Category Archives: executive function

Summer term

First days are always difficult. Henry has spent the whole of the Easter holidays doing more or less what he likes and any sense of routine has been pretty well absent. But this first day has been made much easier by the arrival of a visitor we haven’t seen much of recently – the sun. Being trapped inside by rain, wind and cold for much of the last five months has been depressing, but it has also deprived Henry of one of his most important sensory activities: trampolining. Of course it’s possible to trampoline in winter, but he hates the dead leaves, the dirt, the pools of water that collect under the surround and ambush your feet as you jump. He’s a fair weather bouncer and so this weekend has been the first time he’s been on in months. Today we spent a long time on the trampoline together and I remembered why I love it. Henry managed to imitate a sequence of actions (clap, touch knees, turn around, seat drop) that he would find difficult on ‘dry land’. He’s been struggling with the speech therapy pronunication exercises we’ve been given – consonant blends with ‘s’ and three syllabled words – but ‘sneeze’, ‘snow’ and ‘snore’ came out perfectly while bouncing and saying ‘tram-po-line’ with a jump on each syllable seems to help his articulation too, as well as being a lot more fun than simply repeating it. Eye contact and engagement were great and we had lots of spontaneous speech as well as the ‘drills’ – ‘Mummy sit’, ‘jump high’, ‘lie down’ (I needed that one) and ‘get out’ (when the cat had the temerity to try to join in).

The sensory feedback Henry gets from this type of activity is described by occupational therapists as ‘proprioceptive’ and ‘vestibular’. Proprioception governs motor control and posture and works with the vestibular system, which keeps the body balanced. Together they provide a sense of where the body is in space, an orientation of oneself in relation to the world. Trampolining, which requires constant adjustments of balance, posture and muscular effort in order to stay upright and bounce rhythmically, is a brilliant way to get these systems working in harmony, enabling my son, who cannot jump off a chair, climb a ladder or balance on a beam without support, to do the most effortless and graceful seat drops. As I’ve written before (Hammock, November 2012) being physically regulated also seems to help organise his brain, including the speech centres. And it also makes him very happy and calm. We went into town in the afternoon and he queued patiently behind two people in Next, managed to walk out of a charity shop without melting down because they didn’t have any DVDs he wanted and, having pointed at a Twirl bar in Smiths that was well within grab-unwrap-and-stuff-into-mouth-in-seconds range, accepted without complaint that he couldn’t have it ( I’m not mean; he’s allergic to dairy). Summer, I love you. Please don’t go away.

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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.