Category Archives: speech and language

Brotherly love

One of the biggest differences since we started Intensive Interaction with Henry has been his increased ability and desire to play with his older brother. Although there are only sixteen months between them in chronological age, the huge developmental gap has meant that shared activities have been difficult to find. Henry has always been keen to play with Ned, but his lack of ability to express this in a way clear and  forceful enough to get his brother’s attention has meant that chances slip by. Now he can demand a variety of games, he does so frequently. The video below  is a short extract from footage shot a few nights ago which shows how much easier they both find it to play. Not only has Henry learnt to ask for what he wants more effectively but also he responds to cues from his play partner rather than simply issuing demands. And Ned is learning about tuning in to his brother and following his lead – all great Intensive Interaction strategies.

The more challenging side of this progress is that Henry has become more demanding of attention at all times, to the extent that he finds it difficult to cope if, for example, I am talking to another adult, or Ned is engrossed in DS or iPhone when they are in the back of the car. At the moment his reaction is to shout ‘stop’ repeatedly, or to lash out physically, and whereas I can (most of the time) ignore the behaviour or tell him ‘no’ calmly, it is much more difficult for an eleven year old who is being hit and pinched. Any suggestions would be welcome.

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Fridays

I’m aware that I focus on the successes in this blog and, in doing so, am guilty of skewing the picture  – giving the impression that all our days are filled with happy interactions and signs of progress. Readers who have children with autism will already know that this is unlikely to be the case. I’ve also come to recognise a strange phenomenon – the more that one trumpets a particular success, the more likely it is to turn round and bite you on the bum. A few days ago I wrote a proud post on Facebook about our successful visit to the shoe shop, during which Henry had waited ten whole minutes to get measured, had submitted calmly to the foot gauge and had only needed minor Haribo bribery to try on two pairs of shoes. The fact that they didn’t have his size in stock was a small irritation: I ordered a pair on the internet to be collected in store and received a text message to say that they were ready to pick up today, Friday.

Fridays have always been difficult since we started home ed. From Mondays to Thursdays Henry has a timetable – child-centred maybe, but a timetable nonetheless. I teach him Mondays and Wednesday mornings, Ellie on Tuesdays and Thursdays, Jackie on Wednesday after lunch. We do home-based activities in the mornings and go out in the afternoons. I wanted Fridays to be different – more spontaneous and flexible ( I can hear parents of autistic children everywhere laughing like drains as they read those two adjectives). Some things would be constant – popping in to the local special school for play time to give him some contact with other children, and a lunch time visit to MacDonalds, but other than that we would look at the weather and decide on the day. I have also to admit that I use Fridays to catch up on jobs that need doing, labeling them ‘life skills’ to make me feel better – posting letters, shopping, returning library books. Collecting shoes…

It doesn’t really work to be honest. More often than not on a Friday afternoon I’m left with a  sense of dissatisfaction, a feeling that Henry hasn’t got enough out of the day. Perhaps it’s because it’s winter: playgrounds are full of cold hard iron; parks grey and mushy. Anywhere offering indoor play is stuffed full of scary two year olds. I have a sneaking suspicion that I’m not much good at spontaneous and flexible either, at least not when it’s below 5 degrees.

So today we went to school, where Henry played happily. The problems started when we drove to town. It took twenty minutes to persuade him out of the car and even longer to coax him the 200 yards to the shoe shop. The queue was eight people long. At that point I should have turned and left, but, Monday’s success still in mind, I tried to join it. The way he lost control was sudden and frightening in its intensity. I’ve spent the last ten minutes typing different descriptions of how he hit and pinched me and am uncomfortable with all of them – it seems disloyal, somehow, to lay it all out in public. But of course that is what happened in Clarks, under the gaze of what seemed like hundreds of tutting women, who only saw a ten year old boy attacking his mother and probably didn’t register the fact that, in between the hitting, he was crying and saying ‘big hugs’.  I persevered and got to the front of the queue, only to be told I should be in the other Clarks shop. The shoe collecting was abandoned.

I can see many possible reasons why this happened, hindsight being a wonderful thing. I hadn’t put ‘shopping’ on the visual timetable. One of my friends suggested that Henry probably didn’t understand why he was going back to the shoe shop, having only been there a few days earlier. I did explain, but it’s pretty obvious that he didn’t grasp the meaning of  ‘collecting shoes’ or any of the five other ways I tried to explain it. There may have been something about the sounds or sights or smells of the shop today that made him anxious. Whatever the reasons, it left me shaken and Henry sobbing. I was in a dilemma about MacDonalds, feeling that taking him straight away would reinforce the behaviour, yet loath to end the morning on such a negative note. Luckily he walked back to the car cooperatively, though still crying, and even said ‘sorry’, so we went to the drive-through and peace, of sorts, was restored with the first chip. I say ‘of sorts’ because he has not been himself for the rest of the day – heavy-eyed and pale, as if exhausted by the ferocity of his emotions.

Next Friday I will do things differently. I will plan and prepare and read the signs of anxiety better. I’m also wondering how Intensive Interaction practitioners deal with meltdowns. All suggestions will be gratefully received.

An Inspector Calls…

I know that many parents of children with autism will be familiar with the scenario I’m about to describe. You talk to a professional about your child’s abilities or behaviour; they then meet the child who proceeds to act in a way which bears no resemblance to your description. I can’t count the number of times this has happened to us.  I’ve assured speech therapists that Henry is verbal, only to have him fail to utter a single word in their presence. I remember an Early Years specialist who raised her eyebrows in a faintly pitying expression when I told her that he enjoyed playing, then tried rolling a ball to him. He didn’t just ignore her and the ball – it was as if neither of them existed. And on the other hand, I’ve sometimes warned doctors that he is likely to react badly to certain procedures, only to have him hop up onto the couch and lie down, smiling sweetly. I’m not sure if I’d rather be seen as deluded or over-anxious but I know that a scribble in the margin is possible either way.

We had our first visit from the Elective Home Education Officer this afternoon. She wanted me to talk about our programme and how Henry is progressing, which I did, describing how his speech, social and play skills have improved since September. Henry then came in from the garden where he’d been playing with Ellie and – to my enormous surprise – proceeded to demonstrate everything I’d been talking about: interacting with Ellie, requesting things, trying to get my attention by saying ‘Mummy’, asking the EHEO to tickle him and treating her, not like a stranger to be ignored or got rid of as soon as possible, but as an adult who was very probably going to add to his afternoon’s entertainment. She was charmed and pronounced herself ‘more than satisfied’ with the way things are going.

Now for speech therapy on Thursday…

Splash

Something momentous happened last night. It’s the sort of thing that parents of typical children wouldn’t think twice about. To be honest, until it happened, I hadn’t really registered that it hadn’t ever happened before. Henry was getting out of the bath when he suddenly looked at me, grinned, reached back over into the bath and splashed me, laughing. I said, mock-annoyed, ‘Did you just splash me?’ and he laughed again and touched my wet jeans, saying ‘Splash, splash’.

As those of who who read this blog regularly will know, Henry loves to play. But the focus of his play has always been to get someone else to do something to or for him – tickling, shouting, running fast. This is the first time I’ve ever experienced him initiating play by doing something to someone else and it feels like a huge step forward in terms of his social awareness.

We have our first visit from the elective home education officer tomorrow. The purpose of the meeting to to discuss our approach and the curriculum we’re following. I am really hoping that she will recognise the positive effect that Intensive Interaction is having on Henry and value, as we do, his progress in social, play and communication skills, rather than focusing on the fact that formal teaching, for the moment, takes up very little of our day.

Hammock

I haven’t written much about sensory integration therapy on here as yet, but it’s certainly something that benefits Henry hugely. He seems to crave swinging at the moment, in particular swinging on the hammock in our garden. The clip below shows how this seems to help enable his speech. Occupational therapists would explain this by saying that the vestibular feedback he gets from the movement helps to regulate his sensory system and organise his brain, including the speech centres. Others might say that he’s simply having fun and that this is motivating him to speak. Whatever the reason, he’s certainly having a good time ordering me around!

Half term reflections

Last day of the half term holiday today and time to look back on the first eight weeks of home schooling. What have I learnt, and what, more importantly, has Henry?

First of all, ignoring everything I learnt as a teacher, I set far too many targets. According to my home-grown IEP, he should now be able to dress and undress independently, swim a few strokes without armbands and be able to read his own name and those of family members, as well as about twenty other things, none of which he can do consistently enough to justify ticking them off. None of the targets were unrealistic, but what I didn’t take into account was the huge effect of  the environment on Henry’s learning. So even though he was beginning to swim without floats in the open-air pool in the summer, changing to the covered pool with all its echoes and humidity meant that even getting him into the water was difficult for a few weeks. Dressing and undressing skills? I’d forgotten the annual challenge of  wearing long sleeves. We’ve got past that one now, but it meant that independent dressing has had to be abandoned for a routine of coaxing, cajoling and massage to reduce skin sensitivity. I had always known that he doesn’t make progress in a linear fashion but being with him all the time has made me aware of just how erratic his learning can be. One day he can read all our names without difficulty; the next he struggles to pick out his own.

Despite this, there have been some huge successes. One of the areas in which Henry has made real, definable progress has been in speech and communication. He is now using two and three word phrases to request some activities (name+activity+ please if you’re lucky). He is much more demanding of adult attention (sometimes a mixed blessing) and actively seeks out play even at times when he could be watching his beloved YouTube clips on the iPad. His ability to read  facial expressions and gestures has improved too. Sensory defensiveness has lessened, in particular his ability to tolerate the sound of crying. He is much more able to wait patiently for the computer to load, and to cope with frustration when it goes wrong.

And so I’ve come to recognise that targets have to arise organically, out of what actually happens, rather than what I want to happen. His new communication skills and love of play have developed as a direct result of Intensive Interaction, or rather our peculiar II/ABA mash-up, which involves getting him engaged and involved through II type play, then throwing in short bursts of learning activity which are rewarded with more II (and sometimes crisps). Sensory play (in particular the’noisy’ game) has helped to regulate his ability to process sensation. The child-led nature of the school day has made both of us calmer – I am more prepared to take time, to wait for him to follow an instruction or engage in an activity, and Henry, as a result, is much more compliant and less likely to hit out when things don’t go his way. Our targets for the next half term are fewer and build on the progress he has already made. It would be great if, by Christmas, he could be using the ‘name+activity+please’  phrase to discriminate between different people. At the moment he has a tendency to rattle off ‘Ellie sit down’ or  ‘Ellie tickle tummy please’ no matter who he’s addressing ( a bit like a toddler calling all animals ‘doggie’) although he often uses the correct name when prompted.

Finally, I have learnt that home-schooling is bloody hard work. It came home to me a few weeks ago, when Justin and I had a rare child-free weekend away. It’s always odd to be without Henry – the absence of the feeling of being constantly vigilant has tended, in the past, to make me feel slightly uneasy, as if I’ve forgotten something. But walking along the Cobb in Lyme Regis made me realise that the hyper-aware feeling is something I now experience nearly all the time – and it wasn’t until I felt its absence that I understood that fully. Being tuned into someone else all day is exhausting and, despite the fact we have a huge amount of fun I don’t always do it well – there are days when I’ve been driven to distraction by his refusal to wear a particular T-shirt, bored silly by endless demands for tickles. Thank goodness for the wonderful Ellie, who never seems to tire of tickling, running around the garden ‘fast’ or shouting at the top of her voice, for Jackie, our lovely respite worker, who gives me two hours on a Wednesday afternoon, and for Justin, who takes over the role of playmate at evenings and weekends. I’m aware that I always write ‘I’ in this blog and that this is unfair – I couldn’t possibly do it on my own.

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.