Time for a New Schedule!

Samuel has been using the same visual schedule, slightly modified over the years, since he was six years old.  I always had it as a goal to get him to a new schedule system by the time he was age twelve.  Well, now that age twelve has come and gone, it ends up that I have not yet attained that goal.  Samuel turned thirteen a few weeks ago.  Today, as I was prompting him to go check his schedule he turned to me and said just as matter-of-factly as he could, "Mom, I'm thirteen years old now, leave me alone!"  Definitely time for something new, my boy is growing up!

Reminder Boards! A Type of Visual Schedule

Besides the wall schedule Samuel uses, we also make use of "Reminder boards"  These are 6" X 3" laminated pieces of poster board that we use in order to help keep him on task, while minimizing verbal prompting. (Two psychologists, Lynn McClannhan, Ph.D., and Patricia J. Krantz, Ph.D., of the Princeton Child Development Institute, did a 10 year study regarding the teaching of independent behavior in children with autism.   I highly recommend their book Activity Schedules for Children with Autism.  This is a great book to help parents understand why acitivy schedules are helpful and the importance of correct prompting.  If you look this book up you'll notice there is a more recent edition as well.)

These first two reminder boards help him during his school work. They sit on the table along with the third board showing what subjects he will work on at that current "session" of work.

(This "reminder board) prompts him to get his pencil box, and then put it away when we are finished.)

(This reminder board is to help him remember what his physical demeanor should be during "work time.")

(This shows what tasks he will complete during that session of "work time."  There is space for 5 activities, but I learned early on that trying 5 at a time is not optimal, even though the amount of work he does is quite minimal.)

It can be cumbersome to work with all 3 of these reminder boards at one time, and this does not even include the maneuvering of his papers and books on the table as he does his work.  Also, I had forgotten that initially I was maneuvering not only all of this, but also a token board and small edible rewards!  I haven't needed those in a LONG time!  I try to stack these boards one on top of the other so that not as much space is taken on the table.  It took weeks and weeks for me to figure out how to manage it all.  It took months after that for me to see the benefit of using these. If his attention wanders during school work now, all I have to do is remove his papers or books.  That action seems to serve as a prompt to draw his attention back to his work.

This next board is one I made up to use at church.  We have been using it for almost four years now.  I have found it difficult to use because of its large size, but have kept it as is.  In the coming months I may try to change it.  He has recently taken interest in a "sensory story" about going to church that we got from one of his past Occupational Therapists.  I have done several posts about Samuel's church behavior.  I'll post more about it in the future.  I am doing my best to juggle my desire for him to attend church with us, the reality of his ability to participate, while minimizing the disruption that his behavior might be to others sitting around us. 

 

This last reminder board is for when we eat at the table.  Teaching Samuel to chew with his mouth shut has been very difficult.  After watching him for a while, I realized that he seems to not be able to breathe through his nose while he is chewing food.  A speech therapist we saw for a while was starting to help me work on this, but we had to stop seeing her because of his behavior difficulties.  The therapist recommended that I take him to an ear/nose/throat specialist, which I will do one of these days!  In the meantime, the reminder board is effective for short amounts of time. 

You may notice in the photos that these reminder boards are well used and worn.  Some of them have been around for 3 or 4 years now!  I am in the process of re-doing some of these, and am finally getting around to making "reminder strips" to break down some of Samuel's self-care tasks.  In trying to answer another mom's questions about getting a visual schedule started for her son, I came across this website that has given me some ideas.  I'll post about these as soon as I can!

In recent weeks Samuel has taken a lot of interest in these reminder boards.  He gathers them all together and talks about them.  He even put together his own board about what he should do when he goes shopping!  (Long ago I had made a "fill in the blank" schedule piece.."When I _____________ I should ___________."  It has sat unused in his schedule binder, but now it's there to work with!) I'm trying to take advantage of this interest he has!

I would love to hear comments and suggestions from others about these, and about what kinds of visual aids you use to teach your children.  The development of visual schedules is time consuming and the progress can be very slow.  However, I have found them to be very helpful. Some challenges we still face regarding them:  moving forward to the point where Samuel is more independent in following/creating them and getting the school to use what we use.  (They use visual aids, but not like mine, and I don't think he has his own.. he uses what the entire class uses.  Also, I'm not sure if teaching staff understands the importance of minimizing verbal prompting..)

Walmart and Life Skills/Social Skills Training

My husband and I are doing our best to continue taking Samuel out in public in spite of the chance that he may "melt down". When I take Samuel out I bring along some kind of visual schedule for him to follow. These visual schedules have had various forms over the years. The current one I like to use is a checklist of the broad activities we plan to undertake at our destination. I can just write it out on paper and carry it on a clipboard with a pen.

These days, Walmart is proving to be a great place to take Samuel. I am able to take him there about once a week. Our first trips there had to be very short on getting "my things" done, followed by an opportunity for Samuel to do his favorite thing.. look at the DVDs. (It took him a while to understand and accept that Walmart no longer carries VHS tapes!)

Yesterday morning I had planned to go to Walmart early in the morning. I had a relatively short list of things to pick up, but it was a longer list than I usually have when I take Samuel. However, it had been a while since I had taken him and I knew that taking him would be a real treat for him, so I woke him up and gave him the good news. Talk about a good motivator to dress himself!

Here was the checklist he had:

-Shopping

-Look at Electronics (just looking at DVDs isn't enough anymore, he has broadened his tour to laptops, Blue Ray players, and cameras)

-Pay (stay with Mom, no running around!)

-Look at the Red Box DVD machine on our way out the store (by that time I'm usually more than ready to leave, but giving him a chance to look at it at the end saves me from getting stuck at it when we walk in)

While we are there he gets to work on his social skills (it's okay to say hi to others, but don't ask them what year they were born or what their phone number is, walking down the aisles instead of skipping and running!), life skills (finding groceries, properly placing them in the basket, being patient while Mom has to look for boring things like canned vegetables and toilet paper, one of these days we'll get to paying...), and some OT-related things (pushing the cart, looking where you are going while pushing the cart, not crashing into other people while pushing the cart, not crashing into the shelves and displays while pushing the cart).

Other challenges we face right now when taking him out, besides the ones I just mentioned, are to keep him from manipulating us into getting him all kinds of snacks and sodas. The soda one is particularly difficult. He goes straight for the little coolers right by the cash registers when it is time to pay and gets very close to melting down when I tell him no. Soda is something I try to save an incentive for doing well at his OT sessions, and we allow all the kids to have it with dinner on Sunday.

Tell me about your experiences taking your child "on the spectrum" out in public and how you are teaching him or her!

Waiting, an Important Strategy

I cannot believe that after having this blog for more than a year I am only just now talking about what has become a very important strategy to promote Samuel's independence in following his schedule: waiting.

When Samuel was younger my method for getting him to comply was to simply carry him around or drag him to what we were doing. I had tried using a visual schedule with Samuel before we had in-home help, but I did not understand what had to be done to get him to follow it. I did not understand that I needed a reinforcer (an incentive), and I did not know about using "waiting" as a strategy to get him to comply.

I saw this strategy used by the first in-home helpers we had. I watched, almost three years ago now, as they would "wait Samuel out" when he would flop down on the floor, or go hide on my bed. Samuel would be expected to do what was next on his schedule and if he refused, well then he was ignored until he decided to do what was expected. I cannot remember now exactly how long they had to wait, but I believe it was upwards of a half hour at first. It was amazing to see him eventually cooperate.

It was very difficult for me to ever try this with Samuel while he was in school, time was pretty tight and I had three other children (including a young baby) to take care of. One of the first tasks I used this with steadily was while helping Samuel with his homework last year. It was tough. There were nights I couldn't start homework until almost 7:30 or 8:00pm. I would pray that Samuel would cooperate, but often he did not. When this happened I stopped talking to him and would tell him to let me know when he was ready to work. I know we had some hour long sessions. I made sure that I had something very reinforcing, like a snack or computer time, scheduled for the next activity. You get to a point with your child when you realize that you cannot drag them into what they are expected to do and you cannot force them, they have to decide for themselves. That is what the strategy of waiting is all about, letting your child learn that he has to decide for himself that he has to do what is expected. There were nights we had ridiculously late bedtimes, but it was worth waiting because eventually he would do his work.

It is much easier to wait Samuel out now that we have Samuel at home. I often have to wait for him while he is at the table to do school work. There are times I wait more than 30 minutes for him, but this is happening less frequently than it used to. I have tried to schedule the time I spend with my other children in such a way that it is not a catastrophe when I have to wait for Samuel. Waiting at the table means that I have to stay in close proximity to him, so he won't run off or start grabbing things off the shelves behind his chair. There are times that I have to move Samuel up to his bedroom to finish a session of school work so that the other children can watch a TV show they like to watch. Over time, he is getting better about doing his work, however.

Getting dressed is another time that I often have to wait for Samuel. I don't have to stay in his room with him most of the time anymore. He will eventually get to work. Recently it has been nice to have him go through his routine all on his own. He does so better some mornings than others, but at least there is a good pattern going.

I remember the in-home helpers telling me that eventually Samuel would realize that it's just easier to do what is expected so that he could get to the "fun" thing scheduled afterwards! It's great to see this happening more and more! I'm glad he is discovering this and I don't have to try to physically maneuver him around so much.

"I Don't Want to Do Five Things!"

We're slowly returning to our "normal" school routine, the one we had before we left for our vacation. Our first week back I unpacked, last week we had visitors and it was Samuel's birthday, and yesterday I had to take my daughter for a doctor checkup. So, today was one of our first days back to work!

I made up an ambitious work schedule to start Samuel's morning. I had his token board ready with the reinforcer of raisins after each time he earned four tokens. I figured Samuel might balk at the schedule and, sure enough, he did. He pulled out his negotiation tactics and said, "I don't want to do five things!" I wasn't about to bend first thing in the morning so I replied, "Yes, you are going to do five things, they're easy things!" I knew I was stretching things a bit for Samuel. We often start the morning with only 3 or 4 tasks. My goodness though, he got to sleep in this morning and I gave him some TV time before breakfast, he needed to be challenged a bit! I had to coax Samuel here and there, and had to wait him out a bit, but he got through all five things!

Challenging Samuel in his negotiations doesn't always work. In this case if it had not worked out and he had a meltdown, I would have sent him with his personal attendant up for a "break" in his room. Taking a "break" was a strategy introduced to us by the in-home helpers we used to have. It is a means of letting Samuel cool down a bit before he returns to the task that he is expected to do. A "break" icon sits up in the corner of his visual schedule for him to remove whenever he needs one. We had to teach him how to remove the card (we would model for him, "I need a break," hand-over-hand have him remove the card, and assist him in going up to his room).

The going was a little rocky this morning, but I was happy he got through the work without requesting a break! Five tasks, that's great for first thing in the morning!

"Awesome Day"

The title of this post was in the subject line of an e-mail from Samuel's special education teacher yesterday afternoon. I like seeing those kinds of words as opposed to "behavior log" ! Samuel did not script at school yesterday! He is given some time to do so during breaks, but during class time he did not! His aid mentioned the good news to me when I picked him up and I was just logging on to e-mail Samuel's teacher to ask her "Did you do anything differently yesterday?" Her e-mail to me asked the same question!

I find that when Samuel has had a good day I start analyzing it very closely to see what details must have contributed to the "good" results. Eventually I end up remembering that I need to give things a few days to look for patterns and trends in these "good" things. I also try to remember that sometimes, no differently than for you and me, Samuel just has a "good day". Yes, it's helpful to know the things that contribute to it, but I shouldn't analyze it to the nth degree thinking I'll be able to duplicate all the conditions on another day. It doesn't work like that for Samuel and life doesn't work that way for me either (as much as I want it to sometimes!).

While the scripting challenge has been with us for a little while, around that challenge good things are happening. Samuel's handwriting has improved remarkably. At the beginning of the school year it was a struggle to get him to write lower case letters. Now he is doing so without prompts most of the time. His letter size has also gotten much better. He is also starting to share his thoughts verbally with us. Sometimes he is teasing us, saying things like "Mommy, I'm going to script "Cyberchase". He tells me this with a grin on his face. Other times, however, he tells me about something he did at school. He told me yesterday "Mommy, we are going on a trip tomorrow." I asked him "Where are you going?" and he told me "On a egg hunt." They are travelling to a nearby town for a special needs Easter Egg Hunt today.

He really was in a good mood after school yesterday. He followed his visual schedule quite well and when it was finished for the afternoon he filled in some things himself, which he proceeded to do until I had to interrupt it with a short homework session before dinner. Then after dinner he and his brothers got to play outside and baby sister joined them.

I need to remember this day the next time we have a tough one!

Samuel's Visual Schedule, A Visual!

Last weekend Samuel took the liberty of making up his own schedule, both on Saturday and Sunday. Normally I make up a schedule to cover key points of the day, like getting dressed in the morning, or approaching homework sessions, or perhaps special trips out of the house. When I do that, we cover times in between with an icon like "play."

This is the binder that we keep Samuel's schedule "icons" in. The icons are about a 1.5" square. I print them in black and white using "Writing With Symbols" software on my computer. Our in-home services provider prints them in color on "Boardmaker." The icons are laminated. I already had quite a collection of icons when our in-home services started, so we continued using those icons and they have slowly added to them since then. The icons have velcro on the back and they are affixed to velcro strips on laminated pages in the book, an idea our in-home helpers gave me.

Below is a picture of Samuel's schedule that hangs on the wall in our kitchen. This was put up in consultation with our in-home service providers and we started it almost two years ago. At the time we started using it only a total of 5 icons were on the schedule. Then a few months later we increased it to six and eventually the whole row under it was added. The "break" icon was added as we started teaching Samuel to "take a break," a means of getting him to control his own temper as it starts to escalate. At any point he wants to he can pull the "break" icon and go to a special designated area to calm down, take a break, etc... I will discuss this more at a later time.

The activity that Samuel is expected to complete gets moved to a space next to "It is time for..." When he is finished with that activity he removes the icon and puts it in the "finished" pocket. Then he moves the next icon up. He, of course, had to be prompted to learn how to move the icons appropriately, something that he picked up pretty quickly with our in-home service helpers. I'm usually a few steps behind in the prompting process from them. This is the actual schedule Samuel made up on Saturday and I really liked how he spaced his highly reinforcing activities (snack, lunch, play outside, and downstairs) with less desirable things (though they are still somewhat fun for him) like "calendar" and "game." We sat at the table in the kitchen for our "meeting," which ended up being a conversation about what our favorite movie is (he determined that!). We also filled in the calendar that he has. After "calendar" came "videotape." If I remember correctly he did not watch a video, but asked me to get one for him to look at. After lunch he did go play outside, but he never completed the other things on his schedule after that. The last icon is "guitar." Samuel received a guitar for his birthday last year, but he doesn't play it very much yet. I'm hoping he will take lessons some day. Even though he didn't play it Saturday, it's encouraging that he's thinking of it!

I first learned of autistic children using schedules to teach independent behavior in the book Activity Schedules for Children with Autism,Teaching Independent Behavior, by Lynn E. McClannahan and Patricia J. Krantz. This was what inspired me to make up icons for him, I just never did quite get a good system going on my own, something that our in-home service providers turned in the right direction. This has done wonders with keeping Samuel happy on a day-to-day basis, though we still have a long ways to go!

A Real Day of Rest!

For the first time in many many weeks I didn't worry about coming up with a schedule for Samuel on Sunday. My husband and oldest son were away for part of the day, so we did not go to church together in the morning like we usually do. Samuel did get a bit agitated in the morning over his videos and it took me a while to calm him down. That's not an easy thing to do when I don't have my oldest son to help out, but my youngest son was able to keep the baby company while I dealt with Samuel for 15 minutes or so. Other than that Samuel kept himself suitably entertained the rest of the day. He likes to go back and forth between playing on the computer, playing and watching Playstation, and playing with cars and trains down in the playroom.

I enjoyed not having the pressure of getting "work" together for him, which I've felt I needed to do every day for some time now!

Afternoon Grumpies!

Our in-home services staff wasn't able to come today, her car broke down. I discovered it 15 minutes after she was due to arrive (she had left a phone message before we got home) and was in the middle of trying to keep Samuel calm. Quick change in expectations for the afternoon!

Every day when Samuel gets home he has 4 or 5 things to complete on his visual schedule, all related to putting his coat, backpack away, using the toilet, and then getting to have a snack. On days that our in-home person is here, he then has 3 more hours of activities (including a good bit of unwind time!). On days they are not here, I usually let Samuel play for about 2 hours and then I try to squeeze in a bit of homework before dinner time.

There was a time when Samuel rushed through these first few tasks, eager to get his snack. That hasn't been the case lately. He tries to hide in my husband's home office and looks at his videos. Today I had put the videos away, and he was angry that we hadn't picked up any new videos at the library (we went while he was at school). I spent the first hour we were home today helping him take several breaks. I had really hoped to clean up a bit around here, but I wanted Samuel to know that I wasn't going to put up with him being so cranky so I helped him take several breaks in a row, in which he got explanations from me about how he needed use a calm voice and have "calm hands and feet" to be able to stay downstairs. He finally settled down early in the evening.

Samuel has been asking us to repeat sentences. I used the promise of repeating a sentence as an incentive for him during his homework today! He says "Can you say 'You can't watch Cyberchase on TV because you get too upset? ' " After I do repeat him he says "I don't get too upset when I watch it on DVD"

Auntie is visiting!

My sister-in-law has been here for the past few days. She has lots of experience working with special needs children, and of course, she loves her nephews and niece! Out of all my relatives she has been the most direct help to me and my family over the past few years. Not to minimize the tremendous help and support that other family members have been, she is just in a position to be able to visit us more frequently. She has stayed with our children the 2 other times I have gone in the hospital to have babies since Samuel came along.

Today we took all the kids to the library and then we went out to lunch. We have been using a visual schedule (which has been implemented and refined with the help of in-home services staff members) for almost 2 years with Samuel and now we are at a point where short trips to the library, a fast food restaurant, a family restaurant, the grocery store, the movies are "do-able." I have a "portable" visual schedule that I carry with us when we go out. The biggest challenge is finding optimal times to take Samuel and have the other children cared for. Having my sister-in-law here is a big help!

It was tough today because I couldn't find our library cards, so we could only get a reduced number of videotapes. Samuel had a hard time accepting that, but we had several conversations about it before we got in the library so that helped. He almost had a melt-down in the library, but I was able to calm him down by talking to him. A few years ago it was impossible to take him to the library because he only wanted to play on the computer. He would hit other children and scream when it was time to leave.

Now we use the visual schedule. When we go in the library he has to read a book to us or with us, then he gets a bit of time to look at the videos/DVDs and then he goes up to check them out. He likes to tell the librarians how to open the videos to scan them, and how they should give them to him when they are done! We don't even give him time to play on the computer at the library anymore (because now he gets to play more frequently at home) and he accepts that just fine!

My husband and I will have the luxury of going out for dinner together tonight while my sister-in-law watches the kids. This is the first "date" we will have gone on since before the baby was born 15 months ago!