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Sumlin Notes Part 2

#29

[me-listers: fyi - Our Incidental Note #s 27-29 were all written during the first month of unshadowed pre-school in school where faculty didn't know he'd ever had a problem and we wanted to be sure they never would. We were nearly two years into therapy at this time, still had three therapists left continuing 40 1:1 hrs/wk at home on top of five half days at school. Within a few months we added two full school days, by the spring it was increased to four and by the end of the term, he was doing five full school days right before he began K. Therapy slowly decreased as we added in school hours.]

WHAT'S GOING ON

- He's been shutting off socially so we have to make adjustments to the plan.

- He's stimming internally -- possibly stray, extraneous thoughts floating through his head and interfering with incoming data (i.e., shutdown)

- We've allowed him no outlets for all the pent up stim-energy he needs to release...

THE PLAN

1. INCREASE SOCIAL INTERACTIONS

A. Increase narrating everything you're doing...even simple stuff like "I'm walking [here or there] to get [this or that]..."

B. He can never be left alone

2. REDIRECTION OF STIM

A. If we allow him to tactile stim, it will satisfy his need to release stim energy, freeing him from internal stimming and allow more room in his head for processing important things. So...DON'T re-direct tactile stims (rubbing on your foot: though you may neutrally move out of his way; chair scratching: never remove chair; teeth clicking; rubbing against objects; rubbing pillows -- but blankets and pillows will/should be kept o/o room).

B. ALWAYS re-direct all aberrant play (see addt'l notes below)

C. ALWAYS re-direct weird noises (animal sounds...)

D. ALWAYS re-direct body postures (incl. rolling on floor)

E. ALWAYS re-direct running in house by asking him to "walk", and THEN No/eq, No/eq, Prompt for NOT LISTENING!

3. RE-DIRECTION OF ANIMAL PLAY

A. He's only allowed one animal per session (so that animal never has adversaries).

B. The animal is required to live the life of that animal.

e.g., Lion: roam through the jungle; king of the jungle Pig: living on farm in mud waiting for farmer to feed him Polar Bear: Lives at the North Pole and eats fish

C. Animals cannot fight, growl, bounce, tap, etc...they must behave like animals that are sort of catatonic...but realistic of course.

D. Incorporate his "daily animal" into other drills like Role Play, Play With Narration, Let's Play...

e.g., You can be an Eskimo tribe looking for the polar bear (his animal) to take him to water to look for fish.

E. If he asks for another animal, tell him to ask you. Either say "no" or allow him to switch to another animal (put former animal away so he still only has one animal).

4. GET ME A, DO ME A FAVOR, BRING ME, CAN YOU FIND...

A. Pepper entire session with requests for him to perform various tasks

B. No/eq, No/eq, Prompt (get object and hand it to him to give to you, etc.)

C. We need to DRAMATICALLY increase his responsiveness.

5. EYE CONTACT / ANSWERING THE FIRST TIME

A. No/eq, No/eq, Script - EVERY time you don't get an answer.

B. If he resists scripting ("don't say it", "you don't have to tell me", etc.), re-direct by telling him (in your own words) how you had to guess what his answer would be because he didn't answer, etc. and then ask him again, giving him chance to respond in his own words.

6. ARTS & CRAFTS

A. These drills are on hold as we work on social drills since these are drills of independence. DO NOT MENTION TO HIM THAT THEY'RE ON HOLD!

B. If he asks to draw, color, etc., passively tell him "maybe later", or "not right now"

C. Let us know in the notes or tell us (not in front of him) if he requests A & C.

7. OTHER THAN THAT, OUR STRATEGIES ARE NOT CHANGING

A. Encourage "hello" and "goodbye" to EVERYONE B. Role Play/Social Stories still critical C. Group Rules (see below)

8. GROUP SITUATIONS If in any group situations ([K-simulation place], outside...etc.), he...

a - MUST wait his turn (DRO)

b - can't always go first, speak out of turn, etc. (DRO)

c - must have an incentive to display a & b above by your promising something special...

e.g., "If you wait your turn while we play you can play _____ when we're back upstairs"

If he fails, he should be pulled out of the activity and made to WATCH BUT NOT PARTICIPATE in the activity.

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#30

1. SITTING STILL

A. TARGETS: Sitting at the table & sitting cross-legged on the floor. e.g., leaning, slouching, foot under tush, etc.

B. PROCEDURE:

i) When he 's not sitting well, tell him "sit better/still", "sit up", etc. ii) No(eq), No(eq), Prompt ("do you need help")

- If answer to prompt is "yes", deliver an SD more specific than the (eq) you delivered previously: e.g., "relax your legs", "straighten up", etc.

- If he argues tell him to "be nice" (see "no! no!" below), then deliver time-out (very neutral--in corner, not another room) only if necessary.

C. DRO good sitting whenever you get it.

D. This is to be targeted only in specific drills: Drawing, Painting, Switching Attn, Read Stories, Science & Nature, #s/Letters, Phonics, Spelling, Show & Tell.

2. POLITENESS/MANNERS

Continue to work hard on "please", "thank you", "you're welcome", "excuse me", etc.

A. Require "please", etc. whenever he makes a request.

- No more "gimme's"... only "can I have...please?" - Must say "thank you" when receiving something. - Must reply "you're welcome" when thanked.

B. "No!, No" or any severely argumentative tone is forbidden!

- He gets one chance to straighten this out (don't tell him he gets a chance though!) followed by a time-out.

e.g., "say it nicer", "you can't talk to a grown-up that way!"

- If he answers you back or is nasty after his chance he gets a time-out (send him to a quiet spot; doesn't have to be far) for a few minutes, followed by de-briefing.

3. EYE CONTACT / ANSWERING THE FIRST TIME WHEN ENGROSSED

A. When he's deeply involved in something (reading, etc.) and you call his name, he must answer and/or look at you the first time.

B. For failure to look/answer the first time you must briefly disrupt and return to the activity and then deliver SD again.

e.g., quickly close then open the book and say his name

This action must last a split second since this is not meant as punishment but rather a way to jolt him into attention.

4. ROLE PLAY - A couple of adjustments you should be aware of before you start.

A. We added still another method of doing this which is a "do unto others" method.

- Basically perform his own behaviors on him sporadically during session (within role play "DRILL" and also INCIDENTALLY).

- If he argues with you while presenting these, handle as above in the "Manners" section.

e.g., "ask me nice" and if he argues give him a time-out!

- Mark off in Role Play Drill section.

B. Several of the stories have been adjusted with the changes listed in italics. Most of these changes refer to his school environment and therefore should not be overlooked when doing any of the methods for this drill. Please be sure to glance at the actual stories before doing them in order to catch these small but important changes.

C. There is a new story called "Play" which deals with several of his difficulties when playing with kids. Please read variations on this story every session over the next week or so until you're confident you have the general idea for incidental references to it...this is a BIG one!

5. DRAWING / ART & LEARNING AT SCHOOL

INCIDENTAL CONVERSATIONS to have w/him throughout the session. Because these are not in ink on drills/sheets, these tend to be forgotten about.

Try to remember to:

A. Remind him about the many things that he enjoys that are created by people.

e.g., Mommy built the chair that you love to sit on; Someone cooked the tasty pizza you're eating; what color is your bike? Someone painted it!

B. Talk about how school is a place where we learn things that will help us later when we're grown up and how much easier it is to learn when you're a kid. If you miss out on learning when you're a kid, you might have a hard time when you're grown up.

e.g., "I never cooked (played an instrument, played ball, painted) when I was a kid and now I'm not that good at it." OR "Because I practiced when I was a kid, I'm very good at.....now!"

C. If you do art in school some day you may become an Artist (and other variations below)

e.g., paint/Painter, instrument/Musician, cook/Chef, blocks/Construction Worker.

D. If you want to be a teacher when you grow up, you have to learn to follow all the school rules.

6. ANIMALS

A second animal is allowed BUT:

- He can't play with them both at the same time (has to stick to one animal)

- Animals must be animals

- We will add a 3rd and 4th animal shortly (and be sure he doesn't line them up!), but for now stick with two.

7. PLAY WITH OTHER KIDS

A. Don't allow him to direct play ("play with me" not allowed) since he doesn't play appropriately and will alienate kids.

B. Have him ask to join a game/activity in progress ("can I play with you?") so he can key into and model appropriate play (role play this INCIDENTALLY also!).

C. Always get the next step from him which is inquiring "how to" play/do the activity.

e.g., Have the other kids make the rules and be sure he asks (or is prompted to ask "how?", "I don't know how to...", "show me", etc.

D. NEW RULE: NO TOUCHING OTHER PEOPLE WHEN PLAYING A GAME (end game for him if this occurs).

8. OUTSIDE/BALL PLAY/GROUP PLAY

A. When his name is called by an adult, he MUST stop playing and come over. This is analogous to lining up in the schoolyard at the end of gym, etc. If he doesn't come, de-brief by drawing the comparison between this and getting on line.

9. MISCELLANEOUS

A. TACTILE STUFF - Continue to ignore unless it interferes.

B. TRANSITIONING - Approximately once per session, give him advance warning that he will have to finish what he's doing soon and move onto something else.

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#31

1. TEACHER'S CONCERNS

A. DEMANDING WITH KIDS ("It's not what he says, but HOW he says it") Teachers say: "Ask in a gentle way"

B. TOUCHES OTHER KIDS / PERSONAL SPACE

C. BODY POSTURES & IS MOTOR ACTIVE Teachers say: "Relax your body"; "Quiet body"; "Calm your body down"

D. INTERRUPTS & DOES "I MUST TALK" OFTEN (Particularly during lessons in circle time, Music, Dance & Library)

E. LISTENING TO KIDS Teachers say: "I hear the message ________ is giving you; are you hearing it?"

F. AGGRESSIVE BEHAVIORS / NO REMORSE AFTER UPSETTING OR HURTING SOMEONE

G. LINING UP ("He's the last one on line")

2. OUR STRATEGIES

* We must key into the language used at school to foster consistency.

* If we shape him into listening to the expressions that the teachers use, then they will have more success keeping him in line.

* Please become familiar with the types of expressions the teachers use.

A. DEMANDING / NASTY TONE

* DRO heavily when he's "soft spoken", uses a "friendly voice", asks/speaks "in a gentle way"

* Target (No (eq)/de-brief) nasty/mean tones.

* We need to heavily model gentle tones of voice and explain the advantages.

**** On his "bad" days when we're pounding him, we MUST **** balance our stern tone with gentle tones (5:1) and lots of de-briefing.

B. TOUCHING / PERSONAL SPACE

* In some drills stay in close proximity to him to give him the opportunity to touch you. DRO if he controls it.

* Use brother as an example. If he touches explain to him that he's only 2 1/2; if he doesn't touch talk about how brother is growing up.

* Use "do unto others" method liberally on a bad day!

C. BODY POSTURES / MOTOR ACTIVE

* We've expanded our targets to include darting and weird standing/walking (use No [eq]).

* Use the teacher's expressions ("relax your body"; "quiet body"; "calm your body", etc.)

***** NEVER USE THE EXPRESSION "Body Posture"!!!! *****

D. INTERRUPTS & "I MUST TALK"

* Whenever you have an analogous situation to circle time or an adult supervised activity, DRO for not interrupting, listening patiently, not touching, etc.

e.g., If there's a TV on have him sit quietly and watch w/o squirming or interrupting

E. LISTENING TO KIDS

* Use variations of the teacher's strategy ("I hear the message _______ is giving you; are you hearing it?")

F. AGGRESSIVE BEHAVIORS

* Role Play; Do unto others when it gets real bad.

* Be sure to include lots of empathy (feeling bad when you hurt someone)

G. LINING UP

* Keep targeting this outside when you're on line in a store.

* Not getting to the line last; hurrying up to get on line so you helped sooner.

* Standing still (no weird standing)

* Waiting patiently

* Personal Space

* Following the person in front of you & maintaining the proper space

3. INCIDENTAL STUFF - Do these when the opportunity presents itself

A. Knife for spreading (4-0 skill) B. Knife for cutting (5-0 skill) C. Opens milk carton (5-0 skill) D. Scrapes food off plate (5-0 skill) E. Crosses street safely (5-0 skill) F. Gives a phone message (5-0 skill)

#32

1. STANDING STILL - #1 PRIORITY (& his greatest deviation from typical kids)

A. TARGET IN A CONVERSATION OR GROUP ACTIVITY:

- Leaning, walking in circles, tilting, squirming - Frequently make references to school - Standing at attention = paying attention

B. HE NEEDS TO DEFINE WHAT "GOOD STANDING" IS TO WORK TOWARDS SELF-MONITORING:

i) HE MUST STAND IN A "STRAIGHT LINE"

- Keep referring to this imaginary "straight line" that you should be able to draw in your mind from his head to toe. - If he twists, tell him he's losing the "line" e.g., "you lost the line at the end of that sentence"; "straight line please!" [THIS WAS INCREDIBLY HELPFUL TO HIM!!!!!]

ii) HE MUST KEEP HIS FEET ON THE FLOOR

- "Good standing starts at the feet"

C. CAN'T WALK AWAY FROM A CONVERSATION (promote self-monitoring)

- Take him by the hand, walk him back and de-brief - If this turns into a power struggle de-brief for nasty tone (one chance followed by a time-out). - Keep him thinking about whether or not the person is finished talking before he walks away e.g., very neutrally: "do you think I was done?"

D. WHEN HE'S HIGHLY MOTIVATED TO TELL YOU SOMETHING, SQUIRM AND MESS UP YOUR "LINE" (the "Do unto others" method)

2. APPROPRIATE PLAY - NO TOUCHING OTHERS (you, his brother, anyone)!!!!

A. SOLITARY PLAY

i) Spot-check while you take notes; your actions take priority over notes ii) Since this needs lots of work, be sure he has toy access through entire session iii) Use no/eq, join him and quickly back off iv) Pretend you're writing notes (when done writing) or preoccupied w/something and keep him in peripheral vision.

B. COOPERATIVE PLAY

i) His narration is OK ii) Stimming - Need to ELICIT more of this - Use about six animals (don't let them move in herd) - Let stims begin (do not re-direct before it starts anymore) - Once he starts, shut it down briefly, de-brief and resume drill. iii) Staying in character still needs work; gently no/eq de-brief. - do not shut drill down for this (we'll attack harder later) iv) Idiosyncratic Play still needs work; gently no/eq de-brief

3. LISTENING TO THE MESSAGE

- Always point out to him when he hasn't keyed into message you're delivering! - Often tied in with "I Must Talk" & Interrupting.

4. REMORSE

A. When brother (or anyone) cries (or feels bad) jump on opportunity and grill him about feeling bad for the person.

B. If he cries or looks upset exaggerate YOUR empathy towards HIM!

C. If he hurts someone, discuss heavily in terms of his remorse.

5. LISTENING TO ADULTS

A. CHANGE THE FOCUS

- We need to prevent him from getting argumentative when an adult tells him what to do & to understand adults are just trying to help him control himself.

- Will reduce his nasty tone (& non-compliance) & contrib. to self-monitoring

- Need to help him see that adults can be a bridge towards self-control

- Less focus on re-directing negative stuff; more focus on us helping him to gain control

- DRO if he does it by himself

e.g., "So glad you listened to me; you knew I was just helping you gain control"; "Wow, you caught yourself and looked at me"; "Grown-ups help you get back in control"; "Adults can remind you that you need to get back in control so you can help yourself"

B. DRAW LOTS OF COMPARISONS AND REFERENCES TO SCHOOL

e.g., "I heard when your teacher told you to calm your body that you listened. It's great how she helped you control yourself"; "That's just like circle time in school when you touch someone and the teacher tells you to stop and you listen!!!"

6. FIELD TRIP - He has NEVER had a successful field trip!

A. EVERYTHING OUT OF THE HOUSE IS ANALOGOUS TO A FIELD TRIP!

- NO touching! - NO Talking Out of Turn! - MUST Sit Still - NO rolling on floor! - MUST Stand Still (straight line)!

B. CRITICAL: EMPHASIZE ALL POINTS FROM (#5) "LISTENING TO ADULTS" WHEN RE-DIRECTING ANY OF ABOVE BEHAVIORS OUTSIDE!!!

e.g., "So glad you were able to stand in one place for so long and should be esp proud that you got back into control after I reminded you to keep your body straight; you let me help you get in control"

7. LINING UP - Key into the following when outside on any line (see new Role Play):

A. Last on line B. Standing Still, no weird standing/leaning (straight line) C. Waiting Patiently D. Personal Space/Touching E. Following the person in front of you & maintaining proper space

8. ART - Need a Self-Motivating System

- Lacks intrinsic motivation - Needs lots of self-approving statements - Label and script motivation statements and, where possible, turn negatives into positives

e.g., "you stopped because you wanted me to see what you were doing"'; "Are you enjoying this?" [script] "I love drawing!", etc.

9. READ STORIES

- Build intrinsic interest in stories - Work on predicting; wondering what will happen next; anticipating storylines, predicting outcomes - Do this with books he hasn't read (go to the library) - For books he knows, key him into making up a different set of circumstances e.g., "what else could have happened?" "make up a different ending"

10. EXCUSE ME

Means you are ASKING FOR PERMISSION to interrupt.

- After you remind him of this fact, DRO and give him one of these choices:

i) "Go ahead", "What", etc ii) "Wait", "Just A Minute" "Not Now"

11. STUFF TO KEEP WORKING ON

A. SITTING STILL

B. SCHOOL LINGO "Relax Your Body", "Quiet Body", "Calm Your Body Down" "Ask in a gentle way", "Are you hearing the message so & so is giving you...?""

C. PERSONAL SPACE - Touching, Rolling On Floor

D. I MUST TALK / INTERRUPTING

E. "PLAY WITH ME" vs "CAN I PLAY WITH YOU"

F. POLITENESS / MANNERS / TONE OF VOICE

G. OUTSIDE - STOPPING WHAT HE'S DOING & COMING WHEN NAME IS CALLED

H. 4-0 to 5-0 SKILLS:

i) Knife for spreading (4-0) ii) Knife for cutting (5-0) iii) Opens carton of milk (5-0) iv) Scrapes food off plate (5-0) v) Crosses street safely (5-0) vi) Gives phone message (5-0)

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#33

1. STANDING STILL - Still the #1 PRIORITY

(Particularly DARTING)

A. Straight line; feet on the floor B. Walking Away From Conversation - Take him by the hand and lead him back ("Was I finished?")

2. APPROPRIATE PLAY

- The animals can stray out of character

- He cannot bring himself in as a character (this is not Alice In Wonderland!) except as outlined below.

- Inanimate objects should not act as people (a truck should be a truck...he can, however, be the driver)

A. SOLITARY PLAY: No (eq); join him and back off

i) Maximum 1 toy in each hand ii) No toy touching (clicking, rubbing, banging) iii) No stuffing toys into each other (includes biting) iv) No Babbling/Word Salad v) Continue to shape the length of appropriate play

B. COOPERATIVE PLAY:

i) Up to 6 animals OK as long as they don't form herd ii) Let stims begin (don't re-direct before it starts) iii) No (eq) and shut down after stims begin

3. TRANSITIONS & DOWN TIME

- He's most likely to stim, lose eye contact, not answer the first time, not hear the message, etc. when nothing's doing.

- When he has free time in school (or when you're setting up next drill, writing notes, etc.) he needs to self-monitor himself better since it's unlikely an adult will intervene.

- To shape his awareness of his "behaviors" we must make him think about what he's doing on his own, with NO prompting, scripting or labeling!

i) Compare to free time, free play, class trips, etc. ii) Vaguely ask about what he's "forgetting to do", "should be doing" etc. iii) If he answers "I don't know", "tell me", etc. DON'T BE SPECIFIC but tell him he needs to "think about it". iv) If he figures it out DRO without labelling! e.g., "Good job, you figured it out"; "you're doing much better", etc. v) NEVER mention directly ("look at me", "you're not answering", etc.) ****** vi) REMEMBER, THIS STRATEGY IS FOR FREE TIME ONLY; unstructured activities continue the usual strategies.

4. GOING OFF TOPIC

- When he goes off topic re-direct by telling him he's "changing the subject".

- If he does "I Must Talk", doesn't let you get a word in, interrupts, etc., also make reference to "changing the subject"

5. REMORSE - Please read new Role Play about Apologizing / Feeling Bad-Sorry

6. NAP TIME vs. BOARD GAMES

They don't sound related but they are (as opposites)!

A. BOARD GAMES

- Since his behaviors generally go down when he's engrossed in a game, this is a golden opportunity to DRO good behaviors.

B. NAP TIME

- This is the other end of the spectrum (he's not engrossed in anything) and usually a disaster in school. [we'd ask when our son did poorly on a particular daily school report card item and often find out that it was during "nap time"]

- At the half-way point of your session, dim the lights, remove the blankets and announce it's "nap time", "rest time", etc.

- We're shaping duration so let's start at 5 minutes and take it from there

- Make constant reference to nap time at school and DRO absence of body posturing, talking, moving around, etc.

7. LISTENING TO ADULTS

- Continue all strategies (no [eq], de-briefing, role play, working on tone). - DROP "adults are trying to help" strategy...it was overused and lost its effectiveness. - Keep making references to school

8. FIELD TRIPS, ASSEMBLIES, ETC.

- Still horrendous in school. Every time you leave the room make it analogous to a trip, assembly, etc

- NO touching! - NO Talking Out of Turn! - MUST Sit Still - NO rolling on floor! - MUST Stand Still (straight line)!

9. ART & SELF-MOTIVATING STATEMENTS

- Pull back on scripting/prompting this (he's getting prompt dependent) [Please realize how long it took him to become prompt dependent -- At this time he was already HALF-WAY THRU ONE YEAR OF SCHOOL WITHOUT A SHADOW & W/O ANYONE THERE (teachers, directors & even the School Psychologist) -- KNOWING HE WAS EVER AUTISTIC!]

- DRO big time if he makes a self-motivating statement on his own.

- Watch out for him using a self-motivating statement as an excuse (label it an "excuse" and DON'T DRO!)

e.g., "at least I liked doing it"

P.S. - In general (even out of art drills) label "at least I..." statements as "excuses".

OUR NOTES

KEEPING HIM IN CONTROL

1. If he's had a bad day and received a major response cost: be sure to give back tiny bits each day.

2. If it appears he's on his way to a bad day: Begin de-briefing early.

e.g., "This day can't start like this"; "let's start again"; "get started on the right foot"; "let's get it started right"...

CONFERENCE w/School Psychologist

1. Give examples of how he gets over on them so they watch him more - - they will naturally get stricter.

2. Let's get the teachers to discuss with him (one-on-one) what's expected on a class trip (concise, clear direction)

#34

1. STANDING STILL - We need to naturalize this more but keep the heat up

* Label as "DARTING" & "WANDERING" w/DISPLEASURE IN EXPRESSION

* SOMETIMES "STAND STILL" w/DISSATISFIED GLANCE

* LAST RESORT ONLY: "STAND IN STRAIGHT LINE"

* Will SOON NATURALIZE by FADING TO GLANCE ONLY

2. APPROPRIATE PLAY - MUST USE "REAL VOICE"

A. COOPERATIVE PLAY - He emulates our "therapy goal" words (e.g., you're not looking at me") in play & it INTERFERES WITH APPROPRIATE PLAY

i) Characters and animals must go places & do things (ACTIONS) ii) VERBAL INTERACTIONS TO MINIMUM (more ACTIONS). Limit dialogue between yourself (therapist) & him and between characters. iii) Use imaginative props (e.g., community locations, blocks, bowl as lake...) iv) Be LESS LEADING & MORE GIVE AND TAKE with ACTIONS. ALMOST CONVERSATIONAL (more TAKING TURNS) WITH ACTIONS. v) If you start w/Cooperative Play (& you shouldn't EVERY TIME), pull back fairly quickly (5-yr olds should be able to play cooperatively for 15 min. NEEDS MUCH SHAPING. DON'T GET OVERZEALOUS! 7-10 min. plenty!).

B. SOLITARY PLAY

Can't sustain play; doesn't have enough "material" to prevent drift into stims (toy touching, clicking, stuffing toys, babbling or word salad!) Shoot for 3-5 min. consistently and DURING DRILL (AND AS NEEDED AS IT MOVES ALONG) and as CREATIVELY as possible, ADD:

i. MORE MATERIALS / PROPS ii. STORY LINES AS PROMPTS

3. TRANSITIONS / DOWN TIME - Need to shape HIS awareness of behaviors to help him self-monitor WITHOUT prompts, scripts or labeling. In free time at school there's no way any adult will be as vigilant in intervening.

* Need to purposefully CREATE more REAL down time to INCREASE OPPORTUNITIES TO DELIVER VAGUE PROMPTS when there's no agenda. This is hard but it's a very high priority at this time.

* Start (and of possible end) session w/him in room (while you set up, read/take notes, etc.)

* Pepper time with casual conversations

* If stimming, fails to answer, etc. VAGUELY ask what he's "forgetting to do", should be doing", etc.

* If he answers "I don't know", "tell me", etc. DON'T BE SPECIFIC, just tell him "you know", "think about it", etc. to help him realize it ON HIS OWN.

* If HE figures it out, DRO WITHOUT LABELING

* Draw comparisons to school

4. LET'S PLAY - As in APPROPRIATE PLAY, needs to come up with own ideas for imaginary play.

* He must shift his themes.

* PLEASE KEEP COMING UP WITH CREATIVE WAYS TO FISH IDEAS FROM HIM.

* If he has a recurring theme say: "you can start that way, but you need to change it."

* It's OK to model but shift it to him and have HIM alter it.

* If he uses a movie/book as a model, he has to shift something (just like he does when he guesses different endings in "Read Stories" drill).

5. INDEPENDENT WORK - Keep helping him to a bare minimum!

* 3 - 5 work stations (minimum 2 as art)

* He chooses order

* Built-in contingency of something he'd look forward to (to internalize good feelings about his work).

* No breaks between tasks (not even to evaluate)...keep it moving.

* Make analogous to school

* Track prompts and DRO to gauge his need for support and so how quickly support can be faded will be tracked.

* Discuss concepts of working independently whenever appropo.

* Leave work in final state until AFTER he discusses it

* CLEAN UP (and draw comparisons to school where he hasn't been cleaning up until teacher asks many times because he's not listening to her "message" to do so)

* Deliver the contingency.

* For transitions, prompts should be gentle.

* If he needs more...try putting brush in his hands, putting smock on him, opening glue and handing to him, etc.

* If he makes mistake (e.g., rips paper), DON'T increase level of assistance or he'll look for help (REMEMBER THAT THIS IS INDEPENDENT WORK)

* Notes in "Independent Work" section should deal with above issues, including transitions, interventions needed, etc. Notes in other sections should deal w/the quality of work.

6. GOING OFF TOPIC

* NEVER refer to "changing the subject" or any similar trigger words.

* You can say his "mind is wandering" but PLEASE DON'T OVERUSE this or it will become as useless as "changing the subject"

* Gently re-direct naturalistically to topic within the context of the situation. e.g., "Your answer should be about..."; "I asked you about ____, not ___".

* Avoid de-briefing unless you are 100% sure it's an escape- related behavior.

7. REMORSE

* Keep prompting remorse and work it in where appropriate

* NASTY TONE MUST ALWAYS BE RE-DIRECTED INTO AN APOLOGY!!!!!!

8. TIME - We are contributing to the persev by totally taking it away.

* If he asks, answer him once.

* If he asks again de-brief by telling him that people don't generally do this and that he seems to be "stuck" on it.

e.g., "People don't talk about it every minute" "We don't watch the minutes go by"

9. FIELD TRIP - Make all you can analogous to class trips, assemblies, etc.

- NO Touching! - NO Talking Out of Turn! - MUST Sit Still - NO Rolling on Floor! - MUST Stand Still

10. EXPRESSIONS

* He has ability to recognize something as an expression, but problems getting the content (can't describe what it really means).

* Incidentally throw in a few expressions and ask what he thinks it means. Define and discuss. (It's not age-appropro to yet understand these, but it may be a good (& fun) way to deal with his "literality" and further his attempts to listen closer and understand more meanings w/his advanced cognitive skills.

e.g., "I'm freezing my ears off." "It's raining cats and dogs"

11. "HELP ME BE GOOD" BOOKS - Use often to deal w/SPECIFIC behaviors

* Books structured w/left page containing Social Story-type sentences and the right containing examples

* Have him read appropriate books cover-to-cover

* Re-read left pages with him (sometimes only the pages appropro to a specific problem he had in school or at moment), but this time give an example from his life where appropriate.

12. SCHOOL - ASK HIM WHAT NEW THINGS HIS TEACHERS TAUGHT THE CLASS ABOUT IN CIRCLE TIME THAT DAY. WHAT NEW MATERIALS AND/OR ACTIVITIES WILL THERE BE IN HIS SCHOOL ROOM AFTER TODAY? WHAT IS THE GROUP PROJECT RIGHT NOW / THIS WEEK? (CLASS ALWAYS WORKING ON ONE)

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#35

[at this point our son was more than half-way through his first year in school without a shadow and without any faculty knowing about the dx he'd received or the therapy he'd had, and more than two years into therapy. We had devised a daily report card that we had the teachers filling in, telling us about five or six trouble areas and whether he was better or worse each day, though they didn't know exactly what we were doing with the info. He went from 1s & 2s and the occasional 3 (these were our marks) in these areas to 4s and 5s w/the occasional 3 by this time. I mentioned once or twice that we were doing some role-playing at home, but that's about it. Whatever we were doing, they knew he was no worse for it. We positively reinforced the teachers constantly for THEIR good job ( ; and we're sure that partly because we did this, and because they were good teachers who understood the importance of consistency, they always kept us in the loop with the daily info we still needed to continue helping him in therapy.]

1. STANDING STILL

* Keep requiring him to stand still; continues as BIGGEST problem in school.

* Use natural language ("you need to keep still...") and the language we know they use in school ("you need to have a quiet body").

* The concept of "relaxing" needs to be taught. We always tell him to "relax" but we need him to understand the feeling of relaxing. One way to accomplish this is to heavily DRO and label it as being "relaxed" whenever you see he definitely is. "Look how relaxed your arms and legs are".

2. APPROPRIATE PLAY - Must use "real voice"

A. COOPERATIVE PLAY

a) Characters/animals go places and do things b) Verbal interactions to a minimum (more actions) c) Use imaginative props d) Less leading and more give and take with actions being more conversational (turn taking with ACTIONS). e) Don't always start with cooperative play; pull back quickly. f) 15 minutes (5.0 yr. skill); shape 7-10 minutes

B. SOLITARY PLAY - Shoot for 3-5 minutes.

Replace toy touching, clicking, stuffing toys in enclosed spaces, babbling or word salad with:

* More materials/props * Add story lines as prompts

3. TRANSITIONS & DOWN TIME

Need to shape his awareness of his own "behaviors" without prompting, scripting or labeling to promote self-monitoring.

* Start session with him in room (create real down time)

* Pepper with casual conversation

* If he stims, fails to answer, etc., vaguely ask what he's "forgetting to do", etc.

* If he answers, "I don't know", don't answer specifically

* If he figures it out, DRO without labeling

* Draw comparisons to school

****** NOW expanded outside of downtime & should also be used as general strategy.

4. LET'S PLAY - Needs to come up with his own ideas

* Shift themes (even if from a familiar movie), fish ideas out of him

* OK to model but shift it to him and have him alter it

5. INDEPENDENT WORK - Keep your help to a bare minimum

* In school, the room is divided into "work areas" with materials available with NO specific instructions on what to do. For instance, there's an area with animals, another with math materials, an area with books, one with art materials, a kitchen (called "housekeeping") area (it has mirror/wardrobe too), etc.

* Our previous incarnation of this drill does not mirror this well.

* Set up 4-5 work stations at the beginning of the session (while he's in "down-time" is fine).

* Do not write out instructions on any drills except "Coloring" and "Drawing" (and, hopefully, this will soon be faded out also - ask about fade; don't do on own.)

* Written or verbal instructions are only OK for "Coloring" & "Drawing" since the instructions will serve as prompts to get him started. These are still the two toughest to get him going with.

* He is not to do these straight through, but rather to choose these in "free time", which would be time in betwn other drills.

* "Appropriate Play" is now among the drills that can be included as independent work, but please note that he generally goes to these dramatic play areas first at school (includes blocks w/animals, sand table, "housekeeping" area -- here we have Barbie and her kitchen as option for this, as well as paper plates, cups, etc.).

* Continue tracking prompts/DRO to find out how quickly support can be faded.

* Continue tracking the order in which he chooses each "work choice".

- HUGE DRO for choosing "Drawing" or "Coloring" 1st or 2nd. - HUGE DRO if "Appropriate Play" is not his 1st choice

6. GOING OFF TOPIC - Never refer to as "changing the subject"

* Re-direct naturalistically to topic within the context of the situation. (e.g., "your answer really should be about...")

* Do not de-brief unless you 100% sure it's escape behavior.

7. REMORSE - Keep prompting

* Nasty tone must be re-directed into an apology.

8. FIELD TRIP - Please make EVERYTHING outside our door a "field" trip at some point.

9. EXPRESSIONS

* Recognizes expressions but can't figure out the context.

* Incidentally throw in expressions and ask him what they mean. Define & discuss.

10. "HELP ME BE GOOD" BOOKS - For severe behavior (that day in school or currently in session -- it'll surely have to be done often enough for school)

* Have him read the appropriate book, then read the left pages (not cartoon) with him (similar to our social stories) and bring in the actual situation as it applies to what you just read (instead of reading the examples on the right pages in these books).

11. APPROPRIATE TIME

* We need to start reasoning with him about how some behaviors are only appropriate at certain times &/or in certain places.

* If this is adopted as a general strategy we may be able to shift his more troublesome behaviors into "appropriate" places.

* When you're confronted with a target behavior think about the time and place where it may be appropriate and point out how this is not that time or place (avoid using these exact words to lessen the chance of persev).

e.g., "You should only sing when music is playing like in the car, music class or at a concert. Right now you shouldn't be singing."

" Running is OK if you're playing sports or in a park. It's not OK in school OR in the house."

12. MISCELLANEOUS STUFF

* LOUD VOICE - Tell him to "relax" his voice.

* TIME TO STOP - Be extra firm about him stopping WHEN you tell him it's time to stop. At school, the "teachers would think think you have a "quiet body" if you listened right away" DRO BIG time if he listens first time on this.

* ARMS UP IN JACKET - Watch for this when outside, in basement, etc.

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#36

A. MUST BE DRO'D CONSTANTLY - THE FOLLOWING 3:

1. PERSONAL SPACE - had a significant, immediate & lasting effect after consultant left!

* Remark on his space constantly

* Refer to his "space bubble"

Examples of phrases:

"You're in his space" "Ask first before you go in someone's space" "Watch your space bubble" "It will really help you relax since you won't touch anyone" "Your space is a bit of a problem...thank you, that's more comfortable for me" "Look how relaxed you are now that you put your bubble back up" "Wow, look at the space you're leaving!"

2. RELAXATION - A work in progress; relaxation strategies to follow, in the meantime:

* For now, just DRO when he appears relaxed

* Ask him to relax a particular body part when he seems excited or agitated

* Have him tense the body part and then relax it so he can feel the difference (watch for perseveration on tensing).

e.g., "Tighten your feet, just lift them like that. See how that feels? Now take a deep breath and relax your feet. See how relaxed they feel?"

3. GENTLE TONE

* DRO absence of LOUD VOICE

* Model quiet, gentle tone

B. APPROPRIATE PLAY

1. COOPERATIVE PLAY

* Age appropriate (5-0) is 15 minutes & we're at 10-12; shape 12-15 minutes

* Keep shifting/getting him to shift with you; this is essence of cooperative play - DRO.

* Keep starting w/things he's familiar with & shifting themes away from his usual themes

* Big DRO if he injects his own themes

* Continue working on him asking to "play with you" (DRO if unprompted)

2. SOLITARY PLAY - Keep shaping 7-10 minutes.

C. IT'S TIME TO STOP

* We need to test Newton's Law (an object in motion tends to stay in motion unless acted on by outside force). At school when all the kids are running around and the teacher tells them to stop they all do, except for guess who.

* He MUST stop as soon as he is told "it's time to stop!/ to clean up", etc.

* Do this particularly when he has the MOST momentum going, like when he's really into what he's doing.

* DON'T OVERUSE THIS!

D. AREAS - Need to approximate school more

1. SET UP

* Float through the various "areas" while he works at one

* You can work in the same area as him, parallel work (at an area near him), or not work at all

* Have the DRO/Prompt checklist with you

* No cross-talking from him - he can only talk to you if you're in the same area (you can talk to him-- DRO/Prompt--since you're the "teacher"). "Are you allowed to shout across the room in class?

2. HE HAS THREE CHOICES

i. He can choose himself (DRO if drawing/coloring 1st or 2nd) ii. You can choose for him (remind him that when a teacher chooses an area it's more special and therefore more important to do well and impress everyone!) by sending/ leading him to an area. iii. He can go as the culmination of a lesson about the area which is also special and carries more importance (when teacher talks about it at circle that day, it's more special). Remember at school new areas are intro'd in a circle time lesson so if you're doing a variation in an area you should introduce it as a lesson.

3. IT'S TIME TO STOP

* This is a great drill to test Newton's Law in. e.g., "time to stop"; "time to move to another area"; "time to clean up"

* If he wants to leave an unfinished project for later, that's OK. Put a place card (w/his name) over the unfinished work as they do in school.

E. JOKES / PLAY ON WORDS

- Work in progress -- for now:

* He gets jokes when you tell them but can't come up with his own.

* Only tell jokes which are "play on words"

* Explain the joke to him concretely (tell him why it's funny); you can explain it or write the words

* If he tries to tell a joke, explain to him why it's not funny and help him (prompt) to make it funny.

* All of this applies to expressions too (explain them)

e.g., - If you do a "knock, knock, orange you glad" joke, explain to him how "orange you glad" sounds like "aren't you glad" which makes it funny. Write it out and show him how it's really different but sounds the same.

- If it's a rhyming joke (e.g., "see ya later alligator") explain that the joke has to rhyme ("In a while __")

- If an expression, explain it literally & figuratively to give him more of a sense of what an expression is.

F. READ STORIES / SEQUENCE CARDS - Alternate between two methods below

1. Have him predict the next step or emotion of another (as before)

2. Main Idea

* Set up sequence cards and have him pick the theme, Main Idea, etc.

* Read story and ask for Main Idea, what page is about, etc.

G. DRAMA

* Most kids act out/play things they have recently seen, things from their recent experience, etc.

* Although his themes do come from experience, he has a very limited repertoire

* This drill will help him come up with his own themes.

1. Read a story from one of the short story books in his rm

2. Either act out (like "Let's Play") or play w/ Dolls/Puppets. e.g., "I want to play the story we just read"

3. Gently prompt him toward "the story you just read" w/ simple questions and references to the story (e.g., "what else do we need?" "It's pretty cold out; we need a...")

4. Review (& DRO) what he remembered from the story; also DRO for paying attention if he got it right.

H. MOLDABLES / MANIPULATIVES

* He often stalls before he gets started

* Doesn't really make anything and is vague when you ask him what he's making

* Go back to visualization; use a ton of description

* Get him to describe what he's about to make and keep getting him to elaborate on the shape & structure while he's working on it (you can give him choices as a prompt but give him a minute first to come up w/something on his own).

* If he describes it well but then starts drifting, join him & model (fade out quickly & go back to working from slight distance)

e.g., "Tell me what a _____ looks like. It has a ______; what else? Let's start; I'll make the ____ and you make the _____. What shape is it? It should start to look like a _____ soon".

I. LISTENING THE FIRST TIME / N-O-W

* When grown-ups ask for something they mean "NOW", even if they don't say it.

* If he doesn't answer or takes too long after a request:

1. Ask "what did I/do grown-ups mean? or "when did I need it done?/an answer?", etc. Prompt "NOW" if necessary.

2. If he does answer/perform actions quickly DRO by letting him know that he knew in his head that you/grown-up mean "NOW" (he "heard the message")

3. Every so often add word "NOW" when you make request.

4. Be careful not to overuse this.

J. REMORSE - Explanations after a time out or disagreement are banned

* He MUST go to his time outs quietly without talking back or explaining.

* If you reprimand him he is NOT allowed to explain

* The only thing he is allowed to do is apologize w/o further explanation.

* Once you get him to stop trying to explain, the first thing you need to do is validate him by letting him know you understand WHY he did what he did.

* If he gets used to the fact that grown-ups generally know what his explanation is w/o him having to give it then he will stop feeling compelled to explain his actions instead of apologizing.

* Explain (de-brief) an alternate way he could have approached the situation and stayed out of trouble.

K. EXTREME (BORDERLINE "A") BEHAVIORS

* Just ask him very directly to "cut it out", etc. e.g., "C'mon...stop looking at it that way!" "Do you really have to tap that?" "You don't have to do that junk while you clean up!"

#37

I. BIGGEST PROBLEMS & HOW TO ADDRESS THEM:

1. I MUST TALK - This is the primary one to tackle

a) Hold up a hand or finger(s) and (ONLY if necessary) pair with telling him to "stop talking"

b) He can't resume talking until adult tells him "go ahead", etc.

c) If he doesn't stop, give him a time-out.

d) If he resists "the finger" because he's worried about forgetting what he was compelled to say, let him know it's OK to forget and that it probably isn't that important if you forget it, etc. (as a "stress inoculation").

2. STANDING STILL

a) Continue time-out for walking away from conversation

b) Continue to point out to him when he's squirming, moving, etc.

c) Use "inside feet"

d) We will time out for this (after a warning) starting in wk or 2.

3. HANDS / OTHER PERSEVERATIVE BEHAVIORS

Targeting the following:

a) Fingers making shapes/letters

b) Fingers acting like characters

c) The "unseen eye" (staring at the corners of objects)

To deal with this:

* Grab a piece of paper (not the Journal) and have him write a page of "I will never...", etc.

* Have him say "I will never...." over and over.

4. TALKING BACK DURING / AFTER A TIME OUT

a) Continue shutting down his explanation and validate his feelings

b) If he keeps trying to explain, treat it like "I Must Talk" (hold up a hand, finger(s), etc.)

c) In a week or so, add "relax your tongue" as a redirection.

5. LISTENING THE FIRST TIME

- Continue to use "NOW" but also ask him if he'll remember not to do this again later ("what will you remember?", "have you learned not to do this again?", etc.)

6. THANK YOU / I'M SORRY

THANKS

a) Continue holding all objects an extra moment until he thanks you.

b) Need to generalize this to more abstract areas (appreciation for trips, favors, taking care of him, etc.) He only says "thanks" when we compliment HIM.

THANKS & SORRY

c) When someone does something, another person should ask "did you thank...?", "did you/shouldn't you say you're sorry to...." [of course this is something that we always do w/our second born-NT kid]

e.g., If he tells you about his trip to the museum ask, "did you thank mommy and daddy for taking you?"

This will be more effective than your asking him to thank you (or asking him to apologize to you directly).

Call us in to help you with this as needed apologies/thanks come up.

7. GETTING THE MESSAGE / NON-VERBAL CUES

- especially from kids

a) Use "Help Me Be Good" books and ask "what's the message" keying in as often as possible to the non-verbal messages contained therein.

b) Talk about non-verbal aspects of communication (e.g., body language, expressions, etc.)

II. CONSTANT DRO FOR:

1. PERSONAL SPACE - The Space Bubble 2. RELAXATION 3. GENTLE TONE

III. APPROPRIATE PLAY

He's having trouble maintaining appropriate play and conjuring up themes while he tries to keep his "A" behaviors in check.

a) We must take out one variable by giving him a theme. b) Stay away from prey/predator themes. c) This is no longer part of Areas. d) Watch out for:

- Holding more than one animal per hand - Animals attending to each other as they talk - Animals not held in the middle - Rotating/spinning animals with his hands - Animals moving together in a line

1. COOPERATIVE PLAY - Keep shooting for 15 minutes

a) Create a theme environment and have activities that lend themselves to this environment. (e.g., State Fair, Barn, Zoo, Safari, Doll House w/pet animals, Pet Store) b) Always have people in the activity c) If he strays remind him where he is ("you're at the State Fair!) d) For now, do not convert this into solitary play

2. SOLITARY PLAY - Keep shooting for 5-7 minutes

a) Read a story (or part of a story) where animals are the main character. b) Start acting out the stage you set with the story cooperatively with his animals and then fade back, allowing him to play on his own. c) If he strays, re-join him.

IV. AREAS - Need to make this less structured

1. If he doesn't pull his chair in, hand-obstruct his work and tell him to pull his chair in. Fade request out over time to just the hand obstruction so he'll be less dependent verbally. 2. In school he has to carry his activity over to a table to work at so now his table should become the "work table", "work area", etc. 3. Loosely set up materials for activities in another part of room (a bunch of art supplies on toy chest, blocks/legos/ tinkertoys/linc logs nearby, etc.)

* Special Notes

1. Appropriate Play - No longer in Areas!

2. Manipulatives - Even though there is no longer a formal drill, blocks/tinkertoys/legos etc. should be left out as a choice (put notes on this in Area section when he chooses this.

3. Moldables - Give demonstration (lesson) before starting Areas

- Remind him he can watch but not to touch - Place your demo w/other art supplies (on toy chest) - He can then choose whatever he wants (it doesn't have to be this)

4. Drawing - If he gets stuck on drawing a person (& that's it) try to get him to add another element

e.g., "What's the weather like?" "Where is he standing? (in the grass, by a river?) "What's he doing?"

5. Coloring - While he's working on something else (unless he chooses it first), color in the borders of parts of a coloring book

- Color in less of each part you color (leaving him more) - Place your partially completed art with the other art supplies for him to finish (if he hopefully so chooses)

6. Cutting/Glue/Paint are now combined

- He doesn't have to do these together; just put notes from whatever he chooses in this section (whether he chooses one, two or all three).

7. Notebook/Journal

V. RELAXATION

1. BEFORE STARTING OR AS A RE-DIRECTION FOR "I Must Talk" (in this drill):

"Before I relax anything else, I relax my tongue and let the person who's helping me to relax do all the talking".

Demonstrate what he should do by "zipping" your mouth closed.

2. FOR RELAXATION WITHOUT TENSING USE:

"Try to feel the tension rolling down your arms/legs and out your fingers/toes."

3. BREATHING

"Watch how your belly moves and not just your chest."

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#38

I. BIGGEST DEFICITS ARE APPROPRIATE & DRAMATIC PLAY

A. ROLE-PLAY PLAY

i. He needs to witness appropriate play as an outside observer before he can figure it out on his own ii. Have dolls/puppets play with his toys and engage in all of his perseverative play

* Perseverative Banging * Closure Activities - train tracks must all connect, blocks must start from bed..., paper placed perfectly on table corners, etc. "sometimes roads don't lead anywhere" * Exiting - When a kid joins him, he leaves * Not joining other kids when they're involved in fantasy play nearby * Not listening to/exchanging and sharing ideas * Poor Animal Play - Rubbing, Predator/Prey * Destructive Play * Characters/Animals not looking at each other * Holding animals incorrectly * Not sharing * Not Getting The Message (especially non-verbal messages) * Not Turn taking * Ignoring another persons request for attention while playing * Narration instead of conversation * Egging On/instigating * Going off on tangents

a. Hit all of the above incidentally when he's playing b. Hit all of the above incidentally when [brother] is/isn't doing any of these things c. Hit all of the above incidentally when he is/isn't setting good example for [brother]

B. PRETEND/FANTASY WITH PROPS - Play 100% directed by you

* Kids play roles * Kids stay in their roles * Kids don't get side-tracked * He needs to tolerate props * He needs to handle props appropriately

C. COOPERATIVE PLAY

i. Have [brother] play with him a lot, he's a good model for what to do & what not to do. e.g., If he eggs [sib] on, "what could you have done to calm him down?"

ii. Big focus on sharing ideas - e.g., "I've got an idea..."

iii. DRO/consequence same list as "Role-Play Play"

iv. Cooperative Play must be 100% directed by you. He needs to learn appropo play this way before he can truly have appropo solitary play

v. Continue to create "theme environments" and use "picture this" strategies to help in visualize all the elements

vi. Shorter duration - more quality over quantity (shaping)

D. SOLITARY PLAY

i. If he draws you in (turns it cooperative), that's OK for now. He needs to learn the skills/ideas cooperatively anyway to help him with solitary later & in school it won't stand out as much as cooperative.

II. GETTING THE MESSAGE MUST BE A RUNNING THEME

A. Particular emphasis on non-verbal messages

i. Message statements

e.g., "Are you getting the message" "You got the message" "What message did you just send?"

ii. Increase your non-verbal interactions dramatically followed by message statements with DRO & consequences

e.g., Use more facial expressions (exaggerated & subtle) to convey messages; ask if he got the message. DRO.

iii. Charades

III. DIRECTIONS, BRIDGES, TUNNELS, LISTS & OTHER PERSEVERATIVE TALK

A. Directions, bridges & tunnels

i. When he gets into this you can't break him (a big "I must talk" topic)

ii. Re-direct by telling him to keep the thought in his head e.g., People think these things but don't talk about it

iii. Give an alternative strategy e.g., "What could you have said instead?" "Wouldn't it be better to talk about people instead?" "Try again"

B. Listing things

i. Instead of classifying/categorizing things he's returned to listing them individually in conversation.

e.g., "I'm going to see mommy, daddy, my brother, grandma..." instead of I'm going to see them/my family, etc. "I sleep in my room on Monday, Tuesday, Wed..." instead of "during the week".

ii. Re-direct as above, keep it in his head

iii. Give an alternate strategy as above e.g., "What should you have said?"

C. We've created a drill called Directions, Bridges, Tunnels, Lists

i. This is a role play with dolls/puppets only e.g., Have a doll get into some of this type of persev talk & have the other doll get annoyed, walk away, correct him, etc.

IV. MORE GLOBAL DRO

A. Even though we DRO him a ton, most of it is based on negative inverse -- e.g., "You stood still!"

B. Although we must keep this up we may be making him feel worse (he thinks of the inverse) sometimes so we need to balance this with more global DROs that don't refer to a negative inverse. e.g., "Good job!"; "You're doing great"

C. We need to give him lots of encouragement when he's in a stressful situation.

V. KEEP USING (& prompting) SELF-CONTROL & SELF-PRIDE STATEMENTS

A. PERSONAL SPACE B. RELAXATION C. GENTLE TONE - ("SCHOOL VOICE" "INNER VOICE" -- KEEP INTERCHANGING THESE) D. STAND STILL - (PACING, ETC.) E. I MUST TALK - (RELAX, ETC.)

VI. LOUD VOICE

A. Start pairing "Inside Voice" WITH "School Voice". B. Tell him not to be a "loudmouth" C. US ONLY!!!!: Talk loud to him so he can experience how annoying it is

VII. KEEP STRONG FOCUS ON...

* Using non-verbal cues where possible & ask him what your message is

A. STANDING STILL

i. Label "pacing" ii. T.O. iii. US ONLY!!! Get him hyper & relax him

B. I MUST TALK

i. Hold up finger & pair with "wait"/"stop" ii. T.O.

C. LISTENING THE FIRST TIME

i. "Now"; "When do I mean?"

D. THANK YOU

i. Increased emphasis on favors & for appreciating less tangible things

E. TALKING BACK / MAD FACE

F. PERSEVERATIVE BEHAVIORS - Define as habits/urges that he's over-doing

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#39

I. STIMS

Be hyper-aware of the following three areas. There's not much else to pay attention to so be sure these are on the burner. Less programs will facilitate concentration on these:

1. EXCESSIVE MOVEMENT - Constant DRO for sitting still... These should be targeted directly too, NOT with redirection.

A. FEET, SQUIRMING, ETC.

i. Pair with distracting him from "concentrating, paying attention, etc." ii. Enormous DRO when his feet are still, he's not moving, etc., paired w/how well he's "paying attn, concentrating, getting the message, etc."

B. PACING, MOVING WHILE TALKING

i. Pair with not being able to pay attention to him if he's constantly in motion as well as people thinking you really don't want to talk to them if you can't stay still during a conversation.

ii. Enormous DRO when he speaks and stands still.

C. HAND-FLAPPING

i. Tell him to instead make fists or keeping his hands at his side.

ii. DRO when he's excited and doesn't flap

2. TOUCHING SMALL OBJECTS - We've never completely eliminated this & it's time!

i. As above, pair with distracting him from learning, paying attention, etc.

ii. DRO correct handling of any small object

3. LOUD VOICE / REAL VOICE

i. Let him know it's hard to hear him when he talks like that, "you're giving me a headache", etc.

ii. DRO quiet voice/real voice frequently

* There are few programs so you should be able to cover everything in each session.

* If you need to fill up the time, stretch out the following (continuing to use brother as example where appropo):

a. Appropriate Play b. Pretend, Fantasy With Props c. Coloring d. Areas

II. RETIRED PROGRAMS

1. "Directions, Bridges, Tunnels" are out but be aware and re-direct if it pops back up.

2. "Role Play With Dolls/Puppets" is out but keep incidentally working all themes whenever and wherever they pop up.

3. "Relaxation" is out but use as when he gets excited or has a problem with any body part.

III. ABOUT SOME CURRENT PROGRAMS

1. AREAS

Always start by walking him into the room and picking something. DRO when he picks quickly, goes directly to an area, etc. The school day starts with him walking in and having to pick an area. We think he tends to wander longer than the others before settling into something.

2. COLORING

Do every time; his weakest art skill. Teacher said he gets frustrated and walks away because the other kids do better job (i.e., comparisons make him shut down--doesn't motivate him as it used to, at least in group settings). Lot's of DRO here.

3. NOTEBOOK / JOURNAL

Focus on spacing and doing letters like they do it in class. According to his teacher, this is his weakest skill overall. The teacher gave us a letter chart (different from one we used) and said she's having trouble getting him to adjust to it.

IV. TWO MAIN DEFICITS....AND NEW STRATEGIES

A. PERSPECTIVE TAKING

i. Has a global view of perspective but sometimes lacks it in the moment

B. CAN'T OBSERVE HIMSELF

i. Doesn't see his behavior quite the way others do. ii. We've built these skills auditorily; still can't fully step o/o himself iii. Role-Play has run it's course

1. VIDEOTAPE PLAY

* We'll frequently videotape him playing with his brother.

* He'll watch the tapes & we'll start by pointing out all of the positives

* We'll gradually point out to him and have him critique all the targeted behaviors (his & brother's):

- Pacing - Sitting Still - Standing Still - Real Voice - Predator/Prey themes - Over-stimulation from animals/figures

2. SOCIAL GAMES

* Incorporate four "Social Board Games" (Thinking, Feeling, Doing; The Great Feelings Chase, etc.) into program.

3. COLORING

* Sometimes have him outline the borders of the object he's coloring as a preliminary to actually coloring (a strategy lots of kids use)

4. DRAWING

* Have him draw something in the room he's in (go to another room, the basement, etc. as well).

* We need to keep building a visual link to his auditory skills

* Keep pointing out and having him add details (remember "picture this" drills?)

* Provide lot's of global praise/DRO

V. THERAPY GOALS

* No structure (more real life)

* Major focus on appropriate skills/behaviors; subtle social skills and preaching acceptance of adult re-direction

* If the session strays away from "drills", let it, but keep major goals in mind.

===============================================

#40

1. READ STORIES

a. Use stories he's not very (or not at all) familiar with

b. Use lined paper

c. Must be consistently upper/lower case in the CORRECT way; if it isn't, have him look at any book to grade himself. Be sure that he doesn't have TOO MUCH space between words; do some kind of "one finger" method for correcting (remind him at the beginning about all these things).

d. Have him summarize main idea, themes, etc. in writing

2. WORKSHEETS

a. Make sure he remembers to write name/date first

b. Use all books that are out

3. DRAWING

a. Have him draw things from his life experiences or things in plain view

b. Encourage simple shapes to help get the whole picture in

c. He must color in the drawing for it to be considered "finished" even though the most important part to be keying into is the drawing part.

4. APPROPRIATE PLAY / PRETEND FANTASY PLAY

a. These two drills have been combined

b. Play with him, let him play by himself and observe whatever (just indicate in notes which way you did it)

c. Target and re-direct all items we've been targeting...

d. Be sure he sticks to the theme.

5. ART

Combined Moldables, Cutting, Gluing, Painting

Date: Sat, 10 Apr 1999 01:47:43 EDT

From: Megan and Jim Sumlin <SUMLIN@AOL.COM>

Subject: How many programs per day (1 of 2)

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In a message dated 4/9/99 10:56:14 PM Eastern Daylight Time, Cmhcfai@AOL.COM

writes:

<< If, however, a child's programs are complex, one program may take

significantly more than 5 minutes to complete, making a 40 drill program

a nightmare for both the child and the therapists. >>

me-listers,

There were many months where we had more than 40 drills (without

our maintenance drills) per week for our son. Specifically, this list

was used during a few weeks period of time during which we did

therapy with 7 therapists at home, 7 days a week, 40 or more hours

(sometimes 55) a week. In a way, you CAN call #47 and those after

it (in the first group here) "maintenance", since they were supposedly

1x per session, but we still had a maintenance list of 14 drills during

this period SEPARATE from the intial list of 66. As you can see, it

was so hard to hit all the ones we needed to, even with 7 therapists,

we asked our consultant to prioritize them, after each follow-up workshop,

and this information (3x, 4x, etc.) was added to our drill cover sheets.

I've reproduced an approximate version of the weekly drill grid Jim

and I designed. Unfortunately our email cannot include the grid lines

but I think it gives a general idea of what it looked like. Our therapists

entered either hash marks or their initials (the format used evolved

during the course of therapy) in the corresponding box of the grid.

Before each session (sometimes 3 a day), we put their initials in

the left-hand margin next to each drill to identify which one(s) would

do which drills. This system enabled us to shoot for the targeted #

of repetitions of particular drills per week, promoted generalization

in making sure all the therapists had a crack at all the drills over a

period of weeks, and ensured that none of the therapists would get

rusty on any particular drill. We used color coded w/pens as well.

Five of the therapists, those who came most often, had their own pen

color (to make it easier for us to see what they needed to do).

Most of the above-listed drills can be found in the me-list archives.

If you want to know how to retrieve the drills listed in the next post,

please send an email to listerv@listerv.iupui.edu, subject: archives,

and, in the body of letter:

GETPOST ME-LIST 35076

You should get an answer within minutes. Then do the same but

instead in body put:

search * in me-list where sender contains SUMLIN

In this way you'll get a list of our posts. If you have a problem getting

all the dates we've posted (we've been on the me-list since 1/97 and

they should start from there), send another message (same TO: and

SUBJECT:), but in the body write:

search SUMLIN in me-list from 97/06/20 to 97/12/30

[of course using the correct dates, but in this format]

(i.e., put the dates you don't get). Remember to then only ask for

four or five posts at a time (I don't think you'll be able to get more,

I guess because many are long -- still I seem to recall that someone

on the list seems to know how to) and never put the 0 (as in 034076)

in the retrieval post (only use 34076). As for whichever drills I've

listed in the next post that you can't find at all in the archives, please

let us know (after you try) which they are and we'll EVENTUALLY

type them to the list. When we want to see our drills, we also have to

retrieve from the archives (we don't have them on our hard drive!)

btw, when this school year is over, I hope to get more of our drills

onto the me-list.

megan

------------------------------

Date: Sat, 10 Apr 1999 01:58:47 EDT

From: Megan and Jim Sumlin <SUMLIN@AOL.COM>

Subject: How many programs per day (2 of 2)

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Responsibility for posts to this list lies entirely with the original author.

-------------------------------------------------------------------------------

To visualize what the grid actually looked like, picture the Mon-Sun

headings moved to the right of the numbered drill names, with gridded

squares underneath each day of the week (to the right of each specific

drill). Our therapists entered their hash marks (w/colored pens -- later

initials) in the corresponding boxes, under the day they did the

particular drills. OUR notation (of their initials) for which therapists

would do the particular drill went in the left margin next to the drill #.

We would WHITE-OUT the initals every day after all sessions for that

day were completed and fill in new initials for the next day. After every

follow-up workshop with our consultant, we would re-prioritize the drills

(changing targeted weekly frequencies and thus the drill order...the

drills were always listed in descending order from most to least

frequent), delete drills that were mastered, and add new drills that

our consultant introduced.

D R I L L S

MON TUES WED THURS FRI SAT SUN

[Remember, the above days were actually to the right of the below

drills....our email just can't reproduce it to look right]

1 DAILY QUESTIONS (WEATHER/TIME OF DAY/SEASON, ETC)

EVERY SESSION SD: "WHAT'S IT LIKE OUTSIDE, ETC...?"

2 MONTHS/SEASONS SDs: "WHAT MONTH IS IT?"; "WHAT

7x HAPPENS [HOLIDAY IS] IN [MO.]"; VARIOUS WH QUES

3 FIND WHERE?/WHAT?/WHO? SDs "WHERE IS [OBJ]" "IT'S"

7x [LOC]";"FIND IT";"WHO'S UNDER THE CUP [PREP] [LOC]?"

4 GET MY ATTENTION SDs: "GET MY ATTENTION";

7x "WHAT?"/"YEAH [NAME]"/"YES"

5 I SEE II [PICTURE BOOKS] SQ - S

7x SDs: "I SEE [SUBJ] & [SUBJ]; WHAT DO YOU SEE?"

6 LISTEN TO A STORY [FLANNELBD] SDs: "WHERE...GO?";

7x "WHAT...DO?"; " AND THEN WHAT HAPPENED (NEXT)?"

7 LISTEN TO A STORY [3-D OBJECT]

7x SDs: "WHERE...GO?"; "WHAT...DO??"

8 LISTEN TO A CONVERSATION SDs: "LISTEN/LISTEN TO

7x CONVERSATION/LISTEN TO US" (2 PEOPLE CONVERSE)

9 IDing EMOTIONS IN CONTEXTUAL STORIES

7x SD: TELL STORY; "HOW DID [PRONOUN] FEEL?"

10 FUTURE/PAST TENSE

7x SDs: [COMMAND] GO/GET/WHERE/WHAT

11 DRAWING SDs: "DO THIS"; then "DRAW [LINE/SHAPE]"

7x "DRAW (COLOR) INSIDE"; "CONNECT DOTS/DASHES"

12 SCISSORS

7x SDs: "CUT"; "CUT THE LINE"

13 GLUE

7x SD: "LET'S GLUE/MAKE A FACE/EYE, ETC."

14 TELL ME ABOUT THE PICTURE

5x SD: "TELL ME ABOUT THE PICTURE"

15 LISTEN...I'M THINKING OF SOMETHING

5x SDs: 3 ATTRIBS DESCRIBING FAMILIAR CATEG ITEMS

16 WH? BOOK QUESTIONS

5x SDs: VARIOUS WH? (prompt color/action/prep obs)

17 ASK ME SDs: "DO YOU WANT ME TO [ACTION]"; "DO YOU

5x WANT A [OBJECT]"?; "ASK ME"

18 YES / NO III SDs: "IS [PRONOUN or OBJECT]

5x [PREP/LOCATION]? later "ARE YOU/THEY/WE & AM I.."

19 SEQUENCING (CARDS) prompt is "1st/next/last"

5x SD: "PUT THESE IN ORDER"

20 INFO RETRIEVAL - 3RD PARTY

5x SD: "WHAT DID [PERSON/VERB/TEMPORAL MARKER]"?

21 DOLL PLAY

5x SDs: VARIOUS SITUATIONS

22 LET'S PLAY

5x SD: "LET'S PLAY [COMMUNITY HELPER]"

23 ANIMAL PRETEND

5x SD: "MY ANIMAL IS [ACTION] [NOUN]"

24 BALL PLAY

5x SDs: VARIOUS "ROLL, THROW, CATCH....THE BALL"

25 MINE/YOURS SDs: "GIVE ME [PERSON'S/YOUR/MY]

5x [OBJECT]"; "WHOSE IS IT?"

26 PRONOUNS IV SDs: "WHOSE [BODY PART] ARE YOU/AM I

5x HOLDING? & "WHO HAS [PRONOUN/BODY PART]?"

27 WHERE DO YOU

7x SDs: "WHERE DO YOU FIND/BUY"; "WHERE ELSE"

28 WHO HAS...? / YOU AND I (prompts "you" & "I")

4x SDs: VARIOUS "WHO HAS...?" QUESTIONS

MON TUES WED THURS FRI SAT SUN

D R I L L S (CONT'D)

MON TUES WED THURS FRI SAT SUN

29 OPPOSITES (REC)

4x SDs: (Mostly) "TOUCH [OPPOSITES]"

30 LEFT/RIGHT

4x SD: "TOUCH/POINT TO LEFT/RIGHT"

31 IF

4x SDs: VARIOUS "IF" QUES - INFO FROM WHY/WHEN DRILLS

32 SENSES SDs: "WHAT DO YOU (SENSES)?"; "WHAT DID

4x YOU (SENSES)?"

33 WHAT DOESN'T FIT / BELONG?

4x SDs: "WHAT DOESN'T FIT/BELONG [IS DIFFERENT]"

34 ABSURDITIES/I CAN'T

4x SDs: [2 COMMANDS]

35 PRETEND (REC)

4x SD: "PRETEND YOU'RE [ACTIONS/NOUNS]"

36 WHAT'S IN THE...?

4x SD: "WHAT'S IN THE [LOCATION]?"

37 FINE MOTOR - ADL SKILLS

3x SD: ["ACTION"]

38 FINE MOTOR - NON-VERBAL IMITATION

3x SD: "DO THIS"

39 WHAT HAPPENS (TEMPORAL)

3x SD: "WHAT HAPPENS (TEMPORAL)?"

40 WHEN? (TEMPORAL)

3x SDs: "WHEN DO YOU/IS IT/DO/DOES IT [ITEM LIST]?"

41 WHO? - LOCAL OBSERVATIONS

3x SDs: VARIOUS (many prompt pronoun/prep/location)

42 WHERE? - LOCAL OBSERVATIONS [pronoun/prep/locat]

3x SD: "WHERE IS [PERSON]?" later "....[OBJECT]?"

43 HOW?

3x SDs: VARIOUS "HOW...?" QUESTIONS

44 CATEGORIES I (REC/EXP) prompt "I Don't Know"s

3x SDs: "WHAT IS [ITEM]?"; "WHAT IS A(N) [SUBCAT]?"

45 MATCHING COMMUNITY HELPER MATERIALS

3x SD: "WHERE DOES THIS BELONG?" later "WHY?"

46 WHAT'S MISSING (Photos & Drawings) SDs: "I'M GOING

3x TO MAKE SOMETHING"; "WHAT'S MISSING?"

47 COLOR SORTING

SD: "SORT"

48 SYNONYMS SDs: "WHAT'S THE SAME AS [WORD]?";

"WHAT'S A [WORD]?"

49 ABSURDITIES (Colorforms) SDs: "WHAT'S WRONG/

MISSING/SILLY)?";

"FIX IT"

50 ACTION LABELS II SDs: "WHAT IS/ARE [PERSON(S)]

DOING?"; "WHAT DID [PERSON(S)]

DO?"

51 NUMBERS 1-TO-1 CORRESPONDENCE / QUANTITY RETRIEVAL

SDs: "PUT W/SAME"/"HOW MANY?"/"COUNT"/"GIVE ME #"

52 ARE YOU ? / DO YOU ? [AFFIRMATIVE ANS. ONLY]

SDs: VARIOUS "ARE YOU..?" & "DO YOU..?" QUESTIONS

53 PREPOSITIONS II (REC)

SD: "PUT THE [OBJECT/PREP/LOCATION]"

54 RECIP CONV III / SOCIAL QUESTIONS

SD: INFO FROM RECIP C I AND II & SOC QUES DRILLS

55 WHEN? / WHY? WH- DISCRIMINATION

SDs: WHY? & WHEN? QUESTIONS (& OLD MASTERED ONES)

MON TUES WED THURS FRI SAT SUN

D R I L L S (CONT'D)

MON TUES WED THURS FRI SAT SUN

56 WHO/WHAT? COMMUNITY HELPERS SDs: WHO/WHAT?

QUESTIONS RE: COMMUNITY HELPERS

57 HATS (PRONOUNS & LITERALITY) SDs: "WHAT [COMM

HELP] AM I/ARE YOU?; WHAT DO I/YOU DO?; WHO HAS?

58 WHAT? Q - S

SD: INFO FROM WHY/BECAUSE? & WHEN? DRILLS

59 WHERE? - LOCATIONS (ColorForms/Flashcards)

SDs: "WHERE DOES [OBJECT] GO?"; "WANT TO PUT IT..?"

60 YOUR TURN / MY TURN II (MEMORY GAME)

SDs: "YOUR TURN...MY TURN"; "WHAT IS IT?"; "MATCH"

61 ARROW POINTING SDs: "WHERE/WHO/WHAT COLOR

IS THE ARROW POINTING TO/AT?"

62 BEFORE / AFTER

SDs: "WHAT COMES BEF [ITEM]?"; "...AFT [ITEM]?"

63 BLOCK IMITATION (RECEPTIVE)

SDs: "DO THIS" / "MAKE A [NOUN FORMATION]"

64 CATEGORIES (EXP) II

SDs: "NAME A [CATEGORY]"; "NAME ANOTHER"

65 EMOTIONS III SDs: "WHAT AM I FEELING?;

later "SHOW ME [EMOTION] FACE"

66 PLAY-DOH (RECEPTIVE) SDs: "MAKE A [ITEM LIST]";

including "...FACE"; "WHAT'S MISSING?"

M A I N T E N A N C E D R I L L S

MON TUES WED THURS FRI SAT SUN SAT

1 FUNCTIONS

SD: "WHAT'S A(N) [OBJECTS, etc.] FOR?"

2 FUNCTIONS II

SD: "WHAT DO YOU [VERB] WITH?

3 FUNCTIONS III

SD: "WHAT'S A [OBJECT/NOUN]?"

4 WHAT AM I DOING? (ACTIONS) (EXP)

SDs: "WHAT AM I DOING?"; "WHAT DID I DO?"

5 YES / NO II

SD: "IS THIS A(N) [ATTRIBUTE/ADJECTIVE OBJECT]?"

6 I SEE III PLURALS Q - S

SD: "WHAT DO YOU SEE?"

7 I LIKE I S - S

SD: "I LIKE [VERB/(PRONOUN) NOUN", etc.

8 I LIKE II S - SQ

SD: "I LIKE [NOUN or SUBJECT]" prompt SQ

9 YES / NO - LIKE III

SD: "DO YOU LIKE [NOUN/VERB, ETC.]?"

10 I HAVE II S - SQ

SD: "I HAVE [OBJ] & {OBJ], WHAT DO YOU HAVE?"

11 PRONOUN LABELS II SDs: "TOUCH HE/SHE"; then

"HIM/HER"; then "WHO IS THIS?" prompt "HIM/HER"

12 PRONOUN LABELS III YES / NO

SDs: "IS [PERSONS HE KNOWS] A BOY/GIRL/MAN/WOMAN?"

13 FIRST / LAST SDs: "TOUCH [OBJECT] FIRST/LAST";

"WHAT DID YOU TOUCH FIRST/LAST?" later add "NEXT"

14 WHERE? - THERE! (LOCAL) SDs: "WHERE [IS GENDER-

SPECIFIC DOLL]?"; "..[OBJ]?/..[ARE YOU]?/..[AM I]?"

15 YOUR TURN / MY TURN I (BLOCKS)

SD: "YOUR TURN...MY TURN"

Date: Mon, 12 Apr 1999 00:39:05 EDT

From: Megan and Jim Sumlin <SUMLIN@AOL.COM>

Subject: prioritizing programs, etc.

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-------------------------------------------------------------------------------

A lister wrote us privately with some questions about our recent posts

and with permission we're sending our response to the list. Hopefully

this will clarify some points that may not have been clear. We neglected

to add that the real answer to how many drills one should use at any

given time will differ for every child. These programs should always be

tailor-made to each child's needs, strengths, weaknesses, etc. It's

probably just as detrimental for a child who can't handle many drills at

once to be overdoing it as it would be for a child who can digest lots of

drills who is not given more than a handful. If a consultant is

programming for you and your team, that decision should lie with him/her,

with your input of course (i.e., if you think your child is getting bored with

the same drills, has mastered the few drills s/he has, and/or isn't moving

forward or, if your child seems overwhelmed w/drills and isn't progressing,

there's always chance that your consultant isn't seeing the "bigger"

picture that you are). Without a consultant, it would naturally be up to

parents to figure out what is right for their children. Our post referred to

what was right for ours. That said, hopefully the system we used will

help some...

<< Hi,your post made me think of questions...things I might have

thought I knew the answer too but might have misunderstood.

1. I've been concerned about how to prioritize programs on my

drill list. We have them alphabetical...>>

The order we used always came from discussions between us, our

consultant, and therapists (if they were there) at each follow-up

workshop. We would evaluate the progress on each drill from the

prior workshop and those that needed the most work became 7X

drills, etc. Sometimes a 7X drill would be those that dealt with

behaviors that needed to be addressed quickly. For example, if we

were preparing him for changes or issues at school, an upcoming

class trip, etc. After about 1-1/2 yrs of therapy, we'd put together

the order the same way (at the time of the follow-up w/our consultant),

but we'd usually also interview our therapists (who often didn't make

the workshops since they were in school) in a vacuum - i.e., didn't

tell each what the other had said - to get very specific information

re: each stim, deficit, etc. and if it was worse, better, the same, etc.

We would do this at each of their last sessions prior to the follow-up

with our consultant. Our consultant was coming less at that time,

so we counted on more input from the team.

<< 2. Why did you white out therapist initials daily??? How did

you keep track of who had done what if you whited out initials daily?>>

The margin on the left side of the sheets only had room for 3 initials

so we had to white them out to make room for the next days "assigment".

We printed new sheets each week and saved the prior weeks sheets in

a book so we would have a record (the therapists used hash marks, using

different colors, in the graph box of the specific drills they'd done --

later,

when there were less therapists, they put their first initial in the graph

box). Since Megan and I were reading the notes after every session

so we could know where he was at, leave reminders for them, and

reinforce good stuff they were doing, to stay on top of what we were

generalizing outside, etc., we always knew who might not be doing

particular programs as often as others and we saved these sheets

in a separate book so we could always double check back (when we

left initials for each session assignment) to be sure that therapist was

getting enough rotation on a particular drill. They needed to do them

often enough so they wouldn't forget how to! Fortunately, we had enough

therapists to afford us the luxury of assigning particular drills more

or less frequently to each, without sacrificing generalization, in

accordance with that therapist's specific strengths and weaknesses.

<<3. When your sheet had 7x on it, did that mean 7x's a week, each

therapist or 7x's a week period?>>

7 times per week period.

<< 4. I wish I knew how your consultant prioritized programs....I know

this is a major area of weekness for us>>

The best description of how they were prioritized was in the answer to

your first question here -- Jim

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