Sunday, August 18, 2013

The guiding relationship ~ where we are at!


I am sure you have noticed that our favorite place to hang out is in the kitchen! Even the dogs get a look in. :)

This was us three days ago.... "I threw 3 oranges to Nick in quick succession and he caught them all. He had no way of catching the 4th, so I paused. I gave him time to think. I paused long enough for him to make a plan. He looked around the kitchen, spotted the juicer and then placed the oranges next to it. He then executed a perfect catch as I hurled the 4th orange across the room! ‪#‎thepowerofthepause‬"

Sometimes the dogs drive us crazy by pinching oranges that have been dropped onto the floor. Or, if we are not quick off the mark, a carrot may mysteriously disappear from the fridge as I rummage around for something I need. I feel that the dogs add humor to our situation AND I also love to hear Nick say "ohno" when he sees one of them being naughty!!

I thought I would share a few (very short) video clips of a planned engagement that took place in the kitchen last week

First off, since we have already been doing a bit of baking, I decided to introduce Nick to the fine art of icing cookies. Now this is a brand new experience for my boy and believe me, he is always wary of anything new! Because this was a planned engagement, I had already put thought into the *edge plus one* concept and how I was going to approach it with Nick. I had decided on our roles (i.e. I stir, Nick stirs, I spoon, Nick spoons) and made a note to myself to be mindful of my language and to ensure that I slowed my pace to give him plenty of time to process, think and then react. I also put some limits in place. No screen or music distractions and only six cookies to work with. Having only a few cookies to ice ensured that I didn't drag the activity on for too long. I wanted the experience to be a meaningful and interactive engagement and not turn into being all 'about the task'.


Icing one

I talk about my actions so that Nick is aware of what is going on. You will see that Nick moves away from me and all I need to do is pause the action and wait for him to realise that I would like him to move closer. (0:18 Nick tries to say cocoa!). I set up a nice co-regulatory pattern of us stirring the mixture. Nick has a good episodic memory of stirring, therefore is comfortable with the pattern. He is aware of his role and he can pace his actions with mine. He does have difficulty with sustaining the motion of stirring, however, I don't make an issue of it because the activity is about our interaction, not the skill of stirring! I also spotlight that what we are doing is easy... "this is easy".


Icing two

We finish stirring the icing mixture and I can see that Nick is feeling competent with his role. I also feel that Nick is now at his *edge* of competence and I want to add in the challenge (the *plus one*). I talk about the cookies and we take a little smell. Before I get a chance to talk about the next step, Nick takes the cookie and places it in the mixture. He has never experienced icing cookies before so has no knowledge of what is going to happen next. To be honest, I do feel that I jumped in too quickly to scaffold the situation. I should have perhaps paused and waited to see what Nick would do next. As it is, I didn't give him a chance to *think* for himself. However, that is the beauty of capturing planned engagements on video. It is an opportunity to reflect on my guiding throughout the engagement and to celebrate the success or think of ways to improve the interaction.


Icing three

I mention to Nick that I have done my cookie and he immediately goes into *finished* mode. This is definitely his *plus one* (challenge) and he is NOT feeling competent with his role. However, I don't react except to keep a positive expression on my face; and Nick decides to take his turn. I thought this was fab as Nick made his own decision to take a turn even though he was feeling a little stressed. I am happy with this particular clip, as it shows that I am taking it slow, spotlighting success and I am using declarative language to invite Nick to participate if he wants to. Nick arose to the challenge and I made sure that I didn't push him beyond his *edge plus one*.


Icing four

You will notice (time code 0:17) that as I take a taste of the icing, Nick swiftly moves away from me. This is his general reaction if he thinks that he has to taste something new. I promise you that I have never tried to force feed my child! Hence the reason that we introduce new food very very slowly and don't make a big deal about it! We are now nearing the end of our planned engagement. I add a little scaffolding by pointing out to Nick that he missed a bit of the cookie. As he follows through with my suggestion, I spotlight how easy it is to ice the cookies. I then recap on our experience to highlight to Nick what we have achieved. You can see that he is attentive and nods his head every now and then to acknowledge what I have said. On occasion he looks out of the window, although all I need to to do is pause and he then reconnects with me.




To conclude ~ this is where we are at...

From my perspective I was mindful of the following;

I planned the engagement. I knew exactly what I was going to do and what I wanted to achieve.
Edge plus one ~ starting with a familiar pattern and then introducing something new that was *just a little bit* harder.
Setting limits.
Going slow.
Pacing out the activity.
Pausing the action.
Giving Nick time to think for himself.
Declarative language... and not talking too much!
Spotlighting the important moments.
Giving Nick feedback about the activity at both the beginning and the end.

I thought that Nick did really well....

He referenced me for information.
Reconnected with me when I paused.
Stayed with me throughout the engagement.
Made his own choices.
Arose to the challenge of trying something new.
Aware of coordinating his actions with mine.
He was resilient, adaptable and willing to look to me for guidance.

As for the dogs..... there was one at our feet waiting to lick up any drops of icing mixture that accidentally fell to the floor! :-)


~*~









Tuesday, August 13, 2013

Intensive Interaction ~ Sara's Story (Part Three)


This is the third and final post on Intensive Interaction. Be sure to click on the links if you have missed Part One and Part Two. Thanks again, Sara, for taking the time to share your story and for passing on such helpful information.
.

But my child has many many skills way above baby level!

Our children inevitably have many skills that are way more advanced than a baby and there is no suggestion that these should be ignored.  In fact, by following your child's lead (although this is not all we do in I.I.) you will gain a truer sense of the full range of your child's abilities and, therefore be able to give regard to his/her chronological age and all areas of his/er development. But, if your child is missing out on this essential early communication and social learning, then it is a good idea to give more time to this than to anything else.

How Intensive Interaction is done

Parents usually have 'all the time in the world' for their typical babies' development. They delight in their child and live in the moment without the urgent need to drive their babies' learning forward that we autism parents sometimes feel. Babies are given literally thousands of opportunities to rehearse their communication skills and to learn at their own pace (the perfect pace for them). These moments together are rich, fun, enjoyable and give the messages loud and clear to the baby.... 'You are a great person.' 'Your actions (choice of activity) are great.' 'I love spending time with you.'

Intensive Interaction is based on the parent-infant interaction. No equipment is required. The main (often only) 'piece of equipment' is you, the parent (or other adult) but it can also be done around toys or other objects.  You start by closely observing him/her to work out what s/he is doing and where his/her mind is focused.  Then you try to respond in various ways to some bits and pieces of his/her behavior. You can also just join in the behavior sometimes. This gives the messages: 'Your choices are good.' 'You are interesting.' 'We have things in common.' 'I like spending time with you.' 'You have value.'  Intensive Interaction can be done as little or as often as possible and at first, each 'session' might only last a few minutes. Over time you build up a repertoire of enjoyable games and activities through which your child can rehearse the early skills normally rehearsed and acquired in babyhood. As your child begins to develop these skills, sessions will grow in length and complexity and may eventually spill over into all interactions; and can become a way of being/communicating with your child throughout the day.

My final thoughts on Intensive Interaction


Enjoying Intensive Interaction with me

Although Tom still very much qualifies for a diagnosis of autism, he is back! The boy who used to prefer to be alone in another room is now playful and attention seeking. When I am trying to do dishes, for example, Tom constantly interrupts me, wanting to play with me or show me what he's up to. This was absolutely unthinkable a year or so ago. We are very close now ~ a couple of years ago I was depressed about our relationship. The sessions with his therapists are filled with games and laughter.

The hidden depths of I.I. for me have been that, the more Tom learns, the more he learns! In other words, progress was slow at first when Tom really lacked these skills and we had difficulty even connecting. But as Tom grows and acquires skills, our games and interactions become more and more sophisticated and the amount Tom learns in a session gets bigger and bigger.

Tom's language is no longer solely scripted and he produces much of his own language now and much of that is social.

And it's not just Tom or children like Tom, Intensive Interaction does so much for so many people, including reaching out to adults who may have been isolated all their lives.  It is an inclusive and deeply caring therapy. It has the added benefit of removing barriers for both parties involved and parents, grand-parents, siblings, teachers and other people who care can also experience the joy of the new connection. Intensive Interaction has healed my own personal pain as a mother and has given me back my baby. I now have much greater hope for his future thanks to this therapy.

I love Intensive Interaction so much that I trained as a coordinator and am VERY happy to help you in any way that I can.  Feel free to contact me.

Sara


How to get started/Resources

1.   Contact me anytime with any questions. I am an autism mum and an Intensive Interaction Coordinator.  I also volunteer for Treating Autism - biomedical interventions have played an important part in Tom's progress. mail@treatingsutism.co.uk and mention that the emails is for Tom's mum, Sara. Our website address is www.treatingautism.co.uk

2.   "What is Intensive Interaction?" Dave Hewett answers this question on Youtube. What is Intensive Interaction?. "Who is Intensive Interaction for?"  Dave Hewett also answers this "So, who is Intensive Interaction for?". This clip contains footage of my Tom!!!

3.   For other I.I. Youtube clips, go to this channel. Dave Hewett

4.   Also this one...  Dave Hewett

5.   Very short talk on Intensive Interaction by Miray Kester

6.   Yahoo discussion group for parents using Intensive Interaction with their child. Yahoo group

7.   Upcoming one day Intensive Interaction courses run by Dave Hewett. Intensive Interaction ~ course programme

8.   Look out for Intensive Interaction talks in our future conferences. See Treating Autism for updates.

9.   General I.I. information on Dave Hewett's website or on the I.I. website

10.  Parents' DVD and information pack, as well as parent's course all available soon.  See I.I. website for updates.

11.  Facebook page for Intensive Interaction users. Intensive Interaction for parents.

12.  The Intensive Interaction handbook with a chapter written for parents (available on Amazon). Intensive Interaction handbook

13. Moving beyond the label  A personal account written by the Mum of an autistic boy.

14. Intensive Interaction Parenting  A personal account written by the Mum of an autistic girl.

15. Intensive Interaction article





Saturday, August 10, 2013

Intensive Interaction ~ Sara's story (Part Two)



Sara is talking Intensive Interaction. You can find the first part of her story HERE.

Tom's home programmes prior to I.I were not addressing the core of Toms's autism. Tom did actually learn some things (the kind of things usually acquired after the first year in typical development and usually more consciously) through these therapies, but they were further polarising his strengths and weaknesses. Because of the way in which the therapies were delivered, they also had detrimental unintended side effects: he learned that we disapproved  of his choices, that we were there to put unending demands on him and that a relationship with us was a terrible thing. We gave him no alternative but to withdraw deeper into 'Autism Land'. Through these therapies Tom became unhappier, more stressed, more distant - basically more autistic.

A clever boy

Because Tom was clever, his home programmes had taught him many things. This is how Tom was when we began Intensive Interaction.

He was verbal ~ very verbal with clear speech and a wide vocabulary. He would ask for things. He could read, write and tell the time. He sang hundreds of songs and he was bilingual, yet he used NONE of these skills and talents to communicate in a social way. Tom did not call us or use our names at all. He didn't show or share. Heartrendingly, he couldn't seek comfort from us when he was anxious or in pain; and generally, he preferred to be as far away from us as he could get. Furthermore, he had no sense of self, he never looked in the mirror or referred to himself. He could read and write, although he also didn't use this to communicate; rather he spent his day repeatedly writing out film credits, letters or numbers.




A child-centred therapy

Back then, when we were just about to start I.I., the idea of following our child's lead was a difficult and a completely new way of thinking for us. We had run non-stop, full time, educational home based programmes for our son since shortly after his autism diagnosis at 2 1/2. Our emphasis had always been on bringing Tom into our world.  Suddenly we found ourselves in a scary place - doing a therapy that was based on the complete opposite philosophy; and so it was with suspicion and fear that we entered our son's World of Autism - a world filled largely with film credits, letters and numbers.

Five years of taking 'stims' away from him or restricting them had not had the desired effect of broadening his interests to other things, but had possibly had the opposite effect and made him want them even more! In the years since that time, I have come to believe that consistently taking 'stims' away from a child when you have no idea of their function can have a sledge hammer effect.

One of the many functions of Tom's 'stims' was an aid to blocking out the world when it became overbearing and he simply couldn't deal with it. He was also using them as a way to cope with physical pain (he had severe bowel problems, headaches, etc). I now believe that by forcing my child away from his coping mechanism, I was unintentionally breaching his basic human rights.

We were very pleasantly surprised when we changed our attitudes. Just though the simple act of joining him in his world we immediately saw results. There aren't many quick fixes in  autism but in that instant that you join your child you put an immediate stop to their social isolation. He no longer wanted to get away from us all the time and instead began to take an interest in us. He began to see the potential of us. His 'stims' instantly changed their function. They were no longer something that he did on is own and something that made him unreachable, rather they were a way for me to connect with him.


This was because, just by joining him, we were showing him that (a) he was worth spending time with, (b) we found him interesting, (c) we had stuff in common with him, i.e. shared his interests; and (d) we approved of his choices and interests. Tom's self esteem began to grow and in fact this was the beginning of a sense of himself as an individual (Tom had never previously referred to himself or to anybody else, he'd never even looked in a mirror).

I began to shift my views on Tom's autism ~ whereas I had previously considered him to be unreachable, suddenly I realised that we were unreachable for him. I thought he was a poor communicator but realised that during all those years, Tom had been attempting to communicate with me but my communication skills were too poor to understand him. His 'stims' that I had previously detested because they appeared to take my son away from me were now a way for me to get close to him.

Emergent Outcomes

Intensive Interaction has a very different kind of structure and has no goals or objectives in the way that we typically understand those words, yet Tom's learning took off! The things he was learning are known as 'emergent outcomes' ~ that is ~ the adult provides the right circumstances and scaffolding and the child learns. We do know that children with autism will begin to acquire the skills that young babies acquire, but they also acquire many other outcomes that are difficult to predict. Yet they do come! This is very hard for some adults, very hard to let go, to stop controlling and also to trust that, given the right circumstances learning will happen! And because this type of learning is based on the parent-infant interaction, because it is not man-made but rather designed by Evolution/God/Mother Nature/The Gods (pick the one you believe in) it is far more complex and delicately balanced than any programme we could come up with by ourselves. It took me a long time to understand that something so simple could give so much; and that he was actually learning more and also more quickly than when we had very complicated programmes with umpteen objectives in place for him.

So despite my reservations, despite the simplicity of this intervention, despite the lack of objectives, despite the different type of structure or, in fact, because of all those things I am continually delighted by the amount of learning and other wonderful things that happen for my son through this beautiful, natural, free flowing therapy. It just keeps on giving and day by day I watch him transform into a more sociable, self aware, confident, playful, loving, flexible, communicative and above all, happier little boy.


To be continued......




Wednesday, August 7, 2013

Intensive Interaction ~ Sara's story (Part One)


Introduction: I have always been interested in Intensive Interaction and if I had of known about it when Nick was a little boy, there is no doubt in my mind that I would have started our autism journey with this approach. I linked up with Sara, the author of this story, many years ago and we have been following each other's journey's ever since! Sara has a lot of information to share, therefore I am going to split up her story into three blog posts!

Thank you, Sara, for taking the time to share your story.




When we started Intensive Interaction with my son Tom (then approx 7 1/2), there was no way of knowing just how much this very modestly marketed and exceptionally simple educational programme would benefit him. We have only kept going with this programme for such a long time (about 3 years) because it just keeps on giving and giving. In fact, as Tom acquires even more of the basic learning skills, so the learning outcomes from these skills increase accordingly. Thus the learning outcomes become even more in tune with typical development. In our experience it has been the therapy that promises the least and gives the most!

Background

Little Tom regressed from around 15 months onwards and disappeared into a land called 'Autism'. The light that can be seen in his eyes in this photo went out and we just couldn't get to our baby any more. It felt like he had been kidnapped or had vacated his own body and left us with an empty shell to feed and clothe.

before regression

after regression

Our house felt silent and childless and we were overwhelmed by his distance. We were devastated and utterly heartbroken. This was all compounded by bad experiences with the people being paid by the state to help us. I was desperate to get my baby back and I would have stopped at nothing to do so. I looked around for suitable therapies....

What most autism specific programmes forget...

During their first year, neurotypical babies achieve the most complicated learning of their lives ~ they learn more during this period than at any other time. The stuff they learn is vital for healthy or typical development. In fact, it is so essential that, if they do not learn it, they will probably end up with some sort of developmental delay/SEN, simply as a result of not mastering this stuff. It is the foundation for all other learning. Yet, because we are so accustomed to it being achieved seemingly effortlessly because the adult role in this learning is pleasurable, natural and also non-conscious, we are often unaware of it and it's absolute importance.

Here is an abridged list of what babies learn in their first year;

The enjoyment of being with other people and seeing the potential of socialising
How to build relationships
A sense of self and self worth.
How to play and be playful
To read and make facial expressions
To read and use body language
To share personal space
To take turns
To read and make a wide variety of eye contacts
To do sequences of activity with another person
To use vocalisations
And much much more....

Autism

Perhaps more poignantly, much of this early learning is impaired in people who have a diagnosis of autism. It can be impaired even in those who have some higher skills such as speech or even conversation. It was severely lacking for Tom even though he was verbal. Often Intensive Interaction (I.I.) is used with non-verbal people but can be used for anyone needing this learning.

Parents of children with autism sometimes express some sort of shock when they find themselves communicating/playing with typical babies. It can be a nasty reality check and upsetting for us to see what babies are capable of and just how communicative they are. Many people are familiar with the YouTube video clip of toddler twins communicating playfully without words.


These pre verbal children have so many very sophisticated communication skills. They are turn -taking, vocalising and using and responding to complex intonation. They are reading each other's body language and facial expressions (and using body language and facial expressions at a sophisticated level). They are using and reading a complex array of eye contacts for different purposes (contrast ABA's "look at me"). They are sharing personal space, enjoying one another's company and being very very sociable. They are sharing 'jokes' and showing empathy. They are attending intently to one another. In fact, you can almost watch them making brain connections that will eventually lead to verbal conversation and other more advanced social communication skills.

Why other programmes failed Tom

Imagine what the twins will go on to learn next. Much of what they will learn (speech, naming colours, number, matching etc) will be what we tried to teach Tom before he had all the crucial foundational skills these twins have. Imagine the advantage these boys will have in this learning over a child like Tom who had none of their skills.


To be continued.....




Monday, August 5, 2013