Wait Time

When a child has language delays, oftentimes their processing time is longer than we actually give them. We may say something like "get your coat on" and then when they don't immediately respond, we say "put your jacket on." Then when they still just look at us blankly we say "why aren't you doing what I asked?"

We think that we're giving them plenty of time to respond, but we're not. I've always had a goal to learn Spanish, and I know enough to get by, but not enough to have a conversation. I usually say I can speak like a 3-year-old. I can speak in 3-5 word sentences pretty well. When I have been traveling and people are talking to me (usually much faster than I can process) sometimes I look at them blankly as I try to figure out what they just said. Then just as I'm about to figure it out, they say rephrase what they just told me. So now, not only am I trying to figure out what they said initially, now I have to figure out a new sentence (which actually means the same thing as the first sentence, but I don't always know that). And so it slows me down even more. By the third sentence, I just kind of give up and say "I don't understand."

I honk this can relate to some of the kids we work with. We need to check ourselves to see if we are givng them enough time to process what we've said before we assume they're not listening. Counting to ten may feel like forever, but it may also give enough time for a response rather than prompting a response. Repeating instructions verbatim may also be helpful for kids who take a longer time deciding what you said the first time. 

Sometimes one of our greatest tools can just be our wait time. We don't always have to be in such a hurry :)

When a child has language delays, oftentimes their processing time is longer than we actually give them. We may say something like "get your coat on" and then when they don't immediately respond, we say "put your jacket on." Then when they still just look at us blankly we say "why aren't you doing what I asked?"

We think that we're giving them plenty of time to respond, but we're not. I've always had a goal to learn Spanish, and I know enough to get by, but not enough to have a conversation. I usually say I can speak like a 3-year-old. I can speak in 3-5 word sentences pretty well. When I have been traveling and people are talking to me (usually much faster than I can process) sometimes I look at them blankly as I try to figure out what they just said. Then just as I'm about to figure it out, they say rephrase what they just told me. So now, not only am I trying to figure out what they said initially, now I have to figure out a new sentence (which actually means the same thing as the first sentence, but I don't always know that). And so it slows me down even more. By the third sentence, I just kind of give up and say "I don't understand."

I honk this can relate to some of the kids we work with. We need to check ourselves to see if we are givng them enough time to process what we've said before we assume they're not listening. Counting to ten may feel like forever, but it may also give enough time for a response rather than prompting a response. Repeating instructions verbatim may also be helpful for kids who take a longer time deciding what you said the first time. 

Sometimes one of our greatest tools can just be our wait time. We don't always have to be in such a hurry :)

Circles of Communication

What is a circle of communication? The first half of the circle is an initiation (someone knocks on the door) and the second half is the response (someone else opens the door). There are all different sizes of circles. Some are big and obvious, and some are more subtle and sometimes we miss them if we're not paying close attention. A big circle might be calling someone's name and them turning around and saying "what?" A smaller circle might be when you're playing chase and your child glances back at you to see if you're still coming. A really subtle circle might be when you glance at your child and you see them briefly look back at you.

Circles can be really hard to count at times, but the important thing is this back and forth interaction. As we look at our world around us, it is all about these back and forth interactions with others. Relationships are based on these back and forth interactions. With some kids, this may be a difficult thing to master. They may not see a purpose in it, they may not find enjoyment in it, or they may just not know how to do it.

Dr. Stanley Greenspan introduces the functional developmental levels through DIR/Floortime. Circles of communication begin at functional developmental level 3. As we work with kids to help them progress through the functional developmental levels, it is important that we are aware of how many circles of communication they are getting. We use simple techniques to encourage more circles of communication. As the child increases the number of circles of communication they are having, we also bump them up to a higher functional developmental level.

These circles do not have to be verbal circles, a kid who does not talk yet can get hundreds of back and forth circles without saying a word. How do we do it? We do it through PLAY. It is important that as children learn to increase their circles of communication that we are giving them opportunities to express themselves on their own. We can tell a kid what to do every step of the way, but how much more rich and motivating would it be if the child is giving us cues of what they want instead. We need to follow their lead.

One of the many techniques that you can use is called 'playful obstruction.'  In many ways, that just means playing dumb. We're all good at that, even when we don't mean to be, right? Instead of doing all the mind reading that we tend to do, play dumb. Make the child open a few more circles to get what they want. Give them the wrong thing, say the wrong thing, make them expand, make them work. Just by playing dumb, you can extend the interaction. If it's really really motivating, then expect even more. Be aware of where that breaking point is, and take them to the limits. If you lose them, that's ok, then you know that next time you'll pull back a little sooner.

Having these circles of communication is really important, and is a pre-requisite to having conversations, or engaging in higher levels of play. Try to count how many consecutive circles your child has a time, and try to expand on that. If there's so many it's hard to count, great! Instead of working on the quantity of cirlces, start to work on the quality.

What is a circle of communication? The first half of the circle is an initiation (someone knocks on the door) and the second half is the response (someone else opens the door). There are all different sizes of circles. Some are big and obvious, and some are more subtle and sometimes we miss them if we're not paying close attention. A big circle might be calling someone's name and them turning around and saying "what?" A smaller circle might be when you're playing chase and your child glances back at you to see if you're still coming. A really subtle circle might be when you glance at your child and you see them briefly look back at you.

Circles can be really hard to count at times, but the important thing is this back and forth interaction. As we look at our world around us, it is all about these back and forth interactions with others. Relationships are based on these back and forth interactions. With some kids, this may be a difficult thing to master. They may not see a purpose in it, they may not find enjoyment in it, or they may just not know how to do it.

Dr. Stanley Greenspan introduces the functional developmental levels through DIR/Floortime. Circles of communication begin at functional developmental level 3. As we work with kids to help them progress through the functional developmental levels, it is important that we are aware of how many circles of communication they are getting. We use simple techniques to encourage more circles of communication. As the child increases the number of circles of communication they are having, we also bump them up to a higher functional developmental level.

These circles do not have to be verbal circles, a kid who does not talk yet can get hundreds of back and forth circles without saying a word. How do we do it? We do it through PLAY. It is important that as children learn to increase their circles of communication that we are giving them opportunities to express themselves on their own. We can tell a kid what to do every step of the way, but how much more rich and motivating would it be if the child is giving us cues of what they want instead. We need to follow their lead.

One of the many techniques that you can use is called 'playful obstruction.'  In many ways, that just means playing dumb. We're all good at that, even when we don't mean to be, right? Instead of doing all the mind reading that we tend to do, play dumb. Make the child open a few more circles to get what they want. Give them the wrong thing, say the wrong thing, make them expand, make them work. Just by playing dumb, you can extend the interaction. If it's really really motivating, then expect even more. Be aware of where that breaking point is, and take them to the limits. If you lose them, that's ok, then you know that next time you'll pull back a little sooner.

Having these circles of communication is really important, and is a pre-requisite to having conversations, or engaging in higher levels of play. Try to count how many consecutive circles your child has a time, and try to expand on that. If there's so many it's hard to count, great! Instead of working on the quantity of cirlces, start to work on the quality.

Communication and Autism

On Monday I focused on the area of Social Interactions in regards to the DSM IV (how autism is diagnosed.)  Today I'm would like to continue on to Communication.  As I said in my last post, just because someone has some of these characteristics, does not necessarily mean they have autism.  They must also meet the criteria in the areas of Social Interaction and Repetitive Behaviors.

According to the DSM IV, at least one of the following are present.

• Delay in or total lack of, the development of spoken language (also without gestural communication)
• Individuals with adequate speech have a marked impairment in the ability to initiate or sustain conversations
• Stereotyped and repetitive use of language or idiosyncratic language
• Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

Spoken Language and Gestural Language.  Many times the lack of spoken language is the most obvious sign for parents that their child may have delays.  Typically, kids should have several  consistent words they are using by 18 months.  You would start seeing more gestural communication, like pointing, around 14 months.  Here is a great blog about language development (Playing With Words 365), and particularly, here is a post about red flags in communication.  It gives some great timelines on language development.

Initiating and Sustaining Conversations.  There are some kiddos who have tons of words they know, but making their words functional can be more difficult.  Conversations are a give and take process, we build relationships when we have good conversations.  Some kids may know how to talk, but they do not participate in a back and forth interactions with others.  Some kids are good at responding, and will answer questions, but will not go further than that.  Others will initiate, but will rarely let others respond, thus they are very good at the giving part, but not so much at the taking part.

Stereotyped and Repetitive Language.  Some parents will report that their children speak in movie quotes.  Sometimes it's in context with the situation, but a lot of times it is not.  Some kids may get fixated on certain phrases and will repeat them continuously.  Other kids will repeat what you say or other things they hear, this is called echolalia.  Echolalia includes when they immediately repeat what they hear, or they may also repeat what they heard hours ago.

Make-believe Play or Social Imitative Play.  Make-believe can be difficult for some kids with autism because it involves an understanding of what other people are feeling and doing.  It also requires imitation skills.  When playing with others in pretend play, this skill also requires that the child is able to see the points of view of other people and explain his/her point of view to them to create the experience that they want.  Many kids with autism prefer to play on their own, and may focus more on sensory type play.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Diego Dalmaso via photopin cc

On Monday I focused on the area of Social Interactions in regards to the DSM IV (how autism is diagnosed.)  Today I'm would like to continue on to Communication.  As I said in my last post, just because someone has some of these characteristics, does not necessarily mean they have autism.  They must also meet the criteria in the areas of Social Interaction and Repetitive Behaviors.

According to the DSM IV, at least one of the following are present.

• Delay in or total lack of, the development of spoken language (also without gestural communication)
• Individuals with adequate speech have a marked impairment in the ability to initiate or sustain conversations
• Stereotyped and repetitive use of language or idiosyncratic language
• Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

Spoken Language and Gestural Language.  Many times the lack of spoken language is the most obvious sign for parents that their child may have delays.  Typically, kids should have several  consistent words they are using by 18 months.  You would start seeing more gestural communication, like pointing, around 14 months.  Here is a great blog about language development (Playing With Words 365), and particularly, here is a post about red flags in communication.  It gives some great timelines on language development.

Initiating and Sustaining Conversations.  There are some kiddos who have tons of words they know, but making their words functional can be more difficult.  Conversations are a give and take process, we build relationships when we have good conversations.  Some kids may know how to talk, but they do not participate in a back and forth interactions with others.  Some kids are good at responding, and will answer questions, but will not go further than that.  Others will initiate, but will rarely let others respond, thus they are very good at the giving part, but not so much at the taking part.

Stereotyped and Repetitive Language.  Some parents will report that their children speak in movie quotes.  Sometimes it's in context with the situation, but a lot of times it is not.  Some kids may get fixated on certain phrases and will repeat them continuously.  Other kids will repeat what you say or other things they hear, this is called echolalia.  Echolalia includes when they immediately repeat what they hear, or they may also repeat what they heard hours ago.

Make-believe Play or Social Imitative Play.  Make-believe can be difficult for some kids with autism because it involves an understanding of what other people are feeling and doing.  It also requires imitation skills.  When playing with others in pretend play, this skill also requires that the child is able to see the points of view of other people and explain his/her point of view to them to create the experience that they want.  Many kids with autism prefer to play on their own, and may focus more on sensory type play.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Diego Dalmaso via photopin cc

Setting Events - Figuring out Difficult Behaviors

photo credit: blmurch via photopin cc

When I was the Program Director at a Care Center for people with disabilities, I worked a lot with managing difficult behaviors.  I was usually called in to work with someone after the staff had already been working with that person for a while, and they needed help.

Sometimes figuring out why someone is doing something is difficult, especially if that person does not talk.  Their behavior is how they communicate, and our responsibility is to figure out how to interpret their behavior.

You may be familiar with the Antecedent-Behavior-Consequence form that is used a lot when parents/professionals are faced with difficult behaviors.  If not, I will definitely blog about it another time.  With that form, you look at what happened right before the behavior, what the behavior looked like, and what happened immediately following the behavior.  This is a good way to start noticing patterns, and how to help an individual.

One thing that sometimes is missing is the Setting Events.  These are things that may have happened previous to the antecedent, and could be anything from medication changes to going to bed late or even having a bad dream.  We've all had it happen to us, where our day is thrown off because of something that may have happened the night before, or maybe we got a phone call that made us upset, but we don't erupt until hours later when everything appears to be unrelated.  Those are Setting Events.

Here is an example of why understanding Setting Events can be important.  There was one day that one of the residents (I'll call him Simon) was refusing to eat.  The staff did everything they could think of to get him to eat, but he would not eat.  The dining hall was almost empty, and Simon had not even started eating.  This was a concern because of health issues, so it was important that Simon ate his breakfast.  It wasn't uncommon for Simon to refuse to eat, but generally the staff could get him to eat without involving me. For some reason today was different.

I'm not totally sure everything that the staff tried before they asked me to come assist, but I know they had been trying for probably about an hour.  

When they came to me to ask for help, I immediately asked them if Simon had a belt on.  Now, to an outsider, that probably seems like a very odd question to ask in this situation.  What does a belt have to do with eating breakfast?  The staff said that he did not have a belt on, so I asked them to get him his belt and if he is still refusing to eat then I would come in and help.  I'm sure that they thought I was crazy, but a few minutes later the staff reported that Simon was eating.

So what does a belt have to do with eating breakfast and how did I know that that was the reason why Simon wasn't eating before I even went to check on him?  I had worked with Simon for a couple years, and I knew that he had a very rigid routine that he would follow every day.  If that routine was interrupted, he wouldn't complain, but he would start over.  Simon usually moved at a very slow pace which was opposite the pace that the staff was working at, and oftentimes Simon would be rushed.  Usually rushing Simon had the opposite effect because he would have to start over, so in essence he took even longer.  I had noticed a few days/weeks prior to this incident that Simon had become very attached to his belts, and he always had to be wearing a belt.  If he did not have a belt, then his day would be ruined.  

So one of the Setting Events was that Simon was rushed and he did not have a belt on.  The Antecedent was that he was given breakfast, the Behavior was that he was refusing to eat, and the Consequence was that the staff did everything they could do to try to convince him to eat.  You can see why Setting Events can be important, and why being aware of routines, environment, etc., can be key to your observations.  Without the setting events, our conclusion could have been he was avoiding eating, maybe it was a sensory thing with the food, or maybe he wanted something else.  It could have been that he was doing it for attention.  Those would have been good guesses, but they were wrong that particular day.  

Sometimes it's the obvious, but when what you're doing isn't working, it might be something less obvious.  This is also a reason why communication is important between parents and teachers.  I was always so grateful when parents would call me (when I was teaching) to let me know that something happened at home, or the child missed breakfast, or that they changed medications.  That information can be very useful when you are trying to decipher why there may be a change in behavior, or why what you used to do doesn't work any more.

Joy Mano

Utah P.L.A.Y. Project Home Consultant

Early Intervention Treatment for Children With Autism

photo credit: blmurch via photopin cc

When I was the Program Director at a Care Center for people with disabilities, I worked a lot with managing difficult behaviors.  I was usually called in to work with someone after the staff had already been working with that person for a while, and they needed help.

Sometimes figuring out why someone is doing something is difficult, especially if that person does not talk.  Their behavior is how they communicate, and our responsibility is to figure out how to interpret their behavior.

You may be familiar with the Antecedent-Behavior-Consequence form that is used a lot when parents/professionals are faced with difficult behaviors.  If not, I will definitely blog about it another time.  With that form, you look at what happened right before the behavior, what the behavior looked like, and what happened immediately following the behavior.  This is a good way to start noticing patterns, and how to help an individual.

One thing that sometimes is missing is the Setting Events.  These are things that may have happened previous to the antecedent, and could be anything from medication changes to going to bed late or even having a bad dream.  We've all had it happen to us, where our day is thrown off because of something that may have happened the night before, or maybe we got a phone call that made us upset, but we don't erupt until hours later when everything appears to be unrelated.  Those are Setting Events.

Here is an example of why understanding Setting Events can be important.  There was one day that one of the residents (I'll call him Simon) was refusing to eat.  The staff did everything they could think of to get him to eat, but he would not eat.  The dining hall was almost empty, and Simon had not even started eating.  This was a concern because of health issues, so it was important that Simon ate his breakfast.  It wasn't uncommon for Simon to refuse to eat, but generally the staff could get him to eat without involving me. For some reason today was different.

I'm not totally sure everything that the staff tried before they asked me to come assist, but I know they had been trying for probably about an hour.  

When they came to me to ask for help, I immediately asked them if Simon had a belt on.  Now, to an outsider, that probably seems like a very odd question to ask in this situation.  What does a belt have to do with eating breakfast?  The staff said that he did not have a belt on, so I asked them to get him his belt and if he is still refusing to eat then I would come in and help.  I'm sure that they thought I was crazy, but a few minutes later the staff reported that Simon was eating.

So what does a belt have to do with eating breakfast and how did I know that that was the reason why Simon wasn't eating before I even went to check on him?  I had worked with Simon for a couple years, and I knew that he had a very rigid routine that he would follow every day.  If that routine was interrupted, he wouldn't complain, but he would start over.  Simon usually moved at a very slow pace which was opposite the pace that the staff was working at, and oftentimes Simon would be rushed.  Usually rushing Simon had the opposite effect because he would have to start over, so in essence he took even longer.  I had noticed a few days/weeks prior to this incident that Simon had become very attached to his belts, and he always had to be wearing a belt.  If he did not have a belt, then his day would be ruined.  

So one of the Setting Events was that Simon was rushed and he did not have a belt on.  The Antecedent was that he was given breakfast, the Behavior was that he was refusing to eat, and the Consequence was that the staff did everything they could do to try to convince him to eat.  You can see why Setting Events can be important, and why being aware of routines, environment, etc., can be key to your observations.  Without the setting events, our conclusion could have been he was avoiding eating, maybe it was a sensory thing with the food, or maybe he wanted something else.  It could have been that he was doing it for attention.  Those would have been good guesses, but they were wrong that particular day.  

Sometimes it's the obvious, but when what you're doing isn't working, it might be something less obvious.  This is also a reason why communication is important between parents and teachers.  I was always so grateful when parents would call me (when I was teaching) to let me know that something happened at home, or the child missed breakfast, or that they changed medications.  That information can be very useful when you are trying to decipher why there may be a change in behavior, or why what you used to do doesn't work any more.

Joy Mano

Utah P.L.A.Y. Project Home Consultant

Early Intervention Treatment for Children With Autism