Wow, I had not realized it had been so long since I last posted! Our lives are FINALLY getting back to normal after the last week. Michael went back to school just this Thursday after being out for a week due to snow and ice. Nick was also out of therapy until Thursday for the same reason. Now, we are finally getting back into a normal routine. But, that will also change abruptly when Nick starts preschool next month! I am a little anxious to see how that goes. We had his evaluation with the school system yesterday. We met with a school psychologist,speech therapist,occupational therapist, and a few others that I simply cannot remember at the moment. They will determine how much help he will need in school and we have another meeting with them on Feb 2nd to discuss their findings. The OT already said that his motor skills are on the far end of "normal",so he does not see Nick needing as much help in that area. Tam,our therapist at the center he is at now,provided a wonderful report on him which I will share with you all.
REINFORCERS: (*=highly preferred)
Toys: *Anything that SPINS!(Does she know Nick or what??!LOL!),toys that light up,squishy balls(he used to hate those),bubbles,ball toys.
Activities: *SWINGING!,play-dough,art/magna doodle,singing songs
Social: *yelling "hip-hip hooray" with the motions,* playing peek-a-boo,singing songs and leaving out words for him to fill in,making his feet stomp fast,wiggling his arms,deep squeezes down arms(he has recently started squeezing everyone's arm-HARD!,fingers and legs
Food: *fish crackers, *cookies
OBJECTIVE: to use eye contact in play by alternating his gaze between his ply partner and the materials he's using.
PROGRESS: Nicholas will now consistently use eye contact to make requests when preferred items/activities are withheld;however,he continues to work on alternating his gaze during activities due to his inability to draw himself away from the toy. I typically have to get VERY low on the ground to get access to his eye-gaze,then cover the toy until he looks up,then I allow him access to the toy again.
Imitating with Objects:
OBJECTIVE: to copy the actions of others when told "copy me" or "do this" in order to gain the skill of learning through observation of others
PROGRESS: Nicholas has mastered one "set" of imitation (block in cup,figurine jumping,stack blocks). The current set includes actions with a doll(feed bottle,brush teeth,brush hair,hug)which he continues to work on. This less "discrete" set seems to be more of a challenge,although he is making some steady progress.
OBJECTIVE: to pick a toy,play with it appropriately for up to 3-5 minutes, and put it away independently
PROGRESS: Nicholas has greatly expanded his play skills since he began services. He initially would only pick up objects in an attempt to figure out how to make them spin. Now he is much more appropriate. He loves ball toys, is great with cause and effect toys,does a nice job with shape sorters and puzzles, and enjoys play dough and art quite a bit. He is becoming much more successful with pegs, beginning to put train tracks together independently, and is beginning to gain independence with pop-beads,gears,blocks,and more. He still needs support to stay on task in play and when cleaning up,but he has made very clear progress.
Picture Exchange Communication System:
OBJECTIVE: to exchange pictures with a communicative partner in order to express needs and wants.
PROGRESS: Nicholas is in Phase 1, exchanging with one picture on a page and doing very well. However, as his verbal imitation has improved,we have been focusing a bit more on using words.
OBJECTIVE: to match based on a variety of criteria when asked to "match it" or "find the same"
NOTE: Nicholas has learned to match nesting objects and identical objects that do not match. He is now working on matching pictures which seems to be more challenging for him than objects. We are in the process of trying a new strategy (combining nesting objects and pictures on the table at the same time).
OBJECTIVE: to imitate mouth movements/vocalizations when asked to "copy me" or "do this"
NOTE: Nicholas is spontaneously imitating words with much greater frequency as time goes on,however,he is not yet imitating on request. Thus,we continue to work on consistent oral motor imitation(raspberry sound,clicking tongue,popping lips,blowing) when asked in an attempt to get more consistent responding,while still encouraging word imitation and praising it energetically. He began with filling in the blanks with "1,2,3..."go!",then filling in the blanks of songs,and is now imitating a wide variety of words throughout our time together and according to parent report. He will benefit greatly from continued work on this goal with a shift to language used spontaneously to request preferred items.
Following Receptive Directions:
OBJECTIVE: to follow a direction when asked
NOTE: Nicholas responds well to "put in", "high 5", and "give to me". This was his first "set" and when his attention is gained he responds very well. However, if he is distracted by a light, sound, or other interesting thing in the environment, it takes some redirection to get him engaged and responding again(usually some motor/sensory activity). He is fantastic at following the direction "1,2,3 give it to me"...he will stop anything and hand the toy over, which is very impressive. He continues to work on "stand up","come here",and "clean up/put away",but has made nice progress so far.
Receptive Identification of Objects:
Objective: to identify an object among 3 when asked "show me____","give me____","point to____" etc.
NOTE: this is a fairly new program for Nicholas,however,it appears to be challenging for him. The primary challenge is to get and maintain Nicholas' attention,which shifts quickly based on subtle interests in the environment. If he is clearly attending he does well and shows progress. We are in the process of moving back to only one object on the table, then we will do two objects, and then back up to discriminating from 3 objects on the table.
PROGRAMS ON HOLD:
Signing to request: Nicholas learned to sign "more" fairly quickly,but had great difficulty learning/using other additional signs,we had also observed that Nicholas is a very visual child. This is why we moved to PECS and of course we were always emphasizing verbal communication.
Attending at the table:
NOTE: When Nicholas began,he was scared to be in a new place and in a room with a new person to the point he could not function beyond his fear. He would back into Dad's lap and only with careful shaping did we get him to a point where he was comfortable with new people and places,then we worked on sitting in a chair,which he now does very well. In fact, he prefers table time more than anything,so we are spending quite a bit of time on the floor when appropriate to encourage flexibility(as in routines).
As mentioned above,when he began Nicholas was very sensitive to new environments,toys,people,etc.. Once he bacame calm,he quickly became upset again if he had to move from one toy to the next,let alone from sitting to standing. Now, however,he explores and moves from one activity to the next with verbal directions just like a pro! He has made tremendous progress.
Tolerating New People:
Nicholas was vey upset by new people in his proximity when he began,but he now enjoys his time with his therapists,teacher,and peers quite a bit! Once he was comfortable in a one-on-one setting,he began playgroup and adjusted very nicely to being in a room full of peers,teachers,and parents. Again, he has come very far from where he began.
Nicholas is a smart little boy who pays close attention to detail. He now sits for adult led activities very well and his play skills have been coming along very nicely. He is also becoming much more socially tuned in to others,which has been a joy to be a part of. Nicholas has a delightful and highly contagious laugh and brightens up the room when he is excited. He also benefits from having parents who are very dedicated to learning strategies to carry over with Nicholas at home,and they are also wonderful at sharing information about strategies that they have found to promote Nicholas' growth.
Challenges and Recommended Supports:
Because Nicholas is very sensitive to his environment,it can be difficult at times to get and maintain his attention. One minute he will be very engaged and enthusiastic and the next he is looking off into space making some subtle observation that the rest of us can not always pick up on. When this happens I typically do motor activities to re-engage him(wiggle his arms,stomp his feet quickly on the ground,squeeze down his arms/legs) or I sing a song and leave off the endings of words. I will also sometimes re-engage him by doing a maintenance task(something I know he can do well) to establish behavioral momentum.
It has been a delightful experience to work with Nicholas and his family. He has made great progress since he began Bith-to-three and we are all very proud of him. I am excited to hear of his continued progress in the future.
Well, that is the entire report. Our plans for the day include a trip to our new WAL-MART! Yes, we are very thrilled!! It is about 10 minutes from our house and I just love having another shopping choice!