Monday, November 7, 2011

Colton's Autism Therapy Part 3 (LAST one)

Whew, this is finally the last post about Colton's therapy! I've already talked about why we are doing therapy, the basics of ABA, and now I will talk about:

Speech Therapy, Occupational Therapy, and things I do at home.

Speech Therapy
Speech therapy focuses on speech obviously, but more importantly overall communication. There is a lot that goes into communication. Receptively understanding what people are saying and asking, expressively being able to communicate to others, eye contact, understanding how to comment/answer questions/follow instructions...etc. Although Colton can say 4-5 word sentences, most of his talking a few months ago was just echolalia (just repeating what I say or reciting a line from a book or movie). Speech therapy works not on just speech, but FUNCTIONAL (or useful) speech.

What we've worked on in Speech Therapy
  • We worked on having Colton make choices between two preferred objects ("do want the cow or the horse?"). This then transitioned into Colton making the choice without the verbal prompt (just holding up the cow or the horse, and having Colton choose). And NOW working with Colton on requesting for things with no prompt at all. This is an important skill because he needs to learn how to ask for things without me asking him first.
  • Along with the above was teaching Colton how to ask for help. Colton didn't have the instinct to ask for help, so he would simply just stand at a door pulling and pulling on it getting frustrated, and never think to ask "I need help mommy." Colton is a pro at this now.
  • Looking up at others eyes to acknowledge that THAT is where the object/help comes from. Ex. I wait at the door until Colton looks up at my eyes and says "I need help" before I intervene. Colton is also doing really well at this now.
  • Following simple one step instructions "put block in" "take puzzle piece out". Colton is now a pro at this too and working on 2 step commands, which he is also quickly picking up on.
  • "What" questions and "who" questions. Colton used to just repeat back the question when I'd ask him. Now he knows to answer basic "What" and "who" questions. Colton's echolalia has gone way down through working on this.
Occupational Therapy
Occupational therapy focuses on helping kids with their basic everyday skills (or their occupation), which for kids is playing, drawing and other fine motor skills, self care skills and addressing Colton's sensory a lot of getting Colton's body to feel comfortable in a variety of situations. Colton has major issues with swings/gravitational insecurity, anything flying in the air (especially butterflys), odd textures, all basic grooming (brushing teeth, hair, diaper changes) etc.

OT- Where he was 4 months ago
When we first went in to OT 4 months ago, Colton cried the whole time and we had to go back in a private room where he clung to my lap the whole time. It took us 2 weeks to even get him to LOOK at the main room, and a month to touch the swing. He wouldn't hold a pencil, eat with utencils, or do many fine motor activities.

OT- Where he is now
Colton LOVES Occupational Therapy. He is so happy there, and willing to try everything the therapist wants him to try. He still doesn't like the swing, but tolerates it in small doses. He can draw, and enjoys fine motor activities. He even tried out a tricycle the past few times! It's so excited to see him try new things, where it was impossible before.

Parents make a huge difference in the outcome of early intervention. No pressure right? haha. So, I attend all Colton's therapies, take notes of things to work on, and then actively work on all the tasks. It makes a difference because Colton's Speech Therapist told me that Colton was improving much faster than she anticipated.

I have received training in all the ABA classes, so that everything I do reinforces what he is learning in ABA. There are certain ways to handle situations, and to handle behaviors...and I make sure it is all in line with ABA. Mainly, I am consistent, I follow through on everything I ask him (don't think I'm amazing here. I'm very careful what I ask him to do, since I know WHEN I do I NEED to follow through on it), I am calm and patient, I am positive and always rewarding good behaviors, I don't emotionally give in to tantrums and other negative behaviors.

ME- education
I take all the classes I can. I've taken the ABA classes that my therapists took. I also took a 5 week Parenting Your Child with Autism class. I will continue to read and attend classes to continually learn the best ways to help Colton.

ME- data keeping
For ABA, I keep some basic data to help the Psychologist and Case Manager. I track and tally negative behaviors, I keep a food log, and other logs.

ME- logistics
I manage all the insurance, early intervention, school district, finances, therapist schedules/hours, pay, meetings etc. A team of 8 therapists, and 3 case managers keeps me busy.

And....that's it! If you've made it through all 3 of these parts, you deserve a trophy! Hope you learned a little bit about what we do. I am so grateful to be able to have the support and resources to get Colton the therapy he needs. I realize that this does not happen for all kids, and I feel so fortunate. We are really so blessed. We are a happy family, and I love my little guy.

Friday, November 4, 2011

Colton's Autism Therapy Part 2

So, now that you understand basics on why we are doing therapy for Colton, what areas we are trying to help, and what we hope to achieve (see last post)... is an overview of ABA, the main therapy we use for Colton.
(In my final post, I will talk about his other therapies)

ABA (Applied Behavior Analysis)
Colton is involved in Nationwide Children's EIBI (Early Intensive Behavioral Intervention) program. Hours recommended are 25-40 hours a week, and Colton is currently around 25 hours. He has a psychologist, a case manager as a day to day contact, and 3 aides that work daily with him at home, school (in a few months), and in the community.

Applied Behavior Analysis is a scientific approach to understanding behavior and how it is affected by the environment. The science of behavior analysis focuses on principles about how behavior works, or how learning takes place. Through research, behavior analysis has developing techniques for increasing useful behaviors and reducing negative behaviors. It is used to help skills in all areas including basic skills like looking, listening, imitating, as well as complex skills like reading, conversing, and taking the perspective of others.

Basically, it's looking at things from a behavior perspective, and breaking things down to the smallest/lowest level...seeing where Colton is successful...and then building on it.

What does research say about ABA?
Although unfamiliar to a lot of people, ABA is widely recognized as an effective treatment for Autism and endorsed by many state and federal agencies. Studies show that children with Autism show great improvements in their cognitive, communication and adaptive skills. And, (since Colton falls in this category), these studies also show that many children that participate in early intensive ABA for at least 2 years acquired enough skills to participate in regular classrooms with little or no ongoing help.

What does ABA therapy look like for Colton?
We have aides come to our house around 5 hours a day (2 2.5 hour shifts), 6 days a week to work on programs outlined by our case manager and psychologist. I am very involved in the whole process and have received training in all the ABA areas as well. Everything is fun, with a lot of positive reinforcement, breaks, and play time. They do the programs at a little table we have for him, or wherever it makes sense. Each time they bring him over to the table, they do 4-8 trials of a program (ex. trials means saying "do this" 4 to 8 times with putting the block in the bucket, or imitating an action), and having Colton respond each time...either on his own, or having them take his hand and help him do it, if he is not doing it.) There are also reinforcements involved like verbal praise, food, high fives etc.

Here are just a few of the basic programs Colton is working on now. They sound a little dumb and simple, but I assure you it is NOT so simple for Colton and all very important things for all future learning and success.

Imitation- this is basically Colton learning to imitate things that people are doing. Right now we are on a basic level where the aide says "do this" for the prompt and then does some action (bang a drum, put a block in the box, push a car, clap hands, touch nose), and then Colton is supposed to do the action. This basic act of imitating is usually just instinct in kids, but Colton lacks it. Imitating is the basis for all learning, because you look to others to see what they are doing, and then copy them to learn. It also teaches Colton basic compliance, which he had none of.
Matching- Matching is another basic skill of learning. Colton first matched objects, then flash cards, then 2D to 3D, then similar objects, and how he is sorting. Matching leads into sorting, and grouping, and recognizing patterns, and all sorts of learning skills.
Puzzles- Learning problem solving skills. Colton started with just a 3 piece puzzle and is now doing 8 pieces of a 12 piece puzzle on his own.
Fine Motor- Using utencils, finger strength, pencil grasps etc. Colton works on coloring, playing with playdoh, putting coins in a bank (help his grasp), putting clothespins on a lid (strength and grasp)
Toy Play- Playing properly and functionally with toys. Colton tends to narrow his interests, become ritualistc, and rigid with his toy play. As in, if left up to him...he would play with the SAME toy in the SAME way every time and not vary from it. You can't be successful playing WITH other kids, until you know how to properly play with toys on your own.
Receptive Commands- Following simple commands like "clap hands" or "touch table". Colton used to ignore all commands, and only act on them if he wanted to. He needs to be able to follow commands from others, and in a variety of circumstances.
Receptive Object Labels- Learning basic vocabulary.
"Hi" "Bye" program- Learning to say Hi when people come in a room, and Bye when they leave. That involves looking up at them, saying Hi, and sometimes saying their name.
"Come here" program- Learning to come in the general area of the person asking you to "Come here."

Where Colton Was
When we first started ABA, Colton cried the second he would see any therapist, minimally interact, and bury his head in the ground every time anyone asked him to do anything. He never would respond to what I'd tell or ask him, and only performed tasks on his own terms. I once tried for 30 mins to get him to put in one puzzle piece at an evaluation while he screamed the entire time not complying. He did not eat with utencils, look to me for reactions, or come to me to involve me in activities and throws major tantrums multiple times a day... and on and on...

Where he is just 3-4 months later
Colton now loves all his therapists. He goes downstairs happily with them, pushes me out and says "bye mommy" while closing the door. He interacts, plays games, laughs, and talks to the therapists. He comes over to the table and participates in all programs. He quickly learns programs, because he is paying attention and being reinforced positively. He engages with me so much more, looks to me for my reactions, imitates my facial expressions, handles demands being placed on him, and only throws tantrums about once every week.

Night and day difference. He is improving so much. I work constantly, but it's all worth it...because his life is improving and he is happy. And that is what it is all about. I love ABA.

Ugh, wow. I'm sure no one read all that. :) I'M tired just re-reading it!