Teaching "done" as a concept

[Mom28GreatKids]

Ok, ds (3.5) suspected verbal Apraxia, and spd is in private ST and OT each 1x a week. We were going to ST 2x but have backed off to get some behavior under control. Big thing we are dealing with now is that he doesn't want to leave when it is over, and thus throws a tantrum (sometimes intense). So SLP emailed today to ask if I could work on the concept of "done" this week. She wrote him his own social story about coming to the clinic and working with the therapist, and then happily leaving saying "bye bye, see you next time." Anyone have any good ideas of what we can do at home to work on this and make the transition smoother. SLP said she would rather have this problem (not wanting to leave) than not want to be there at all. Thanks.

[kbutton]

I think a social story is great. Any chance that she can add some kind of visual for him? It could be a line that shows how close to the end they are as they begin each task, or a picture card for each task. It could even be a stack of materials--she could show him that these are all the things they will do (be sure to include something physical to represent a choice if he gets to make a choice). As she starts each activity, she can remind him that when they are done, she'll put it away, and then they'll be x more to go. On the last, she can maybe find a way to check his understanding that it's the last thing, and then he goes home.

 

My son had trouble with transitions when he was little, so if I had to drop him off at the nursery at church or something, I would count backwards. He knew when we got to 3, 2, 1, it was getting close to go in, and he was great about it. Counting backwards let me start at whatever point gave me the time I thought he'd need to transition. So, if there is a specific thing he does to end his sessions, maybe a little ritual at the end to signal "done" would be appropriate? An activity or routine (putting things away) that is always the same (or similar enough) might fill that need. If it's something small, like putting a token in a jar, then maybe if he needs more transition time, you can customize how many tokens? (It would need to seem somewhat random to him though, so that he doesn't try to fuss to get more tokens and make things longer.)

[Mom28GreatKids]

They have tried a picture schedule. She also set a visual timer on her iPad. There is a routine. They clean up, go get shoes out of cubbie, put them on, leave. When we go from the speech room to the hall where the cubbies are, he often bolts and hides. He did so well this week, even signed potty, so we wnet before shoes. She tried to reward him with a scooter ride to the shoe cubbie because he was so good during therapy. She is really trying to teach him.

 

Today we played a game that could have gone on forever, and so I said 10 more laps and we are done. He did his 10 laps and then I got up to be done, and he cried and cried. I also try with book time at night. He picks 8-10 picture books, and I say, ok, when we read all of these, then we are all done and we turn out the light. That invariably turns into 1 more, etc. And then years resistance to really being done.

 

I like the token idea, kbutton-. Ibwill have to think about that.

[geodob]

Though what this makes me think of?

Is the difference between; 'done' and 'transition' ?

 

Where 'done' comes to a halt.

While 'transition' is more of diversion.

The definition of 'transition', is 'change to'.

 

Where the methods that you described, are procedures to arrive at a conclusion.

But what they don't provide, is a 'where to from here' ?

Where the focus could shift to the next 'activity', and the transition to it.

 

No stopping involved, just  a diversion.

[Lecka]

I think a picture schedule and a first/then card are both good ideas. 

 

When he is transitioning from a highly-preferred activity straight to the car ----- is there any way you can break that up with something he likes, that you pause for in the lobby (if that would help at all). 

 

Can he have something he likes as soon as he gets into the car (to get in the car).

 

Can you go from speech to something he likes, like a park or something.  Could you have a good snack for him in the car. 

 

I agree with the idea of, not just leaving the old activity, but looking forward to the new activity.  To look forward to the new activity -- it does need to be fairly good.  It can't be the worst thing ever (which if he doesn't like riding in the car or being strapped in a car seat, it may seem that way to him).  If you are going straight home for naptime -- that is not promising, either. 

 

I think there is a lot to be said for naming his emotions (you are sad it is time to go) or (you are sad it is time to put x away) and take the time to spend 20-30 seconds naming his emotions ----- not b/c this is probably going to do a single thing right now, but it is a good habit to get into, and sometimes if you do "emotion matching" (where you match his emotion and express his emotion for him, I think) it is something that can be a really good thing to do.  But at this point -- I don't know that it would do much, but it is a good habit for sure, and who knows, might help a bit.

 

Then I would move from there to the more jollying of "this is what's next" and the distractions of "can we have a silly walk" or "I'll hold your hand if you want to walk with your eyes shut."  If he has a blanket or something like that, you could bring his blanket for when you pick him up.  I kept a blanket for this at an older age than when you are supposed to, but it worked out well and it didn't last a long time, it helped a lot for a few months, though.

 

If you have not tried a visual timer ----- that might be good.  There are phone aps for visual timers.  There are iPad aps.  If you want to go this route -- you might set a 5-minute timer, then every so often point out how much time is left.  My son had a big program with this (with ABA) and if he didn't have a meltdown when the timer got to zero, he could add 2 more minutes.  This really helped him to change his automatic reaction of "it is horrible when the timer gets to zero."  Another thing that can help is to use it to count-down things that he will have no trouble with, so then when he does a good job, you can say "wow, look how good you did" and stuff, so that he does not only associate the timer with stopping things he likes.  It is the kind of thing -- I honestly would not do this (in my situation) without advice from someone, b/c if I introduce it in a way that makes him not like it (more than he will already not like something that has to do with making him quit things) then it is not going to be a good tool for me.  We were not in a good place at the time that my son started ABA and special needs pre-school, though.  But anyway -- there are strategies like that, to help accept using it and start to see that it is okay.

 

We had a low point once when we went to a zoo where the exhibits were separated by little walkways, so that when we left one little section, we could not see the next little section.  My son cried and cried between every little section, and then he was so happy as soon as we could get to the next little section.  It was still a good day, but I saw that he was having a hard time in a way I hadn't seen it before (somehow) and realized that he just didn't have this understanding that he was going to go on to the new thing (this was with us telling him).  So I think if I could have prepared him better it would have helped.  But, sometimes there is the first time and he just has to see what it is like.  That was several years ago now, and we went to 3 zoos this summer and he did great at all of them. 

 

This is something where ABA helped a lot for us.  That is what is available to me. 

 

Here is something I would be told:  if you say a certain number and do a countdown (which maybe you could make it visual, by having the stack of books, and when you reach the bottom, that is the last one..... or maybe there is another way to make the counting-down visual)...... if he *whines* for more, you cannot give him more.  If he *asks nicely* (or whatever appropriate behavior) then you *should* give him extra-extra (like 2 extra books or 3 extra books) while it is a new/special behavior, b/c you want to *encourage* that behavior.  If you can *prompt* him to ask nicely (or whatever appropriate behavior he is capable of) and he does that, then you can give him one extra book.  If you need to start earlier to allow time for this -- then that is good. 

 

If you want to make this a practice session -- which you might not, at bedtime, that is not the best time, maybe, but at a different time of day, maybe..... you could plan that "okay, he likes 10 books."  "We will pick 3, put them in the stack."  After that -- all done, BUT if he asks nicely he can have another 3.  If you do this ----- you suspect that he is going to SUCCEED and get the next 3 books.  If this is not going to happen, don't do it.  But hopefully you are practicing that "all done" is not the end of the world, and he can ask nicely.  When you do it this way -- maybe (probably) you still have the meltdown at the very end (especially if it is time for bed ----- if you did this before snack, though, he might be pretty willing to be "all done books" and go to snack).  I would do this kind of thing getting specific advice from the ABA therapist or pre-school teacher (there are little details that are hard for me). 

 

But you do want to think about:  what are his favorite things?  What are his least favorites?  You *never* want to go from "most favorite" to "least favorite."  You want to change your schedule so you go from "least favorite" to "most favorite."  This makes a HUGE difference.  HUGE.  There is also high energy and low energy ---- you don't want to go from high energy directly to low energy, either.  For that ---- the car is low energy (you are just sitting there strapped in).  It does not work sometimes to have a little pause/break before the car, but if it can work, it is good.  Otherwise -- I would often add a good break as soon as possible after being in the car, that will be more of a relaxy thing (like a park, or going somewhere he likes, just for enough time to let him relax a bit and be more ready for the car). 

 

Another thing ---- his speech therapy honestly sounds good to me.  It sounds like she is using a lot of good strategies. 

 

But, it is still stressful in a way, for him to be there -- he is probably trying pretty hard, even if it is fun.  It is probably a hard transition in a way just because of that.  I have seen that.  That doesn't make anything about the speech therapy bad -- it just is what it is.  If you have an at-all long drive, I would really try to take a minute to re-connect, or (b/c sometimes that just doesn't work) add a little stop somewhere to re-connect, kind-of.  Or let him have a relax time. 

 

It was a bit of a long project for my son to have appropriate behavior in the car, though.  If he is already pretty good in the car or adjusts decently once you get him in the car (which my other 2 kids would do) then I think -- that is not needed. 

 

I would also, before the appointment, go over your schedule and his expected behavior.  You can talk about it in the car and before getting out of the car.  You could use a visual schedule possibly.  When he is at this point (it took a little time for my son to get to this point) -- but ideally you can build in little "first/then" statements (or use a first/then card) where "first" he does the thing you want him to do, "then" he can do the thing he wants to do.  This is where, again, the less-liked thing is first, and the more-liked thing is second.  When there is a need to go from less-liked to more-liked ----- build in a pause with a medium-liked thing or have a snack.  Building in the pause will save time.  You just don't want to go straight from the most-liked to the least-liked, and it really helps me to think in those terms. 

 

Anyway -- these are some of the kinds of strategies we used.

 

At a certain point -- it is not fair to ask kids not to be sad at all that a favorite thing is over.  We just want them to be able to handle it better.  We want them to feel sad but have that bit of understanding that life goes on, and that bit of ability to regulate their emotions.  Well ----- both of those things take time and practice.  They are not things that you can just do one little thing, and all of a sudden, kids understand that it is not the end of the world and magically have the ability to regulate their emotions.  But there are lots of supports that can help, and there are ways to look at these as (LOLOLOL) "learning opportunities" to "practice or be exposed to regulating their emotions" (with your help/guidance) and understand that the world is not going to end. 

 

B/c, what you want, is not a child who doesn't care at all that he has to leave a favorite thing..... you want a child who can handle it appropriately ---- you would like something like "I wish it wasn't time to leave" and then "but I know I will come back next week" kind of response.  But your child may not have much sense that "I will come back next week" and also may not have the self-regulation to regulate that way, and may not have developed those kinds of strategies. 

 

But it is stuff he can learn.

 

I think just saying "well we want him to understand all done" is true, but simplistic a little.... what you want him to learn is that when we say all done, we mean all done, that he may ask for more, and maybe the answer is yes and maybe it is no, and for him to be able to accept this and handle this.  That is a lot more involved kind of goal, and I think it is really pretty involved, and probably it is going to take some time.  But that is okay -- every time you do it, he is learning.  He just may not be at the point of "putting his learning into action in an independent way."  That is okay.  That is the same as every other thing with kids and learning, where we say "we know he is being exposed and engaged, we just have to trust it is percolating around up there" (though we also look for signs that it is, to know we are being effective) ----- but it is not like "okay, we do this today, we get this result tomorrow" for some things, b/c it is just a longer process than that, but it doesn't mean that kids are not learning in their incremental ways all along, even if we don't see "the proof" until later. 

 

Edit:  This is different for everyone, and your speech therapist does sound good to me.  I got help for this kind of thing only when my son started ABA, though.  That may not be on the table at all, and may not be needed ----- but we were in a bad place, that was our situation, and then this is what was available for us locally.  Special needs pre-school also really helped.  They have a structure, and they follow the structure.  It is an odd thing -- my son didn't LIKE the structure at first, but once he got to understand it, it was really good for him, and it helped him to like structure more in general.  For him ---- at first structure was the opposite of "do what I want when I want."  So, he didn't like it.  But truthfully, he was not so happy doing what he wanted when he wanted.  Even though that was a hard change for him, he liked it better once he was used to it. 

 

But it is a pretty significant problem (I think you realize) when you are having to cut back on speech therapy, for a child with apraxia, b/c of behavior issues.  Are you on a waiting list already for further testing?  I think, when you go to further testing, make sure to emphasize this.  I know you want to make your child come across like the sweetheart that he is.  But, when he has a behavior issue causing him to not have speech therapy that he needs, then it is something you need to make a fuss about when you go to further doctor appointments/testing and if you need to get a referral for testing, or when you do further testing, etc.  If you are in the middle of the process -- it just takes time.  In the meantime -- I think your speech therapist sounds like she has a lot going for her. 

 

But at the same time, if her strategies are not working well enough that you can go 2x/week instead of 1x/week, then that is a sign, you maybe need a different kind of professional to help him. 

 

I also will say..... nothing against social stories, at all, they are great.  But  my son was not ready for social stories when he was 3.5.  They were like a "let's do this b/c it is dropping a pebble in a bucket, and getting him used to this, and someday down the road, this is going to be a really good strategy for him."  But when he was 3.5 he was not at this point.  So -- I am glad you are doing it, but if this is the best the speech therapist has got for you, it may not be enough to be effective.  Like -- I think she sounds good, but if the social story does not help, that doesn't mean that you are doing it wrong ----- it can just mean, he might need help from someone specializing more in behavior issues. 

Edited January 15, 2016 by Lecka

[Guest]

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Edited February 10, 2016 by Guest

[PeterPan]

The answers you already got were thorough.  The only thing I might add is not to assume the obvious interpretation is correct.  He might be loving it, yes, or it might be a transition issue.  When we're not quite to the point of seeing everything going on, we can get swept up in the "he likes it so much" thing and not get to "he has transition issues."  

 

With my ds, we have to FORCE transitions.  I'm saying force, but I mean require, be firm, be clear in expectations and work through it with support.  We can't let him get stuck, because then he's REALLY stuck!  And it can be ugly till he gets the routine.  So to me, you might even have a break part way in your session, just to practice.  We have 2 hour sessions now, so we do a break midway.  He didn't want to stop, and we had to FORCE the issue.  It was ugly, and he would get physical and awful.  Now he gets it.  It's healthier for everyone.

 

I don't think  you really want a break in his therapy hour, but you can practice those breaks and transition strategies in OTHER things, so they're familiar.  I would be really proactive on the shoes mess.  When my ds is done with therapies, we have to be like ZIP ZOOM.  He gets really loose cannon and volatile.  And I think Lecka said this, but the therapy was hard work and pushed him to yellow zone.  That was NUTS to take someone already probably at his limit (working hard, holding things together) and give a highly stimulatory input like that.  Rewards should be something CALMING like a drawing a toy from a box.  Our SLP did that for a while with ds, right about when he was that age.  There would be an egg with some kind of small thing inside.  If she doesn't want to do it, provide it yourself, kwim?  But mercy, the SLP could do this.  CALM transition routines.

 

For music therapy, they have a song at the end to create a clean breaking point and routine.  But really, I think it's many things, like Lecka is saying, not one thing.  It's not letting him get loose afterward but getting him directly into the next structure.  It's pretalking expectations.  It's keeping things calm because you know he has pushed into yellow zone by working so hard.  

 

This stuff is hard.  I wish I were a whiz at it, mercy.  What was a small issue at that age is like OH MY LANDS now.  And remember, the quibbling over the diagnosis is because it would give you insurance coverage for a behaviorist to get some actual serious help for this.  Cuz you don't want to know how unfun it is as they get bigger.

Edited January 16, 2016 by OhElizabeth

[Mom28GreatKids]

OhE yes, I think it is a transition issue, yes. We have them all the time. I do think he likes ST more than he used to, and he likes the therapist, but, it is the transfer to the next thing. Lecka has given me immense help in a series of pm's. I never thought about the "next thing" being something he hates (getting strapped in the car). Wowsa. Yes. That is an issue. And OhE, you know how hard they work in that session, so yes, he has been pushed into agitated state so he is a ticking time bomb. The best transitions are when SLP has no one after us. Then it is a more peaceful transition as she is not in a rush to get to her next thing. She often will walk is out to the car on those days.

 

What she wanted to be sure of is that he truly understood the concept of when something was finished. So, she asked me to work on doing activities this week with clear time limits, and when it was finished, to clearly show how to move to the next thing, whatever that was. She is using a visual timer with him. I did a count down tonight with books. Here are 8 books. Ok now 7. When there are no more left, we go night night. . . blah blah. You get the picture. It was better. Not perfect. But better. Lecka is right that this will not improve over night. It will take some exposures.

[Carol in Cal.]

For transitions that are predictably hard, I used to say, "We are going to have to leave soon.  If you want to play for 5 more minutes, you have to agree to leave with no crying or arguing when 5 minutes are finished.  Or, you can cry and argue now, and then we will leave right away."  This was pretty effective.  If 5 minutes was up and DD got upset, I would remind her, "Hey, you said you wouldn't argue or cry; you can choose to feel good because you played for 5 more minutes, or feel bad because we are going to leave.  But either way we have to go now, and no arguing."  This is all conveyed cheerfully but sympathetically. 

[Guest]

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Edited February 10, 2016 by Guest

[PeterPan]

I'll probably be saying this a lot, but the Joyce Show book Teaching Your Child with Love and Skill  is AMAZING.  Fabulous, so worth the read.  I keep plowing through in little chunks.  TONS of ideas and inspiration.  So much where it's like oh, I have to stop and implement that right now!  

Edited January 16, 2016 by OhElizabeth

[Guest]

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Edited February 10, 2016 by Guest