Saturday, February 21, 2009

Dr. Levy's 10 Things - this is a long post, FYI

Two weeks ago we went to the in-law's house for Friday dinner. Nikko came across a wooden backscratcher that also had 3 wooden balls for massage on it. Needless to say, he wouldn't part with it without a scene so it came home with us. It ended up in the Pilot for a few days unseen, but also made its way into our house. Tonight was Friday dinner again and I bid it farewell because we brought it back. Sure enough, right before we walked out the door going home, Nikko spied it from the corner of his eye, dropped his two trains and picked up the backscratcher. It's in our kitchen again....

Today was not a bad day for Nikko. He had breakfast and a visit from Cindy the social worker. She brought toys for him and Ronin battled it out over a toy animal hospital, then a battery-operated puzzle. The session wasn't really for Nikko, but for me to vent or tell her anything on my mind. I really appreciate her visits because she's very easy to talk to. Nothing earth-shattering came of our visit today, but the company was appreciated. Lunch was normal, and the afternoon kinda stretched out before us. Audrey was fussy between naps and I couldn't seem to get Nikko to sleep. He'd sleep in the car on the way to the in-law's anyway. At snack time I made him pb&j bread, but he took a few bites and didn't want it. I don't know if it's the peanut butter or the jelly he's not crazy about, but I'd take a bet that the jelly wasn't the most appealing. He did respond to the chocolate pudding I gave him in a bowl, however, and he used a spoon to take minute bites of it. He stretched out that bowl of pudding, I tell you.

I finished reading that book "What You Can Do Right Now To Help Your Child With Autism" by Jonathan Levy. I want Denis to read it so I can have a discussion about it with him. There are 10 things they outline that can be done immediately with Nikko:
1. Don't react
2. Make eye contact a priority
3. Join with the stims
4. Respond differently to crying
5. Five your child as much control as possible
6. Focus on your attitude
7. Work one-on-one in a non-distracting room
8. Be dynamic with your child
9. Get more language
10. Make sure food isn't part of the problem

These 10 things drew me to get/read this book because we do some of them already. I am not going to summarize the book, but I do want to comment on each point:
1. Don't react - I have a tendency to make a big deal of the bad things, probably in a way to discipline. I should tone it down, but I am not sure how not to draw attention to the "bad" things. However, I believe that I do offer praise when it is due, and I believe I praise big. I am always so happy to see Nikko do something big or small that is in a positive direction.

2. Make eye contact a priority - This was the first point that drew my attention to this book. Nikko's eye contact has improved quite a bit since his 18 month doctor visit. However, I know it can be improved. I will still employ the techniques the book describes, but I know that he could do better. Sometimes I still have to get into his face to get his eyes looking into mine.

3. Join with the stims - This is going to be one of the hardest points for me to follow, let alone fully accept. The book says to not try to stop Nikko from stimmying. Instead, join him. This is supposed to foster a relationship with him, build trust, and make him more open to WANT to learn from me. He will WANT to be around me, someone who theoretically believes and enjoys in what he is stimming over, which is supposed to be something that satisfys him. It's supposed to increase his interest in other people because he will soon learn to be interested in being with ME. This point is very different from what our current therapists have been applying in their therapies with Nikko, especially Shelly the OT. When Shelly sees that Nikko is stimming, (stimming, stimmying, don't know which is the proper way to say it) she is inclined to interrupt his stimming, or sabatoge it with an activity, or take away the stimming object. I can see that this has a big disadvantage in that Nikko becomes very upset when that happens; it takes some time for him to transition to a new activity, and if he's mad at us for taking away his stim object then he may refuse to participate in the future. This is something that the book is pointing out. Dr. Levy says it's better to join in the stim instead of take it away for those very same reasons, to get Nikko to want to be around me. It's truly an interesting concept that I haven't nursed before. Will it work?

4. Respond differently to crying - This point makes sense for both Nikko and Ronin. Here's his excerpt: When a child cries without having injured himself, there are only two possible reasons. Either your child is: 1.) Genuinely unhappy, and crying is an expression of that unhappiness. 2.) Faking it. That's it. In both instances, the book says to be peaceful in both situations. I just marvel how manipulative these kids can be, especially Ronin, who is the BIGGEST WHINER and is probably getting the things he wants by whining all the time in addition to crying. This point means I have to build up more backbone and not give in to the crying if I don't want Nikko to have something. That's it.

5. Give your child as much control as possible - The point here is to foster a more trusting relationship, and it's not through physical manipulation/force/restraint. Some points here to remember are to tell Nikko what I'm going to do before I do it (the book made some very nice illustrations about how autistic children are often dragged around, thrown around, and put into situations because they had to be moved, dressed and wiped without anyone warning them in advance). I believe this point is also about having respect for Nikko, and remembering that he is an individual with his own feelings that can be hurt, or his own space that needs to be respected. But move him if his safety is being compromised, of course.

6. Focus on your attitude - I had to reread this chapter because it was more about me than about Nikko. It's talking about understanding how you feel about yourself and the things you do, because it impacts how Nikko will feel. It says that because Nikko is nonverbal, he pays very close attention to ALL our nonverbal cues as well; he can tell if I'm truly happy or not. And who wants to work with/be around someone who is not happy or positive? This chapter says I should figure out why I'm unhappy if I'm unhappy, and that it will affect Nikko. So don't be unhappy.

7. Work one-on-one in a non-distracting room - I thought this point was obvious from the title. BUT, Dr. Levy goes on to describe school settings and basically says that non-autistic classrooms AND autistic classrooms will not benefit Nikko. He de-emphasized academics because by teaching Nikko academics instead of interaction skills, [I am] helping [him] to have skills that he won't be able to apply. He needs to master the skills of eye contact, attention span, and speech among others. That's a very fascinating concept that I'll need to go into later on, with more discussion....

8. Be dynamic with your child - I already do this, I won't elaborate.

9. Get more language - Nikko needs to be motivated to speak, and this may not happen if he learns sign language or a picture board first. That's what Dr. Levy says, and it's totally opposite of everything the therapists have been teaching us. He says to teach Nikko action words: Tickle, Up, Down, Eat, Drink, Bounce, Throw, Pull, Push, Roll, Squeeze, Sing, Swing. Then reward him quickly, to encourage the motivation. Another Dr. Levy teaching: there's no added impact right now to teach Nikko to say Please, Thank You, or I Want because right now they are not useful or powerful. We should focus on descriptors, clearity of speech, and increasing sentence length. This is, of course, after Nikko acquires some language. Getting him to look a little bit more normal [by teaching an autistic child to say Please and Thank You] is just wasting energy that could be spent on learning things that will be of use to him, like eye contact or more useful words. I'm still trying to wrap my mind around this one because we have spent so much time trying to enforce Nikko to sign More, when here Dr. Levy is saying to just connect Eat with the food. Do I stop the picture board (PECS) stuff and signing or keep going?? Gloria the Speech Therapist keeps saying she doesn't think Nikko is ready for PECS yet anyway, so maybe there's truth in this...

10. Make sure food isn't part of the problem - Fruits and vegetables. Nikko has a hard time eating these things, except for grapes and bananas, and spinach if it's mixed into stuff like pizza or cream of spinach, and sometimes cooked carrots in a soup. Oh yeah, and red kidney beans. I don't think Nikko has any food intolerances such as dairy or wheat. I don't deny him sugar, but he doesn't get it that often. He does eat crackers or cookies from time to time, but not every single day, so I don't think his diet is completely garbage. He does eat chicken nuggets, which I don't mind, but I know he should eat different things. This is another area where some creative presentation of foods is in order, as well as a stronger backbone. It would help if I actually liked cooking, I guess. An excuse?

1 comment:

  1. Mich, I laughed about the backscratcher. Rex likes that thing too.

    I thought number 9 was very interesting. What Dr. Levy says about language makes a lot of sense.