Pincer

Did you ever notice how we are very reliant on our thumb and index finger?

The motion where our index finger moves towards the thumb looks much like how the crab’s pincer moves, earning it the name. This simple motion is the basic that helps us to pick up things that we dropped, enables us to hold a chopstick or pencil etc. Although most typical babies should meet the milestone to develop pincer motion around 12 months old, some may miss it and needs a little more help.

My boy, for one, prefers to use his middle finger rather than his index finger, which might be one reason why his pencil-holding or writing skill is impeded. The therapist decided to work on his pincer movement first.

Here is a video of how it can be done:

http://youtu.be/871gRO5FrfU

Screen Shot 2015-02-03 at 3.48.12 pm

In the video, we used small coloured thumbnails for the boy. These thumbnails are close to the table surface and hard to pick up, forcing him to use two fingers if he wishes to do that. Initially, we started the course by teaching him to imitate the pincher motion (not captured in the video), before we move on to the second part (as shown in the video).

As you can see in the video, we need to pay attention to his movements and whether he is paying attention to our instructions.

A few things happened in this short video and this is how I was told to overcome them:

Issue 1: Boy was guessing what we want him to do and not really listening to instructions. We can see this happen when he picks up a thumbnail before we identify the colour we want.

Strategy: Keenly observe where his hand was hovering and prevent calling out the colour that was near him. This can make sure he is really listening when he picks up the right colour.

Issue 2: He reverts to using the middle finger instead of the pincer motion with the index.

Strategy: Remind him by doing the pincer motion in front of him. I verbalised the “pincer” words too, but it should fade away as he gets more familiar with the motion.

Gentle reminder, a new programme should not be too long, let him go away on a good note, when he is still performing well.

P/S. This exercise also can act as a good practice for sorting.

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His boy is now a doctor

It must be destined for me to be on his cab. The cabby and his son serves as a great encouragement for us.

In the short 10 minutes ride, we never mentioned ASD or autism. I had never been consciously avoiding having to tell anyone about his condition when should anyone ask. I was usually happy to offer the information. But this time, the diagnosis was simply taken out of the conversation and it feels great, especially when the other party whom I don’t know don’t find anything strange about the boy’s mannerism at all… =)

Here is how the conversation went:

Me: (Jumping on board and telling him our destination)  boy, say hello to uncle.

Boy: Hello uncle.

Cabby: Hello. How old are you?

Boy: … (No reply.)

Me: 4 years old.

Boy: (Repeats) 4 years old.

Cabby:  Where are you going?

Boy: … (No reply)

Me: Going to school.

Boy: Going to school.

Cabby: What is your name?

Boy: … (No reply)

Me: Sorry huh, he sometimes don’t answer.

Cabby: It’s okay. Let him take his time. He is very good already. My son never talk until primary 6. He don’t speak to anyone one. My wife was so worried. At least your boy can speak. My son much thinner than your boy when he was young….

Me: (Interested) But his studies is okay?

Cabby: No la, P1, P2 always fail one… but later after PSLE he goes to N(A), then O levels and NJC. Now he is a medical student, MO in a government hospital.

Me: Wow! Thank you uncle. Thanks for the motivation.

His son might not be ASD, during his time, the diagnosis was not so prevalent. But he might be ASD? I don’t know. The cabby uncle might have exaggerated his son’s condition. I don’t know. I don’t harbour any unrealistic expectation to what my boy can achieve but this account is another one to tell us that every child have their own path and we should not limit them but what they are thought to be at a young age…

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Video-ing our kids can help them and us

There is a report about how video feedback can help reduce autism.

http://www.autismdailynewscast.com/video-feedback-may-reduce-autism-young-children/22231/robertahill/

I know how video-ing our kids can be the last thing on our mind, let alone videoing our own interaction with them. I mean most times, we would be busy guiding them, if we are lucky enough not being required to mange their idiosyncrasies.

Why would we want to video such frustrating moments?

I vaguely remember how we were videographed while playing with our boy in therapy sessions and was given feed back on what we can do to improve interaction with the boy, engaging him more.  It helps to heighten or awareness as parents as we engage in a personal review.

For example, I never knew that by sitting him back facing me, and facing the book when I read to him, actually refuses him of any chance to look me in the eye during the highly animated and interesting story-telling session. After the video session, we consciously sit him facing us.

You can think of it like how some people may videograph themselves before they do a presentation. That helps them to review where they are lacking in and do better. The concept is similar.

Now we are also video-ed at the start of every new therapy module for the boy. He will also be video-ed again after he has mastered a certain skill. That sort of serves as a reminder for us where he started off and how he had improved.

A source of motivation too.
Try it!

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Scouting for the right learning place

At four and a half years old, he has been to three schools, early intervention centres (he will be switching to his second one next year) not included.

Looking for the right school and the best of the best childcare centers is on the minds of many Singapore parents. I can’t remember exactly but I did call up some big names in the market and being told that the waiting time can be up to many many months. No wonder they charge so high. It is all supply and demand.

Those were the days where I am a believer of brands and facilities.

Now, I am more into the heartware, not the hardware. And I am fortunate to be recommended a small family run enrichment school who is open to receiving children with special needs and believe that if all partners work together, it can work. I.e. the child will normalise one day.

There are passionate educators after all. Morning Glory Playhouse, Thank you for working with us as a team.

Whatever I do at home with my therapist and Rayson, I will tell the school. The principal and teachers will do their best to make sure they are on the same page. No chance for the boy to practice differently in the presence of different people and that consistency in expectation and intervention helped.

A very big thank you to my boy’s teachers and principals.

You made a difference.

You may be looking for a suitable school when you are reading this.

These was what I looked for when I sourced for a suitable childcare centre for him.

1) A passionate and committed principal who sees every child under her care as individuals. Headship is key to how the ship is steered.

2) Whether the child will get an individual education plan on top of the integrated curriculum for the bigger class

3) A small class size which means better attention paid to every child

4) A half-day playgroup is better for him compared to a full day care, for he won’t be too tired

5) A school with lots of hands on activity since he is usually quite active

6) Parents of existing students say good things about the school, describing the teachers as caring and passionate.

However, be prepared that there are also educators who are not so updated on the needs of the child. I did run into one and documented it in one of my earlier post (http://parttimemama.wordpress.com/2013/10/21/when-asd-children-are-trouble/) You can see how upset I was. But I am lucky that I did not insist on placing him there simply for convenience sake. If I had, I would have done him a disservice.

 Disclaimer: This blog is based on one mother’s experience with one child and does not seek to represent any advice from therapist or paediatrician. Please consult your specialist for further advice.

 

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Game for the weekend

This was a game we played one and a half year ago but I thought it really helped.

So am sharing in this post. If your boy belongs to the sensitive profile and is fussy with textures, this may be the game to make him comfortable with something he would find yucky most of the time.

For your attention, this is 50 cents game that leaves my boy happy for one hour. Very very focused for a boy who was then shifting from station to station in a matter of split second. So you can tell why I really like this game.

So here it goes.

All we needed was some corn flour and water. Mix the water to the appropriate amount of flour as desired to get the consistency that was needed. Take note not to add too much water.

The result is interesting! Something like liquid that has a solid form, which the boy can pinched, hold and mould in his hand while it slowly melts away…

The game was introduced by his teachers at the Building Bridges.

You see, my boy is a sensitive boy. So are his classmates. They are tactile sensitive and have low tolerance for mess. Introducing games with different texture will help to familiarise the boys with the sensory contact and help them overcome it.

When my boy played the game for the first time, he watched his teacher play with it for about 15 minutes before putting one finger in the mixture. (Sometimes I like his caution but he simply has too much of it for his own good.) Then, it was one hand. And then it was two hands. Later, after his friends ended the game and washed up, he was still very engaged.

corn-flour9

Benefit of the game:

1) While he picks and mould the flour mixture, it helps build his fine motor skills.

2) While he plays with the mixture, he learns how to manage the mess and learn that he can be in control.

Today, towards the end of the game, Rayson was a little bored. So I added a little colouring to the mixture. Try it. =)

Additional thought now that I learn about ABA.

You can try, in the middle of play:

1) block the opening of the pail with your arms and only lift them when the boy “speaks” to you or give you eye contact at least.

2) When adding the colour, add it drop by drop, only adding one more drop when the boy says things that approximates “colour”, “more”, “want”, “pour” etc. and remember to cheer when he does that.

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How to teach a child about their special friend

“He is running again. He is always like that in class, ” says the little girl, walking behind the little boy she is talking about.

“You are also like that what,” replies the girls mummy.

“No, I am not!” rebutts the girl vehemently.

The girl was reporting factual observations to the mummy, no value loaded. But the reporting was untimely, and perhaps embarrassed the mummy, hence the response, not the best but not bad given that she was caught off caught.

The girl was telling her mum about her special friend in class.

Three year old is the age when children start to become aware of self, when they start to know the similarities and differences between themselves and their peers. Perhaps this is also the time when they come home and tell you about their best friends and report the bad things the naughty ones had done.

This is also the time when value is taking form, thus the best time for adults to instil the correct value in them.

Frankly, I have no idea how as I am still learning to be a parent myself.

But this is what an author I read have to recommend, teach them that every individual is different, just as how one is a boy and another is a girl, or one is tall and the other is short.

Perhaps, we can teach by referring to nature itself, e.g. there are many types of flowers, different in species, colours, resilience, smell etc. Even flowers belonging to the same species can be different in terms of size, richness in colours, health status etc. They may not all look pretty or smell good but have strength in their own way. Just like how some bear fruits rich in vitamins, others act as vegetable in our food and some found in herbs and medicine…

If this is all too hard, tell her a story.

Here’s a book I plucked from the library shelves: Clancy the Courageous Cow

Image

In this book, you learn how someone is different and how they try hard to fit in, often hurting themselves, but one day, the mainstream discovers the outcast’s strength and he saves the world! World peace to the courageous cows. Simple. =)

Happy reading~

 Disclaimer: This blog is based on one mother’s experience with one child and does not seek to represent any advice from therapist or paediatrician. Please consult your specialist for further advice.

 

 

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My sensitive boy

Despite it termed as a genetic disorder, I sometimes ask myself why they are the way they are.

My boy is autistic with hyperactive traits and very sensitive.

And here goes my theory on why he is finding hard to make sense of the world, causing him to be a more difficult child than his peers:

Perhaps he has super keen senses.

He can hear sound that the typical us cannot, perhaps of a higher frequency range. Often, we see him cupping his ears when we can’t hear anything at all.

Perhaps he has a wider visual perception, hence taking in more visual information at any one time. Now that he is more attentive to information, he often points out things that are outside of our attention.

He is often seen putting things to his nose and smelling them. Initially we thought that the action is totally inappropriate. More recently, he is able to distinguish the ingredients that makes his meals even when they are not visible, sometimes verbally identifying them.

Most times, it can be difficult for us to start feeding him. Perhaps he is worried that there are taste that he dislike in his meal and his heightened sense of taste can deem them too overpowering. Once we succeeded in getting him to take the first spoonful and receive his approval for the culinary, the rest of the meal is much easier.

He dislike getting messy or wet, spill some water on his shirt and he will require a change. Perhaps he has learnt that being soaked and wet can make him ill more readily? It is just his way of protecting himself?

Well all in all, he might be bombarded with loads more information than a typical child, and hence finding it hard for us to organise his thoughts. Get them a organisor (in their case, a therapist) and help them to sort things under categories, putting them into drawers and teaching them where to retrieve the various information under different circumstances can help them go a long way.

Because they have so many information to sort out, they may take some time.

Be patient with them and once they learnt how to organise themselves, they might be a bag of pleasant surprise. =)

 

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Let’s talk more about talking

If your child is already starting to talk and understanding the power of speech, congratulations.

But it is only the first step and more needs to done. After all, we do not stop at expressing our wants and needs, nor are we satisfied with being able to tell what we like or dislike.

Our objective is for them to be able to carry out meaningful question and answers, or perfect if they can one day present their thoughts in an argument. That will take lots of time and many other issues can happen along the way.

Here is a couple of issues that we are facing and how we may be tackling it:

parrot_xlarge1) Parroting: Repeating questions instead of answering

Possible reason: They have been taught to talk by copying what we say and repeating them, hence they have yet to understand the concept of question and answer.

Suggested intervention: Have a prompter beside the child. I.e. station an adult beside the child. Whenever anyone ask him a question, respond like he would, with a whisper in his ear, so that he would copy you instead of copying the questioner. But the prompter has to be real fast though. Ideally, the prompter should be standing behind the child so that he doesn’t see him.

Scenerio before intervention:

Q: Have you eaten?

Boy: Have you eaten?

Suggested intervention:

Q: Have you eaten?

Prompter: Yes

Boy: Yes

2) Repetition of requests

There are times where he wants something so badly he will just repeat his request again and again and again, rapidly, without looking at us or really having any form of meaningful interaction. He is just aimlessly saying out his request aloud, aiming at no one and hoping for things to happen according to his wishes.

Scenerio before intervention:

Boy: I want yakult. I want yakult, I want yakult (X 100), with his requests increasingly irapid and intense, showing signs of frustraions

Adult: Gives him yakult without any demand on him to correct his actions.

This feeds his actions and actually tells him that it is alright to behave in this manner.

Suggested intervention 1:

Boy: I want yakult. I want yakult.

Prompter (assumingly mummy) goes up to him, facing him, place his hand by his side, holding the hands down before he gets frustrated. Wait for him to calm down and look you in the eyes.

Prompter: “Mummy, may I have a yakult please?”

Boy: Mummy, may I have a yakult please?

Prompter: Good asking mummy.

Practice again by extending the yakult to him but holding in your hand, not letting go yet. Look expectantly in his eyes and wait for him to say something.

Boy: Mummy, may I have a yakult please?

Prompter throws a party, says in an exaggerated voice: Good job! Good asking mummy for yakult. You can drink!

Suggested intervention 2:

 

Boy: I want yakult. I want yakult.

Prompter (assumingly someone in the house) goes up to him, leads him from behind, with a gentle finger push for him for walk to mummy. Hold his hand and guide him to tap mummy’s shoulder.

Mummy turns and asks “Yes, can I help you?”

Prompter and mummy wait for something to happen. Ideally, boy asks for the yakult while looking into mummy’s eyes. If nothing happens, prompter needs to speak on his behalf for him to copy.

Prompter: Mummy, may I have the yakult please?

Boy: Mummy, may I have the yakult please? … and the rest of the steps continue as per suggested intervention 1.

The purpose is to teach him how to approach adults for help and how to engage the adult’s attention. Let them know that if he did not get the adult’s attention, he is not going to get what he wants.

 

3) Meaningless repetition of certain rhetorics when he is upset

We may not understand but we may observe that in certain situations, the child may repeat a certain same rhetorics or lines when they are upset or caught in a situation that makes them uncomfortable or simply unhappy.

Suggested intervention

If you read that his undesired action is actually meant to attract a certain reaction, don’t give him his “reward”. Ignore him. Hopefully the action will fade by time.

In our case, ignoring did not work though. Therapist suggests that it might just be his coping mechanism, i.e. what he does to calm himself down. In this case, the suggested intervention 2 is to teach him an appropriate coping mechanism when he is calm and quiet, e.g. breathing in and out or telling himself “It is okay”.

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Getting them to start talking

The dictionary defines Communication as a process that involves the imparting or interchange of thoughts, opinions, or information by speech, writing, or signs. Hence, it is difficult for a child who is in his isolated world to start communicating, not until he is able to notice the people, objects and happenings around him.

Communication Temptation is a way to engage them and get them to notice and pay attention.

Many therapist I came to work with seem to suggest bubbles as a good toy to use to get the kids to start speaking, as most children are fascinated by the transparent soapy body that floats and pops in the air.

blowing bubbles

There are many opportunities for them to make a request in a simple bubble play. Take note, from the first approximation, to a complete sentence, it may take months or even a year and more, depending on the progress of each child.

Here is what I did with my boy, at the stage when he is non-verbal and had no eye contact (or when he tends to escape our visual contact).

1) Put the bottle of bubbles in a place that they cannot reach. Make it as visible yet unaccessible for them as possible. This gives them a chance to ask for help. Decide on the word you want to teach and stick to it until he acquires the word. Too many different choice of words may confuse him. I chose “bubbles” as the “B” sound seems to be the easiest for most kids to pick up.

2) When they show signs of wanting to take the bubble bottle, do not be too anxious to grab it off the shelf. Place yourself at the eye level and help them to look at you.

3) Make sure eye contact is established. Label the desired action achieved. Say in a delightful, cheery manner, “Good looking!” and “Bubble” (exaggerate your mouth movement as you word the term to help him how to make the sound of the word, talking in an animated or drama manner helps to catch their attention too), and give him the bubble. In this process, you are teaching him to look in your eyes when he has a request to make, and giving him a new word called bubble.

4) After that, you can put the bubble back onto the shelf and repeat step 2 and 3. This gives you a chance to reinforce to the child, what is required of him. Repeat this step.

5) You can blow some bubbles for him, and go back to repeat steps 2, 3 and 4 again. The break in interval creates more chances to reinforce our expectation to the child, while giving them more opportunities to practice. It also helps us to access whether the child had retained or remembered the requirement.

6) After the child is consistently able to give you good eye contact, increase the level of expectation. Get him to make an approximation to the sound before you give the bubble to him. For example, he may be looking at you expectantly, but not saying anything. Say “bubble” (exaggerated) and pretend to give the bubble to him, and take it back. May need to repeat again, and wait for him to give an approximation. If he did not say anything again, say “You did not say bubble.” and remove the bubble from him. Say “bubble” (exaggerated) again and pretend to give it to him.

7) If the child gives an approximation, e.g. only saying “B”, encourage him by cheerfully saying, Good trying to say Bubble and give him the reward, i.e. the bubble play. If he can’t, then have to reduce the expectation back to the level where he is ready.

8) After he is able to make the “B” sound consistently, then expand the expectation for him to say “Bubble”, “Want bubble” or “more bubble”, then “I want bubble”, then “I want to play with bubbles” etc.

It is important NOT to negate the child’s self confidence. Positive words of encouragement can help them to be more confident in picking up new skills.

P/S: Different words can be taught in different settings.

Listen to the therapist

Here is a video I found on Youtube that you can refer to:

A speech therapist illustrating how to apply C.T.: https://www.youtube.com/watch?v=XSAxjq_6mQA (The child already has quite a lot of speech in this video but you can get a rough idea.)

Hope this helps!

 Disclaimer: This blog is based on one mother’s experience with one child and does not seek to represent any advice from therapist or paediatrician. Please consult your specialist for further advice.

 

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How much therapy is enough to “cure” autism?

I suppose the answer is “the more the merrier”.

The intensity and consistency of the intervention matters.

My son’s therapist keeps reminding us that he needs more therapy sessions if possible. It is easy to think that she is only trying to sell more hours and write off the suggestions, but the fact is her advice is based on research results and not to be taken lightly.

Although she constantly remind us that the boy needs a minimum of 30 hours of therapy per week, online reports actually suggested that 40-hour weekly intervention is preferred. Researches had shown that children who receive this minimum amount of intervention are most likely to outgrow their diagnosis and progress to be indistinguishable from typical kids, perhaps even performing better.

Currently, most early intervention programmes for infant and children (EIPIC) supplies a 6-hour week. This is greatly less than the recommended amount. To add up to the recommended number of hours would be an additional 32 hours of private therapy a week, 128 hours of private therapy a month. Let’s say if the private therapist charges $100 an hour, it will mean financial commitment of $12800 per month in private therapy!!!

This means that the scenerio is likely not able to happen for most of our children, as most of us would earn only a fraction of that.

Although we will not be able to afford the recommended amount of therapy, what parents can do is to still engage some private therapy or at least sit in the EIPIC sessions where possible to learn the skills from the therapists and special needs teachers and practise as much with them as possible.

This means that the parent or caregiver who is sitting in, must be one who has time at home to work with the child.

Perhaps this means that someone at home will have to resign to become his designated teacher. Difficult decision as I would attest as this means one salary gone and how to ensure long-term financial security for the child is a constant question we have on mind.

But for me, this is the thought that makes me finally decide: “It is about investing in them now when they are young and hope that they grow as much as possible into an independent adult or continue to work and save up for them but find myself too tired to help them out at the end of a tiresome workday, and they may not grow.”

I chose the former. A struggle but so far the right decision.

Nonetheless, this is just one mother’s thought.

The rule of the thumb is: the more frequent we practise with our children the more they will know the expectations of us on them and perform accordingly. This is actually nothing new in parenting but the consistency is more important in their cases. If possible, share with the other family members what you have learnt and make sure they have the same level of expectation from the boy too.

It may sound like a lot of work for the child but it can be built into our daily lives and make the process as natural as possible. Afterall, looking us in the eye when they are making a request is not only to train their attention, but good manner that any child should have. =)

Disclaimer: This blog is based on one mother’s experience with one child and does not seek to represent any advice from therapist or paediatrician. Please consult your specialist for further advice.

 

 

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