Monthly Archives: October 2012

Progress

Five weeks into home schooling and the main focus is still on Intensive Interaction. I’m aware, however, that our version of II may offend the purists. We tend to start the day with pure II, simply mirroring Henry’s body language and sounds, in order to engage him. But then, as the day goes on and his engagement increases we begin to introduce more demands, while still allowing him to lead the play. Most of these demands involve the prompting of speech. Henry is good at using language to get what he wants, but he has always used single words. He has been able to do this since he was four and in the six years since, although his vocabulary has widened, he hasn’t really moved on, apart from learning the phrase ‘ I want X please’ by rote, which he will gabble, often with the words in the wrong order, if pressed.

Although some of this is autistic pragmatism – why use four words when you can get what you want with one – much of it is bound up with Henry’s difficulties with sequencing. He has always had huge problems with motor planning, or executive function as it is sometimes called: the ability to organise actions or speech into logical order to achieve a desired end. It affects every area of his life, from playing with a train set to articulating a sentence. Using a prompting method, something we learnt when following an ABA programme, seems to help. In brief, you start with a full prompt (ie. helping him to do an action hand-over-hand) and then gradually fade the prompt, giving less and less help until he is able to accomplish the task independently. With speech, the full word or phrase is given, then gradually faded to an initial sound, a sign, a raised eyebrow and eventually, just a pause.

So, what we have ended up doing in some sessions is a kind of ABA-meets-Intensive Interaction hybrid, which will no doubt horrify some of the proponents of both approaches. How much of each approach we use in a session depends on how engaged and relaxed Henry is. There is no doubt that pure II gets him ‘in the right place’ for speech. But I feel that he also needs the prompting structure to help him to organise and articulate what he wants to say.

The short clip below shows Ellie, Henry’s new tutor, using this approach. It seems to be working, in that Henry is trying to string words together in a way he has never done before. Best of all, a number of people who’ve met him over the last week or so have commented that they find him easier to understand. I feel hopeful about his speech in a way I haven’t done for years. Exciting times.

Birthday

Henry was 10 on Friday and, as usual, his birthday was accompanied by a mixture of feelings – pleasure at the progress he’s made in the last year and a heightened awareness of the vast gulf between him and a typical ten year old. We started mentioning his birthday a few days before and, for the first time ever, this information got a response: ‘cake’. Being on a gluten, dairy and, until recently, egg free diet has meant that Henry has had the same birthday cake for six years – a hollow papier mache creation filled with sweets, made by his older brother and me from an Art Attack annual. It’s a bit Miss Havisham these days, but seems to act as an object of reference for birthdays.  On the morning itself, the cards, presents, banners and balloons were ignored as usual – on being wished ‘happy birthday’ he said ‘cake’ – so even though he was getting a real cake this year we dusted off the cobwebs and lit the candles at breakfast time.  The photo below shows another first – Henry trying to blow out the candles – even if it was from such a distance away from the scary burning things that it barely made them flicker.

Noisy – Part 2

We were in the car this morning when a rubbish truck rattled past.   ” Noisy!” Henry said. If you have watched the video attached to my last post, you will understand how happy this made me.

Henry has been speaking to request things since he was four. But that is all he has ever done with words. For him, it seems, language is a tool to get the things he wants – food, DVDs, games. We’re working on extending the barked commands – ‘ Toast! Thomas! Tickle! ‘ – to a more complex (and socially acceptable) ‘More X please’, which works because of the built in reward factor: you can withhold the request until the whole phrase has been said. But encouraging comments is much, much harder because it has no immediate pay-off. We can point at stuff when we’re out and sometimes, if he’s in a good mood, he’ll tell us what it is. But unprompted speech to comment on a sight, an experience, to share attention? Never. It’s a problem that’s been occupying me for some time – he has a very basic level of functional language, sure, but without comments it’s difficult to develop it into conversational speech. Yet the fact that he’s happy to engage in the gestural back and forth of Intensive Interaction, with all its characteristics of conversation – listening, responding, turn-taking – makes me think that it’s not lack of motivation and interest that’s stopping him making comments, as I had previously thought, but just not knowing how to do it. And maybe, just maybe, this is another way in which Intensive Interaction will help. I can’t wait.