Monthly Archives: November 2020

Autism Strategy

Planning for Success

Twelve little picture cards are placed sequentially down the wall. Each one in the green coloured section showing that they are still to happen.

I remember the process we went through to get to the full list of the day’s events. Initially I had placed them all on the wall and somehow expected Rhys to acknowledge the process – I was obviously delusional, or maybe just had a lot still to learn!

Three years ago we had mastered the first-then strategy. The use of two pictures to move Rhys between activities, communicating a clear sequence and managing the transition. Pictures became the basis of everything. I used them to communicate with him, reducing anxiety and avoiding meltdowns.

I would place little pictures onto a green card showing where we were going and what would happen next. Crouching down to Rhys’ eye level in carparks, shopping centres and play areas with my sequence of pictures got a number of stares from the passers by, but I didn’t see the on looking eyes, I saw my son and the need to do everything to communicate with him and avoid a meltdown due to confusion and frustration.

The miniature schedule worked extremely well, and I continued to use it in a portable fashion.

After a few months, I changed to a red and green card adding a few extra activities to the sequence. Hand-over-hand I helped Rhys move each activity card from the green section to the red section to signify its completion.

It didn’t take long for Rhys to master this second step.

Once comfortable, I implemented the final stage. I took the schedule card we had been using for a number of weeks and stuck it to the hallway wall. The perfect central location to communicate our plan. As the activities were completed, I would take Rhys to the wall for him to move the card to the red section.

He soon knew where to see his plan. Now consisting of over twelve activities per day.

As I finished making the dinner this evening, I spotted a mop of blonde hair walk up to the communication wall. The little hand reached for the dinner card and moved it across to the red, “All finished” he said. But he wasn’t finished, he kept going. Bath, pyjamas, brush teeth were moved across too, and then the hand tapped the last card, “Bedtime!” it said, and two little legs walked down the hallway and up the stairs.

Schedules can help communicate the events of the day, but they can do so much more, like communicating when your little one is done.

👕🍳🚗🛁🛏

Click here to get a step by step guide to schedules.

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Autism Strategy

Countdown to Bed

“Rhys wash hair” I state, holding the little toy watering can where he can see it. I use simple words to explain what I am about to do, so he wont be taken by surprise.
“Ready, steady, go” I announce, and being careful to not get any water in his eyes, I lift the watering can up to his head, and start to count.

With every canful of water I count down, making Rhys aware of how long the activity is going to take.
“Five” first canful of water weting the top of his head.
“Four” the water running down the back of his head.
“Three” making sure the left hand side is saturated.
“Two” then the right.
“One” pouring the last canful on the top.

“Well done, Rhys” I say excitedly, wiping his face clean from any stray droplets of water. I take some shampoo in my hand and lather his long hair into a Mohawk, more for my enjoyment than his!

I then begin the process again.
“Rhys, wash hair” I say again, the watering can held high. “Five, four, three, two, one.” Lifting the towel to his face, I give Rhys a few seconds to breathe and reset. There is still a lot of shampoo in his hair, so when he is ready, I start the cycle again.

Washing Rhys’ hair use to be traumatic. Without any means to communicate with him at the time, it resulted in force and a close call to water boarding 😮 (or so it seemed). I had no way of getting him clean without a swift quick-as-I-could dunk in the bath. We both grew very quickly to hate an experience which was meant to be fun, engaging and relaxing.

“All finished” I announce. Lifting Rhys out the bath and wrapping him up in a large fluffy towel. His big blue eyes and contagious smile peep out from under the folds, confirmation that his bath had been fun.

I leave Rhys to put on his pyjamas, which I have laid out in order on his floor. Picking up the hair brush I wait for him to be ready. The brush is a pink anti-tangle one with unicorns on it, and actually his sisters, but it works a treat.

Kneeling down on the soft carpet and looking up at the dressed pyjamas I state, in the same way I did ten minutes earlier “Rhys, brush hair”. With each stroke I count “five, four, three, two, one”

Once I am done I scrunch Rhys’ hair into its natural curl, and give him a huge cuddle, breathing in the fresh fragrance of the bath.

“Sleep well Buddy!, you did great!”

🛁👨‍🦰

Click here to get a step by step on Countdowns.

I have used countdowns in so many ways to communicate time with Rhys and how long events are going to last. From hair washing, to brushing teeth and even during haircuts.

I use the Ready Steady Go technique to communicate the start of the activity, which is a great foundation for many other strategies. See more details here.

You can also add traffic lights to help with the length of the activity, and pictures or sequence cards to supplement the communication.

Be creative and combine strategies in ways that will be able to help you communicate and enjoy activities with your child.

Most importantly – sometimes things don’t always work first time, so assess what you are doing, keep trying and if needed, ask for help.

If you have missed any of the other strategies, find them all detailed here.

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Autism Strategy

Sock It Up!

It was early January and Rhys was due to start school after the summer. At the age of three and a half we had overcome so many challenges, but hundreds more lay ahead. I wanted to keep smashing down the barriers and not let his autism be a blocker to his achievements. Things were harder. Goals took longer to achieve. Additional support was needed. But together we could work out a way to succeed. 

I opened his drawer and gathered up his clothes, with a goal in my mind that I was keen to work on and see him accomplish. I wanted him to be able to get dressed by himself, a simple but hugely challenging task for my little boy.

I looked at the socks in my hand and thought about how I pulled my slightly larger versions onto my feet daily without thinking. A task that had become a habit, but had probably taken me a lot of practice from a very young age. 

Walking back to my room, I took a pair of my own socks from the drawer. Sitting on the end of the bed, I purposely concentrated on my actions, as I slipped my naked foot into the fluffy material. Gather up the sock, place over my toes, pull over my foot, around the heel, and then pull up over my ankle. A simple task for me, but a five step process which my son would need to master.

I gathered up Rhys’ clothes which I had collected from his room and started to lay them out on my bedroom floor. They formed a sequence, a visual schedule of clothes, with the pair of socks placed at the very end.I then grabbed my phone and took a picture of the setup and put it into my First-Then app followed by a reward of some bubbles.

“Rhys, get dressed, then bubbles” I said.

I sat Rhys down in front of the clothes sequence, and from left to right, I got Rhys  dressed, with no expectation or request for him to do any of the actions himself. It was not about Rhys trying to put on any of the items, that was my job. The plan was for Rhys to complete the final step, and we would move backwards from there. I moved along the clothes sequence dressing Rhys, first his pants, then his trousers, and finally his T-Shirt, we finally approached the socks. I moved behind him and thought through the task breakdown I had identified earlier. I gathered up the sock, placed his foot into the opening, then pulled it up his foot and over his ankle. Coming to the final step of the task sequence I took hold of Rhys’ hands to help him do this part himself. Placing his thumbs between the sock and the skin of his ankle, I hand-over-hand, helped him pull the sock up his leg.

“Well done Rhys” I cheered, and hugged him with delight. He had accomplished the first (or last) step of the task. Following my promise, I filled the room with bubbles.

Over the next month, Rhys mastered the goal of pulling the sock up his leg all by himself, and we moved onto getting it pulled over his heel and then continuing backwards through the routine, to him placing his foot in the gap, finally gathering up the sock in his hand. Socks proved to be one of the most challenging goals, but step by step we got there, and Rhys managed to put on his own socks after a few months of hard dedication. 

Every morning and every night when Rhys got ready for bed, I continued to lay out his clothes and pajamas in the same order to get dressed. As soon as he had mastered his socks, we continued to set goals from the end of the clothes sequence, breaking down each piece of clothing into simple steps.

It took a year in total, to get Rhys independently dressing himself, and now three years later Rhys still has his clothes laid out in the same order for him to get dressed.

Break down the goal. 

Persevere. 

Never give up. 

It took Rhys a year, I would have kept going even if it had taken two! 

***

Click here to get a step by step guide on using Backward Chaining.

*The content which I have shared is all a result of my own experience. I am not a qualified speech therapist or OT, I am just a parent who wants to share what has worked for us, and hopefully help others with my knowledge and experience.

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Autism Strategy

Writing for Chocolate

I sat on the cold, hard floor, my phone in my hand displaying a picture of a writing book followed by a piece of chocolate.

“Rhys, First writing then chocolate” I stated, pointing to each picture in turn. It was the tenth time I had muttered the phrase but each time I had remained calm and consistent, while Rhys remained stubborn and resilient.

There was a goal in mind, and it was even more important for me to push forward in progress due to school closures across the country. Covid had taken its hold and we had been confined to our house for the past three months, with no sight of change or the reintroduction of education. In the absence of formal schooling I needed to step up. I needed to develop and teach my son.

“Rhys. First writing then chocolate” I said once again, knowing that the reward needed to be big to get my son to even consider doing something out of the norm. The same response was returned, a scream of frustration and refusal to follow through in my request. 

I looked towards the bright digital display on the oven, I had been persevering for over twenty minutes, with not one of us willing to cave into defeat. I hadn’t introduced anything fundamentally new in months.Coping with everyday life had been the priority, but now things were going to change, we were going to push through. The first step was always the hardest, the introduction of a new routine or developmental need. I knew that this was the worst bit, it would get easier. I just needed to stay calm and strong.

I stood up and opened the cupboard, taking out a mini bar of Kinder chocolate, realising that the image of the chocolate wasn’t enticing enough. Sitting back down on the hard surface, I placed the book and pencil in front of me, and in Rhys’ line of sight. I then repeated my request, but with an addition to what we had last time. “Rhys, writing” I said pointing to the picture on my phone and then pushing the book forward in his direction, then I said the words “then chocolate” pointing to the picture on my phone, then holding the physical chocolate in front of me. Rhys saw his reward immediately, and lunged for it, but I was quick. 

“Rhys writing then chocolate” I said again, pushing the chocolate out of his reach and placing the pen in his open grasp. I then guided his hand to the page, and he traced over the letter ‘L’ with physical frustration and the anger from losing the standoff. Immediately I gave him the mini kinder chocolate. “Well done, writing finished, now chocolate”. 

Rhys consumed the chocolate in one bite.

It had taken forty minutes to get Rhys to trace a single letter in the book. 

Two hours later I was seated once again on the hard kitchen floor, my phone in my hand and the book in front of me. “Rhys, writing then chocolate” I stated, pointing to each picture in turn. With the memory and taste of the chocolate still in his month, Rhys took the pen and drew another ‘L’, then looked at me, “Chocolate” he said, and I handed him his reward.

Although a teacher or health visitor may not advocate the use of chocolate as a reward, that is where I have the advantage. I can bend these societal views and offer my son whatever reward will get us over that first hurdle. After those first few challenging days, I started to change rewards, to bubbles, or an icelolly. The length of time Rhys started to write extended over time through perseverance and consistency. 

That was five months ago.

I stood up this morning to get a cup of tea, and walking past the lounge I caught sight of Rhys sitting at his little table, pen in hand doing his writing. It had not been prompted by myself, a task he had gone and done himself. Those forty minutes, five months ago that I sat on the same kitchen floor, were worth every second to see Rhys this morning.

A change takes time. The implementation of a strategy takes time. Often it is painful and tough and moments of wanting to scream. But I hold that all inside, remain calm and persevere. Seeing my son independently taking himself to do writing, is proof that it is all worth it. 

Get your pictures out and try the First-Then strategy.

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Autism Strategy

The Car, The Stick and The Tennis Ball

I sat on the floor of the speech therapists office. She sat opposite and looked at me.

“It’s ok” she said.

It was Rhys’ speech and language session. The third in a block of four which we had waited six months for, but Rhys was not there. He had not been in any of the sessions, leaving me to sit alone, stressed and trying to think of a way to get him to come into the room. I could see him through the open door, he sat in the waiting room on one of the big blue sofa’s, his number flashcards in his hands, each one being moved as it was counted.”What is your biggest challenge at the moment” she asked.

It was such an open question. Everything was a challenge, and I had no idea of where to start or even articulate the complexity of our current situation, so I just said the first thing that came into my head, “I just want to be able to leave the house!”
It was the biggest thing for me, and the most simplest action for any other family.

“What is stopping you” she asked

“When we walk out the house” I started to explain, “Rhys assumes we are either going in the car, or sometimes up to the park, but we will actually be going across the road to the school. It ends up with him on the floor in meltdown, because he thinks we are going somewhere else”

“How do you let him know where you are going?””I tell him” I responded.
She looked at me and repeated a summary of our predicament. “So when you leave the house, there are three options. The park, the car or across to the school?”

“Yes, and I tell him where we are going, but he wants to go somewhere else”

“I want you to go home and get three objects. A toy car, something to represent the park, perhaps a ball and then something for school” she explained. “When you leave the house, take the object representing where you are going, and place it in his hand and state clearly where you are going”

As soon as I got home, I started searching. I found an old blue car in the bottom of a drawer, and behind the door I found a tennis ball, the perfect object for the park. School was difficult, and I could find nothing to represent it, so I settled on a colourful stick in the hope that it would work.

An hour later, I needed to walk across the road to collect my eldest from school. Ready for a full meltdown, I nervously bent down to Rhys’ level and placed the small stick in his hand. He grasped it, feeling the edges press into his soft palm.

“Rhys, school” I said.

I then took his hand and nervously walked out the house. He collapsed to the ground, the stick in his hand in the same way he did every day, but I persevered. I pressed his hand against the stick and stated “school”. It continued to be hard, but I continued with the process and over the next few days, the objects started to associate themselves with the activity.

A week later, I placed the stick in Rhys’ hand, stating the activity in the same way I had done everyday, “School”. He held the stick in his hand and looked down at its colours. I opened the front door, took his hand and we walked across the road and down to the playground. All the other parents stood chatting amongst themselves. I stood with my son, his one hand in mine and his other clasping the little coloured stick. He was smiling.

No one looked at us. They didn’t look because for the first time we stood calmly, both fully aware of the sequence of events. I wanted to stand up on the table in the corner and announce our accomplishment. I was beaming with pride inside. We had made it across the road, not a meltdown, kick or scream in sight.

Those three objects saved our lives. They helped me communicate with my son. We soon progressed to pictures, and still use pictures today in new and complex situations. But today we leave the house like any other family, announcing our destination verbally, with not a tear in sight.

I still have the toy car, the tennis ball and the stick. They were three objects that represented activities to Rhys, but today they are objects which represent so much more to me. They represent a breakthrough. The journey forward and finding a way to communicate with my son.

Click here to get a step by step guide on using objects of reference to engage with your child.

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