Helping an Autistic Child to Write a Letter

I have the best sister-in-law ever. She thinks of brilliant ideas for building relationships with my kids. Her place is the first stop on our Camp Bergenholtz trips. When she heard about our plans for Countdown to Camp Bergenholtz, she asked if she could join us in our activities, completing some of the projects at her house, while we do them at ours. If that wasn't wonderful enough, she came up with the idea that each of the kids would "mentor" her with the crafts, emailing questions and pictures back and forth, asking for suggestions and exchanging ideas...and building relationships.

She started off with Alex, my 20 year old autistic son. Here is the email she sent him.

Hi, Alex.  I need your help with the summer treat packets we are making today.  First, are we using the watermelon design or something else?  Also, what kind of goodies should I put inside? 

Thank you, Aunt Brenda

I had him read the email, but he was not able to make the leap to answer the question on his own. So, I had to help him by giving him some options of what people might expect for the answers.

I made two basic categories for him, toys and candy, which were reasonable answers to the question, and wrote them on slips of paper. I then made up slips of paper with possible things that fit in those categories.

First, just to get his mind thinking, I had him decide which of the two categories the items on the different slips of paper went under. He had no problem doing that.

Then I read the question to him again, and he then understood that he could pick from the possible items. We took one category at a time and he picked his favorite from the choices. Then we went to the second category and he picked a few more choices. He was having a great time with this activity.

I then left the slips of paper he had chosen on the table and showed him how Aunt Brenda had started the letter with his name, and that he should start his letter with her name, to let her know that the letter was for her.

I then had him read the question she asked again, and he answered by listing all the choices he had made. I then I showed him the wording of the question, "what kind of goodies should I put inside?"  I reminded him that the answer to a "what do you think I should put" question should be answered by "I think you should put", so he wrote that down. Then he listed all the things he had picked out before. Then I reminded him that he needed to put "in the goodie bags" because she needed to know where to put these things. Alex has difficulty with prepositional concepts so I was not surprised that I needed to help him add that to the sentence. Then I told him that he needed to tell her why that was his suggestion. He didn't know what I was asking him, so I needed to coach him on some possible answers, and I gave him a few including some ones that were silly, so I could see if he was really picking. He laughed at the silly ones so I could tell he was paying attention and he picked one and wrote that next. 

I then showed him how Aunt Brenda had concluded her letter and said that he needed to tell who the letter was from, so he added "love, Alex" which finished his letter.

Aunt Brenda-
I think you should put stickers, a rubber ball, pencils, chocolate,
Skittles, gummy bears in the goodie bags. They are what I like best.
Love,
Alex

Brenda wrote back:

Alex, thank you for the letter with those great ideas.  Now I know what goodies you all like and will make sure some of those favorites are in my treat packet.   When I am working on this project, I will send you a picture to get your opinion, okay?  But, the goodies inside will have to be a surprise!  Talk to you soon.

Love, Aunt Brenda

So, now we have another letter to write!

(A post about the summer treat packets coming up soon.)

Autism Awareness

There are two aspects to autism awareness. One is that many do not know the behaviors associated with autism, and therefore can mistake these behaviors for discipline issues and the such. My son has been a victim of this, so I know it first-hand. Here is one of many lists out there of these behaviors.

The second aspect of autism awareness is much more controversial. I can only tell you my experiences. When my daughter was 18 months old and she was not speaking at all, I questioned my pediatrician about it. He referred her for speech and occupational therapy and to Johns Hopkins because of her persistent gastric reflux. At 18 months she often could not keep anything down and would cry for long periods of time unless she was held with an arm across her stomach just under her rib cage. She could only sleep like this or in a baby swing. At Johns Hopkins she qualified to be entered into a trial for Bethanocol for her reflux. We were so pleased that it helped her reflux. She became much calmer and happier. We were surprised when we came back for our last follow-up appointment to find out that the study determined that Bethanocol did not help enough people with reflux to merit it's use. It had cured her reflux totally. Meanwhile I had my first son, Alex. I put Katie in a preschool in hopes that it would help her language, social and behavioral skills. The preschool teacher was wonderful with her, but Katie still dove under the tables in school when she became overwhelmed.  She then started public school Kindergarten. She was fortunate enough to have a wonderful teacher, but she was unable to handle Katie's behavior issues and the needs of the other 25 students. She requested that Katie have an one-on-one aide through the school system and meanwhile I came to school with her acting as her aide and helping her through her day. By this time my son who had spoken a few words, suddenly retreated into a glassy-eyed world of silence. With each doctor's visit he seemed to get worse.  He was enrolled in the public school's Infant and Toddler program to help his speech. As part of the process of getting Katie's aide, she was sent to DuPont Hospital for Children for evaluation, all paid for by the school system. She was seen separately by five different psychiatric doctors. Each of the doctors gave a different diagnosis (anxiety disorder, global speech disorder, PDD-NOS, Landau-Kleffner Syndrome) and each suggested a different medication, some of which had side effects of speech impairment. At that moment I realized that I was going to have to take control of the situation and not rely so heavily on doctor's and teacher's suggestions. I began researching, not so much to find out what it was they had, but to find out what I could do for them. From my background as a Addiction's Counselor, I knew how to write Treatment Plans. I began forming one for my daughter of intense speech and behavioral therapy. Meanwhile, my son who was practically mute by this point began treatment through the school system of Applied Behavior Analysis. The school system began paying for people to come in my home and administer the program and for someone to oversee it periodically. Then they withdrew the program and I had to find my own volunteers at the local college and administer the program my/self. My husband and I would also do therapy with him on a daily basis. He would work the hardest for Cheetos and Doritos, so he had his fill of them every day. He improved so little and every time we felt he had gained a skill, he would just lose it and we had to start over. I was then told by a friend about possible connection between autism and vaccinations. By this time my second son was born and he had already gotten the first round of shots. I went to a lecture by Dr. Wakefield and Dr. Stephanie Cave and listened to what they had to say, and what they had to say made a lot of sense. I decided right then to stop vaccinations on my son Sam. We had to change pediatricians as our doctor refused to see us if we did not vaccinate. We now drive an hour away for our pediatrician. By this time Alex was becoming so violent, I was afraid for his siblings and the thought that perhaps we might have to put him in an institution first crossed our minds. We learned about the gluten and casein-free diet and we cleared out all of our cabinets and stocked them with the new foods. We realized that our feeding him daily snacks of Doritos and Cheetos was only hurting the situation and was perhaps why did not retain the skills he managed to learn. Once on the diet, we began see immediate improvement with Alex's behavior and Katie's remaining digestive issues. I no longer had to use the body hold for Alex that I had learned when I worked for the prison system. We had hope. They both continued to improve with intensive therapy. By this time we had severed all connections with the school system (another story) and were on our own. Alex was tested for heavy metals and was off the charts in his mercury levels. Under a doctor's supervision, we began chelation for Alex's heavy metals. We began giving him high doses of vitamins and enzymes for digestion. We also gave the enzymes to Katie, who still had residual gastric issues. It was like an onion, each time we removed one level of things that were holding him back, it only revealed a new layer. By the time he was seven, we decided to try him in the school system again. We moved into a school district we liked. They assigned him a one-on-one aide. About a year later, we began noticing that it seemed as if he was hallucinating. His doctor prescribed him some medication for Juvenile Schizophrenia and he immediately became more responsive and the hallucinations began to cease. We decided not to send him to public Middle school and brought him back home to be homeschooled. Katie, who was now about 11 was re-tested by the school system's psychiatrist and was determined to "no longer qualify for the diagnosis of PDD-NOS."

Alex is still functionally mute, but he is much happier and is able to take part in family activities at his own level. Katie was later diagnosed with Epilepsy, but no longer has the gastric issues she once had. I later found out that  Bethanocol is now being used as a treatment for autism. Perhaps she just happened to get what she needed at the right time. I know that there is a lot of controversy surrounding vaccines, and that the media and the medical field consistently support that there is no connection between them and autism or any connection between autism and gastric issues (which is what Dr. Wakefield was suggesting.) I can only tell you my experience. I know that there was definite gastric issues in both of my children on the autism spectrum and that they both improved by treating those issues. Katie, fortunately, received stronger medication early. Perhaps that was in some way the difference between the recovery levels of the two of them. I have not vaccinated any of the other three children (except for the first round with Sam) and they do not have autism. I know this is not enough proof to submit as any sort of evidence, but it is enough evidence for this mother. I offer this not as a means to become controversial and to enter into debate. I only offer my experiences as hope for a mother who is searching for help for their child. If you are searching, this might be a good place to start to learn about the possible medical interventions.

Association Method: Round-up Stories and Descriptive Stories

We have been working with Alex on the structure of preposition sentences (in, on and under) and although he seems to answer the questions for the most part correctly, he doesn't seem to have mastered the concepts. These prepositional concepts seem to be very difficult for autistic children to master. For this reason, we are going to continue practice in these concepts by activities such as "having miniature objects, making specific arrangements of them, and asking..." him prepositional questions. He, in turn, can make arrangements and ask prepositional questions. "Such placement concepts as between, behind, in front of, and around may be taught in the same manner as the more basic concepts of placement... it may be necessary for these concepts to be taught as part of the content in a story." -quotes are from Teaching Language-Deficient Children by N. DuBard and M. Martin

Descriptive Stories should include:
1. Familiarize names of rooms in homes
2. Familiarize with terms such as "another", "the other"
3. ordinal numbers
4. increasing number of sentences, using longer sentences
5. compound subjects and compound predicates
6. increase use of modifiers
7. write descriptive stories of their own
8. apply previous vocabulary and concepts

Examples and more about this here.

How Groundhog's Garden Grew

I picked up this most lovely book at the library a couple of weeks ago.We think of gardens at this time of year, and I thought the cover was so attractive, I put it with my stack of books to read to the boys.

I did not realize what a gem I had until I really looked at it.
Using animals for all the characters, it actually follows the cycle of plants and gardens throughout the year.
It has absolutely gorgeous pictures throughout, and has quite a bit of factual information weaved within the story. It even has beautiful and accurate illustrations around the borders.
Even the end papers have illustrations of the growth cycles
of different plants mentioned in the book.

The portion about planting potatoes was very timely as Katie and Alex had planted potatoes the day before.

This garden is their special project together.

Helping to take care of living things can be very helpful for autistic children.

Can you see how much of his attention she has as she shows him what to do. His hands are together in such an expression of excitement.

We also showed James the potato plants that are coming up from the potato sets that we planted last fall.

I dug around the roots of one to show him that small potatoes are forming under the plants. These will get larger over the summer and we will dig them up in the fall when the plants die back.

James, inspired by the book, also wanted to plant, so she gave him a pot and some garlic bulbs to plant.
After watering, he set them on our front step so we can watch them grow.
Perhaps How Groundhog's Garden Grew would inspire your little gardeners too.

See more ideas at Fantastic Fun and Learning.

Association Method for Teaching Language-Deficient Children: Prepositions In, On and Under

"Where is the ____________?"

"The ________ is _______."

Alex has been able to write Personal Description Stories for the people in the Guess Who? game for some time now, and we will keep doing this while we start this new step. "The primary purpose of this phase of the program is to teach the concepts and appropriate language for the placements in, on and under..." Besides teaching the new vocabulary, we will be expanding sentences to include more modifiers and increasing the length of sentences. We will be using the pictures cards from previous lessons to introduce the concepts, but using them in unusual arrangements. "A unique approach can be valuable in focusing attention on concepts which are obvious to the average individual but which may be less than obvious to the language disordered child. In addition, these pictures add a welcome bit of humor to the whole teaching/learning process."

(Quotes are from the book, Teaching Language-Deficient Children; Theory and Application of the Association Method for Multisensory Teaching by N. Etoile DuBard and Maureen K. Martin.)

Relationship Development Intervention, Part 1

This is a program that is becoming part of the fare of therapies that are being talked about and used by people wanting intervention for their autistic children, and for good reason. A great explanation can be found here. The basic idea is that many therapies center on the verbal aspects of autism because it is obvious when a child is not talking, but neglect the other delays such as body language and other aspects of relationship development.
The very first steps of RDI focus on making declarative instead of imperative sentences when talking to an autistic child. We tend to just tell autistic children things, ask them questions or prompt them to do things. This is imperative communication. Communication, however, which we typically have contains 80% declarative communication, and 20% imperative communication.

Declarative communication is what we think of when we think of talking to others. It is true interaction. You share things. So, how do you use declarative communication with a non-verbal person? You can share your thoughts, reflections, even discussion of what you are doing. This feels awkward at first because you feel like you are talking to yourself. You are not, however. Your autistic child is listening and absorbing. It takes the pressure off of him to perform, which is the primary goal of Applied Behavioral Analysis, the other primary therapy used currently.

Also, the use of simpler and slower sentences is encouraged. It has helped us to use the Association method sentences that Alex has learned because they are shorter and simpler in construction. Slowing down speech is a bit harder, especially when you do feel like you are talking to yourself and are feeling somewhat self conscious.

RDI also suggests including the unexpected to peak your child's attention. This goes hand-in-hand with what we are just starting with the preposition work we are starting in the Association method step we are working on. This is called "spotlighting" because you are emphasizing what you are saying in some way. This gets their attention in a world where everything seems to demand equal attention for them.

The most important piece for me, however, is that RDI initially asks you to work hard on your non-verbal communication. I think I have almost totally dropped trying to communicate with Alex non-verbally because he just didn't notice non-verbals. I just dropped them altogether. RDI tells you, instead of dropping them, to teach your child how to follow them. When you teach something like tying shoes or household tasks, teach them by dramatically emphasizing your non-verbal language. Tammy's blog has tons of information and examples of how to do this, including some wonderful videos. Following her example, I recently taught Alex how to cook a chicken dish.

This leads into two more RDI terms, Framing and Scaffolding. Framing is simply to set up situations in which to practice the above and other RDI exercises. My planning to teach Alex how to cook the dish was the framing so that we could practice non-verbal communication as well as other goals...certainly not cooking. Scaffolding is simply providing whatever things your child needs to achieve success and feel that achievement. I will tell you more about this as I blog about our steps and advances. As you can see from the pictures of our cooking experience, Alex referenced what I was doing a lot to know what to do himself. I emphasized what I was doing and used little, if any words. I had his attention and he was successful.

Association Method for Language Aquisition for Special Needs Students: Personal Description Stories

We have started Alex on personal description stories, which is a continuation in working with question language. The goal for these stories is to use the pronouns he and she and the possessive adjectives my, his and her. He has to change the language in order to use the proper words to refer to himself and others. Another goal is to increase his awareness of his own and other's personal appearance. The method is supposed to be used in a classroom and since I don't have access to 30 people or so to talk about, I chose to use the Guess Who? game I have. He has to answer questions such as "What color eyes does he have?" or "What is she wearing?" We work on a half dozen people each day, several which are review from the day before. He also has to answer similar questions about himself.

Association Method for Language Aquisition for Special Needs Students: Incidental Language, Animal Stories and Inanimate Objects

We have been working on Alex's language difficulties and he is now ready for the next steps:

Incidental Language: This is language patterns that typical children just pick up. It is answering the questions, "What do you see?", "What is this?" and "What do you want?" We completed all the drill for this during the 2009 school year but Alex still will not use these phrases in everyday life unless he is forced to. We will continue urging him to.

Animal Stories: These are designed to strengthen vocabulary -noun (animal names), adjectives, plural nouns (body parts), abilities of animals (fly, swim, run, etc.), numbers (usually two or four) and affirmation and negation. Alex has a lot of trouble with negation. We completed these during the 2009 school year, but I didn't feel we got everything we needed to out of them, so I added Venn Diagram drills to our work. For the 2010 school year we will continue with these Animal Venn Diagram drills while we work on Inanimate Objects stories.

Inanimate Objects: With these stories we introduce the pronoun "it." We are teaching the vocabulary of articles of clothing in a descriptive context. He is to apply numbers. He is to increase practice with question language, adding variety and increasing sentences. He is to work on part-to-whole concepts. We are also working on how to distinguish the days of the week and the months of the year and will tell time.

Using the Association Method for Language Aquisition for Students with Autism and Other Language Impairment

I learned about the Association Method from Tammy. We have been working on Alex's language skills since he was a baby. With Katie's diagnosis of Autism at 3 years old, we were right on top of Alex's diagnosis. We had a whole team of people working with him using Applied Behavior Analysis, but we ended up reaching a point that he just could not pass. The public school system worked with him using one-on-one aides, speech therapy and various other methods, but he mostly just learned how to look like he was learning things instead of actually learning them. We brought him back home and I have been winging it ever since, just working with him as instinct takes me. He has a good memory for history and science facts, but I am never sure just what he understands. Then I stumbled upon Tammy's posts about the Association Method. Since it was written for aphasic children, it seemed to focus just on Alex's weaknesses. We have completed the Incidental Language exercises. He has not carried them over to his daily life, which, of course is the goal, but I am not sure anything will get him to. We seemed to have reached his limit when it comes to spontaneous language.

He will work with me on the Animal Stories; read them, memorize them, repeat them, write them, dictate them, etc. and he will enunciate fairly clearly, if I remind him to. I thought we were doing pretty well but when we came to the end of them I just didn't feel satisfied that he had the skills down, so I added in the concept of making three-way Venn diagrams, using all the information in the animal stories we had completed. Well, it became very clear that, although he had memorized the stories, he had no concept of what they meant. When using the sentence "Birds have feathers," as an introduction, I would as him if the other two randomly picked animals, such as horse and cat, have feathers, he would answer "yes." When I started calling him on his wrong "yes" answers, he switched to answering "no" to all the questions. When he answered that birds have four legs, I would ask him to count and point to their four legs. He pointed to the head, the wing and the two legs. Does this mean that he doesn't know what legs are, or does it mean that he doesn't want to bother to think about answering the question correctly? On other occasions when he given the task of pointing out the legs of various animals, he could do so correctly, so it appears that the structure of the language is the problem. When asked questions, he seems to go in a separate question-answering mode, in which the goal is to answer the question as effectively as possible, not to really think about what is being asked. After all, this method was pretty successful in public school. So much so they didn't even know what he was doing.

So, the question now remains, where should I go with this now? My plan right now is to go on with my Venn diagramming of the Animal Stories and to continue ahead with the next phase which is Inanimate Object Stories, being mindful that it is the question/language aspect that is most likely the problem for him.