Friday, 4 April 2014

Trampolining Fun ...

Today after school M. went out for a bounce on her outdoor trampoline.  Normally she only bounces for 2-3 minutes before getting bored and going onto something else.  On a whim I decided to copy her bouncing moves (stamding on the garden path - I'm not convinced the trampoline could withstand both of us!) and it led to a fantastic I.I. session.

First of all she noticed that I was copying her and she looked right at me and laughed.  That is the magic of I.I. - that first moment of connection when you get direct eye contact and a sense of really being together in the moment.  Then she started to introduce some variations to her bouncing to see if I would follow - big and small bounces, bounces combined with turning around - and she was clearly pleased that I continued to follow her lead.  When I started a very simple running commentary - 'Boing!  Boing!  Boing!' she immediately joined in.

After a while, being somewhat less fit than the unstoppable M., I sat down on the doorstep to catch my breath.  I had intended to continue I.I. in the lazy way (running commentary only).  M. was having none of it.  She climbed off the trampoline and dragged me up to standing position, looked right at me to check I understood, and then climbed back on again, triumphant, and resumed bouncing.  I was delighted at the assertiveness and the taking control of the situation (although also wondering how much longer I could physically continue!)

We then introduced a few more variations - I noticed that M. liked running her hands down the mesh enclosure of the trampoline to make a scratching sound so I copied her and she liked that.  She also likes pressing her nose up against the mesh enclosure so I pressed it and said 'Parp parp!' (it's a Mr. Tumble thing).  She found that really funny too.  I think the trampoline is a naturally good setting for I.I. because it is elevated (and the garden path is on a slope) - so it significantly offsets the height difference between her and me.  I noted in a previous post that this seems to be important and M. is often responsive to I.I. when I position her above me so she's looking down.  I guess having tall parents she doesn't get to do that very often!

Overall the trampoline session lasted much, much longer than the usual 2-3 minutes - clearly the I.I. dimension gave it a 'value added' dimension.  And I'll definitely do that again even though I'm exhausted as I type ... But at least I have burned enough calories to earn a few vinos tonight! :)

Friday, 7 March 2014

Intensive Interaction with Semi-Verbal Children: Part II

As outlined in my previous post, I've been trying to develop my I.I. skills and repertoire with my son, who has quite a lot of scripted and echolalic speech but not so much functional speech.  Because he is quite physically inactive by nature a lot of our I.I. tends to revolve around word play and singing.  Here are some activities which I have found to work (and I will continue to update this when I think of more)...

1. Listening to the rhythm of his scripted language and then echoing it through clapping or on a drum.  (Thanks to Sara from the I.I. Parents' Facebook group for that one!)
2. Making up a simple song to capture what's going on (e.g. 'The car is on the drum' to the tune of 'The Farmer wants a Wife') and then playing around with the positions of the toys to require flexible adaptations of the original verse ('The tractor's on the drum...')
3. Using his phonics learning in nursery as the basis for I.I. fun play (e.g. c-c-c-c-c-c-car!) which can combine nicely with burst-pause and anticipation sequences.
4. Copying what he says in different voices - this is quite effective at gently sabotaging the 'monologue' nature of the script and engaging his attention with me.  He particularly likes when I whisper what he has said and will start to show eye contact and whisper back.  Alternatively vary volume or pitch or put on a silly voice.
5. As a variation to (4) above buy a 'voice changer toy' for added fun with the echoing.
6. Adding Makaton to speech - although he isn't motivated to sign himself at the moment it does encourage eye contact and connection and adds something extra and different to speech which could easily slide into scripting.

Additionally, I can imagine that 'sabotage' could work well for some semi-verbal children (e.g. answering them with a very silly answer to provoke a flexible response or protest) - at present we're not quite there yet with R.

Thursday, 27 February 2014

Intensive Interaction with Semi-Verbal Children

My I.I. practice with R. (my son, more verbal) has always lagged behind that with M. (daughter, less verbal).  I think partly this is because I harboured doubts about the applicability of I.I. to a semi-verbal child for a while.  With M. we started from a place of reduced eye contact, reduced connection, and few words, so I.I. yielded quick and dramatic results (and was very satisfying as a result).  It was easy to see that it was the right thing to do.  With a semi-verbal child it's a bit different: their scripted speech (echolalia) might give the impression of being very advanced and so you can start to worry that I.I. is actually taking them back a step.

Example: R. can recite many car related facts: 'Mummy's car is a Volkswagen, Daddy's car is an Audi, Mummy's car is black, etc.etc.' (and so on for all the neighbours'  cars as well!)  This is the kind of scripting that makes people who don't know him well express surprise at how he could possibly have SEN when he is such a 'clever boy'.  We also have videos of him apparently 'reading' entire books, which looks really advanced for a three year old - until you realise that I have just read him that book beforehand and he is recalling the entire episode (including the inflections of my voice, the 'extra bits' I added in to the story, etc.) just like a voice recorder.

In a video-recorded session of I.I., however, he appears considerably less verbal sometimes.  An outsider's observation might be that it was encouraging him to go backwards.  We play games (often with phonics sounds because that's what he's studying in nursery) - for example: we say 'c-c-c-c-c-car!' and copy each other saying it in funny voices and have a good laugh about it.  Superficially, that seems less advanced than reciting 'Mummy's car is a Volkswagen'.

However, I have become convinced by the I.I. literature that although linguistically and syntactically it may be less advanced, communicatively (pragmatically) it is more advanced.  'Mummy's car is a Volkswagen' is actually just the repetition of a series of sounds that I taught him to say - whereas playing funny games with sounds demonstrates reciprocity, turn-taking, pleasure in another person's company, humour ... In short, lots of the 'Fundamentals of Communication' in I.I.-speak.  These 'Fundamentals' need to be reinforced if all the clever speech is to become meaningful, functional and actually cognizant of the presence of the communication partner!

I also think that as I become more proficient at 'semi-verbal I.I.' the goals of reinforcing the 'Fundamentals of Communication' and extending his verbal development will not be in opposition but will actually complement each other nicely.  For instance, a few days ago we had a really satisfying session with a selection of drums and vehicles where we experimented with different combinations (the car is on the drum, the tractor is on the drum) and sang a song about each combination.  R. was getting enthusiastic about making up new verses to reflect all the different possibilities - it was the most flexible use of language I have ever heard from him.

So in summary, I wrote above 'you can start to worry that I.I. is actually taking them back a step'.  I think it's true that it does, and this is exactly what needs to happen.  If good verbal development continues without a strong foundation in the 'Fundamentals of Communication' you get an individual who can talk at length, monologue-style, about their own special interest without awareness of the effect on the listener - and so I think 'back a step' is completely justifiable to encourage speech which is flexible, functional and socially aware.

Tuesday, 14 January 2014

Motor Imitation Skills

I remember trying to get M. to imitate actions with ABA therapy.  The idea was that I would do an action (clap, whatever) and if she copied me she would get a reward.  She did it (providing the rewards were of the edible variety) but it didn't feel natural or fun.  It also didn't generalise very well - I didn't notice a general increase in imitation skills outside of therapy.

Since we switched to II we've taken a different approach to imitation skills (as you'd expect).  I think it's working better.  As an example, a few evenings ago M. initiated a music session (she drags her daddy to the piano and makes him play nursery rhymes).  She also has a PECS choice board to help her select which song she wants.  As she danced to the music I copied her dance moves (they tend to be fairly big gross motor actions such as jumping, rocking on left and right leg in turn, shaking head dramatically from side to side to make her hair flick).  She was really interested in me copying her, started taking notice, giving eye contact, and starting new moves with a look that was definitely inviting me to follow.

When we'd got a good connection going for a while I started introducing a little Makaton.  M. has never been receptive to Makaton, more of a PECS girl.  To my surprise however, she copied my sign for duck!  It wasn't perfect, her hand was out to the side, but that didn't matter.  I really think that me copying her movements first got her in a relaxed and receptive place where copying me in turn became possible.

Sunday, 22 December 2013

Intensive Interaction: therapy for parents??

A thought-provoking post on the 'Intensive Interaction for Parents' Facebook group got me thinking about this question.  Is I.I. somehow therapeutic or healing for parents of children with autism (or other LDs)?

Certainly my own experience suggests yes.  For me it was a bit of a 'chicken and egg' conundrum: I'm not sure whether starting to feel better about the diagnosis and more accepting of it led me away from ABA and towards II; or whether the move to II contributed to me feeling better about it.  Probably a bit of both as I think the II and the feeling more positive mutually fed each other.  Here are some of the reasons why I think II might be therapeutic for parents:

1. It promotes 'mindfulness' - living in the moment, enjoying your child's presence without thoughts about the past or the future.  Mindfulness is known to be generally therapeutic and a powerful antidote to stress and depression.

2. It is easy to do (once you have got used to it and adjusted your mindset away from goal-oriented approaches) and does not require an outlay of money, resources, or time spent on paperwork and form-filling.  This means the family can feel they are engaged in a positive intervention without adding to family stress.

3. It promotes bonding with the child - and where the child has been distant and apparently unresponsive in the past this will have been a source of pain (and maybe guilt and self-blame) for parents.  It's therefore very healing in that respect.

4. I.I. somehow (gently, without you realising it) changes your concept of your child and of autism.  Your child stops being a deficient, defective problem to be fixed or normalised in the shortest time possible and becomes a human being with personality, likes, dislikes, preferences and an astonishing capacity for human connection right here and now.  Autism becomes less of a big, scary, huge disease  and somehow just a condition or state that you can all live with.  For example, before I.I. I found stimming really distressing and abnormal to watch, now I use it as an opportunity to 'get in there' and build a bridge.

5. I.I. makes you realise that your child's childhood is not a rehearsal - there is only one childhood and it's happening now, so you (and they) need to enjoy it!  Planning for the future is OK in moderation, but there was a time when I was so saturated in goal-oriented approaches that my head was just full of likely projected adult outcomes regarding speech, functional skills, etc.  I was failing to see the childhood unfolding right in front of me in the here and now.  I.I. Has helped me with that.

6. It gives you hope.  Even if you remain uncertain about the extent of speech development, independence, functional skills, etc. that will be possible for your child (and I.I. will help there too) you get the reassurance that your child CAN be happy in life and enjoy fulfilling human relationships.  And isn't that what any parent wants for their child?

Sunday, 8 December 2013

Creating enabling communication environments

I found a really excellent (and readable) little article on the subject of 'creating enabling communication environments' for children.  You can read it here.

The authors suggested four aspects of a communication enabling environment:

1. The minimal speech approach (i.e. Don't use a long complex sentence where 1-2 words would suffice).  I've been doing this for four years now but it is surprisingly easy to forget!  It makes such a huge difference though - so much easier to process a couple of key words than a big sentence that sounds like 'blah blah blah'.

2. An explicit and consistent focus on creating frequent and high quality opportunities to communicate.  This is something we could do better at - it is sometimes easier to just anticipate needs and give the drink/ food/ toy etc. without requiring communication because you want to keep life running smoothly and avoid meltdowns due to frustration.

3. Using 'proximal communication' - which I think sounds very similar to Intensive Interaction!  It is described as using a range of generally non-verbal strategies to encourage children to initiate communication (such as rough and tumble play, imitation, burst-pause sequences).  Very much what we do in II.

4.  Access to a conventional communication system.  We have had such a strange trajectory with PECS - got off to an amazing fast start, plateaued for a very long time at stage 3, became limited to requests for food and drink.  We're doing quite well at the minute, using choice boards consistently for nursery rhymes, TV programmes and food/drink.  I must mention the lovely Sandra at ASD Bright Ideas who creates amazing colour laminated resources for us.

Playing the harp ...

Strangely it never occurred to me to use my harp as an opportunity for Intensive Interaction.  Until this morning, when R. started to strum on it!

A major advantage of the harp over the piano is that if you kneel down on the opposite side of the harp you can get really good eye contact with the other person (through the strings) - overcoming the usual problem with the piano of sitting side-by-side.  So I copied some of his rhythms, sequences of notes, etc. as well as experimenting with some rather unorthodox techniques including rubbing harp strings with our fingers and thumbs to make them 'squeak' as well as patting the strings with the palms of our hands.  We both had lots of fun!

Wednesday, 4 December 2013

Variations on a Theme

'...the activities gradually expand.  They gradually expand in duration, they gradually expand in content and they gradually expand in sophistication and complexity - simply through the main engine-room of that repetition'. (Dave Hewett, The Intensive Interaction Handbook, p.149)

I have really seen this taking place with the relatively recent game of M. pointing to my eyes, nose and mouth in turn for me to label.  I wrote about the first time it happened here, and it was a really amazing sense of connection and interest in another person's face (which is not something she would normally look at for a sustained length of time).  Then there was a bit of a further development where she spontaneously added the label 'leg' and pointed to my leg (see here). The next time the game occured I took a risk and started alternating between labelling 'Mummy's eyes' and 'M.'s eyes' and she was comfortable with that (see here). Yesterday the game occured again, with M. adding another variation of beginning with her own face instead of mine and also adding in 'head' before 'eyes', 'nose' and 'mouth'. 

After we had played the game a few times (with her variations) I decided to take a risk with a little bit of playful sabotage, and when she pointed to her mouth I said 'arm'.  She didn't show any response to this but terminated the game shortly afterwards... Clearly variations on this game are on her terms! :)

Thursday, 28 November 2013

Dressing up ...

M. wanted to dress up in one of my dresses again.  This is something she has spontaneously initiated (by fetching a dress from the wardrobe) about four times in total, all in the last few months.  I'm really pleased about it because although most children start wanting to dress up at an earlier age, she has (eventually) discovered it spontaneously by herself.  It makes me think of the old days when we tried to 'train' her to do pretend play 'properly' using ABA therapy - I think now that was misguided.  A child will certainly 'perform' pretend play mechanically for a reward if the reward is sufficiently motivating but it doesn't mean that they fundamentally see the point in it.  Coming to pretend play naturally and spontaneously (in their own time frame) is so much better.

So I encouraged the dressing up in an II context: we did a running (sung commentary) by singing 'M.'s wearing a dress', we used the mirrors in the sensory room to look at the dress and exchange eye contact/ facial expressions and we talked about the dress.  She wore it for about 20 minutes in total and we had some really good interaction together in the sensory room all around the theme of the dress.  I can't wait for her to open her Christmas presents because she's got several dressing up outfits - am hoping this will lead to more opportunities for great interaction!

Sunday, 24 November 2013

II and Echolalia

A post about R. (for a change)...

I was talking to R.'s one-to-one play worker about his speech.  She said that she finds the 'ready, steady (wait to build anticipation) GO!' sequence good for children prone to scripting and echolalia (a very pronounced tendency with R. these days) as it reinforces the message that language 'does stuff' (the functional, pragmatic use of language).

I found this quite interesting because I tend to think of II objectives either in terms of Fundamentals of Communication outcomes (reciprocity, turn-taking, eye contact, engagement etc.etc.) or else the social inclusion aspect.  I don't tend to think so much about what II can do for the higher-functioning/ Aspergers children (perhaps due to the focus of my academic research).  However I can totally see the logic of what she's saying there.

Thursday, 21 November 2013

Sneezing!

An unplanned brief session on the sofa led to a really good connection ...

I was sitting on the floor so (like in a previous post) slightly below her eye level.  Again this worked well and quickly established a connection.  She pointed to eyes, nose and mouth in turn for me to label and I was able to extend this by alternating e.g. between 'Mummy's eyes' and 'M's eyes' without breaking the connection.  Then M. sneezed twice and each time I said (in dramatic voice) 'Bless you!'.  This led to one of those really good 'shared joke' moments that never happened before II where she looked right into my eyes and burst out laughing.  Result!  :)

Wednesday, 13 November 2013

Intensive Interaction beats iPad!

Today, a first - M. chose II over the iPad!

It happened like this.  She was playing iPad and also making a noise.  I copied the noise and she looked round the side of the iPad and smiled.  Next thing I knew she had thrown the iPad away, grabbed my hand and dragged me to the bed where we tend to bounce around and do II.  So pleased - this is the first time she's ever voluntarily chosen II over her beloved iPad.  Normally I have to hide the thing in order to make II possible - but if II has become so fun that it naturally wins out, even better!

The II session was good.  There was a bit of bouncing around on the bed, drumming on the wall, vocal imitation and sung commentary (she liked sitting in her chair and me singing a song about it).  Then she came and approached me and did that really intense thing where she looked directly into my eyes and pointed to my eyes, nose and mouth in turn for labelling.  There was a new development, however -she then touched my leg and said 'legs'.  We hadn't used that word at all in the session, it came entirely from her.  :)

Tuesday, 12 November 2013

Increase in spontaneous requesting

There has been a noticeable increase in effective requesting recently by M. using various modes: physical action (dragging us to the door!); objects (presenting us with a bottle of squash to show she wants a drink); PECS and sometimes speech.  In the spirit of the 'Total Communication' approach (see here) I am acknowledging and accepting all of the above.  PECS is most systematically used for food/drink and to request nursery rhymes on the piano: the music choice board has been a great success.

Yesterday there was a lovely example of objects combined with speech: M. went over to the DVD collection, selected her favourite one and presented it to me.  I went to put it in the DVD player but apparently wasn't quick enough because she shouted impatiently 'Come on!  Come on!'  Not polite, perhaps, but good use of functional language!

Drumming in the Shower

I found M. fully clothed in the shower (water off, thankfully) having a lot of fun drumming on the glass with her hands.  Although my initial reaction was to get her out I decided to seize the moment for a bit of II instead and it was great!

We often take turns drumming on the wall with our hands but a limitation of this is that we're both facing the wall so eye contact is problematic unless you actually turn your head sideways.  The shower overcame this problem because I could align myself on the other side of the glass, meaning that not only was eye contact easy but also we could align our hands together too.  When the interaction was established I tried developing it by alternating loud drumming with gentle finger tapping (she reciprocated) and more rhythmic drumming to accompany a sung commentary about her actions.  She listened to that with interest and smiled but didn't feel like joining in.

Sunday, 10 November 2013

Positioning

Yesterday I had a very connected session with M. which involved amongst other things her looking deeply into my eyes, using my fingers to point to head, eyes, nose and mouth and waiting for me to label.  Unintentionally I was physically positioned differently from usual - normally I get down to eye level so we are equal, but today M. was standing on a table and I was sitting on the floor so she was actually looking down at me, which was unusual.  I wondered if that contributed to the good connection and whether it's worth trying that position again.

Intensive Interaction and PECS

Haven't updated so much recently, partly because II is starting to shift from a separate 'session' scheduled into the day to an approach that is embedded in everything and in every random moment of the day.  There is therefore too much to record sometimes!

There have been a lot of great developments over the last few weeks though. One of these is that we're getting better at integrating II and PECS together.  I think PECS is fully compatible with II providing that it is genuinely enabling the person to make choices and influence their environment.  A particularly good example of the two working together is with nursery rhymes,which M. finds very highly motivating. So typically we would wait until she initiates a nursery rhyme session (Scenario A) - typically by dragging us over to the piano, pulling out the piano stool and physically making us sit down! - although this morning she also verbalised 'play' as an instruction which was great.  Then we produce her PECS choice board so she can choose which songs she wants.  She has a very consistent order of preferences - always 'Twinkle twinkle' first, then 'I can sing a rainbow', then 'The wheels on the bus', 'Five little speckled frogs' and 'Hickory dickory dock'.  There are fourteen songs to choose from in total.  If both of us are available one will play the piano and the other will do behavioural mirroring of her dancing to the music which she loves.  Typically the PECS is Phase 3B (handing over sentence strip with I want + item), occasionally there is verbalisation (Phase 4).

I think the two work well together because PECS enables choices to be made on a practical level, whereas II addresses the deeper problem of motivation to initiate - something M. struggled with because we started PECS very early.  The problem at the time was that she cognitively grasped the PECS process but still didn't fundamentally feel motivated to approach another human being and communicate (in any mode).  II works on that initiation as a 'Fundamental of Communication' - spontaneous initiations (usually gestural or PECS based) have become more frequent because of the II contribution to the process.

Tuesday, 22 October 2013

Spoiling it!

Drumming with her hands on the wall - joining in with this worked very well, she was looking and waiting and there was good turn-taking going on.  She also enjoyed having the little plastic teddy bears poured over her head and said 'teddy bear' at one point.

A funny incident occurred later when she was playing her drum.  I thought it would be a good occasion to join in by mirroring her rhythms and establish a turn-taking sequence.  M. had other ideas - it was clearly a solo event.  After a few efforts on my part to get in there she glared at me and shouted 'spoiling it!'.  I was so happy about that use of language, both functional and actually quite advanced.

Sunday, 20 October 2013

Best session ever!

We were on the bed generally bouncing around with vocal and behavioural mirroring.  M. was squinting up at the ceiling light as she often does and said something that sounded like 'I see the light'.  I repeated 'I see the light' and she just turned and looked right into my eyes and smiled with delight - I knew I'd got it right, and I was 'in there' because I'd understood.  The next 10 minutes were really intense as a result - she said 'I see window', 'I see light', 'I see eyes' (pointing to my eyes), then got my finger and pointed to eyes, nose and mouth in turn, waiting for me to label each one.  The sense of connection was unbelievable and it gave me a glimpse of the level M. can operate at when conditions are optimal.

Tuesday, 3 September 2013

Caterpillars, Pianos and Pontipines

Started with a really good reading session.  In 'The Very Hungry Caterpillar' she was very interested in the eyes in the sun and commented on them.  This made me think about using books as a springboard for II practice, dropping expectations so we talk about whatever aspects she likes and don't necessarily have to read it in order.  Part of me would rather read a book 'properly' rather than explore it M.-style but at least it is getting her back into reading.

Then we had a great II session on piano.  It was initiated by her - she led me over to the piano and then placed my hands on the keys.  I wondered how to get her even more involved as I played.  I tried pausing for her to insert words or actions but she didn't.  She was clearly really engaged, listening and swaying to the music.  Possibilities to follow up: create a PECS choice board for her favourite nursery rhymes, or buy a voice recorder disc she can press to insert words into songs.

Finally I tried the In the Night Garden dance again.  She wasn't up for it today but was very verbal during the programme, saying Makka Pakka, Upsy Daisy, Castle (Pontipines' house), Go to Sleep, and Tombliboos. Possibility: would an INTG soundtrack on CD enable me to get better connected with her as less visual distraction?

Reading

Reading with M. presents me with a bit of a dilemma.

On the one hand, the II perspective would be to encourage M. to choose the book she wants to read from her bookshelf and go with her choice (even if she wants to read it over and over).  I can see the merits of this because she was reluctant to read for a while and now we've brought her out of that phase I don't want to jeopardise her enthusiasm.  Reading 'That's Not my Frog' ten times in a row is better than refusing to read ... On the other hand just for the sake of language and vocabulary development I'd rather be reading ten different books!

I guess the way forwards is to see if I can extend the reading experience of the same book each time by sharing the experience in different ways, talking about extra vocabulary and detail, etc.

Monday, 2 September 2013

Happy ...

Had a short session of II on the bed today which went well.  There were some great moments, especially when M. looked at me and said 'happy' - which made me happy!  Also when we were playing the bedtime game (pretending to tuck M. in) she looked at me and said 'Night night' which was great.  Vocal imitation worked well at getting really good eye contact, and so did the tent game (making a tent under the duvet).

I was also pleased with the results from tickling - although it was firstly initiated by me she started re-initiating by taking my hands and placing them in position on her tummy.

Saturday, 31 August 2013

Iggle Piggle!

Firstly tried an II session with musical instruments, which didn't work.  My mistake was to put too many instruments out to choose from.  It turned into a general throwing event to which I was definitely not invited.  Lesson learned - next time I try music it will be with just one drum, to encourage turn-taking.

However to my surprise we had a really good unplanned II session while watching In the Night Garden!  M. was dancing to the Iggle Piggle dance.  I joined in and she noticed immediately, finding it very funny!  So we rewound and did it a few more times.  It was a really effective Joint Focus activity.  I'll definitely try this one again.  She was also speaking really well during the episode, naming several characters.

Friday, 30 August 2013

Swimming

Good Intensive Interaction in the swimming pool today.  The Hat Game didn't work at all for some reason but she was very connected and showing good eye contact when we played a game with a beachball, involving burst-pause sequence and 'Ready steady go!' as well as 'All the little ducks' and 'Ring-a-ring-a-roses' in the water. She spoke twice which I was really pleased about: once to say 'let's go' at the end, and once to say 'too tight' (referring to how I fastened her shoes at the end) - especially happy about that because it was pure functional language.

Thursday, 29 August 2013

I like bed!

M. initiated a session of II by taking my hand and leading me to the bed. We had 20 minutes of general II play including vocal imitation, spoken and sung commentary and some behavioural mirroring.  She did the aspirated H sound again but didn't respond to imitation today.  She enjoyed tickles but it was more Scenario B (initiated by me) than Scenario A (initiated by her) today.  After 20 minutes she announced 'I like bed' which I was really pleased about.

Wednesday, 28 August 2013

Reduced Lighting ...

I have often thought that M. has issues with visual processing and gets very distracted by the presence of bright lights.  So it was interesting that this morning we had a very good session of II in bed with the room in semi-darkness.

Again I found that running commentaries are more effective when sung rather than spoken - she doesn't really seem to engage with a spoken commentary but in a song version it becomes more interesting.  There were some good moments of connection: e.g. when M. initiated tickling by placing my hands on her tummy and whispering 'tickle'.  I think I could have pushed this further than I did by delaying further and extending the burst-pause sequence in the tickling, but I'm still wary of breaking the 'connection' by pushing it too far.  There was also a nice moment where she was making an aspirated H sound and when I copied it she looked right at me and laughed.  Again I think I could have pushed this a little further by varying the sound.  Finally, I initiated the 'tent game' by holding up the duvet and inviting her in.  She liked that and then restarted the game a number of times independently.

Thursday, 22 August 2013

A change of scenery ...

I was having a rather less than productive II session in the living room today.  We didn't really feel very connected, and M. was repeatedly presenting me with her favourite book (Five little Speckled Frogs).  In -some ways this was great - she was non-verbally indicating that she wanted it read, she was turn-taking by turning pages and pressing the sound effect buttons at the right time - but she wanted it read over and over and over again, doing the exact same things each time.  I couldn't decide how to move it forwards.  Do I accept and respect her desire for the safety and security of repetition?  (She was initiating the repetitions voluntarily).  Do I try to do the activity again but maybe extend it in some way - e.g. encouraging the vocalisation of 'splash' when she presses the 'splash' button?  Or do I try something else altogether?

In the end I decided that a change was in order.  (There are only so many times you can sing about Speckled Frogs ...) so we moved to M's bedroom.  I was so glad we did because we then had a SUPER twenty minutes bouncing and rolling on the bed.  I did a bit of vocal imitation (I love that feeling when she looks right at me and smiles and I know that she's aware I'm copying her), and also a bit of copying behaviour.  A particularly funny moment was when we both ended up lying on the bed with our heads hanging over the edge, shaking our heads and laughing hysterically.  She definitely liked that a lot.  She also likes pretending to go to sleep so when she tucked herself in I sang a song about that and said 'Night night!'and she looked right at me and chuckled.

(If only actual bedtimes were that easy ...)

Tuesday, 20 August 2013

Bubbles ...

I had a lovely burst-pause sequence with the children using bubbles a couple of days ago. What was unusual about it was that both the children were simultaneously engaging with the activity, at different levels.  This does not happen often (if at all) ...

Each time when the bubbles had been blown and popped, I simply put the lid loosely back on the tub and sat back to see what would happen.  Both the children initiated a repeat burst of bubbles - M. non-verbally by taking my hand and placing it back on top of the bubbles, R. by shouting 'More!  More!'  Several repetitions were achieved in this way.  It was so lovely to see them doing it simultaneously, even if they weren't actually interacting with each other.  A sign of newfound sibling love and affection (or at least tolerance) perhaps?  We'll see!

Bye bye, socks!

M. has a particular dislike for socks. She takes great pleasure in ripping them off and then throws them as far as possible across the room, just for good measure.  Sometimes if they don't land far enough away for her liking she will go and throw them a bit further, just to underline the point.

One day it occurred to me that this was an opportunity for II.  M. has been known to use 'bye bye' to indicate that something (or someone!) should go away - 'bye bye pie!' can be heard at the dinner table, for instance.  So when she ripped off the socks and threw them I remarked 'bye bye, socks!' and she looked right into my eyes and chuckled.  It was a great moment of connection.

The next day I tried to develop it into a turn-taking sequence.  We did 'bye bye, socks!', again with eye contact and laughing.  So far, so good.  Then I quickly retrieved the socks and threw them back at her, saying 'hello, socks!'  she laughed and threw them away again so we did 'bye bye, socks!'  This continued back and forth for a couple of minutes, and was a lovely time of connected turn-taking.

Next step ... maybe I should hold back a little to give her a chance to say it first?


Tuesday, 13 August 2013

All the little ducks ...

This is a favourite interaction which M.tends to initiate by scrambling into my lap and then grabbing both my hands and holding onto them like bicycle handles.  She knows how to make it clear when she wants something without using a single word!

The song goes like this (you may know it):

All the little ducks go upside down,
Upside down, upside down!
All the little ducks go upside down
As they dabble at the bottom of the pond.

Every time I sing 'upside down' M gets suddenly tipped backwards until her head is nearly touching the floor. She loves this because she loves quite dramatic sensory stimulation.  I get lovely eye contact and can also introduce dramatic pauses before the 'upside down' - she tends to look directly at me and shake my hands to make me hurry up!

Tummy Patting!

A few days ago I noticed that M. was patting her tummy repeatedly and smiling.  I started singing a song about her patting her tummy and she instantly recognised the running commentary being connected to her actions - I got that lovely but fleeting eye contact and a smile.  She then stopped the patting so I instantly stopped the singing and she looked directly at me in surprise, and then started patting again. So we stopped and started our patting/ singing together for a few minutes.

I think she got a great feeling of mastery and control from this little (totally unplanned) game, a feeling that she could have some control and influence over her environment by making the song stop and start.  I suspect that is also one of the reasons that she loves her iPad so much - it's such a safe environment to learn new skills because she can have complete control.  I remember reading a little anecdote by the American psychologist Martin Seligman about how important that is, because a feeling that you have NO control over your life can lead to depression. As an example, he wrote about how he used to copy his baby banging on the highchair and she used to love that feeling of control.  This was written in a totally non-II, non-autism context, but still interesting.

Sunday, 14 July 2013

In the Swimming Pool ...

On Friday evening I took M. swimming as usual.  She absolutely loves all water - swimming pools, bathtime, paddling pools, sprinklers, you name it!  The swimming pool used to be a great place to connect with her and get eye contact and joint attention. In the last few weeks, however, I've noticed that the weekly swimming trip actually makes her very hyperactive and a bit disengaged - she just rushes around the swimming pool, splashing madly and laughing hysterically!  I don't mind too much though, as she really enjoys herself and there are plenty of other times to do Intensive Interaction anyway.

We did have a lovely minute or two of interaction towards the end of the swimming session, however.  M. found a plastic ring in the pool (one of the toys that are designed to sink to the bottom so that children can practise diving for them) and she put it on my head, looking right into my eyes and smiling.  I knew what this was about - our 'Hat Game' - so as usual I sang to the tune of 'The Farmer Wants a Wife':

Mummy's got a hat,
Mummy's got a hat,
Hey-ho, my-dear-io,
Mummy's got a hat!

She laughed and put the ring on her own head so I sang a verse for her as well.  It was a lovely moment of connection amidst all the splashing and jumping and excitement!  This 'Hat Game' is a fairly common event during Intensive Interaction sessions for us, involving all sorts of random objects being placed on my head!