Tag Archives: intensive interaction

Flexibility

A few weeks ago Henry’s tutor took him to the outdoor swimming pool, a place he loves. He starts saying ‘swimming’ the moment we put the picture on his visual timetable and this is continued at regular intervals, reaching a peak on the walk there, like a constant check that he’s actually going. On this particular occasion they arrived at the pool, Ellie helped him change and then looked in her own bag – to find no swimsuit. They had to pack up again, walk into town, buy a swimsuit in a crowded, noisy sports shop and walk back again. All of which Henry managed without a tantrum or a single head-hit.

I’ve told this story many times (apologies to family and friends reading this!) as it amazed me. Henry, like most autistic children, does not like plans to be thwarted. He is not a fan of shopping. He particularly dislikes waiting while people choose what they want to buy – any shopping trips with him are usually of the grab and run variety.And although he understands the ‘first X, then X’ formula, it doesn’t seem to make it any easier to cope with the prospect of deferred pleasure.

To be honest I thought it was a one-off, but in the weeks since this happened we’ve had more examples of an increased flexibility, an acceptance of unpleasant situations and a willingness to wait for the things he wants. So much so that I feel able to invoke the Bloggers Curse (write about a positive change and it immediately vanishes, never to return…)

Food has always been a potential flashpoint. Henry’s day is structured around his meal and snack times and, possibly because of blood sugar issues, he can get very agitated if a particular food is unavailable or a meal delayed. When he was at school his favourite word was ‘lunch’ – they heard it a lot. Two weeks ago we started going to the special school he will be attending in Year 7 for some transition activities, one of which is the midday meal. We arrived early and Henry immediately sat down at the empty Key Stage 3 table, looking expectant (and yes, repeating ‘lunch….lunch….lunch’.) As I was saying ‘ Let’s wait for the other children’, a TA told me that the students have set places and as she didn’t usually sit on that table, she couldn’t remember exactly who sat where. It was a dilemma, as neither of us wanted Henry to be upset at having to move, yet we didn’t want the pupils’ routine disrupted either. It was worth a try – “Let’s go and wait on the bench until the other children come in”. And he did. No problem. Definitely one of those proud mother moments.

At half term we experienced the ferry trip from hell when travelling to the Isle of Wight on a rainy, windy Friday: no seats, people packed into every spare inch of space , babies crying, a constant loud buzz of conversation, no electronic gadgets. He sat with us on our allotted three foot square of carpet in between the car deck stairs and the life-jacket cupboard and ate crisps with his fingers in his ears – resigned, not enjoying himself, but calm.

I am wondering at the reasons behind these changes. His sensory defensiveness has definitely decreased since we started home education – I am even wondering if its too far-fetched to suggest that all the ‘noisy’ games he loves have acted to desensitise him to sounds he used to find uncomfortable? Intensive Interaction has had a huge effect on his trust in us – maybe he’s prepared to prepared to wait because he is confident he’ll get what he wants in the end?

As I type this, Henry has just finished his lunch, which included a tiny portion of carrots, peas and sweetcorn – the first separate, non-disguised vegetables he has eaten for six years. I am giving him a piece of flatbread for every cube he swallows, but a few months ago this wouldn’t have made any difference – he would have ignored the flatbread and dropped the veg on the floor, or become very upset at not being allowed the bread on its own. He’s not loving the veg – far from it – but he’s prepared to give it a try to get something he wants. I’m hoping the love will develop!

It’s not all tranquility by any means, as anyone within 100 metres of a certain hairdressing establishment yesterday will testify. There are still some situations which Henry finds very difficult to cope with. But afterwards, when we went next door to the newsagents to buy his post-haircut bag of crisps and they didn’t have any ready-salted, he accepted my assurance that we would go to another shop without any fuss at all, despite the fact that he had been very agitated only moments before.

This weekend we are taking him to a wedding, his first ever. Watch this space…

all photos 234

Intensive Interaction at the Dentist

One of the huge benefits of Intensive Interaction was demonstrated to me this afternoon when we did our six monthly trip to the dentist. Henry attends an access dental centre which specialises in treating people with additional needs, but even though they’re infinitely patient with him, our visits tend to be swift, with the dentist getting a snatched look at his teeth at best. But this time was different. Instead of pacing the room before being coaxed onto the chair, he jumped on straight away and sat there nonchalantly swigging minty water while I talked to the dentist. Instead of assuming his usual rigid half sitting up ‘fight or flight’ position when the chair was raised he lay flat, grinning up at the dentist and her assistant. I knew what was coming. ‘Tickle my tummy’ he said. ‘Be noisy’. And to their credit, they did both. After that, opening his mouth was a doddle. Teeth were seen that haven’t been examined closely for years. I wish I’d had a camera with me, as it was a really joyous occasion – and how often can any of us say that about the dentist?

I’ve written before about how Intensive Interaction has made Henry see all adults as a potential source of entertainment and that was definitely part of what was happening this afternoon. But it has also helped him to trust and to relax. The familiar play routines seem to give him security in potentially stressful situations and he uses them socially, a bit like conversation, to gauge whether an adult is worthy of attention and response. To him, this afternoon, opening his mouth (and, crucially, keeping it open), rather than being an instruction imposed on him by a stranger, was part of the whole business of back and forth interaction.

iPad lad (with thanks to B’s Dad)

Henry brings me the iPad to show me a thumbnail photo of his brother watching television.”TV, TV” he says. I’m busy in the kitchen and say “Yes, Ned watching TV” in speech-therapy-approved-extending-the-phrase style but this isn’t what he wants. What he is pointing at in the photo, increasingly insistently, is a miniscule rectangle of green balanced on the top of a heap of similar tiny rectangles piled on the table beneath the TV. Helpfully, he grabs the iPad back, selects the photo, enlarges it with finger and thumb and shoves it under my nose again. If I squint, I can just about make out a video. Rosie and Jim:Trees. Of course, this, according to the Law of Things One is Asked When in the Middle of Cooking Dinner, is the one video that is no longer in the pile. We have Rosie and Jim:Puppets, Rosie and Jim:Hats and Rosie and Jim:Gingerbread Man, but none of these will do. I spend many, many minutes looking behind sofas and under beds and many, many more trying to explain that Rosie and Jim:Trees has disappeared, is gone, lost, not here, while Henry grows increasingly frustrated. It’s in the photo, therefore it should be here.

Despite the hair-tearing, this incident got me thinking about Henry’s use of IT and my thoughts were further stretched by a post entitled ‘The IT Kid’ on the blog ‘Life with an Autistic Son’ (http://autisticson.wordpress.com) in which the writer, ‘B’s Dad’, discusses his son’s obsession with computers. I hope he won’t mind me taking the theme and running with it for a while. Although our sons are at the opposite ends of the spectrum, much of what he writes hits me with a thud of recognition.

Henry adores his iPad. It is the first thing he asks for in the morning and he would happily use it all day if we let him. Before the iPad, it was our PC and before that, a portable DVD player, but neither had the ease of use and sense of control that the iPad seems to provide. He doesn’t play games, but has built up a vast library of bookmarked Youtube clips around which he scoots with dizzying speed. Each clip brings up a menu of alternative links, and he is able to navigate between these, sometimes jumping between six or seven screens before finally arriving at the clip he wants. There must be part of his brain that resembles a London Underground map, telling him that to get to Truly Scrumptious he has to travel via Trumpton and Tots TV, changing at Toyland and Fun Song Factory and finally alighting at Chitty Chitty Bang Bang. Each clip is also studied in minute detail, so that he knows exactly where to move the play bar in order to get to the moment when Thomas sneezes or the judge tells Toad he is sentenced to ‘another year for being green’. He’s also interested in the photo library, though not to anything like the same extent, tending to focus on pictures of himself eating chips and the aforementioned TV photo, but other than that, it’s YouTube all the way.

We have rules for iPad use – he only has it during the school day at lunchtime and isn’t allowed it after dinner in the evening. We’ve also introduced ‘iPad sharing time’ in the morning, whereby he engages with a speech therapy, colours or drawing app in return for a turn on YouTube, which we then watch with him. But there are still a huge number of hours a week when he’s glued to a screen. Like many parents, this makes me feel guilty, but there is perhaps more anxiety attached to the issue when you have a child with autism and speech delay, and particularly one who responds so well to therapies like Intensive Interaction. Every minute that he spends communing with YouTube is one less minute spent interacting with another person, one less minute learning about two-way communication, one less minute exploring the real world (and who am I kidding typing ‘minute’ when I mean ‘hour’?). Another worry is the fact that iPad use seems to increase stims, in particular a repeated, drawn out ‘ Eee-eeee’ sound which, not to put too fine a point on it, just makes him sound more autistic.

And yet and yet – it’s the only thing he can do independently with any degree of skill. His fine motor skills, so delayed in other areas, are precise and delicate when he’s navigating on screen. Listening closely to the clips he chooses reminds me of something I’ve always known – that he loves the sounds and rhythms of words as much as music – and that is something we can use in II sessions. It gives us time to do other, necessary, domestic stuff. It saves the TV remote from imploding. Apart from the fact that he still favours CBeebies and Hit Factory, his skills are more age=appropriate than in any other area of his life. And above all, what his use of the iPad demonstrates is his enjoyment of having something he can control, absolutely and completely, in a world where not much else is easily controlled.

Of course we’ve considered cashing in on Ipad-love to try using the device as a communication aid, but Henry absolutely refuses to have anything to do with Proloquo2Go or any of the other talker apps we’ve tried. It’s the old story – anything he wants, he learns to say or finds a way to show us, as the ‘Rosie and Jim’ incident demonstrates. It’s not something we’ve ruled out though and although we’re following the speech therapist’s advice to concentrate on developing his spoken language at the moment, it’s something we’ll revisit. Unfortunately, I think we’ll need another device – one without Youtube!

A question of age

We had another speech therapy review earlier this week, with two therapists this time, and again it was a very positive experience. Henry was hugely excited at the prospect of having four adults to play with and was throwing all the words and phrases he knows at us to keep it going. The therapists were delighted with his progress and full of useful ideas about how we can capitalise on his increased desire and ability to speak.

One thing that was said brought me up short, however. ” You have to consider,” said one of the therapists, ” whether ‘tickle my tummy’ is an appropriate phrase for Henry to be using with people outside the family. ” She pointed out that this was the very first thing he’d said to them when they entered the room and I had to agree that, at the moment, it does seem to be his greeting of choice. Henry has always been quite discriminating in the way he approaches people, reserving familiar games and routines for those who he sees often, but since we’ve started home education, and in particular Intensive Interaction, he does seem to feel that everyone who visits the house is coming with the express purpose of entertaining him. And when the man who’s come to service the Aga is asked to ‘tickle my tummy’ it’s probably time for a rethink.

So the therapist’s comment has got me musing about the issues that arise when you have, in effect, a three year old in a ten year old’s body. There’s the obvious matter of social appropriateness, but there are other things to consider too. Should we be attempting to ‘age up’ the games we play, the books we read and the songs we sing? At the moment one of Henry’s favourite pastimes is to stick his foot in your face and demand ‘This little piggy went to market’. That’s a SIX WORD PHRASE and even if he’s not quite saying all the words (it comes out as ‘tikka piggy a market’) it’s still one of the longest speech sequences he’s ever been able to produce. Steven Wertz of Growing Minds, who we used to work with when Henry was younger and whom I respect and admire greatly, is a proponent of making the game fit the actual age of the child and I can see his point. Henry is much more likely to make friends of his own age by being able to kick a ball back and forward than by shouting ‘be noisy’ at them, by wanting to listen to Cee-Lo Green rather than CBeebies. And then there’s the thorny question of social rules. Henry has become very demanding of attention, shouting ‘stop stop’ if I’m on the phone or having a conversation with someone else. He wants to play his games over and over again and although he understands the concept of ‘one more, then finished’, he often becomes distressed and angry at the prospect of stopping. In effect, he wants Intensive Interaction much of the time, and while this is great, it doesn’t always work when a friend has come round, outside school hours, wanting coffee and a chat and finds herself coerced into spinning madly in the middle of the sitting room instead. Of course, this demanding of attention is a stage that most typically developing toddlers go through, but whereas I’d be teaching an NT three year old to wait, not to interrupt and to play independently, the desire to interact is something that we welcome, quite literally with open arms, in Henry’s case. Of course I want him to learn social rules but at the same time I’m very keen not to smother his new-found joy at being able to connect with other people. If you ask him to wait he won’t sit and join in the conversation or play on his own nearby – he’ll disappear upstairs with the iPad.

So, it’s a puzzle and one we have to mull over in the next few weeks. Teaching him who he can ask to tickle his tummy is the easy bit. Extending his vocabulary will help too, as he is often using ‘tickle my tummy’ to mean ‘play with me’ in the same way that he uses ‘be noisy’ to mean ‘talk to me’. But how do we teach him that he’s not always the centre of the universe when his II sessions are telling him the opposite?

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.

Remembering Mum

I was looking through some old video tapes over the weekend and found this, from five or six years ago. My mother was a wonderful playmate for children and Henry was no exception. She had the gift of being able to enter into the child’s world and never seemed to get bored: the perfect Intensive Interaction partner.  It would have been her 77th birthday today so I thought posting the film here would be a fitting tribute, as well as demonstrating how important play has always been to Henry’s communication.  Happy Birthday Nanny – we miss you.

Talking

We had a visit from a new speech therapist last week. One of the purposes of her visit was to assess Henry for an AAC device (an electronic talker). It’s something we’ve been considering for a while, ever since a friend of mine started blogging about her son’s amazing progress using a device called a Vantage Lite, which uses a system called LAMP (Language Acquisition Through Motor Planning). Even though Henry has some speech, there are a number of  reasons why he might benefit from such a device: it could make his speech clearer to others, help him with word retrieval and possibly also help him to sequence  words into longer phrases and sentences.

Henry was on talkative form that day, grabbing the speech therapist’s hand as soon as she came through the door, pulling her into the sitting room and demanding tickles and ‘fast running’. She was obviously quite surprised, saying at one point that she had ‘ been expecting a non-verbal child ‘ and commenting positively about his intonation, imitation skills and obvious desire to communicate. For someone whose child had been described by one teacher at school as having ‘no functional language’ you can imagine this was music to my ears. Her advice was to delay a decision about an AAC device for six months, as she felt Henry may be on the verge of a ‘language explosion’ ( more music, a full symphony orchestra this time). We agreed that there are barriers that he has to overcome: difficulties with word retrieval, some consonant blends and sequencing (syllables and words) but that the main hurdle of old, his motivation to speak, is gradually being overcome by Intensive Interaction. I’ve written before about how his speech is confined to requests, but II is helping to extend those requests and also seems to be encouraging him to comment. We’ve had many repeats of the descriptive  ‘noisy’ I wrote about a few weeks ago and we now also get a running commentary at meal times – ‘chips….drink….sausage….chips’. When he started doing this we responded with a slightly irritated  ‘yes, look, your chips are there’, assuming that he was requesting as usual, but quickly realised that he was telling us, not asking. We now say ‘ Mmm chips, yummy’ and he repeats ‘yummy’ and carries on tucking in.

The speech therapist gave us some ideas for how to further extend Henry’s vocabulary and length of utterance within his narrow range of interests. Some of it we already knew, but had become lazy about: not letting him get away with using ‘toast’ to mean both toast and bread, insisting on the phrase ‘I want X please’ instead of just running to fulfil his single barked commands. Other ideas we had never used, for example, the use of scripts to accompany favourite games and other requests, the labeling (with a named picture) of items around the house. She advised us to ban questions that demand unmastered vocabulary as much as possible, concentrating on giving choices instead.  ‘Is this a sofa or a chair?’ is much easier to answer than ‘What’s this?’  as the correct word can be picked, rather than dredged up from memory (when his most frequent response was not ‘sofa’ but  ‘so far away’ !) Above all, she affirmed the growing confidence I’ve been feeling about Henry’s verbal potential.  The motivation to speak is now there, and we need to work as hard as possible on giving him the tools and the practice he needs to do it.

The video below shows Ellie working on a number of scripts with Henry, attempting to turn ‘blanket’ into ‘come under the blanket’, ‘ noisy’ into ‘Ellie, be noisy’ and ‘tickle tummy’ into ‘I want you to tickle my tummy’ (we’ve since changed this to ‘ tickle my tummy please’). She does this by modelling the phrase, then giving a prompt. It’s early days, but he’s definitely getting there. Happy Christmas everyone.