prairiewindmomma Posted July 18, 2019 Share Posted July 18, 2019 On 7/12/2019 at 5:28 AM, Lecka said: Also — some things I have tried with my older son..... A choice between me bringing it up at school or we try something that is not school. He is very highly motivated for me not to bring things up at school, and he has made grudging cooperation on a few things where he knew I would bring it up at school otherwise. It’s hard to explain but if your son would not want to see a school counselor or have more time with a specialist of some kind at school, it could be helpful. Or maybe he would rather have it at school and have you less involved (my older son is also motivated to have me less involved a lot of the time). I have also made some deals with him that if he goes to something a certain number of times and gives it an honest try, I won’t make him go after that. We did that with church youth group (but not at our church, at one that has kids from a lot of churches). Well — he went with a good attitude 6 times and then he didn’t want to go anymore. But I was satisfied he gave it a chance. I wouldn’t do that unless it was okay with you. I also made him agree basically — he would try something else after a year. At this point he has agreed to try youth group again after we move (next year). But for now I think he gave it an honest chance. I think he did go more than 6 times actually but I’m not sure now. I have also said things like “look you are going to do at least one thing,” but then he can have a choice of 2-3 things. He doesn’t want to do any of them, but he still has some choice. Choice (offering choices) is another big ABA strategy, btw. This won’t work if he refuses all of them or uses it as leverage to say none of it must be that important. But my older son will compromise this way. It doesn’t take one conversation because he will argue for nothing, but if he doesn’t choose then I will choose for him. But ideally he will choose because just the act of choosing creates buy-in (in theory). But if he refuses then oh, well. (Edit: I will pick for him.) We use these strategies a lot in our house. 1 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 6 hours ago, Storygirl said: I've been trying to do a little research about therapy options. At this moment, I am feeling both that there are too many things that I need to address and too many directions that we could head in....and also, that we have not been presented with enough good options. Fwiw, I doubt you're crazy on this. I find these therapists, doctors, etc. tend to want you to TURN OFF YOUR BRAIN and just give them money and trust. And you're like no, it really ought to make sense and add up and be cognitively reasonable! And I don't think that's too much to ask. 3 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 6 hours ago, Storygirl said: And I need to find a psych who can address the anxiety, who would also be able to continue working on the pragmatics when we are ready to shift into that (with the thinking that we can get him through the door with the anxiety thing and then establish a relationship with a counselor who we can continue working with). Someone who is familiar with ABA. But also a psychiatrist to talk about meds. And then there is the suggestion to update the OT and SLP evaluations (putting that on the back burner, but still they are on the list). And I need to contact the school to give them this new report and see if they think his IEP needs changes. Ok, so rather straight talk. -OT-At this age it's rather worthless. Somebody can say otherwise. I'm just saying the ship has sailed, they should help him get to know his sensory profile and send him packing. -SLP-Why is this low on the list? Language disability and pragmatics both fall under SLP. They aren't psych issues. The language disability is going to submarine the psych all over again. Pragmatics issues are not volitional or a matter of willing to do better when you have a language disability. Can't milk a turnip. -pdoc for meds-Sounds good. That's probably a month out for an appointment meaning you might be able to get him on something before school. That would seem really high priority. I would not use anxiety to say not starting before school. I would say the opposite, that starting before school would be HIGH priority. It might be your thing that gives the biggest bang for buck, biggest change. And it might unlock all the other ideas. -IEP-Yeah, sigh, joy. At least they've already said they want to. So my two cents is to let the school do the pragmatics and you do the things the school won't do or won't do well. They can't do meds and they won't bother with the narrative language/SLP stuff. Sorry it's confusing and overwhelming. Deep breath. You've got this. 2 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 You mentioned ABA and counselor. This makes no sense to me. You would want a behaviorist. ABA is a combo of someone supervising and helping YOU and someone hiring workers to spend hours with him. My two cents is I would get the pdoc and the meds now to make the ABA go better. And I think you'll have enough of a waiting list for ABA potentially that you could get on the list now and have your meds done and going in 1-3 months when you finally get hooked up with the behaviorist. It will take even more time to line up workers. So really, even if you start now, you're looking at beginning ABA in 3-4 months maybe, which means waiting list for it now and going to through the choosing process for who you like while you get the meds. Clear as mud? Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 In office ABA will not generalize as well as work done in your home, etc. That's why it's not a person he just shows up to and sits with, staring at for an hour. You want them to come to your home and actually work with him. You want them to take him on outings around town. It needs to generalize. They can target some language too btw. But at this point ABA goals for language would be the generalization and the SLP work would be the direct instruction. I would do both. Well if your car holds out and you don't faint, lol. I'm just saying it's not overkill to do both and that's why. The school could also add narrative and expressive language goals, but good luck on that. 1 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 On July 14, 2019 at 2:51 PM, Storygirl said: But I think since he is wanting to address his feelings of anxiety, that that is an opening and makes a good place to get started. If he can establish a connection with a therapist, then I think they could move into working on other things, in addition to anxiety. Sounds like pdoc plus behaviorist. It can be a counselor like you're saying, sure. And if he wants that, fine. But the language issue is still going to be there. Pdoc should be able to do CBT and strategies and the behaviorist can then help him *generalize* them to more places. Generalizing means you practice the skill lots of places till you can do it anywhere. With autism, if you learn something one place, say school, you might have it so connected there in the brain that then they don't do it at home. So you always want to generalize, so that the instruction can carry over to life. That has probably been a frustration for you, that he's been taught Zones and all kinds of stuff in school and doesn't DO it at home. He will not probably generalize well on his own. He will need help, and the behaviorist and those ABA hours are a way to get there. 2 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 6 hours ago, Lecka said: you might want a licensed social worker for counseling Our behaviorist is a licensed social worker. Depends on who you get and the skill set. I think there are a lot of hairbrained, barely, on paper qualified people. It takes some work to find a behaviorist that is ready to work with older kids and do transition. 1 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 (edited) 6 hours ago, Storygirl said: I'm stressed. You probably couldn't tell. 😏 I'm encouraging DH to do more to help me figure this stuff out. Okay, "encouraging" is a nice word for freaking out and insisting that he needs to help me bear the load. He's a nice guy. I feel badly that I dumped all over him. However, he is equally a parent, so why am I stuck with most of the stress and decisions? Ok, the chaste advice I was given was PICK TWO THINGS. I'm not saying I follow that scrupulously. I'm just saying right now you're stressed maybe because of guilt more than sense. It is cognitively IMPOSSIBLE for him to process all the good of the therapies if you do too many things at once. NO PROFESSIONAL would tell you to do this. If you get a behaviorist and let them get to know him, they will see big picture and help you prioritize. It's what they DO. And they'll probably say pick 2 things. They'll say keep his life good. They'll say make sure he has time and energy to do things he enjoys and is not missing things he enjoys for therapy. They'll probably say to focus on things that are naturalistic or that you know have gotten good results in the past. So if there's something he does that, when he comes back, he's more compliant, more connected, more calm, more happy, try to do therapy through that, through more of that. That's your big clue. And yeah, they might tell you to up the pace on getting the meds. That would be the elephant in the room. Our behaviorist is a licensed social worker, so she's trained in DSM and meds, able to diagnose everything, and she always has her radar going on mental health, what really needs to happen. 6 hours ago, Lecka said: He has a good foundation in place with many of the big things! I think this is a really important point. It's why more talking at him, more in-office, more of what he's already had might get the same results. (not generalizing to life, not improving family life). If you want to improve in-home and in life, you need workers in-home and in life. You cannot make it better or make the autism go away, no matter how much you do. No matter how much therapy you do, he will still have a language disability and things will still be hard. How he feels (his stability, connectedness, possibly joy) can improve. Pick two things, do them, then see if there's room for a 3rd. That is sane. PS. If something is only once a month, like the pdoc, I wouldn't really count that against the two. PPS. Art therapy is the bees' knees for getting to emotional regulation with someone with a language disability. Just saying. One session and we got breakthroughs. And ds left unstressed. Couldn't believe it. Edited July 19, 2019 by PeterPan 1 Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 19, 2019 Author Share Posted July 19, 2019 18 minutes ago, PeterPan said: Ok, so rather straight talk. -OT-At this age it's rather worthless. Somebody can say otherwise. I'm just saying the ship has sailed, they should help him get to know his sensory profile and send him packing. I think the OT issues are things for us to work on at home -- tying shoes, etc., so it's not a high priority for me, but the evaluator put it on the list, so I need to think about whether there are some needs there that can be addressed. -SLP-Why is this low on the list? Language disability and pragmatics both fall under SLP. They aren't psych issues. The language disability is going to submarine the psych all over again. Pragmatics issues are not volitional or a matter of willing to do better when you have a language disability. Can't milk a turnip. He gets speech therapy (pragmatics) through the SLP at school. Other than that, it's not really low on the list, just that we have other things to line up first. Since he does get some help for this already, I think we need to prioritize the things that he's not getting help with yet at all. -pdoc for meds-Sounds good. That's probably a month out for an appointment meaning you might be able to get him on something before school. That would seem really high priority. I would not use anxiety to say not starting before school. I would say the opposite, that starting before school would be HIGH priority. It might be your thing that gives the biggest bang for buck, biggest change. And it might unlock all the other ideas. Yeah, we don't want to wait until school starts to figure out the medication, if we can get appointments before then. We are just not making progress on figuring out who to go to. I left a question about it for the pediatrician last week, but she hasn't called me back; following up with her is on my list. -IEP-Yeah, sigh, joy. At least they've already said they want to. So my two cents is to let the school do the pragmatics and you do the things the school won't do or won't do well. They can't do meds and they won't bother with the narrative language/SLP stuff. Sorry it's confusing and overwhelming. Deep breath. You've got this. 1 Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 19, 2019 Author Share Posted July 19, 2019 23 minutes ago, PeterPan said: You mentioned ABA and counselor. This makes no sense to me. You would want a behaviorist. ABA is a combo of someone supervising and helping YOU and someone hiring workers to spend hours with him. My two cents is I would get the pdoc and the meds now to make the ABA go better. And I think you'll have enough of a waiting list for ABA potentially that you could get on the list now and have your meds done and going in 1-3 months when you finally get hooked up with the behaviorist. It will take even more time to line up workers. So really, even if you start now, you're looking at beginning ABA in 3-4 months maybe, which means waiting list for it now and going to through the choosing process for who you like while you get the meds. Clear as mud? It's just confusing to me. The evaluator never told me that we need to look for a behaviorist but said over and over that he needs counseling with someone who understands autism. So it seemed to me that she is expecting a counselor to use ABA in their approach. The people she referred us to are psychs (and the LISW), not behaviorists. 1 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 (edited) 12 minutes ago, Storygirl said: I think the OT issues are things for us to work on at home -- tying shoes, etc., so it's not a high priority for me, but the evaluator put it on the list, so I need to think about whether there are some needs there that can be addressed. For my dd the tying shoes improved with vision therapy. Have you had his eyes checked by a developmental optometrist? I wouldn't assume OT is the need there. It's a really voodoo vague field. He's had OT on his IEP for years, so they should have addressed it by now if they could. He's way too old to need "tying shoe" lessons. Something else is the cause. 12 minutes ago, Storygirl said: He gets speech therapy (pragmatics) through the SLP at school. Other than that, it's not really low on the list, just that we have other things to line up first. Since he does get some help for this already, I think we need to prioritize the things that he's not getting help with yet at all. Pragmatics is totally different from narrative language and expressive language. Not saying you *have* to prioritize it, just saying they're different. You could say he's 15, roll with it, move on. It's a judgment call you make. But if his talk therapy sessions have gone down the tube before, they may still. At least that's how it seems with my ds. You can't take the emotional loading of the emotional regulation issues and approach it through his disability area. At least not with my ds. If he really wants to, I guess see how it rolls. They're just judgment calls you make. It's also ok to try things and change, lol. 12 minutes ago, Storygirl said: Yeah, we don't want to wait until school starts to figure out the medication, if we can get appointments before then. We are just not making progress on figuring out who to go to. I left a question about it for the pediatrician last week, but she hasn't called me back; following up with her is on my list. Our local parent support group FB is exceptionally opinionated and only likes a few pdocs even for such a large city. Odds are the ped will refer through the children's hospital, and in our area the children's hospital is NOT well-liked in the support group, go figure. 9 minutes ago, Storygirl said: It's just confusing to me. The evaluator never told me that we need to look for a behaviorist but said over and over that he needs counseling with someone who understands autism. So it seemed to me that she is expecting a counselor to use ABA in their approach. The people she referred us to are psychs (and the LISW), not behaviorists. People have opinions. My ds has a language disability, so we've gotten burnt with people expecting to use too much language. I think it's an age-appropriate recommendation she's making. Whether it actually works with his language is a different question. We got dropped by a psych who was trying to use so much language with my ds. My ds responds well to very quiet, gentle coming alongside, things that are naturalistic and engaging. I think use your judgment. Sometimes I have a hard time seeing patterns, which is where the behaviorist helps me. Like I was telling her that ds was doing so well after our week at the lake and that I wanted to figure out what was working so we could keep doing it! I'm like is it the supplements, the this, the that. She's like HELLO IT'S THE LAKE! I think it can be like that sometimes, that we get really caught up in professionals and lists. Find something that has worked well for him and that might be your clue to inroads and ways to get more good results. The reality is you can work on the same goals lots of ways. So you can work on emotional regulation with an OT, a psych, an art therapist, an SLP, an ABA behaviorist or RBT, a music therapist, on and on. It was always the same goals, and you can say well he's doing really well right now and learns well or seems to improve when he interacts more *this* way or *that* way. But ANYBODY could work with him. The goal is the main thing and the modality, who works on it, is more just a question of who is clicking and what way seems like an open door. And you are probably best qualified to judge that. That's your decision. Edited July 19, 2019 by PeterPan 1 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 Have you asked him what he wants? Like you could say I'm trying to find options for your anxiety and in addition to meds you could -talk with the pdoc and do CBT -talk with a LSW who could address more issues you want to talk about -work with someone who would use less language but more doing like an art therapist, behaviorist, music therapist, etc. and just see what he says. Might be interesting. Or don't, lol. I'm just saying when I don't know what to do, that's what I do. I also seem to have trust issues, because I don't seem to trust professionals very far. If the explanation doesn't make sense, it probably isn't right. It's ok to want it to make sense, to jive. If you like the answer, do it. If it doesn't make sense to you, hold the thought, take the good, translate it into something that will work. 2 1 Quote Link to comment Share on other sites More sharing options...
Rosie_0801 Posted July 19, 2019 Share Posted July 19, 2019 Does he let you read aloud to him? Quote Link to comment Share on other sites More sharing options...
Lecka Posted July 19, 2019 Share Posted July 19, 2019 (edited) I am going to ask a question: would the purpose of ABA be primarily for behavior management? If yes — I think a lot of people could do that. He is verbal. He has appropriate behavior and awareness of appropriate behavior at many times and places. I think you are pretty aware of the times and circumstances when he is likely to possibly have an issue: mornings, when given feedback or directions. I could be wrong — but I think this does not sound like needing really broad ABA. And, it doesn’t sound like there are a lot of mysteries where he is having an issue and you have no idea where it is coming from. It also sounds like the level of the issue is not that high. I don’t mean that at all to minimize anything — I do not. But it’s my impression. I think there are in-office things for behavior management that do work. I’m also going to add (as someone who has a child in school) that your son’s schedule is already full of very, very positive things. Things that are very positive and that overall are going well. The hours in the day are not there for you to do ABA like Peter Pan says, and it would probably not make sense to take away his current activities to replace them with this. Maybe it would — but probably not — this is something people look at. I think the ABA side may be meant to be — something where someone is familiar with the behavior management side, and gives you advice that you do at home, and also works with your son. I do agree there has to be some change at home, that needs to include professional guidance, but I think it can work for that to be from an office setting. Because — this is my impression — most of your issues are around two specific times/issues. Somebody could come up with a plan for those, and it could cut down the issues by a huge percent. That is the ideal — but it can work out that way. It’s not that it would be easy — or even easier. It’s just a different model. But I think it’s a model that is worth a shot. I also think — is the county thing where you need goals, for summer only? If so — it’s already half-way through July. I would call an apologize and say it’s not going to come together this summer. Or just do generic goals — which people do all the time — of — conversational skills, increasing independence in the community, umm... those are off the top of my head, and very important goals that aren’t too specific. It would be fine to put those down, most likely. It might even be the kind of think TO put down. It’s not like it needs to be an IEP goal!!!!!! Probably. Unless you have been given guidance on this, it’s probably NOT like the kind of thing with an IEP goal. Edit: I do think — it’s worth trying the lsw, seeing if he/she seems like he/she is going to provide behavior management. I agree with trying to get the appointment about medication. Maybe it is okay to start with your doctor (for work medication) while on a waiting list for someone else — I think this could be okay. Edited July 19, 2019 by Lecka 1 Quote Link to comment Share on other sites More sharing options...
Lecka Posted July 19, 2019 Share Posted July 19, 2019 I also think — I understand things are complex and interrelated, but I think trying to reduce behavior issues is a good first thing to do. The reason is — first, it will make everything else easier. Second, it might reveal what things are priorities then. Sometimes things are a bit hidden by behavior issues. It can also be that there HAS to be skill-building to reduce a behavior issue. But if some could be reduced, then you could see what was left. I think the lsw and meds would be decent to try. And then there is room to go more intense from there. But you could find out a lot from trying it. 1 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 ABA with my ds at this age works on connection, cause/effect, conversation skills, the kinds of things Story is saying are getting therapied in school but not generalizing or actually happening in real life. It's relationship work, the thing she was saying she was MOST concerned about long-term. I liken it to wild horse taming. Of course Kbutton met my ds and said he was feral, so there you go, lol. I think it can be a lot of things, because it's so big umbrella. So fwiw,, when my ds has that kind of interaction, all the other stuff goes better. Like the behaviors that Story is citing go down. It's kind of surprising for me. I get used to how he is and don't realize how much better he can be. For my ds, sometimes the actual aut of the autism (that he's in his own world, that he has pulled in) makes everything harder. At least that's what I think is going. So then you ABA him and do serious 1:1 and you get this bump. It wasn't that they were working on compliance or this or that but he just came back a bit and has LOWER STRESS and is feeling more connected. STRESS is something the behaviorists look at a lot, and they look for patterns. But you know roll with your gut, try some things. Some of it is who you find that you think would fit. You can look at lots of people and realize you can't find the person who's right for x or that they have a waiting list. For my ds prioritizing relationship is really good and anything naturalistic, done in life is really good and so far the most powerful. 1 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 About the shoe tying, have you looked at Lock Laces? They sell them at the running stores, maybe other places. They're just nice stretchy laces with a cute bungie clip. My ds uses them. My ds technically *can* tie shoes, but they're tedious. So when we buy shoes, we have the lock laces put in, boom done. That way they coordinate with the shoes too. They're like $3. 1 Quote Link to comment Share on other sites More sharing options...
kbutton Posted July 19, 2019 Share Posted July 19, 2019 13 hours ago, PeterPan said: The language disability is going to submarine the psych all over again. Pragmatics issues are not volitional or a matter of willing to do better when you have a language disability. My son needed scaffolded and structured conversations, and that wasn't going to happen with a psych. He'd talk, but not about anything important. On the other hand, using books about real-life problem-solving (What would you do if? kinds of books) or books about being a good friend were things that helped him a lot, and they gave him something to talk about. We used a behaviorist for this because the behaviorist would see the ABC's that would keep my son from being successful and be able to strategize. Also, in our area, that's who was familiar with the range of "what could go sideways with this" that autism brings in a way that an SLP might not be. (I am sure some SLPs are great at this though.) https://www.amazon.com/dp/0470259361/?coliid=I3VIME5RLL8IOF&colid=3494X931L2H07&psc=1&ref_=lv_ov_lig_dp_it This book had to be adapted with my son, but it was a GREAT resource for him to talk through life stuff. They also used these sometimes: https://www.amazon.com/Growing-Up-Bucket-Full-Happiness/dp/1933916575/ref=sr_1_2?keywords=bucket+full+of+happiness&qid=1563550947&s=books&sr=1-2 https://www.amazon.com/Making-Stuff-Sandra-McLeod-Humphrey/dp/0898243793 We used some of the Social Thinking books, but the language got in the way, though we were only just beginning to realize it at the time. It is astounding the things that will now come out of my son's mouth as a question or problem statement vs. a series of statements that just sound like statements until you put them all together, take his agitation into account, and then realize there is a problem buried inside those statements that you must intuit. I strongly recommend work on language too. 13 hours ago, PeterPan said: You want them to take him on outings around town. It needs to generalize. Our behaviorist did trips where my son would have to problem-solve (or we at least tried). They did phone skills, a lot. Eventually when all that was working pretty well, they found a place that my son could do some volunteering, and the behaviorist went along with him to help things generalize and to make sure he stayed on task, didn't get too wound up and do impulsive stuff, lol! (And now he volunteers just fine--lots of maturing since then.) 13 hours ago, Storygirl said: It's just confusing to me. The evaluator never told me that we need to look for a behaviorist but said over and over that he needs counseling with someone who understands autism. So it seemed to me that she is expecting a counselor to use ABA in their approach. The people she referred us to are psychs (and the LISW), not behaviorists. Yeah, I am not sure the qualifications matter so much as understanding autism, understanding that things need to generalize, and being able to get around or through the language component when one is there. But getting carryover to real life is the big deal. 13 hours ago, PeterPan said: But if his talk therapy sessions have gone down the tube before, they may still. At least that's how it seems with my ds. You can't take the emotional loading of the emotional regulation issues and approach it through his disability area. At least not with my ds. If he really wants to, I guess see how it rolls. They're just judgment calls you make. It's also ok to try things and change, lol. I think it's an age-appropriate recommendation she's making. Whether it actually works with his language is a different question. We got dropped by a psych who was trying to use so much language with my ds. My ds responds well to very quiet, gentle coming alongside, things that are naturalistic and engaging. I think use your judgment. Sometimes I have a hard time seeing patterns, which is where the behaviorist helps me. Like I was telling her that ds was doing so well after our week at the lake and that I wanted to figure out what was working so we could keep doing it! I'm like is it the supplements, the this, the that. She's like HELLO IT'S THE LAKE! The reality is you can work on the same goals lots of ways. So you can work on emotional regulation with an OT, a psych, an art therapist, an SLP, an ABA behaviorist or RBT, a music therapist, on and on. It was always the same goals, and you can say well he's doing really well right now and learns well or seems to improve when he interacts more *this* way or *that* way. But ANYBODY could work with him. The goal is the main thing and the modality, who works on it, is more just a question of who is clicking and what way seems like an open door. And you are probably best qualified to judge that. That's your decision. Bingo. For us, this was also a behaviorist followed by work with an SLP on narrative language. SOME people can do both. The narrative language problem, for us, was not glaring or else the behaviorist would've worked on it. Behaviorist #2 (1st one changed employers) solidified the problem, we got testing, but then that behaviorist was still not meeting my son where he was at and then blaming him for not having the language. Then we found Mindwings and tried the SLP. It was new to her, and she hit some real frustrating spots, but once it started going well, it has been really helpful. By then we were doing it for academics, but the personal stuff has just come on its own and been really nice. 4 hours ago, Lecka said: I am going to ask a question: would the purpose of ABA be primarily for behavior management? If yes — I think a lot of people could do that. He is verbal. He has appropriate behavior and awareness of appropriate behavior at many times and places. I think you are pretty aware of the times and circumstances when he is likely to possibly have an issue: mornings, when given feedback or directions. I could be wrong — but I think this does not sound like needing really broad ABA. And, it doesn’t sound like there are a lot of mysteries where he is having an issue and you have no idea where it is coming from. It also sounds like the level of the issue is not that high. I don’t mean that at all to minimize anything — I do not. But it’s my impression. I think there are in-office things for behavior management that do work. I think the ABA side may be meant to be — something where someone is familiar with the behavior management side, and gives you advice that you do at home, and also works with your son. I do agree there has to be some change at home, that needs to include professional guidance, but I think it can work for that to be from an office setting. Because — this is my impression — most of your issues are around two specific times/issues. Somebody could come up with a plan for those, and it could cut down the issues by a huge percent. That is the ideal — but it can work out that way. It’s not that it would be easy — or even easier. It’s just a different model. But I think it’s a model that is worth a shot. Also, if you don't think he'd have negative behaviors with an outside person, the office model might be the only thing that works. For the real-life problem-solving stuff, you might already have access to that with the county and with the job training/mentoring program. So there's that side of things. What we found beneficial with a behaviorist might be something you farm out to different people, or you might find needs a different angle. 4 hours ago, Lecka said: I also think — I understand things are complex and interrelated, but I think trying to reduce behavior issues is a good first thing to do. The reason is — first, it will make everything else easier. Second, it might reveal what things are priorities then. Sometimes things are a bit hidden by behavior issues. It can also be that there HAS to be skill-building to reduce a behavior issue. But if some could be reduced, then you could see what was left. Yes, exactly. In our case, the behaviorist was the angle that got us there, and then language once we knew it was an issue. If we'd had the language nailed first, I think we might have been fine and just liked the behaviorist as a less stressful way to get some skills in than doing it ourselves, lol! 3 hours ago, PeterPan said: ABA with my ds at this age works on connection, cause/effect, conversation skills, the kinds of things Story is saying are getting therapied in school but not generalizing or actually happening in real life. It's relationship work, the thing she was saying she was MOST concerned about long-term. So fwiw,, when my ds has that kind of interaction, all the other stuff goes better. Like the behaviors that Story is citing go down. It's kind of surprising for me. I get used to how he is and don't realize how much better he can be. Ditto here. I could do some of that on my own, but it was exhausting. Also, I was doing it with a younger child who WANTED to understand how the world worked. He was highly motivated while also highly frustrated. Some of the connections we made were when he was really little, and the behaviorist just upped that game when he was at a different developmental stage. The language work just fixed some quirks in his brain. For problem-solving specifically, Mindwings has the Critical Thinking Triangle in Action package as well as the Making Connections books. They are often used for social thinking outside of using them for literature or language arts types of things. Those two tools were SUPER powerful for us. I suspect that to have productive conversations, you need something along those lines to get the thinking pieces in place for problem-solving of any kind (relational, practical, impulse-control, etc.). 2 Quote Link to comment Share on other sites More sharing options...
kbutton Posted July 19, 2019 Share Posted July 19, 2019 The two Mindwing products can be purchased together: https://mindwingconcepts.com/products/the-critical-thinking-triangle-in-action 1 Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 19, 2019 Author Share Posted July 19, 2019 12 hours ago, PeterPan said: Have you asked him what he wants? Like you could say I'm trying to find options for your anxiety and in addition to meds you could -talk with the pdoc and do CBT -talk with a LSW who could address more issues you want to talk about -work with someone who would use less language but more doing like an art therapist, behaviorist, music therapist, etc. and just see what he says. Might be interesting. Or don't, lol. I'm just saying when I don't know what to do, that's what I do. I also seem to have trust issues, because I don't seem to trust professionals very far. If the explanation doesn't make sense, it probably isn't right. It's ok to want it to make sense, to jive. If you like the answer, do it. If it doesn't make sense to you, hold the thought, take the good, translate it into something that will work. He has always had poor metacognition, so he tends to not have many goals for himself. And he does not love it when other people set goals for him. Example -- He dropped out of cross country this summer after a couple of weeks, because he felt the expectations and goals were too stressful for him. He didn't express it this way, but just said he didn't want to do it, because it was too hard. It was not too hard physically at that point, because they were not running further than he was used to. So I think it was the emphasis on and expectation from the coach for hard work and improvement that put him off. He wanted to run and was excited about cross country, and he enjoyed it on the middle school team, but when the goals stepped up, he quit. This is a kid who was running up to 10 miles a day on his own, for fun. But when the coach required them to run at home and track miles, DS stopped running at all, outside of practice, and then ended up quitting. There is more to how this all went down, as far as how we tried to encourage him to stick it out, etc. He has not run even a single day for fun, since quitting the team a month ago. Somehow, putting expectations onto running made him run the other way (figuratively). So ugh, he doesn't always know what he wants, or doesn't know how to articulate it, if he is thinking about it. He does say periodically that he wants help with the anxiety. He repeats that occasionally. He specifically does not want help with anything else and hates practicing conversation skills and would not go to his job skills class, if we did not require it. If we give him options about anything, the answer will always be No. I did talk with him just this morning about therapy, in general, and explained that if he works on skills with DH and me, so that he practices and gets better, then he wouldn't need as much help from therapists. That the goal is for him to learn the skills and then not have to go. He listened without responding, other than to say, "yes," when I asked if that made sense. Based on history, however, I don't anticipate that conversation will change anything. I am just trying to lay groundwork, in the hope that eventually, he might be willing to take on goals of his own. Working toward goals that others set is not motivating to him. 12 hours ago, Rosie_0801 said: Does he let you read aloud to him? He is resistant. So he will allow it, but he may tune out and not listen. He does have better comprehension with listening than with reading to himself. When I read aloud, I will stop to explain things, and he hates that. He just wants me to read things straight through, because to him the goal is to get to the end of the passage, not to understand the passage. I have a book I selected to read aloud to all of the kids this summer. but we haven't started it yet. They have been doing independent reading, but I have to require it, or two of them will not read for fun at all -- DS15 with reading comprehension issues, and DD14 who has dyslexia. I still try to do read books aloud sometimes, even though they are all teens and would rather be doing something else. They all prefer listening to music over audiobooks. 4 hours ago, Lecka said: I am going to ask a question: would the purpose of ABA be primarily for behavior management? If yes — I think a lot of people could do that. He is verbal. He has appropriate behavior and awareness of appropriate behavior at many times and places. I think you are pretty aware of the times and circumstances when he is likely to possibly have an issue: mornings, when given feedback or directions. I could be wrong — but I think this does not sound like needing really broad ABA. And, it doesn’t sound like there are a lot of mysteries where he is having an issue and you have no idea where it is coming from. It also sounds like the level of the issue is not that high. I don’t mean that at all to minimize anything — I do not. But it’s my impression. I think there are in-office things for behavior management that do work. I’m also going to add (as someone who has a child in school) that your son’s schedule is already full of very, very positive things. Things that are very positive and that overall are going well. The hours in the day are not there for you to do ABA like Peter Pan says, and it would probably not make sense to take away his current activities to replace them with this. Maybe it would — but probably not — this is something people look at. I think the ABA side may be meant to be — something where someone is familiar with the behavior management side, and gives you advice that you do at home, and also works with your son. I do agree there has to be some change at home, that needs to include professional guidance, but I think it can work for that to be from an office setting. Because — this is my impression — most of your issues are around two specific times/issues. Somebody could come up with a plan for those, and it could cut down the issues by a huge percent. That is the ideal — but it can work out that way. It’s not that it would be easy — or even easier. It’s just a different model. But I think it’s a model that is worth a shot. I also think — is the county thing where you need goals, for summer only? If so — it’s already half-way through July. I would call an apologize and say it’s not going to come together this summer. Or just do generic goals — which people do all the time — of — conversational skills, increasing independence in the community, umm... those are off the top of my head, and very important goals that aren’t too specific. It would be fine to put those down, most likely. It might even be the kind of think TO put down. It’s not like it needs to be an IEP goal!!!!!! Probably. Unless you have been given guidance on this, it’s probably NOT like the kind of thing with an IEP goal. Edit: I do think — it’s worth trying the lsw, seeing if he/she seems like he/she is going to provide behavior management. I agree with trying to get the appointment about medication. Maybe it is okay to start with your doctor (for work medication) while on a waiting list for someone else — I think this could be okay. About ABA -- the only time the evaluator mentioned it at all is one place in her report. She never mentioned ABA at all to us in our conversations with her. In the report, it says, "As a direct result of his ASD, GAD, ADHD, and ODD diagnoses, he continues to present with significant deficits in the areas of social-emotional development, behavior, communication, sensory integration, and self-regulation. Therefore, ongoing intensive (35-40 hours per week) structured classroom learning, related therapies, ABA-based intervention/therapy, and counseling service are supported at this time." During the school year, the school day is about 7 hours, minus lunch. And then he has a lot of extracurriculars with music and sports. There are a lot of things packed into that recommendation, and it will take finding multiple providers to work on those areas. Anything we can do within a single provider will be really helpful, because we just don't have enough time in our schedule to do many different things (and I also have three other kids). I am very open to DH and me learning new things to implement at home, as well. About the second question about county services -- The funding is year round, but I was hoping to use it this summer. Because our schedule gets packed during the school year. And because the person we selected to be his personal worker is a previous teacher of his, so she is also busier during the school year. I am considering just telling our county coordinator and the teacher that now that we have this new list of things in the evaluation, that we need to prioritize finding professional help first. Then hopefully, our counselor can suggest things for the worker to work on with him, as well, so that we are all connected, working on the same skills, in the counseling office, at home with parents, and with his personal worker. I think having a focused approach like that would make more sense to me. There are some goal in his individual plan from the county that can easily be connected to the goals in his autism evaluation report. I feel that all of these individual goals are kind of scattered now, and that it would help to have someone make it more cohesive. It sounds like Peter Pan's behaviorist does that for them. I'm not sure that we need a behaviorist for that, and maybe the counselor can be the one to spearhead things. Social workers do do that, so that could be a reason to choose the social worker as his main therapist (assuming she has room in her case load, which I don't know yet). 2 hours ago, PeterPan said: About the shoe tying, have you looked at Lock Laces? They sell them at the running stores, maybe other places. They're just nice stretchy laces with a cute bungie clip. My ds uses them. My ds technically *can* tie shoes, but they're tedious. So when we buy shoes, we have the lock laces put in, boom done. That way they coordinate with the shoes too. They're like $3. Yes, we've used them in the past. I like them! Right now, DS15 is wanting to wear high top style sneakers, so he needs to be able to untie and tie them more completely, in order to get his foot in and out. He has, for the past few years, mostly just pulled his shoes on while leaving them tied, but he can't do that with the high tops. He is getting a little better now that we are having him practice daily. Not great yet. For some reason, he is ending up with three loops, instead of two, and he doesn't pull the strings tightly enough, so we have a ways to go. He does not want to practice this and just wants us to do it for him. He resists listening to instructions and trying to use tips that we have to offer. So we are taking it slowly, to minimize the opposition. Right now our goal is -- "you try it, just once each day, then I will fix it for you, if needed." If we start giving instruction, he gets mad, so we are taking baby steps. Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 15 minutes ago, Storygirl said: he felt the expectations and goals were too stressful for him. Stress and lowering stress is something our behaviorist talks about a LOT. The guy at the Autism Discussion FB page talks about it too. 16 minutes ago, Storygirl said: So ugh, he doesn't always know what he wants, or doesn't know how to articulate it, if he is thinking about it. That makes sense. Have you looked into Special Olympics or getting a running partner for him? It can be ABA even. I've read some articles on adults with autism using running partners to be able to run. I'm looking into Special Olympics for my ds, because he hit the same thing. He can't handle the stress and intensity of the push push push of typical competition. He needs something lower key, more recreational and I'm hoping SO will get him there. They're schedule is a LOT lower key, and decreasing business and increasing recovery time helps stress. How is he doing this summer vs the school year? Not saying I have a brilliant interpretation, just that it's interesting to ponder in terms of stress and sources of stress. 20 minutes ago, Storygirl said: So ugh, he doesn't always know what he wants, or doesn't know how to articulate it, if he is thinking about it. This goes back to that article I linked you. I think that's not uncommon and it's ok to make a good choice. It's just hard sometimes to know, sigh. 22 minutes ago, Storygirl said: He specifically does not want help with anything else and hates practicing conversation skills and would not go to his job skills class, if we did not require it. If we give him options about anything, the answer will always be No. I did talk with him just this morning about therapy, in general, and explained that if he works on skills with DH and me, so that he practices and gets better, then he wouldn't need as much help from therapists. That the goal is for him to learn the skills and then not have to go. He listened without responding, other than to say, "yes," when I asked if that made sense. Based on history, however, I don't anticipate that conversation will change anything. I am just trying to lay groundwork, in the hope that eventually, he might be willing to take on goals of his own. Working toward goals that others set is not motivating to him. What an awkward situation. No one wants to be fixed. Is there anything that is going WELL right now? What happens if someone comes to the house and just tries to hang with him? That's basically where a behaviorist would start. It's very low key, not a lot of language, no stress. 25 minutes ago, Storygirl said: He is resistant. So he will allow it, but he may tune out and not listen. He does have better comprehension with listening than with reading to himself. When I read aloud, I will stop to explain things, and he hates that. He just wants me to read things straight through, because to him the goal is to get to the end of the passage, not to understand the passage. Given that his reading is like 4th grade, what level do you think you'd have to drop to so that he could understand *without* you explaining so much? 27 minutes ago, Storygirl said: About ABA -- the only time the evaluator mentioned it at all is one place in her report. She never mentioned ABA at all to us in our conversations with her. In the report, it says, "As a direct result of his ASD, GAD, ADHD, and ODD diagnoses, he continues to present with significant deficits in the areas of social-emotional development, behavior, communication, sensory integration, and self-regulation. Therefore, ongoing intensive (35-40 hours per week) structured classroom learning, related therapies, ABA-based intervention/therapy, and counseling service are supported at this time." I don't think I'm reading that the same as you. She just said to get his total time (school plus all forms of therapy/professional interaction) to 35-40 hours a week. That's pretty serious. And she's saying to get ABA. I don't see a don't bother with ABA there. How much is he in school? That's going to eat up a ton of his availability. 29 minutes ago, Storygirl said: Right now our goal is -- "you try it, just once each day, then I will fix it for you, if needed." If we start giving instruction, he gets mad, so we are taking baby steps. That level of volatility sounds hard to live with. It's a reason to get him with the pdoc and get something going. Meds, biomedical, something. 30 minutes ago, Storygirl said: And then he has a lot of extracurriculars with music and sports. So you've got 35 hours of school during the week, which leaves 5 hours. That would be 1 hour with a behaviorist weekly, another 2-3 hours one day a week with an RBT who would come to your home and work with him (preferably Saturday to get him spiffing for Sunday, but Sunday could work), and 1, at most 2, hours for something else. Which sorta fits with the *2 things* advice I was saying. I'm not sure it means sign him up for 7 therapies. I'm not sure it's realistic. Some of that paper trail is so you can possibly add goals or services to his IEP and get it done during school. But after school, seems like you just have 5-6 hours total, not endless amounts. 33 minutes ago, Storygirl said: And because the person we selected to be his personal worker What is this person? If she's available and knows him, you could just allow it for now, just to get hours. You've got another month before that changes and you probably won't really have anything new going before then. 34 minutes ago, Storygirl said: Social workers do do that, so that could be a reason to choose the social worker as his main therapist (assuming she has room in her case load, which I don't know yet). So our behaviorist is a social worker. She has that training and only works with autism. Not trauma and alcoholism and depression and and kwim? Do you have some objection to someone in your home? I don't know, just kinda poking there to see what happens. It *almost* sounds like that's uncomfortable for you. Because I'm just gonna tell you that same person in your home will be more helpful to you than in an office. Your ds will be different and she will get more info to help you more accurately. And it promotes generalization, etc. But just my two cents is if you're picking someone to trust, let them into your home. Let them really see what's going on and really know so they can give you straight advice. Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 19, 2019 Author Share Posted July 19, 2019 The Mindwings kit looks great! I know that Mindwings products have been talked about a lot on the LC board. Because DS's work with his SLP has been through the school, and because he is resistant to doing work for me at home, I have not looked at them extensively before now. Do you think this is something his county worker / teacher could work on with him? Or I could see about hiring our OG tutor to work with him, if she would be willing. We don't have a relationship with an SLP right now, other than the one from school -- I like her, and DS likes her, but I got zero feedback from her over the school year, other than at his IEP meeting, so I wouldn't say that I have a relationship with her, really -- so I don't have an SLP that I could hand the MindWings materials to and say, "please work on this." But I could do that with the tutor. Or his county worker. If they were willing, and if the program is something they can work through intuitively, without extra training or without having to spend a lot of non-tutoring time on preparation. Meaning, I would not want to ask them to learn how to teach this; I would just want them to be able to open and go. Of course, I could work on it with him at home. But I know how that would go. Same thing with interoception. He could use work on this. But would he be willing to work on it with me? Very iffy. As a former homeschooler, I know that I could easily take some of these things on myself. But things quickly turn "not easy" when he is unwilling. Quote Link to comment Share on other sites More sharing options...
kbutton Posted July 19, 2019 Share Posted July 19, 2019 32 minutes ago, PeterPan said: Do you have some objection to someone in your home? I don't know, just kinda poking there to see what happens. It *almost* sounds like that's uncomfortable for you. Because I'm just gonna tell you that same person in your home will be more helpful to you than in an office. Your ds will be different and she will get more info to help you more accurately. And it promotes generalization, etc. But just my two cents is if you're picking someone to trust, let them into your home. Let them really see what's going on and really know so they can give you straight advice. I really hate to pile on, but I agree with the bolded. We have found in-home workers to be very supportive. Frankly, they are used to seeing chaos or at least a HUGE range of household standards. 27 minutes ago, Storygirl said: The Mindwings kit looks great! I know that Mindwings products have been talked about a lot on the LC board. Because DS's work with his SLP has been through the school, and because he is resistant to doing work for me at home, I have not looked at them extensively before now. Do you think this is something his county worker / teacher could work on with him? Or I could see about hiring our OG tutor to work with him, if she would be willing. We don't have a relationship with an SLP right now, other than the one from school -- I like her, and DS likes her, but I got zero feedback from her over the school year, other than at his IEP meeting, so I wouldn't say that I have a relationship with her, really -- so I don't have an SLP that I could hand the MindWings materials to and say, "please work on this." But I could do that with the tutor. Or his county worker. If they were willing, and if the program is something they can work through intuitively, without extra training or without having to spend a lot of non-tutoring time on preparation. Meaning, I would not want to ask them to learn how to teach this; I would just want them to be able to open and go. Of course, I could work on it with him at home. But I know how that would go. Same thing with interoception. He could use work on this. But would he be willing to work on it with me? Very iffy. As a former homeschooler, I know that I could easily take some of these things on myself. But things quickly turn "not easy" when he is unwilling. Open and go might be a slight stretch, but I think they are something someone else could implement. To make them more open and go, you could prep companion materials--so, a story or scenario you want used with the critical thinking triangle would be nice because it's not a workbook. It's a tool you use to apply skills, and you need the content to apply it to. I think, but I am not positive, that there are exercises in the Social Thinking materials that this tool is meant to be a bridge too, so if you had a worker who was familiar with the Social Thinking materials, they might see where this tool fits into things easily, for instance. Intuitive is highly individual. Our speech therapist found it workable, but she didn't realize the potential of the tool at first, though this kind of therapy was not her bread and butter (articulation is). Eventually, she really started to hit her stride before moving onto a new realm of practice. Our new tutor, who doesn't have training in this stuff, finds it very intuitive on sight. So, you never know. I bet you can use parts of it in stealth mode at home with conversations though. Or use the triangle as a whole family activity so that it's at least familiar--it's a great EF support, you just have to use it a bit differently when you use it that way. It has you look at context, people, emotions, form a plan, connect the parts and pieces of things...wonderful for doing EF from another angle. I see the trash is not being taken out...and then problem-solve. I see that someone worked on cleaning the tub, but it's still dirty in spots...where is this process falling apart? It can be used with non-fiction, so using it with study topics is totally possible. Maybe a worker could use it that way to introduce the terms and then stealthily use it with interpersonal stuff. Just some ideas. 1 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 Ok, with what you're saying, having the OG tutor do the MW would make a lot of sense. Even if it's a little prep, it will be right up her alley and increase her skill set. It's stuff dyslexic kids often need, so it's worth a try to get her to do it. On the interoception, I'm having a little trouble finding people in our area prepared to do it. What you could do is talk with your ds about doing a discrete set of weeks. It has 3 phases and they can get through all the lessons for phase 1 in 8 weeks. It would pair EXCEPTIONALLY well with your medication work. 2 Quote Link to comment Share on other sites More sharing options...
Lecka Posted July 19, 2019 Share Posted July 19, 2019 In that written recommendation — I look at that and I see — for how things are for us — we could use that wording to ask for a lot of different things from insurance and from school. The 35-40 hours a week is an intensity level but I wouldn’t take it literally necessarily — or I would do things like “count” music, but maybe not “count” something at school where maybe he was not getting much out of it. You could use that to ask for some different things from school if you think there are any parts of his day that could be different. Or have a lot of options with insurance. I could be way off — but that is how I would take it. *I would go more by her verbal recommendations.* At least to start. Also a lot of things are “therapeutic” without being “formal therapy.” A lot of things in his day might be therapeutic. When I have done the high-hours recommendation with my younger son — they count all kinds of things. Bath time can count towards that time. I like and agree with other comments you are getting! 2 Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 19, 2019 Author Share Posted July 19, 2019 (edited) 1 hour ago, PeterPan said: Have you looked into Special Olympics or getting a running partner for him? He wouldn't agree to it. His attitude toward other people with disabilities is tricky. Meaning, he mocks disabilities, will use the disability as an insult (he does this with his dyslexic sister, and also uses the word "autistic" as an insult that means "stupid") and so on. He would not, I think, be mean to the other kids. But he would mock them once he got home. This is pretty horrible, of course. We struggled with this this year. He picked up these things from some of his "friends." This has been extremely, super, horribly frustrating for us as parents, because it is the opposite of all that we have ever taught him. Although I would like to say that it would be good for him to mingle more with other people with disabilities, so that he could learn compassion, I don't think compassion would be the result. He will still run track at school, I think. Hopefully. They have an indoor winter track program, and then one in the spring. One of the suggestions from the county intake person was that his county worker could be someone who could run with him. But the teacher that we selected is not a runner, so that didn't pan out. How is he doing this summer vs the school year? Not saying I have a brilliant interpretation, just that it's interesting to ponder in terms of stress and sources of stress. It depends upon the circumstances of the day. Breakfast time is still really hard, but less stressful over all, because he does not have to get out the door so early. His earliest commitment right now is at 10:00. He's been spending a lot of time playing his instruments and playing video games, both with his brother and by himself on his phone. He generally can be loud, as he bangs around, moving through the house, plays music loudly, talks loudly, stirs up arguments, etc., but he has been quieter this summer. He is keeping more to himself, and fewer interactions with others results in more peace in the house, because he likes to stir things up. But also, he is not interacting with others as much, which is not great, obviously. He has been less chatty this summer. Usually he keeps up a fairly steady stream of talking about his interests and asking the same questions over and over about his interests, but he's been quieter. He still talks plenty, but it's not as non-stop and insistent as during the school year. It's interesting, now that I post that, because we also switched his ADHD meds this summer. Not sure how much these differences are due to the new meds, versus having a lighter schedule. Now that he can immerse himself in practicing his instruments, he does a much better job of occupying himself than he used to. He's productive, whereas he used to be looking for stimulation in negative ways. When we require him to do anything, he is typically very irritated about it. He has things that he needs to do daily, or whenever it is his turn, and even though they are consistent and expected and are not things we are springing on him in anyway (we usually give him a ten minute warning, etc) he still argues and avoids. Like brushing his teeth, for example. He argues over that and tries to avoid it 80% of the time. Even though he always has to do it in the end, so what is the point of arguing? Sigh. Is there anything that is going WELL right now? Music. He likes youth group at church. He has friends there. He is never asked to do anything by his friends -- like go to a movie, or hang out -- but he is happy with his friends (I am not happy with most of them, so I am actually glad they do not ask him to hang out). He has said he likes his job skills program (only a three week deal), but he also complains mightily about how he hates it that we make him go, whenever it conflicts with something that he would prefer. It's my fault for making him go, always. I try to redirect this to him understanding that I don't set the schedule and that he has commitments to the program, but it is still my fault, in his eyes. Oops, drifted into a negative there, while trying to think about the positives. I guess the point is that there is almost always a negative, from his point of view. He is crotchety. He is in a church band with peers, run by one of the dads, and that is completely awesome. Still an occasional thorn to manage, but mostly roses there. Music is the key to almost all that is positive, for him. Which is why we super prioritize band and music lessons. He told the psych that he practices his instruments for three to six hours a day (he told her three hours on each). I have not timed it, but it may be accurate. What happens if someone comes to the house and just tries to hang with him? That's basically where a behaviorist would start. It's very low key, not a lot of language, no stress. It's one of the things they said his county worker could do. But I have a hard time picturing it. They would need some structure, I think. This is where the county coordinator said that the worker could play music with him or run with him. But we went a different direction with our choice (teacher that he really likes and has a good past relationship with, instead of hiring a stranger that we don't know, but who could maybe play instruments or run with him). Given that his reading is like 4th grade, what level do you think you'd have to drop to so that he could understand *without* you explaining so much? Very tricky. Because books for fourth grade and up through middle school almost always have more complex plot structures, characterization, and language. I just looked up the book he is doing for independent reading time now, and it is grade 3.8. We tried some others first, and even though I tried to be picky, it was hard to find something he could read. Or was willing to try to read. The book I picked for our readaloud this summer has a 4.5 grade reading level. I've been having a hard time finding a consistent time of day to read to them this summer, because our schedule has been so variable, and they would rather not do it at bedtime. And because DD14 often wants to go to bed much earlier than the others. I just need to pick a time, so we can get through our book before school starts. I picked a funny one -- A Year Down Yonder -- to entice them with humor. We will see if DS gets the humor, though. He loves humor, but often doesn't understand it, unless it is explained to him. I don't think I'm reading that the same as you. She just said to get his total time (school plus all forms of therapy/professional interaction) to 35-40 hours a week. That's pretty serious. And she's saying to get ABA. I don't see a don't bother with ABA there. How much is he in school? That's going to eat up a ton of his availability. Yes, she put ABA in that list. She didn't say not to do it. But it was not what she was emphasizing when she talked to us. I really think she believes that a counselor familiar with autism will be incorporating ABA methods into the work they do with him. So you've got 35 hours of school during the week, which leaves 5 hours. That would be 1 hour with a behaviorist weekly, another 2-3 hours one day a week with an RBT who would come to your home and work with him (preferably Saturday to get him spiffing for Sunday, but Sunday could work), and 1, at most 2, hours for something else. Which sorta fits with the *2 things* advice I was saying. I'm not sure it means sign him up for 7 therapies. I'm not sure it's realistic. Some of that paper trail is so you can possibly add goals or services to his IEP and get it done during school. But after school, seems like you just have 5-6 hours total, not endless amounts. Five to six hours a week is really hard to fit into our schedule, though. I have to be available for my other kids, not just to be around as mom, but to get them to their activities, as well, as the transportation. Driving three kids around (oldest can drive herself, mostly) and getting all of their things to fit in our family schedule is tricky. I agree that that block of text that I quoted was probably partly to list all of the categories of things that she felt his IEP and private therapy (therefore, insurance, possibly) should be addressing. We'll see if the school will add anything to his IEP. He has a lot in there already, and they may think they are covering it. He does not have behavior or emotional regulation issues at school at all, so they will not see a need to add things for that. So really, most of the list we will need to do with private therapy, I think. Except the communication piece, and he is getting speech already in his IEP. What is this person? If she's available and knows him, you could just allow it for now, just to get hours. You've got another month before that changes and you probably won't really have anything new going before then. His county worker is his sixth and seventh grade teacher from his old school. She knows him very well, from having worked with him for two years. In seventh grade, his class was comprised of only two students, so she worked with him very closely. He likes her, and she likes him. She sees his oppositional side and doesn't take it personally but just kids him for being a pessimist. We could have her work with him, but she needs me to tell her what to do with him, and I'm not in a good place for planning it right now. I hoped she would just be able to pick up the ideas that I fed her and run with them, but she is needing more direction. Figuring it out is stressing me out. Just this week, we finally got the notice that her paperwork had been approved for her to start working with him. It has taken so long!! And we have such limited time. He is in his job training class three days next week. The next week is more open, but he will have band practice most of the day two days of the week. And then the third week is all day band camp all week. And then school starts. And we still need to find time just to have summer be summer. So I'm not sure. Do you have some objection to someone in your home? I don't know, just kinda poking there to see what happens. It *almost* sounds like that's uncomfortable for you. Yup, I'm uncomfortable. I personally find it difficult, but I have managed before. I've had early intervention people in my home. I've had tutors in my home. I've done it. But it makes me feel edgy, and so I have to address my own anxiety. I can do it, if it's needed. But it's complicated by the fact that the times when we would most need someone are the times when I most DO NOT want someone. Mornings before school, for example. He will get on the bus at 6:30. I just can't handle having someone come in my house at 6 am or earlier. Having someone here at 8 or 9 at night? Not as bad as 6 am, but still bad for me. I would have a hard time managing my regular family functioning with another person around, and I need things to function for my whole family, not just for DS. So I'm not keen on the idea. If we could do something after school, it would be better. He has trouble with homework time, so that could be an area to work on. Edited July 19, 2019 by Storygirl Quote Link to comment Share on other sites More sharing options...
kbutton Posted July 19, 2019 Share Posted July 19, 2019 37 minutes ago, Storygirl said: Yes, she put ABA in that list. She didn't say not to do it. But it was not what she was emphasizing when she talked to us. I really think she believes that a counselor familiar with autism will be incorporating ABA methods into the work they do with him. That would be very effective, I think! 38 minutes ago, Storygirl said: We could have her work with him, but she needs me to tell her what to do with him, and I'm not in a good place for planning it right now. I hoped she would just be able to pick up the ideas that I fed her and run with them, but she is needing more direction. Figuring it out is stressing me out. Just this week, we finally got the notice that her paperwork had been approved for her to start working with him. It has taken so long!! And we have such limited time. He is in his job training class three days next week. The next week is more open, but he will have band practice most of the day two days of the week. And then the third week is all day band camp all week. And then school starts. And we still need to find time just to have summer be summer. So I'm not sure. So, if you have something she can do short-term, as you said, school starts. She could do more life-skills during summer, and then during school do a combo of life skills and homework help (but don't get so into homework that you don't get what the school won't give). Once you get rolling, you can both probably see some areas that need work, and if not, maybe you can try out a different person. I am sorry she'll need direction--I have had both kinds of workers, but most have needed direction, though in our case, it was largely because they didn't "see" my son's issues, which was frustrating. 39 minutes ago, Storygirl said: But it's complicated by the fact that the times when we would most need someone are the times when I most DO NOT want someone. Mornings before school, for example. He will get on the bus at 6:30. I just can't handle having someone come in my house at 6 am or earlier. Having someone here at 8 or 9 at night? Not as bad as 6 am, but still bad for me. I would have a hard time managing my regular family functioning with another person around, and I need things to function for my whole family, not just for DS. So I'm not keen on the idea. If we could do something after school, it would be better. He has trouble with homework time, so that could be an area to work on. It is harder to find hours during school. That would be frustrating. But after school sounds like good timing. It might help establish a less stressful homework routine even if she does different work with him sometimes. 2 Quote Link to comment Share on other sites More sharing options...
Pen Posted July 19, 2019 Share Posted July 19, 2019 I just returned to thread after a time, and thought I should go back to the first few messages because I felt like I’d gotten lost... sharing this in case it might be helpful for you too @Storygirl where is this child in family order — yours, I mean, not biological. Is he eldest boy? Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 19, 2019 Author Share Posted July 19, 2019 Yes, he is the oldest boy. We have an odd spacing between kids, and I know it can seem confusing. DD17 -- entering senior year DS15 -- the one with the long list of diagnoses, including ASD, NVLD, ADHD, etc., going into 9th grade, has an IEP, and is the one from this thread. I've always talked about him having NVLD previously (the ASD diagnosis is new). Then we have DS14 -- entering 8th grade, has 504 (but has been doing well for the past two years, so I have not posted much about him recently) DD14 -- entering 8th grade, IEP for dyslexia, also probable ADHD (undiagnosed) DS15 is only 8.5 months older than DS14. And DS14 is only 4.5 months older than DD14. So the three younger ones are around the same age. Their preschool teacher used to call them the triplets. But nope. Not even twins. 1 Quote Link to comment Share on other sites More sharing options...
Lecka Posted July 19, 2019 Share Posted July 19, 2019 I have a couple of comments. One, I doubt he would qualify for Special Olympics. He might bc I think it does vary by location. But when my son did it, they went by school placement for sending out the invitation letters, and my son was in a “cognitive delay” room at the time. His placement has changed now, and for our previous location I doubt he would be the intended audience. This will depend but I am just saying — based on his school placement he would not have qualified there. I don’t know a lot about it, but my son had a great experience with track and field at the time. I bet his IEP team would know. But to me I think it’s a non-issue it wouldn’t be a good fit for him — because it wouldn’t be a good fit for him anyway. Two, (rhetorical question) did the evaluator like his school placement? Did she think he was successful/appropriate in his current placement? Did she say anything about amending his IEP, asking for more school services, or changing his placement? I am assuming no — and that means she does think his current placement is appropriate. It says a lot and there is a lot to read into it because it is his current placement. It’s his current successful/appropriate functioning level. A lot of suggestions can be made off of that placement level, if it is a good level. It is what it is. I don’t think the Mindwings are the most user-friendly — it depends a lot on the person. Also be aware some people are not paid for prep. Some people if they are paid fairly low and aren’t compensated for prep time — you are asking them to work for free and they don’t make a lot of money. For other people, they are paid more, they are paid for prep time, or they are furthering their professional goals and it is worthwhile for them. I think it depends so much. I think they are great materials for sure. I think some Social Thinking seems more — maybe not user-friendly — but more “do this lesson, then the next lesson, we have the lesson planned, here is a worksheet or key points.” Things I have had would be a lot easier to give someone to use than MW, at least for my son. But the language delay he has makes some things much harder to implement. I think hopefully the lsw can make recommendations, and over time you also make recommendations or ask her to look at webpages for things. Or ask people who might be the ones using it, if it wouldn’t be you. I think the listening/reading comprehension level is going to be a level that many materials are aimed at that are for HFA/Asperger’s/whatever. 2 Quote Link to comment Share on other sites More sharing options...
Rosie_0801 Posted July 19, 2019 Share Posted July 19, 2019 The chick who wrote 'Queen Bees and Wannabes' has a book for boys: 'Mastermind and Wingman' or something like that. I'm reading it to dd and as much as we hate it, we both agree it is valuable information. It is also organised in quite small chunks, so if you sell it to your son as a partial solution to his anxiety, it might do more good than harm. I think the schema style of thinking kind of works with the grammar, logic and rhetoric stages. You have to upload a whole lot of them and provide scaffolding before the logic stage, cross-pollination of concepts will start working. Rhetoric comes much later, lol. I have a traumatised Aspie mate in his early 20's and being a highly traumatised Aspie pushing 40, we have some doozies of arguments at times. Even at my age, my speech will cut out if the stress levels are too high and I have to resort to writing. (That pairs well with the way his ability to listen will cut out if either of us are too stressed, so it's a system that works.) When it comes to speech, with him, it can be anywhere from three weeks to three months before he's willing and able to spit out what his issue is. Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 19, 2019 Share Posted July 19, 2019 4 hours ago, Storygirl said: We could have her work with him, but she needs me to tell her what to do with him, I guess I'm kind of unclear. When we bring in workers, we sit down with the worker and our behaviorist and we make a list of goals. So who is supervising her? On her own she's not qualified to do what is essentially ABA (setting goals, working on things) and it shouldn't be falling to you alone either. Sometimes county funding (at least from the way I hear it online) is glorified babysitting. If you want it to be more, you need a behaviorist establishing goals, making data, helping it be more. It's not that doing this is hard, just that it's intentional. And it shouldn't be you figuring it all out. Also seems to me home hours would help with the transportation issue. 1 hour ago, Lecka said: One, I doubt he would qualify for Special Olympics. In our county anyone with an IEP qualifies. 4 hours ago, Storygirl said: Yup, I'm uncomfortable. I personally find it difficult, but I have managed before. I've had early intervention people in my home. I've had tutors in my home. I've done it. But it makes me feel edgy, and so I have to address my own anxiety. I can do it, if it's needed. So there you go. Doing ABA in-home would be radically more effective at changing how he functions in your home than talk at you therapy in an office. You've already done that. I've done it too. Zero changes. It has to be naturalistic, relational, and generalized to real life. So if this teacher paid for by the county is going to be in your home, just up the ante and get a behaviorist so she has actual goals and isn't just babysitting. I was told in our county that's how most inhome rolls, glorified babysitting. Your ds is ready for more. 4 hours ago, Storygirl said: But it's complicated by the fact that the times when we would most need someone are the times when I most DO NOT want someone. Mornings before school, for example. He will get on the bus at 6:30. I just can't handle having someone come in my house at 6 am or earlier. Having someone here at 8 or 9 at night? Not as bad as 6 am, but still bad for me. I would have a hard time managing my regular family functioning with another person around, and I need things to function for my whole family, not just for DS. With a little child they might provide a worker in the morning to get them out the door, but no that isn't what I'd be expecting. In-home would be after he gets home from school, possibly 5-7pm. They might cook dinner for the family, eat, play a board game. She'll try to get him to do things she wants to and not only stuff he wants to. Work on skills. It might actually make your life BETTER. He's old enough to be left alone with a worker, meaning you don't need to be there. I had to be exceptionally careful when I started (low verbal 6 yo), but your ds can self-advocate. You don't need to be there. They actually might do life skills with him. They might help him with homework and then cook dinner. It could be a clone of you. What I find is that when I have the right in-home worker, they're basically doing what I would do if I were super-energetic and could do it ALL. Sort of cloning me. Not replacing, not distracting. When I'm having to try too hard, those people get fired. The right person is really like a glove, a help. I can leave my ds with them for 2-3 hours and know they're doing good things. I trust them, they get it done, and it lets me get my stuff done. It DROPS my stress. When my stress goes up with the worker, it means I don't have the right person yet. Think about simple things they could do together (your ds and the worker) that would be engaging and beneficial. Don't make a long list, because she also needs to do what HE wants. Like she might do some music stuff with him or play nerf or do things he choses. But dinner, food prep, something life skills, that could be really good stuff to be doing. And if you have a behaviorist or a coordinator, they'll show her how to use the *foil* of that interaction to hit the goals. But the first how many weeks all they'll do is pairing, developing good rapport, building her ability to make demands. In-home workers are usually, hopefully, a pretty positive thing. It might help with some of the negativity! Meds may help too. With my ds, the biomedical plus the interventions sort of reset his sense of normal for himself. Where he was constantly in closets, under tables, negative, ouchy, he just has a better sense that it can go well and that he can be positive. So maybe as you make a couple moves these things will come together. They could. 2 Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 20, 2019 Author Share Posted July 20, 2019 Thanks, Rosie! I ordered that book. Also, I think it's awesome that you and your daughter are reading a book about understanding boys! 1 Quote Link to comment Share on other sites More sharing options...
Rosie_0801 Posted July 20, 2019 Share Posted July 20, 2019 24 minutes ago, Storygirl said: Thanks, Rosie! I ordered that book. Also, I think it's awesome that you and your daughter are reading a book about understanding boys! We're still working through Queen Bees, since dd needed that after being tossed unceremoniously into school. She's being sent to a girls' school, so I don't know 'Mastermind' is going to get to the top of the priority list. We don't have much time together. 'Queen Bees' does cover a bit of the info from 'Mastermind,' though and we have read puberty books for boys, for understanding purposes! In the end, we can only do what we can do, eh? Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 20, 2019 Author Share Posted July 20, 2019 Oh, the whole county worker thing complicated to explain. We just got qualified for funding from the county, so it is all new to us, and it is not really working out the way I had hoped, so far. I was under the impression that having services would help with things, but right now it has just been a big pile of more things that I need to figure out and do on my own. NOTE -- the case manager and the "worker" are not the same person, in my comments below. The case manager works for the county. The worker is any person that I hire to work with DS, who is paid out of his allotted county funding. So, yes, he can have a worker. But then I discovered that I was pretty much on my own for finding and hiring a worker. They have a system where you can post an opening with details when you want to hire someone, but other than that, it was on me to find someone. I kind of think that the case manager that we have is not as helpful as some. She doesn't seem to be doing anything for us, other than having us fill out paperwork. She didn't even know the answer at first about how much funding we were allotted, and I had to asked her pointedly in an email to give us that info. When she doesn't know the answer to questions I have, I have to push her to find out the answers, instead of just saying, "I'm not sure about that." This has happened more than once. When we talked about her helping us find a worker, she kept turning the question around and asking me to think hard about who I already knew and could ask. So, basically, she has been little help, and the website is very general, so not a great source of info, either. We met her just once, at our house. She came and asked a bunch of questions, most of which had already been asked already by a different intake lady at a previous meeting at our house. It's all circular and redundant, which maybe shouldn't surprise me, since it is the government. Based on what we said in that meeting, she wrote up a plan, which is kind of like an IEP, with goals. I kind of think the goals were meant to be created by us with her, but she just presented them to us. They are okay goals; I don't disagree with them. Some of the goals, she put were to be worked on by the parent (I thought it was interesting that she assigned me things to do, like that, without discussing choices with me), and some are marked to be worked on by the assigned home care worker, and I think some are marked to be done by the school in his IEP (which is already happening). So, to answer your question, there are goals that the county set for him. But no one but me is assigned to make them happen. Either by doing it myself or by instructing the worker to do it. And then it seems frustrating, because even though there are goals in the plan, the case worker wrote an email to me this week, asking me to tell her what the goals are that the worker will be working on. See what I mean by redundant? And then she says she can "train" the worker on the plan, or I can, but I'm not sure what she means by "train," other than to go over the goals, which are just plainly written and can be read over in a few minutes' time. So anyway, I have had emails back and forth, giving the worker some ideas of things she and DS might do, and her response is always kind of that she will do whatever we want. So she is not comfortable, I guess, with picking up the ideas in my list and going with it. I'm going to have to outline for her specific things to do, it seems. Which, again, is just about as much work for me as just doing those things myself with him. You know, in the time that it would take me to outline a plan for her to take him to the grocery store and do some shopping, I can just take him to the store and shop with him myself. So it seems like.... what is the point? It might be simpler just to work on those goals myself. If I just have her over to hang out with him... well, it's kind of weird for his teacher to just be hanging out, talking to him without a purpose. So I proposed that they meet at the library and walk around and explore it (he hasn't been to that branch before). She didn't really respond to that one, other than to say that she wasn't going to be in that town (where his old school, where she works is) on that day, but that she could meet in another town she named. She didn't say whether she was interested in the library idea. The teacher/worker needs to have things spelled out for her in a different way, I guess. I just haven't figured it all out yet. I think in the long run, it's worth it, but right now it seems like more work on my part than it is worth. And I feel like I am running in circles and not getting anywhere. What you describe that your workers do, Peter Pan, sounds nice! But I'm not sure it's quite what we need. I actually had thought about volunteering, as kbutton has had her son do. That was my very first idea. The worker would be willing to do that, but I would have to set it all up. Here's an example of how it's frustrating to figure things out with the worker. I suggested that maybe he could just come to her school and help clean off bulletin boards or dust shelves in the library, or something like that, which she could just work on with him, depending on what she could see needed to be done. And her response was that she couldn't think of anything to do, and that whenever she has asked the church staff (that school is in a church building) about volunteer activities for students, the church has never been able to come up with anything for them to do. So, I thought that would be easy -- certainly as a teacher, there is something he could do to help set up her classroom!! But nope, she tossed it right back at me to figure out. Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 20, 2019 Author Share Posted July 20, 2019 (edited) So here are the goals assigned to the home worker, from his county plan. 1) Create a checklist or weekly schedule for tasks at home/school. Create a workable document that DS can transfer/use for any task given to him. I don't see why that is assigned to a worker instead of to a parent. I don't need someone else to do that for us, really. The hard part is getting him to use it. 2) Meal planning and grocery shopping. This is assigned to both me and the worker. This would be okay, but the worker seems to expect more instruction than this, which I would need to figure out. If I'm figuring it out, I might as well be the one to take him to the store, honestly. It might be something that our teacher/worker would be comfortable doing after she has been working with him for awhile, because it probably means being in my kitchen, which is kind of personal, and I'm not sure she's comfortable with that yet. 3) Helping with personal care , such as knowing not to re-wear dirty clothes and whether he got himself clean in the shower. Making sure he does not overeat snacks (there is history of issues with food). This is assigned to the home care worker, but... really? There is no way he is going to want to talk about underam sweat with his female teacher. We are struggling in these areas, which is how they ended up on his list, but I don't think that he is going to be willing to work with anyone but parents on these things. I think we need better strategies, but that parents need to be the ones doing it. 4) Handling money. Assigned to parent and worker. Okay. I didn't disagree with these goals when she presented the document to us. But they are wimpy goals, and I'm not sure we need to be paying anyone for these things. What I do think is that he will benefit from practicing communication skills with a non-family adult person. So anything he does with the worker can be beneficial for that. But that is just too wide open; our teacher/worker needs to have some defined things to do with him. And I seem to be the only one to come up with those defined things. So the whole thing, right now, is just feeling like extra work to me, when it is meant to be extra help. That makes me grumpy and also makes me feel ..... inept, because I don't know what I'm doing, and somehow I have to figure it out. I thought the county case manager would be helping me figure things out, but she only questions me about my plans. I don't know. I have to make plans, somehow. This seems like it should be simple, but I'm finding it hard. And this is on top of the list of things from the autism evaluation. That list of things was more helpful and better targets his root needs. Which is why I just feel like chucking the county worker thing for now, until we get an idea how to move forward on the root issue things. That's our right, I'm sure, to not use money that is offered. But also, they said that if we don't use the funding, they can decide that it is not needed and disqualify him. We don't want that to happen, because I think having the funding in place for him in adulthood may end up being more important than having it now. We honestly didn't need the money; we needed to have the help. If we decide not to use the worker for now, I can ask to use the funds for something else. There is a wide variety of things I can use it on (according to our school special ed coordinator), but it is kept mysterious -- no one at the county gives us a list of options to choose from, for example. I have to drag things out of them by asking lots of questions. Sorry, this is all kind of a vent. But it reveals why I'm finding my thinking about all of these things to be in disarray. I'm finding it hard to make things happen. And to figure out what I should be making happen. I think on Monday I will call the counseling social worker on the list. Maybe maybe maybe she has openings and can help us sort out where to start and how to dig through the weeds to make a plan. And I need to pester the pediatrician about a referral to a psychiatrist. On Monday, it will be two weeks since I left her a message. It's not like her to not call me back, so perhaps she didn't get it. Or is on vacation. Edited July 20, 2019 by Storygirl 1 Quote Link to comment Share on other sites More sharing options...
Lecka Posted July 20, 2019 Share Posted July 20, 2019 This is just an idea — would she like a book from Social Thinking that she goes through with him? It would be talking, but it would have some structure to it? If something like that would appeal to her? And you can link it to a county goal of money handling if they go to a coffee shop and he orders and pays, and they work on it there? Or maybe she could go through an educational book about self-care and hygiene? It wouldn’t have to be personal to him. Just thoughts — I have seen books like this I think (and for this purpose I think). 1 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 20, 2019 Share Posted July 20, 2019 1 hour ago, Storygirl said: So it seems like.... what is the point? It might be simpler just to work on those goals myself. I think the issue is that they've got someone who is not a behaviorist and who isn't being given the access of a behaviorist trying to do, on a govt level, the work of a behaviorist. So on the FB group I'm on there are a lot of people with workers like that, and they're basically babysitters working on life skills. You've got a high quality person, but you need the person to supervise it, which could be a behaviorist. So sometimes what happens is kids are just alone. So with a worker is better than alone. But with a high quality person (which you've got) with supervision/instruction/guidance by a behaviorist (which you haven't got) and it becomes really good ABA. I've had young people in college and I've had grad students for in-home workers. I really like having these high caliber people. But even then, they need some guidance. Or think grandparents. Grandparents are basically free ABA. They dote and they push back and they're willing to do whatever the kid wants to build relationship. 1 hour ago, Storygirl said: The teacher/worker needs to have things spelled out for her in a different way, I guess. So if you had taken the worker the county had already trained, you wouldn't be jumping through these hoops. And not everyone who is good with kids is good at this. It's a really different thing. You actually have to LIKE the kid to do this, and not everyone actually likes these kids. Like that's just the jolly truth. Sometimes, if you dig in, it turns out the worker maybe had some funky background (relatives with issues, whatever) and that's why they gel. I don't think you get somewhere by forcing what isn't working. On the library thing, I guess look at your goals. You keep pushing against your home and yet home is where your worst problems are. See here's the thing. When that worker is in my home and ds does something he does, then it gets SEEN. That's the point. Then he realizes more people care. And he cares about the relationship with that worker, so he doesn't want to offend them. In home could really help you here, because so many of your conflicts are in-home. He's already nailing the community, seems to me. He goes places, doesn't have meltdowns, complies in public, yes? So it's in-home that is the issue. 53 minutes ago, Storygirl said: But that is just too wide open; our teacher/worker needs to have some defined things to do with him. If they seem too wide open, she might not be your person. They are kind of general, but they're also really important. Personality really matters with this. It took me a while to get a good groove on this. 54 minutes ago, Storygirl said: So the whole thing, right now, is just feeling like extra work to me, It has felt like that with workers. It took us some bumps before we started getting workers who didn't need ME telling them and goading them. It was the caliber of person. You could have used the person the county had already trained and they'd just come in. And yes, it really does feel like they're making the pace of you're world too fast and trying to get so much done and you're like slow down and let me breathe. But on the other hand, the dc will suck up the attention. If it's done right, it will connect with the dc and be something he's hungry for. Your county is doing stuff ours doesn't do. Our funding in our county is so, so low compared to some other counties in our state. So are you paying or they are or a combination? I think you may have to try some people to get the right fit. If you're having to tell this person who to do those tasks with him, she isn't your person. It's kind of a personality, a temperament. It's ok to go through some workers and have a learning curve. I would ask the coor if you have the right person or if you should be trying someone else. I would bring the person into your home because those goals are all in-home. They seem like good goals to me. Like from what you've described of him they're on the money good goals. You just might not have the right worker. The right person comes in ready to do those things and is basically your clone, your duplicate, your person doing what you would do and can't do because you're not Wonder Woman. It's ok to let people help you, and when you get the right person it will feel right. When you get the right person, it will feel right. That's my two cents. I'm sorry it's hard. It took me a while to find my groove with workers, to figure out what I wanted them doing, to realize the caliber of person it takes with ds. To work with him, the person has to bring it and have some gravitas. It was a learning curve and frustrating like you're finding it. But maybe just work through that and figure it out. 1 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 20, 2019 Share Posted July 20, 2019 1 hour ago, Storygirl said: 1) Create a checklist or weekly schedule for tasks at home/school. Create a workable document that DS can transfer/use for any task given to him. I don't see why that is assigned to a worker instead of to a parent. I don't need someone else to do that for us, really. The hard part is getting him to use it. 2) Meal planning and grocery shopping. This is assigned to both me and the worker. This would be okay, but the worker seems to expect more instruction than this, which I would need to figure out. If I'm figuring it out, I might as well be the one to take him to the store, honestly. It might be something that our teacher/worker would be comfortable doing after she has been working with him for awhile, because it probably means being in my kitchen, which is kind of personal, and I'm not sure she's comfortable with that yet. 3) Helping with personal care , such as knowing not to re-wear dirty clothes and whether he got himself clean in the shower. Making sure he does not overeat snacks (there is history of issues with food). This is assigned to the home care worker, but... really? There is no way he is going to want to talk about underam sweat with his female teacher. We are struggling in these areas, which is how they ended up on his list, but I don't think that he is going to be willing to work with anyone but parents on these things. I think we need better strategies, but that parents need to be the ones doing it. 4) Handling money. Assigned to parent and worker. Okay. I lOVE these goals btw. So yes, to me they would start at home, hit #3 with a checkin, go over the day/week to hit #1, then plan out #2 (1 meal they're prepping together) and head to the store (goal 4). So for us, doing social thinking curriculum would really let him dig in his heels and go oppositional. He might be like I do this at school, I'm tired, I'm done with it. What I like about the goals from the county is they're different from school and can be personal and interesting. You want things that empower him, and these do. If this teacher doesn't want to be in your home, maybe she's not your person?? It just seems like it was a different relationship. This is a very personal thing they're doing. You're basically handing your child to someone and saying I can't do it all, you take him for 2 hours and do what I would have done. And with the right person, you don't have to say a lot. My SIL does this for me right now. She has taught my ds tons of stuff, and I never had to tell her how. She literally ABAs him and no one ever taught her how. So when a person is really uncomfortable, they might not be the right person. Or maybe you shouldn't be the one they're learning on. Ok, so to me, I would back door #3. Like maybe she just sees that he picked up his room or teaches him to do his laundry and working on laundry and where the clothes go naturally hits the don't rewear dirty stuff goal, kwim? Back door. And even grooming is back door. That's what my SIL did with my ds. He'd show up with his hair sticking up and she's like TURN AROUND, I WON'T GO OUT WITH YOU LIKE THAT, lol. See that's how RELATIONSHIP motivates him to do the things. He will want to be clean because he will want to go out with the worker and the worker will demand it. Motivation, relationship, cause effect. It's good stuff. It's ABA. And if this friend you have isn't clicking, maybe hire someone else. Our workers usually come from way outside our social circle. I usually list on Care.com You might try it. Instead of bringing someone in and then being afraid because you know them and they're getting too close, bring in someone who is so unfamiliar that it's just like your obgyn, in and out. Sorry, I don't go to an obgyn, like not ever. But you get the point, lol. My dh thought workers should be relatives, that we should be private. My best workers are ALWAYS people from way outside our social circles, just these random motivated people who want a job and are willing to bring it. I got a real gem through Care.com last year. I would highly recommend looking there. I've had multiple grad students want to work with ds. They have an autism-specific section, so you can literally specify what you want. You're wanting someone to cooking with him, grocery shop, hold him accountable for homework, talk about grooming and possibly teach him to do laundry. People who would respond to that would be people who were agreeing upfront they were cool with that. 2 Quote Link to comment Share on other sites More sharing options...
Pen Posted July 20, 2019 Share Posted July 20, 2019 To me the county things seem good—and working on them with someone else will give communication and social practice. could be nice to add cooking what was meal planned and cleaning up too 😊 15yo boys tend to need to do separation from mom (some of his blaming you may be part of this), and him having someone else to deal with on lifeskills could be a great help. 2 Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 20, 2019 Author Share Posted July 20, 2019 1 hour ago, PeterPan said: So if you had taken the worker the county had already trained, you wouldn't be jumping through these hoops. And not everyone who is good with kids is good at this. It's a really different thing. You actually have to LIKE the kid to do this, and not everyone actually likes these kids. Like that's just the jolly truth. Sometimes, if you dig in, it turns out the worker maybe had some funky background (relatives with issues, whatever) and that's why they gel. I don't think you get somewhere by forcing what isn't working. On the library thing, I guess look at your goals. You keep pushing against your home and yet home is where your worst problems are. See here's the thing. When that worker is in my home and ds does something he does, then it gets SEEN. That's the point. Then he realizes more people care. And he cares about the relationship with that worker, so he doesn't want to offend them. In home could really help you here, because so many of your conflicts are in-home. He's already nailing the community, seems to me. He goes places, doesn't have meltdowns, complies in public, yes? So it's in-home that is the issue. I just clipped out these two comments. The county didn't offer me a a trained worker. I had to find my own, either someone I already knew, or by posting an "I need a worker" message on their job board. So, sure, it's possible that someone who responded to a message like that would have done it before and have some experience. But there were reasons we thought that going with someone we knew was better than going with an unknown person. Ms. B really likes DS a lot. They work well together; I just haven't been able to figure out a plan for what they should be doing together. I'm actually not convinced that a behaviorist (or worker/whoever) would see the problem behaviors at home. He is a different person when others are around, than he is with us alone. Always has been. His ODD diagnosis is just based on how he is with DH and me, and he never behaves in a rude way to other adults. I have questioned it, and the traits need to be exhibited only in one environment to get the ODD diagnosis. The psych told me before she met him that the ODD diagnosis was one thing she would be reconsidering, to see if ASD would cover it instead, during her evaluation, and she upheld the ODD. So he has enough defiance at home to get the diagnosis, but no one else ever, ever sees it. Ever. Extended family has seen glimpses of him being difficult, and would believe that he is hard to parent, but have never seen what he is like. Well, his siblings know. His teachers at school consider him a rule follower. I just asked DH, and he said, "I don't think he would show the arguing, ranting, yelling, stomping that we deal with. He might sometimes be uncooperative with them." That's what I think, too. No one will see it, but us, so we have to be able to get help from someone who will believe us and understand when we describe what it is like. Teacher Ms. B knows the arguing side of his personality already. She's one of the few adults that he has shown that side of himself to, in the past. She gets both his quiet, rule following persona, and his more spunky side, though a mild version of it. He scored pretty low on the ratings scale when I had to rank how he does out in the community. Not because of behavior, but for things like knowing how to navigate a grocery store and how to know if something is a good price or too expensive to buy. He can hand over money to a cashier and has done it a few times when he has been out without me with him, but he needs to practice all aspects of money handling, really, including how to count coins, because he has forgotten. He needs a lot more practice with these thing. The community experiences will not be about how to behave, but how to navigate the world more independently. 1 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 20, 2019 Share Posted July 20, 2019 1 hour ago, Storygirl said: The community experiences will not be about how to behave, but how to navigate the world more independently. I hope she can do that for you! The list from the county is certainly getting you there. It's the kind of stuff my SIL has done for ds. She's single, and she would go in with these super short lists for grocery shopping with him. That's why I was saying he plans the meal with her, buys the stuff, makes it. That was all the tolerance my ds had, this really short list. That's really hard when you feel like people are constantly doubting you and not seeing what you deal with. Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 20, 2019 Author Share Posted July 20, 2019 (edited) Oh, and he does not constantly behave in an emotionally charged way at home. It is episodic. There are certain times of day when the angry outbursts are almost guaranteed to happen. But there are also long stretches of the day when he is calm and pleasant. I could go into what triggers things, but it will be more helpful for us to work that out with a counselor. Using a checklist or to-do list is so tricky with him, that having someone check in with him about it once a week would not be effective. He had two years of daily academic planner check-ins with the intervention specialist at his old school, in sixth and seventh grades. In 8th grade, even though it was in his IEP, his new school did not make him do it. So he didn't. And wouldn't when encouraged by me and by an intervention teacher who suggested that he do it but didn't require it. So two years of daily practice did not result in long-term success. He had a paper planner (what he was used to; I even made sure it was set up in a familiar way, like his previous ones), but he did not use it one single time. He was offered a digital planner by the school and would not use it. There are reasons that I'm skeptical about the checklist thing working. I do think that it's worth doing, but I think I need to figure it out and do it 365 days a year with him and gradually work toward solid independence. I will benefit from having someone give me tips about creating and implementing a plan. But there are reasons why I think that particular goal is not best suited to being overseen by a worker who sees him occasionally. They might check in on it, as an added accountability. I think having anyone outside the family tell him he needs to shower more, because of BO, will just be mortifying and not inspirational to him. I asked him awhile back if he would prefer to have a buddy to talk to about hygiene instead of me, and he thought it was insulting. You know, he's 15. I can check with him again, but we're working on it within the family, and it's okay for it to be hard but for it to still be a family, not an outsider goal. I think we can learn new strategies for this, as well. Because this is personal, I think I have to respect his feelings about it. So I think there are two good goals, with the money and the shopping/cooking. But those areas are layered with levels of needed instruction -- he can't use a knife well, for example -- so a worker would still need to have me explain the needs in detail and plan things out. I'm not against that. I am just saying that it doesn't translate into less time or effort on my part than working on those goals myself. The benefit of working with someone other than me is real. And is probably makes it worth it to train someone else, rather than do it myself, even if it saves me no time. I would not ask a worker to help him prepare a meal for our six person family, so what we are talking about is for them to prepare a snack or perhaps a meal for the worker and DS to share. So it wouldn't be replacing the need for me to cook dinner. Edited July 20, 2019 by Storygirl Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 20, 2019 Author Share Posted July 20, 2019 I mean, the other two goals are fine -- they are areas of need. I just don't see us using the county worker for them specifically. I do think I am feeling a disconnect with this. Because the county case manager and the other county people we met with are kind of like, "he can just have a buddy to go running with, or go shopping with." Like just being a friendly companion is enough. But then there is this serious seeming document, with the goals. And the goals are not about running. And then the goals seem kind of on the simple side. Like, "hey, let's put on deodorant every day and learn how to make a sandwich and count pennies." But then the disconnect is that the worker is expected to make progress on the goals, and I have to give the case worker an explanation of how the worker is going to do that. So I feel pressure from that. Because these things sound easy, but they are so, so hard to breakthrough and make progress on. And it's not going to happen by someone being his buddy and going running with him. So there is a kind of let's just find someone he likes to hang out with vibe. Contrasted with goals that seem on the surface to be simple. But are so hard that the buddy is going to need me to be behind the scenes, orchestrating things, in order for any progress to happen. I know, Peter Pan, that you are going to say that it's a behaviorist who should be overseeing and orchestrating. I'm not doubting that you are right. I am just hoping that our counselor, when we find one, can fill that role. And so I kind of feel like waiting on the county worker stuff until I have more help with making the plans for what the worker should do. And also, honestly, it seems like this county worker system is a little light on the expectations for an organization that is dealing with people who have disabilities. I mean, the reason that these things are hard is that they are affected by the disability. But we can address it with a running buddy? Honestly, I expected more. Our county is known, actually, for having good funding for disability services. I'd like to feel that what we get is more robust. I think there are things available that might dig in deeper and help more, but I don't know what to ask for. I do know some things that the special ed person at our school told me, but I know I don't have the whole picture, because she just listed a few examples of what the county can do. The county case managers didn't tell me anything from that list and just presented the home care worker as what they thought we needed. But maybe there is a service we could use, that would help us even more? To be blunt, I don't see how a paid worker is going to accomplish goals that we have been working on for years with him, when the worker is not required to have any expertise, other than that I want to hire them? No qualifications, otherwise, other than passing the background check. I don't know. I'm just processing it. It's new to me. I'm just throwing out rambling thoughts, because it is way too late. But they are things I am working through. We are also going to have to figure out how much these other kinds of private therapy are going to cost and what insurance will cover. I would maybe prefer to have our county funding paying for some of our counseling bills, if possible, since we have not met our deductible yet this year. Doesn't it make more sense to use the money for expertise? Because if I am using it to pay someone to do things that I can do myself, then it is basically respite, or as Peter Pan called, it glorified babysitting. I'm not knocking that, because if anyone is burned out, it is me. But still, I don't know if that is what I would choose to spend money on, if it were my choice. My brain is befuzzled. I need to go to sleep. Quote Link to comment Share on other sites More sharing options...
Lecka Posted July 20, 2019 Share Posted July 20, 2019 Just two quick thoughts..... One, with your current worker, sometimes it happens that people realize they are going to spend x amount of time driving and all of a sudden it doesn’t make sense to drive an hour round trip for 2 hours of work. Just because that is how their schedule is shaking out. Two, for some examples I think you can think about recurring tasks or repeating tasks. For using a knife — yes, it is trouble to explain this. Or to write a bullet-point about it. But then what if he needs that level of “practicing with a knife” for 6 months or a year? And then you schedule it as weekly, or x times a week, and then — you don’t have to plan it again. For example you could have him do some prep work cutting and place the things in a container, and put them in the fridge. Then you could always cut a few items you might use, and practice the same items, for a while, but then if you end up not using it you can just throw it away. Which is wasteful except he did improve his knife skills, hopefully. Or choose a snack where he has the same snack and uses a knife, and you just have one of 3 foods on hand, and he picks one of the three — and make that be weekly, or x times a week. This is how a lot of things are — where it is hard to set up, but then once it is set up, the same “program” is done for months or a year. And then to update it might be moving from a plastic knife to a metal knife, or cutting something harder to cut. 3 Quote Link to comment Share on other sites More sharing options...
Lecka Posted July 20, 2019 Share Posted July 20, 2019 (edited) I’m going to add I learned a little about an area I think is called “life skills coaching.” Where we used to live, there was a community college about 2 hours away that had an autism program, where they offered supports and they offered classes that were non-academic, so some students might be taking a mix of academic and non- academic, some might take nothing non-academic but participate in some of the life skills-type things, and some might not take any academic classes. It was for ages 18-26 iirc — I know 26 was the oldest age. Anyway — I called and talked to the man who ran this program, and it turned out one of his kids had Aspergers. Anyway — I got a name from him for a psychologist in my home state (neighboring) who offered some services for life skills for adults. So the model this psychologist used was — she had a list of life skills tasks and had them written up so it would be easy to say “here is the current skill level, here are some appropriate goals.” And then the parent would need to locate and hire staff for 5-10 hours a week. This psychologist didn’t offer the service of “you pay me, and then I employ them and pay them and all of that.” She suggested hiring through the College of Education at the local university and it came across like — parents found people that way. Then she would offer training and consultation to the worker, and do the goals and the programs (an activity to practice the goal). For this one — a lot of it (or the part I asked about more, possibly, bc I was looking into it wrt a specific person) was that they would want the worker to assign a couple of tasks, and then the next day, check up on them. Which is appropriate as a goal when it’s an appropriate goal for someone in their 20s. And then the young adult was not supposed to call parents for help, was supposed to try to problem-solve on their own, and then if there was a problem, work it out with the worker. So — that is a model I am aware of. As with many things, the psychologist charged $$$ and the college student would be paid much less. The psychologist would bill x hours (I don’t remember but a certain range) to set up the initial program and do the initial training. Then many months the psychologist might bill 0-1 hours. So — this is an example of a service model. There are a lot of service models out there but you see what is out there local to you. Local doesn’t have to be very close at all, when the model is that you hire locally and then maybe “training and supervision,” “consulting,” “program design,” etc is on the “outsourced” side. My last state had a lot of rural areas served in this way, for some services, by just 2 or 3 cities. Anyway — sometimes too there are books published that have lists of skills, programs, take analyses, etc, and you can buy a book and then use it to generate goals and programs. AND this is where — maybe the lsw could hook you up with a book with this info, to where a lot would be pre-done for you, but have decent lists and activities — where maybe the lsw has been to a conference and heard about good resources, and then she shares them with you, and it is what you need. This can be a model, too. Or maybe you do look for an agency where they hire, they pay, they design programs, etc, and you don’t have to do any of that. My son’s ABA agencies have been that way. I’m going to add..... I know where we used to live “navigating the community” could be a goal and could include everything from crossing streets to using public transportation, which meant calling for a van service for people with disabilities, and talking to the people on the phone and then riding independently. And that would be something where it was set up like — they might do the same thing for weeks, so it’s not like you have to re-write the program every week. Like for example — we lived walking distance from a park and a Dairy Queen, and my son could pick where to walk, and then they would go, and for either place he would be practicing walking on the side of the road, noticing when to stop and watch for cars, etc. But for months it was “practice x skills, by doing one of these two things.” It took brainstorming to come up with it, but then it was smooth for months afterward. And surprise-surprise, he found Dairy Queen and the park both very motivating, so he wanted to walk good/safely so he could get there. Edit: this is one of those “natural” programs that I find to take so much thought and planning, that I feel like “hey that is a big fat ABA program with a task analysis and levels of prompting and increasing independent practice of skills” but it’s also just walking to the park. Edit: and I needed him to walk safely so I could do things like park in a parking lot to pick up my older son from things! Edited July 20, 2019 by Lecka 1 Quote Link to comment Share on other sites More sharing options...
Lecka Posted July 20, 2019 Share Posted July 20, 2019 (edited) I’m going to say too — maybe he would like video instruction? It is recommended sometimes. My daughter is left-handed and she really preferred watching a YouTube video showing left-handed shoe-tying, to me trying to help her and show her. I still helped her at first with the video, but then she could do it with the video but without me. I have done this with tooth-brushing for my son with autism, with a video that just showed brushing the different areas. He liked watching the video where he would have hated me telling him. There are videos for a lot of things. Edit: and my husband watches YouTube videos for a lot of cooking things. Edited July 20, 2019 by Lecka 2 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 20, 2019 Share Posted July 20, 2019 (edited) I'm sounding down on the counselor, but that's because that person sits in an office and tells people what to do. You need more coming alongside. All this starts with RELATIONSHIP and that is what gives them the trust, the street cred, to make demands (asking him to do things). If there is no pairing, no relationship, then it's more like prison guard shouting things at you, which is just going to raise opposition. Yes, my ds is horrific with lists. He put his Garmin in the frig to hide it, haha. I only finally found it because an alarm went off right when I happened to open the frig, lol. I want to start him on lists for school and I'm dreading it because he has torn them up and been hard in the past. Clearly I need to put my thinking cap on and pair. So your county coor is functioning right now as the behaviorist, the coordinator, and you don't have a trusting relationship where you trust that her recommends are spot on. They're kind of distantly good. It will be interesting to see what changes with the pdoc mes. I really don't know what of that will change. I never *doubt* you when you say your ds is kinda jekyl/hyde or hard to work with because my ds is very similar. What you're saying makes sense. When I don't know what to do, I go back to basics. Pair more. Everything starts with pairing. Get the body calm (med, biomedical). Reduce stress. Start small and work up. Pair things that are not preferred with something that will be preferred. (pair isn't a bribe. Pair is making life good, making the demand incidental and small in comparison, a blip in a life of good) My ds eats up 1:1, so I don't think it's ever wasted. And ironically, the person does NOT have to be making an extreme amount of demands for my ds to come out better. Having one relationship go well (with the worker) makes the rest of the relationships go well. So it's less about them making demands and more about them building relationship and slowly making small demands. And if he likes to eat, then maybe start there. When do his meds wear off? Is he hungry later? Maybe have them problem solve the problem he feels he has. Like if his meds wear off at 8 and he's hungry THEN, then that's what he wants to plan/shop/prep for, not a dinner that he's not hungry for. But maybe make it social, like a food he can buy/prep and share. Edited July 20, 2019 by PeterPan 2 Quote Link to comment Share on other sites More sharing options...
Storygirl Posted July 20, 2019 Author Share Posted July 20, 2019 Thanks, friends!! I mentioned earlier in the thread that writing helps me clarify my thoughts, and that has definitely proven to be the case here. When things that seem like they should be simple for me to do instead seem hard, it helps for me to try to work out why that is the case. Sometimes it is my own worries getting in the way. Sometimes there are other blocks that I need to identify and figure out how to work through. I think in this case, that it has been both, so it has felt overwhelming. And then, partly, that makes me feel dumb, because I have a sense that I should just be able to figure out this stuff without so much internal stress and external frustration. I'm a procrastinating perfectionist, so if I can't see a way to do something well and right, I balk and have a hard time getting started. I think there are things that I could do to make this county worker situation be helpful for us. But also, I think that if I don't think that it will be the most helpful thing, it would be okay for me to put it on hold for right now and focus on something else first. DH and I can discuss it, and now that I can explain better what I'm struggling with, I think we can feel better about being able to make a good decision. In other related news, I got an email late yesterday from my cousin's wife that gives us another idea for where we could go for the counseling piece. She is an educational psych, and she gave me some information about the place where she works, and I think it sounds like a good place to check out. They have psychiatrists there to figure out medication, but also do therapy with people who have autism. It's possible that we could get two kinds of help from that one place. She gave me the phone number for the intake people, so I'm going to call to see what's what after the weekend. 1 Quote Link to comment Share on other sites More sharing options...
PeterPan Posted July 20, 2019 Share Posted July 20, 2019 4 hours ago, Lecka said: I’m going to say too — maybe he would like video instruction? It is recommended sometimes. Just as a total aside, don't overplay what this has to be to accomplish some good! Sometimes my ds is at a place when the worker comes where they literally just sit and watch tv with him. Seriously. They just hang with him. Isn't that the most foundational point of a relationship, when you say I WANT TO BE WITH YOU? And you meet them where you are. You just sit and hang. And then you're like hey I want a pop do you want a pop. And then you're like hey after this commercial wanna play ping pong? So tv, nintendo, whatever are actually legit inroads, even if they're not like this whole therapy discussion. It can be, but we're always going back to relationship and saying I enjoy just being with you. It's maybe something he's deprived of in a way, because his behaviors are offputting. My ds finally figured out he has paid friends, haha, but in a way he doesn't care. And having paid friends helps him learn how to have the other relationships he wants (siblings, parents, peers, acquiantances, etc.). And I'm just thinking out loud here. Like a teacher is used to be top-down unless they put on their friend, slow down hat. A counselor is a very different relationship. It's just choices. I'm just pointing out that bringing the in-home worker in is asking for a different type of relationship. 1 Quote Link to comment Share on other sites More sharing options...
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