a relief to meet with Cheri again! She’s an Early Childhood Educator who has a gifted son with Asperger’s Syndrome. Last fall, I called her for a consult when I was having problems with our speech therapist. Cheri was a breath of fresh air and a burst of positive energy. She observed Tyoma, connected with him (and me!) and declared that he while might be “different” he was still “okay.”

She gave me a ton of useful advice and tips, since he does have some autistic traits. Two weeks later he was talking. Hmmmm? Because of her? I suspect he followed his own internal schedule, but her attitude and encouragement helped me feel more relaxed and confident. Those two weeks felt like the blink of an eye.

Anyway, we had a long and fruitful meeting. She spent two hours with us in the morning, filling out the Hawaii Early Learning Profile used by her center. Tyoma was not only on his best behavior, but he brought out his reserve of extra cuteness to boot. We noshed on cinnamon rolls and sipped tea while the questions rolled on. At 11:30 she took off for another appointment and came back at 1:15 to finish up and generate a treatment plan. What dedication!

At the end of our marathon meeting she told me that Tyoma has very scattered skills and abilities that don't fit any particular profile in the autism spectrum.  Much of his behavior is age-appropriate. Certain cognitive abilities are exceptionally advanced. And, of course he has little islands of strangeness. She said that nothing screams autism, but he is different enough to benefit from services—in particular she said that early help with socialization might help him avoid being the sort of nerdy kid that others will single out. He’s on the fence and whether or not he receives services is largely up to me.

So I say, sure! And we worked out a plan where she visits once every 4-6 weeks. Cool! I feel supported, less stressed and confident that our family is following the right path. Yay!!!

More Snow!!!

Yesterday it was in the sixties and lovely. I took the squirmy guy out to the park and we seemed to spend most of the day outside. Lovely weather! Then BAM!  Snow again! Looks like eight inches at least. I told Tennisfiend that there's no way I'm shoveling the driveway for him today! Sheesh! Some really good news came in yesterday. Tyoma's speech therapist called and said that Tyoma is 100% caught up with his peers and no longer needs therapy! Yay!!!!

Somebody Help Me!

Behavior Log

The past two weeks I’ve been keeping a log to identify problem behaviors and triggers that interfere with Tyoma’s speech therapy and joint attention activities. These observations, along with a retrospective of my journals gave me a “top ten” list of activities that cause distress; i.e. “tuning out” or becoming hyperactive. These situations invariably cause behavior problems. They follow, in order of most intense (serious, continuous or intense meltdowns) to least (fussiness, running away to avoid activity).

Activity	Behavior	Cause?	Solution
Hair washing	Red faced screaming, shaking, hysteria	Doesn’t like water poured on head	Nothing has ever helped.
Trips to the beach	Series of meltdowns when movements restricted	Overwhelming, too many new things. He loves the ocean/beach.	Hard to work with.
Putting on hats.	Cries, pulls off hat. Wails/fights if forced to wear hat.	Always hated anything restrictive on head.	If it’s very cold he’ll wear the hood on his jacket.
Cleaning ears.	Fights/screams	Sensory	Work quickly & distract.
Haircuts.	Fusses, twists about.	Hates water sprayed near face/ hair touched by stranger	The right stylist makes the difference.
Speech Therapy/ Dr. Appointments	He runs off, becomes “hyper.”	Overstimulation?	Still working on it!
Serious Conversations	Hyper, gets into stuff.	Sensitive to tone of voice.  (not volume)	Give attention, talk elsewhere.
Wal-Mart.	He fusses and tries to get out of the cart	Sensitive to noise from TV/loudspeakers	Redirect attention, rock cart.
Bookstores	Fusses, tries to get out of stroller.	Distracted by print? Does not have trouble at toy stores.	Be quick, rock stroller.
10:50 and 4:10 Madness	Hyper, gets into stuff.	Hungry, needs to burn off energy.	Intense play, snack

Behavior is communication. I’m not sure if I identified all the causes of Tyoma’s challenging behavior, nor am I certain that I am using the best solutions. But I am certain that by sharing this with you that we can develop a plan to help make his therapy sessions more productive.
Let me add a bit more about Tyoma’s behavior. His baseline is sweet, affectionate, and compliant with just a touch of mischievousness.  His remoteness and hyperactivity are not predominate or persistent.  They occur in specific situations and usually have specific triggers.

Remoteness

Tyoma can tune the world out. When he does, he will rarely respond to prompts or look at you. This frequently happens when he is deeply focused on a favorite task (attentiveness will return after he’s finished). I am not troubled by this type of self-absorption—I consider it to be willful ignoring and his Papa and Grandpa are masters of it. What concerns me is the other type of “spaciness” where he is truly in his own world. 

I’ve noticed that this aloofness is often connected to his health. At home, the aloofness goes hand in hand with fevers, blue circles under his eyes, cold symptoms and fussiness. Tylenol and cuddling make the difference.  I’d estimate that 70% of his remoteness in our home is associated with him not feeling well. This is unfortunate, since preschool floods our house with new viruses every other week.

His remaining remoteness I ascribe to some sort of mental overload. New activities, uncertainty of expectations and too many distractions contribute to Tyoma shutting down. He won’t answer questions, participate in activities or even look at you. This reaction goes hand in hand with hyperactivity.

Hyperactivity

Tyoma sometimes transforms from the sweet well mannered boy I know into the hyper-monster.  He runs about, gets into stuff and tests limits. A part of this behavior is the need to burn off some physical energy. I can predict when he needs a break by the time of day. Break given=energy spent, his focus and attention return. Being overtired or hungry also brings out the hyper-monster. I suspect that this behavior is fairly normal and that most toddler boys need to run around, eat when they’re hungry and sleep well.

This hyperactivity becomes demanding when it interferes with play, speech therapy and conversations with other adults. Tyoma probably has some sensory issues that contribute to this problem. The novelty factor is a major influence. And I am all out of time! I’ll finish this up for you later!

SLP Surprise

I started the day hustling Tyoma off to preschool, while Tennisfiend lounged in bed. Afterwards, the two of us took off for breakfast at our favorite coffee place, J Beaner’s. We ordered the apple pancakes, which turned out to incomparably delicious! The yeast raised pancakes, similar to crumpets in texture, were baked on top of luscious cinnamon apples. Beautiful to look at, delicately spiced with cinnamon (too much cinnamon=Big Red chewing gum) and best of all, theses pancakes were not overly sweet. Yummy! Tennisfiend smoozed me, asking about my dream kitchen and I rambled on for most of the meal. New paint, new dining set, hutch for Tyoma’s arts & crafts. Breakfast was so nice; we plan to bring Tyoma sometime.

We did a bit of browsing after, Tennisfiend searched for cross country skis and I hunted for school paste. Do you remember that sticky, sweetish smelling stuff, perfect for macaroni pictures? We plan to make Moses proud! My day took a turn when our speech therapist (Karen) called wanting to know if she could come over today instead of this coming Monday. I felt totally put out, but I said yes. I like to mentally prepare myself, type up notes for her and make the house sparkle (even more). But, why not get it over?

So, naptime was spent writing my report (I do this for Tyoma, so we have a good idea of his progress, especially since he has some developmental issues). Anyway, the session went fine for about ten minutes. I really believed we would have a productive session, since last time was such a success, but then the toys kept coming out of her bag, and she kept pressing him to talk. Tyoma shut down and turned into the hyper-monster. Session over. Well, not really over. We talked and talked about autism. Too much.

These sessions need to be all about Tyoma and not some diagnosis that has not been confirmed! I need to remember this, too. I warned her that she was over stimulating him, but she seemed not to hear. He is wonderful with us and dreadful with her.

Fortunately, Tennisfiend came home at the peak of the situation. The three of us tried a game at her suggestion, which made everything worse. Our SLP said, “If only he would sit still and engage for 30 seconds!” Ack!!! My hubby took psycho baby to the side of the room and gave him his alphabet. In less than five minutes he was calm and talking. In six minutes, he was spelling words. She about died watching him spell “open,” “six” and “star,” chatting all the while.  I could tell that she felt bad, but I was vindicated.  I told her, “The moment Tyoma ran off into the other room, you lost him.” Sigh.

For the twentieth time, I seriously debated firing our SLP and replacing her with the SLP I met last week (Cheri). Tennisfiend suggested that we be calm and give her another chance—she sincerely cares about our son and does try hard.  In the meantime, we have a session (not speech therapy) scheduled for December with the other SLP, if she connects, we have a new therapist. If not, hmmmm…

Until then, I will take over the sessions, and squeeze the appropriate therapy from Karen, especially when it looks like Tyoma is getting alienated. Tennisfiend thinks our SLP doesn’t seem to understand what she’s doing wrong and won’t change unless I teach her another way. This makes sense, the session I “took over” last time was fantastic; I guess expecting her to remember and implement my (brilliant! J) approach was too much.

So, now I am the self-appointed ambassador for my son and his SLP. It’s awkward, because I should be looking to her for the tools to reach and teach my boy. Nevertheless, I’m up to it. This probably won’t be the first time I “work with the system,” so I’m going to take it as an enormous learning opportunity. I secretly hope that a miracle will occur with Cheri, it would take a load off.

Speech Therapy

November 14, 2008

Tyoma’s Progress

Tyoma has been feeling well for the past few weeks, although he has been coping with a change of staff at KinderCare. On Oct 31, one of Tyoma’s teacher’s (his favorite!) was fired from her position. Although a staff member has filled her position, a few other temporary workers have rotated through the classroom—it was a chaotic week. He is adjusting to the situation, but I am uncertain if they have “settled” on a new girl. His meltdowns have practically vanished and are greatly reduced in intensity when they occur. 

• Tyoma communicates some internal states to us. He now consistently indicates when he is cold—I’d say almost 100%. We’ve gotten some “eat-eat-eats” out of him when he’s at the table, although I’m relying on schedules to keep him fed/hydrated.
• I have totally changed my focus regarding his speech—it’s now geared towards sharing and having conversations. This really works! He finishes sentences from his favorite books and songs and will answer some simple questions. I let him initiate conversations when we look at books or play. It’s generally a one or two “word” commentary.
• He’s been spelling words like exit, start, six, and open with his alphabet letters for about a week. He can sight read from some of his simpler books.
• His pronunciation of words remains about the same, with modest improvements, and nothing seems to improve it but time and repetition.
• Tyoma is using the word “where” appropriately.
• We started a gluten free/casein free diet Oct 31. We’ve noticed some improvements (25%) with his speech/play, but it could be incidental.
• He’s spending less time “organizing” the alphabet/numbers and playing alone. He’ll play alone for 10-15 minutes during the day before seeking me out, usually to show me a letter/number/book. He still has 30-45 of imposed quiet time in the evening, but will knock on his door to cue companionship.

Friday, November 7^th, I observed Tyoma in the playground for about 15 minutes. He spent most of the time running around by himself, or jogging by his peers without noticing them. Miss Ronda stated that this was fairly typical of him (70% time), although he does have “good” days when he runs along with his peers.

This Monday (10^th), I had my first official parent/teacher conference at KinderCare. Although I speak to the staff at least once a week, it was good to have some focused time without distractions. On the top of the list of my concerns was Tyoma’s social behavior. During our meeting, she said Tyoma has a “friendship vibe going on” with a boy named Vinny. Tyoma will run with him often and shows a preference to being next to him.

When asked about his participation, she mentioned that he does not like loud music or to play with musical instruments—he will leave the area when these activities take place.  This was a surprise to me since I have never noticed sound aversions at home, but in his defense, the music at daycare is thunderously loud. Miss Ronda also said that Tyoma does not seem to “get” painting. He goes through the motions but does not “engage” like his peers. I have noticed similar problems at and I have a plan to get him more involved.

Miss Ronda said that Tyoma has made great progress in sitting with his peers during snacks/meals. He is cooperative and will remain seated while eating. He also joins in circle time and “seems interested” in what is going on although he does not usually sing/talk/dance like his peers. Miss Ronda made one significant comment, “He is very compassionate.” She elaborated by saying that he notices when a classmate is crying or upset and that he seems concerned. He does do anything but watch intently until the situation is resolved.

Tyoma’s Progress

The past two weeks have been difficult for Tyoma, primarily because he has been ill. He has missed daycare and been more sensitive and prone to meltdowns. Intense speech therapy was sometimes put on the back burner while I coped with my tearful son. Nonetheless, here’s our progress:

·   Tyoma seems to have great difficulty communicating internal states to us. He does not consistently indicate when he is hungry, thirsty, hot, cold or in pain.  He also uses no words or signs for his emotional states. Recently, he has said “brrrrr!” when cold and will clack his teeth to indicate tooth pain. We are working with him intensely to use gestures (sign) to show hunger/thirst rather than bringing me his cup or booster seat. Since he has been feeling unwell, this has been a major priority and we could really use some good advice.

·        I have been focusing not on the addition of new words (which he accomplishes easily), but the pronunciation of existing words. He has not regained the improved pronunciation that he had when my mom was here. Tyoma typically utters the first syllable of a word and does not bother with the rest. He can, however count to 12 with clarity.

·        Tyoma now completely “gets” the word mine, which is has become a source for meltdowns of late. Auuugh! He also says “where,” but it is unclear if he “gets” the meaning of the word or is just repeating it as part of a game.

·        He uses two word combinations regularly, but is reticent when pressed. He has begun to string together three words; such as “want…bath…open” (open the door to the bathroom). His “I want that!” from a few weeks ago has vanished.

·        Tyoma’s  pronunciation has slipped a bit—he has gone back to good days/bad days. I’d say he has about 20-30 words that he speaks clearly and consistently now. More, star, car, want, pop, no, zoo, white, the numbers 1-12, 23 letters of the alphabet, and a few more I can’t think of as I write this. A definite pattern exists, most of the words are nouns and most of the words relate to things he is profoundly interested in. The rest of his speech is about 25-30%  recognizable to a stranger.

Verbal reports from daycare staff indicate that he continues to do well there, the director commented on “how far he has come” and “how quickly he has adjusted.” I have begun to leave Tyoma for the full four hours so that he can have the experience of sitting and eating lunch with his peers. He is finicky about the food, but otherwise he is adjusting nicely. At home, we have playing social games like chase and hide and seek. Tyoma has been imitating Papa as he rakes leaves and quickly followed Papa’s example in learning how to fall in a pile of leaves. We have also been playing “airplane” with him (where we pretend to be airplanes flying) and he mimics us with gusto. Physical games engage him and bring out cooperative behavior and a few words.

Speech Therapy

Tyoma’s Progress

·        Tyoma consistently uses about 50 words each day. He continues to add new words quickly and has been learning positional adjectives, exclamations and more verbs.

·        Although he has successfully said a few words with multiple syllables, his frequency of correct pronunciation has dropped off.  

·        Tyoma is beginning to understand more personal pronouns such as “me,” and “mine,” but he uses them infrequently. He seems to be a bit confused between “your” (as in “Show me your nose.”) and “my” (“Show me my nose.”).

·        He uses two word combinations several times a day and has even said “I want that!” a few times.

·        Tyoma’s  pronunciation is about the same—some improvement on  his more familiar words while about 25-30% of his regular speech could be understood by a stranger.

·        While looking at books, Tyoma has started talking to himself, naming objects in the book and even describing simple activities taking place. As I read to him, he continues his descriptions, and is delighted to count and make animal/vehicle noises.

·        Tyoma is grasping the concept of time. He can ask for five more minutes of a favorite activity and understand that story time is for thirty minutes.

Things have leveled off speech-wise for Tyoma the past two weeks.  Although he has not made any extraordinary language advancements, he has made tremendous progress socially at day care. He is more cooperative, friendly and engaged than ever before. In fact, we have just upped his attendance by one day a week!  He has begun to play more imaginatively and creatively, adding more words in the process.  

Speech Therapy

 

Tyoma’s Progress

·        Tyoma consistently uses over 50 words each day. He speaks about 80-125 words regularly and seems to add new nouns and adjectives as quickly as you can teach him (over 10 a day).

·        Tyoma now uses “Bye” and “Hi” regularly with family, preschool members and neighbors.

·        New sounds include W and Wh. At last he says “want!”

·        He has been successfully saying a few words with multiple syllables. Generally, he either pronounces the first syllable correctly (not bothering with the rest of the word) or he utters the cadence correctly. However, he can intelligibly pronounce a few words like potato, pumpkin, carrot, and ice cream.

·        He uses two word combinations several times a day.

·        Tyoma’s  pronunciation has improved on some of his more familiar words. Nevertheless, about 25-30% of his regular speech could be understood by a stranger.

·        Tyoma can finally say the numbers 1-20, which he uses to name his flash cards. He also uses numbers to describe things, like “two cars” or “five” in referring to the number of times he wants to be swung in the air.

The biggest change in Tyoma the past few weeks has been the absence of “bad talking” days. Virtually every day he has a great deal to say and speaks spontaneously. His frustration level has dropped since he is able to request which books he wants read, which toys he wants to play with and which activities he wants to pursue. We no longer need to coax words out of him, although he can still be shy and not always intelligible. He has begun to play more imaginatively and creatively, adding more words in the process.  

 The day after the last therapy session, he was able to categorize objects by color in a game similar to the teddy bear cup exercise. He can easily categorize by color, shape, or function, but he is often quickly bored and prone to mischief. We have been regularly singing nursery rhymes to him. Although he does not join in the song, he genuinely enjoys the songs and will repeat words from the songs afterwards (E-I-E-I-O!).

Last week Tyoma’s Grandfather visited. Tyoma was not bothered by the switch to Russian (previously the switch distressed him). He not only understood Russian, but he spoke a few words and seemed very comfortable with both languages.

Speech Therapy

 

Tyoma’s Progress

·        Tyoma is saying up to 48 words each day.

·        He is adding 2-7 new words a day.

·        Tyoma will now spontaneously name/describe objects.

·        New sounds include a long I and O as well as the consonants F and J.  He can clearly pronounce the consonants sounds B, D, G, H, K, M, N, P, S, T, Z and ST. The vowels he can pronounce are short A, E, U and Y. Emerging sounds are short I and R. He does not seem to be able to say L, Q, W, or X.

·        He is beginning to use adjectives like stinky, dirty, soft and fuzzy.

·        He has not been using many two word combinations; they crop up once every two or three days. 

·        Tyoma’s  pronunciation is modestly improved. About 25-30% could be understood by a stranger.

Tyoma has really had a speech explosion this past week. Although every day is not a “talking” day, the frequency of his words has picked up so much, it’s difficult to keep track of. We continue to follow recommendations for therapy and have been taking him out for stimulating activities daily. He still has his binky around bedtime and for brief periods (10 minutes here and there) during the day, but he is becoming less attached. He is less reluctant to give it up and permits his teachers at preschool to take it from him.

My Speech Therapy Report

 

Tyoma’s Progress

·        Tyoma is saying 15-20 words each day.

·        He is adding one-two new words a day.

·        He uses the words more, help, draw, bath and enough consistently to get his needs met.

·        Sunday the 25th he used his first two word combination, “help pop” to get me to blow bubbles for him. Monday he said “more draw.”

·        Friday the 22-Sunday 25 he named the letters of the alphabet clearly and correctly.

·        Overall, his pronunciation has drastically improved. His words are finally becoming clear enough that a stranger could understand them.

We’ve followed your recommendations for therapy play and oral motor exercises, although he still has his binky around bedtime and for brief periods (10 minutes here and there) during the day.

Here are a few target words we are working on:

Want           Hungry                  Sleepy                            Hurt

Open           Close                    Mine                     Bye-Bye

We could really use some suggestions for teaching two words in particular--want and hungry.

He uses the words “more” and “help” plus his usual gestures and vocalizations get the idea of want across. What to do?

We are having a hard time getting the concept of hungry across. I almost suspect that he does not recognize being hungry until he is already in meltdown mode, which makes teaching the word even more difficult. I’ve had moderate success getting him to say the word, but not to use it appropriately. Suggestions?