What I Hear, I Learn!!

An anxious mother and her lively 4 year old This little boy has been diagnosed with Autism Spectrum Disorder. He uses one word to label things and both 1-2 words for need based communication and answering questions Mother’s language sounds like question and answers almost all the time. While Robin (name changed) sits to play with blocks, mother asks, which color is this? What shape is this? Robin tell me how many blocks are these? Let's count these blocks. When Robin comes into the kitchen, mother asks so which room is this? When Robin goes to pee, mother asks 'Robin which room is this?' OMG!! This is what Robin might think -  "If the whole day someone is asking me questions with an expectation that I answer correctly, I will go crazy. Who is going to answer correctly. I will say what comes to my mind first." For Robin not every moment can be a teaching moment.This will not give him a chance to think, explore and learn. His exposed language at present only has questions in maximum part of the day. Children learn from the language they are hear everyday. Asking questions now will mean his language later might sound like questions only. Later when Robin grows up and now has the language to use templates, phrases and sentences he will ask us questions. Which will irritate us. Then a language therapist will have work on helping him break this pattern and make his language more appropriate which has narratives, sharing information, expressing ones feelings, likes and dislikes, commenting on something, jokes, pauses, etc Mother was suggested to talk about the situation in terms or self talk and parallel talk. Self talk is when one is expressing ones own self, where as parallel talk is, when one is talking on behalf of the child. You are expressing for the child, how he would sound in  terms of tone, pitch and even the emotion in his voice. This way one can enrich the quality of his language.  For e.g. Mother asks him what time of the day it is? He says night and day as per the time and the conversation finishes. She was told to talk about the night time and say it is dark. I can see stars in the sky too. It is chilly too. Or in day time she can say "it is sunny today. i can see everything so clearly. It is bright light. Wow!! look at the clear blue sky." This way mother can share so many things with Robin. This way of talking will help Robin learn how a conversation sounds like. When mother is talking about the stars in the night, Robin might remember his poem 'Twinkle Twinkle little star' and they can sing it together. Then when mother elaborates on everything being so dark, we can play peek a boo and say, oh when my eyes get covered, I cannot see anything. Its so dark. Next time when we talk about 'Dark' we can discuss it like 'dark in the closet, dark room, dark in the blanket, dark sky, dark skin, what shines in dark? etc. Another example could be- when mother daughter is playing with blocks with Robin. She can construct something simple and share with Robin saying - "look Robin, I made an Ice cream with blocks. Let me lick my strawberry ice cream. U want to have a bite too. Come let's share. Ohoo!! The ice cream is so cold. It makes me feel cool." Robin will join in the play if he likes Ice cream. "Ok now let me make a burger with blocks. Yummy!! Look I made a cheesy burger. It has your favorite cheese and Chicken in it. You can eat it with some sauce. It will be very tasty. U want to eat a bite of the burger." While playing with blocks, this will lead to more sustained play rather than a question and answer session about colors and numbers. This will also help Robin learn ways to play with blocks, rather than just counting them or sorting them according to their color and shape. Such a way of conversation will expand your child's divergent and convergent thinking and also enrich his language many folds.  Let's try this and share feedback if possible!!

A newly discovered Tool for therapy- SNAPCHAT!!!

It is amazing when we can use social networking applications as a part of therapy. I used Snapchat as an activity with a 3 year old child diagnosed with Autism. In the last few months we worked on his intent and language development. He now rightfully makes a choice and expresses his opinion as a part of the activities.

While trying different filters on Snapchat, I told him the sequence to follow to click a picture- click, save and next. He observed me following the sequence, and we clicked some nice pictures too.

He got really interested and then started to observe himself more mindfully and follow the sequence of Click, save and next. He first practiced the sequence with a couple of filters. As he became comfortable, he started to chose the filters on his own. He looked at himself with different filters and only clicked and saved the pics where he really liked the filter for e.g. the dog with the tongue, or the rainbow tongue or the fat red cheeks. He skipped some of the filters and some, even if he tried, he didn't click. He laughed and shared the ones he liked, while we clicked pictures together. He also turned to look into the mirror and then laugh seeing his face in place. He found some of the filters very funny and laughed. The play looked so happy and fun like any other kid.

I loved seeing all skills that he has learned in last 9 months in place. Intent to play, Joint attention, sharing joy and excitement, choice making and executive functions of staying on the task, sequencing and memory too.

Thanks Snapchat, It was total fun : )

PLAY AGAIN: It surprises all the Time

Harshit (name changed), a 6 year old kid, joined Potentials in the month of April, 2016.

He has been consistently taking Occupational Therapy for Sensory Integration and ABA therapy outside Potentials. At potentials, he began with Play-Social Communication- Language Therapy in April, and Speech Therapy in June.

 His first session with me was on 1st April, 2016.  As we begun, Harshit only wanted to jump. So therapists joined him. When I insisted on him to sit, he again got up. It was as if we had springs. It was a super jumper session, with 3 of us jumping all over the room.

 I was told that Harshit is here till September, 2016. I can deliver as much as I want in these few months. In the beginning, I was a little scared, as understanding the kid, and the autism specific to him will also take some time. Initially his sessions, and thinking of goals and activities was becoming cumbersome, because all my thoughts were revolving around the deadline “September”. Hence, his sessions were boring. In retrospect I would analyse the session to be boring. I didn’t enjoy at all. Something was missing. Then after a lot of introspection and analyzing, I realized that Play with him was becoming a task. My focus shifted from the deadline to co-creating joy and having fun with him.

This one thought made all the difference. The sessions were transformed. Since he loved to jump, we kept different things to jump on. So once we kept pasta. Raw pasta from the market was the play material. We first explored it and found that it makes a sound when it breaks. I threw some on the ground and started to stomp my feet on it. Harshit joined in, and he wanted more. So with one activity that was fun, we could target his joining in the game, body orientation towards the play partner, asking for more pasta when it was all crumbled. Now when he was tired, we sat and broke the pasta with our hands and heard the sound, and felt the texture. I broke a pasta piece close to his ear. So we could also target proximity, and tolerance of another person close to him. Gradually we introduced bubble paper and thermacol balls. Playing with all these things was total fun.

I started looking forward to Harshit’s session. Earlier he had a blank face or a frown at times, but now the facial expressions where easing down. We started seeing an Ok face, and gradually we saw Harshit smile more. The expression of joy changed into sharing of joy with the therapists. With consistent Occupational therapy, his sensory needs were also getting fulfilled, and he was learning new skills. Harshit was sitting willingly now, so we did some structured sitting tasks.  Narrations before an activity were helpful. The narrations helped Harshit know about the activity, what is expected out of him and what might be difficult for him. This strategy eased his anxiety of the newness of the task. A clear start and stop was also defined for structured activities. For unstructured activates we told him the activity that followed. The confusions in his mind were getting clear, the uncertainty of the moment, that time or class was becoming easier to understand, and his verbalization was increasing too.

One fine day, I happened to talk to Harshit’s mother about his progress and present skills. The mother was elated to share that Harshit has started playing, though for shorter intervals, with his cousins. The best part for the mother was that he has started tolerating children around him. I took this as an opportunity to ask mama to write the progress that she sees in Harshit. I gave her a sheet of paper to write. I am so glad to share with all of you. The mother wrote: Small improvement in joint attention and eye contact.

1.            Has started tolerating other people around and also let them play with him for short duration. Was playing with his cousin with ball.

2.            Lately we are also observing playing appropriately with toys and showing interest in them.

3.             Listening and following commands.

I was so happy to read the progress that the mother shared. I was glad to see, how the mother could observe the small changes in Harshit that will make a big difference to their life. Harshit’s family has preponed his trip, and they are leaving in August itself.

From a therapist’s point of view some changes that I saw in Harshit over a period of 4 months:

1.             He has calmed down, and jumps in excitement.
2.                     He is willing to sit and do a task.
3.            He makes an attempt to play, or do the work given, even though he finds it difficult. This is a wonderful thing about Harshit, because until someone tries, how will they know how much fun can the task be, and what to improve upon.
4.          He will also reach out to the play partner or therapist for help if he finds the task difficult with therapist facilitation.
5.         He joins into take out pre-speech sounds with us. He attempts to produce a sound, and we can see that with his mouth shaping.
6.          Harshit has been able to internalize the point that- when he speaks, uses his words, people understand him better. He picks up words from his exposed language and says something when he wants a reaction, or asking for something (need based communication) or asking for more play. This is a beautiful skill that he has picked up. He learned to say chapak chapak (Hindi words for splash splash), when it was time for water play.
7.          He has started doing reciprocal coordinated play. Like ball catch and throw with 2 play partners, sliding a ball over a slant surface taking turns. He waits for his turn, and observes the play partner with therapist facilitation.

In 35 sessions across a period of 4 months, with 2 sessions in a week, Harshit could learn some basic foundation skills that will help him in his growing up years. Harshit left to his home town, leaving a beautiful experience of play with me.

(Un) Realistic Expectations: Expanding My Version of My Own World

Another day passed at work. It was a day full of action including parent outburst, dialogues and discussions amongst Team Potentials, some play and more play. While driving back I was thinking about a set of parents, who comes to us. It’s not just about this set of parents, but most of the parents with children with special needs, who struggle to strike a balance between ‘Who their child really is?’ And ‘What they want their child to be?’ Let’s understand this through a child’s life who comes to us for therapy.

Prateek (name changed) is a 4 year old boy, with a diagnosis of Autism. He started coming for therapy 1 and a half months back. The child is yet to open up for us to know the real Prateek. To support the child to be more of him, we need to know the real child.

The first goal sheet[1] I have prepared for him are generic goals that are targeted with almost every kid. While noting down observations about him, I struggled to zero down on even one favourite toy of his. Things specific to the nature of his disorder are yet to come out. Prateek's parents are very anxious about his current state. They opened up while talking to us at Potentials that they are depressed and sad about his diagnosis. They are giving their best to cope up with the situation and do their best for Prateek's growth.

Being weighed down by the tag attached to Prateek now (of being diagnosed with Autism), the mother is typically unable to sense Prateek’s own potential, giving up on any real possibility of transforming their current situation and instead passively accommodating themselves to others and their immediate surroundings or to the larger trends in society. Mother's thought process about diagnosis, therapy and the social stigma attached to it, the social trend of making him join school like any other child his age has made her way of life dependent. She wants the situation to turn around completely 180 degrees, and at the same time she is losing belief in the unbound possibility of life which is only giving rise to anxiety in her own life.

In her own way, mother is giving her best for her child. She is trying to protect her child from any real exposure that might hurt him in the environment around him. My team together could join the dots to see many such instances of how the mother is trying her best, but her restricted and protective vision for her child, is not letting them break the barriers and remove road blocks for Prateek. This is making it difficult for her to develop her trust in people around. She is becoming over powered by the negatives of the situation feeling she has been put into the situation to suffer, with the thought of ‘WHY ME’.

The pressure of time running out at a fast pace, and expectation, that Prateek must go to a regular school is stopping the mother to see the real potential of her own child. Grasping the true nature of our child, weighing his relative strengths and weaknesses will only help us be more realistic about the expectations we can have from him. She deals with Prateek as his mother, where as I play the role of a therapist. We both are equally sensitive towards the child, with a minor difference. The mother and the therapist would want best for the child but from different perspectives. I see the child keeping my emotions on one side and bringing every rationalisation in, which keeps me aware of child's strengths and weaknesses.

Being empathetic towards the child, and getting emotional about his condition are two very different things. Being emotional towards his lack of skills will only create a road block for mother and child to move ahead. That's the role a therapist plays. Rather than seeing the child in comparison to others his age, we would be realistic and view him and the nature of his disorder to remove the barriers that are stopping him to bring out his own potential, in his own unique way. Dr Daisaku Ikeda says, “Each of us is different, but we are all alike in that we possess tremendous potential. The truth is, you can do almost anything if you set your mind to it. The worst thing is to lose confidence in yourself and limit your own potential.” Each of us are born different. Understanding ones potential needs a realistic picture of who am I? To see the real picture, one needs wisdom.

The perception that I make of the child, should not be focussed on short term goals (Unrealistic expectations), for e.g. he/she must start going to school by age of 4, s/he should start talking like others, s/he should behave nicely when we go to a relatives place, s/he should start playing with toys quickly. This is liking posing your expectations of who the child should become without an eye on the long term goals that will lead to holistic growth of the child. The parents transfer their anxiety into the child, which hampers his/ her growth. Rather, one must focus on life skills that helps the child express him/ herself better, be comfortable in his/her own being rather than running in a rat race of being like other children his/her age.

This whole dilemma of where I am? And where I am heading to? Can only be sorted with a Dialogue. The parents who feel stuck in this space must continue to talk to other parents at the therapy centres they visit, and the therapists they are trusting their child with. Society as a whole has seen a lessening of our capacity to appreciate others- as they are and who they are. I believe that the surest way to change this is by carefully attending to the stories of each other’s lives through one on one dialogue. Forming my point of views in isolation can be very scary. Then I view the situation from a subjective point of view. In order to construct societies that are resistant to judgement and embrace people as they are, people need to be exposed to and reminded of different perspectives. Face to face dialogue can play a crucial role in this.  In order to break through our self-imposed limitations, one needs to break through every obstacle and every intrigue that seeks to block our advance and boldly and courageously win. Talking to more and more people, making friends and sharing my heart out will only help me expand my version of my own world.

---

[1] Goal sheet: from the point of view of therapy, a goal sheet includes childs present behavior, a goal based on that and the strategies therapists will use to target the goal. This gives a clear picture to the parent of the current state of their child, and where are we approaching.

Who am I? A Surprise Package

Some of us are born with a difference. Our mirror is tarnished and it needs to be polished. This polishing of the mirror brings out our true nature. 

With small steps that a child takes each day through parent’s support and various therapies he is accessing- a new, dynamic, and a happy child is born. It is amazing to see the true nature of the child. This transformation in the child is a relief for the parents, the therapists and loved ones. The child struggles to adjust in his new identity. It is like exiting a comfort zone, because of the time he has spent there and learned ways to cope up with difficult situations in that. Exiting this not so easy comfort zone to enter his real zone is a challenge.

The new zone is the new way of life the child learns. Entering that, breaking the barriers of the old him, where he has been for the longest time, is not easy. But with correct direction, and facilitation, he enters. That’s how a child might feel: “Wow!! That’s a new me. I am still learning to be the new me. It is sometimes frustrating since I am not able to gather the courage to exercise the newly learned skills with complete confidence. But at times, my parents and teachers around me hold my hand through the path, and once I exercise the skill, that’s the moment of extreme joy and elation. I just love it.”

The play way method of ‘Eye to I’ helps the child come across the real him. By co- creating joy while playing, the child explores new things, exercises his own ways of doing things, breaks the monotony, makes mistakes and in that learns new stuff, makes his favourites, likes and dislikes and enjoys the good things, pushes away the not so good ones. He shares how he feels in his own unique ways. That’s what makes him more human. When the children come alive, the one who is relieved the most is the parents.

I have a child coming in for therapy since last 5 months. Parents were so stiff in their body language and expression of thought, that it made me worry. But feeling bad for them was not the solution. All teachers taking the child were observing the discomfort of the parents. We gave our all, brain stormed and came up with best ways to support the child. Once we could understand the Autism specific to the child it was easier to take action. We found reasons behind the behaviour he exhibited. It goes like: When the Why is clear, the How will follow. The child became easier to understand, and our ways and strategies for therapy were altered at all levels. This integration of therapy, helped us see beautiful holistic development for the child. The causes we made to help the child be more comfortable in his own self, had clear effects not only on him but on his parents too.

The child has become more assertive. He laughs more, and expresses anger. He shares things he knows and enjoys every moment of it. Seeing him is a treat. He is getting to know his true potential which he is exercising. Actually he is exploiting his new found talent where ever he can. Laughs!! I am loving it as his play and communication therapist. It’s an important milestone we have achieved together.

The parents came in for a meeting, where in they wanted to share how is the child doing at home, and wanted to ask about his progress at Potentials. We were all amazed to see how comfortable the parents have become in last 5 months. Their body language was relaxed, they made eye contact and smiled and laughed. They had their questions and doubts. They could also see, that they discovering a new, more vibrant, happy child in their boy. They laughed sharing their experiences with him at home, and we cherished listening to them.

My goodness!! He is a surprise package!! Keep watching, there is more to come.

Wonders of Play

Wonders of play amaze me all the time. Little Kian (name changed) came in as a passive kid with his head hung low most of the times. He would submissively engage in activities, start and finish them following the therapist.

His obedience at times made me feel frustrated. My goal sheet was getting achieved (he was learning to make two word templates, his sustenance was increasing, and he was also becoming more aware of his surroundings) but my anxiety was increasing at the same time. His passive approach was dull. This is not how one can be. He is born to smile and enjoy. He must explore new things and find his likes and dislikes, passion and struggles. As I sat to make the next set of goals for him, I brainstormed with my boss, as to what next. There was something amiss.

Kian is moving towards becoming active and aware of his surroundings. He is more aware about the people surrounding him, noticing movement, people coming in, or leaving the room while he is playing in the session. But he would not look and had no idea that he can make a choice and express his opinion.

The next goal I wrote was- Kian will be more aware of people around him (his therapists) and he will also be mindful of activities he is engaged in. He will be an ACTIVE PARTICIPANT in connect to his environment, and people around. It is usual that we use the strategy of choice making for a passive kid.

As I went on to understand the Autism specific to Kian, after repeated discussions and joining dots of how the session flows my boss said, “Kian needs to know that he can have an opinion.” This touched my heart, and now I exactly knew how to approach him, and even guide other therapists across sessions for integration, as it would lead to holistic growth for the child. We started giving him opportunities to make a choice out of few games and toys. We give him clear narrations to know that he can ask, and make a choice.  His facial expressions started becoming freer and less restricted. He smiles often to the therapist now. With increasing opportunities, he has now started to initiate a game and therapist joins in and builds up interactivity. This also helps Kian sustain on an activity that he has chosen. Intensive therapy in the month of June worked wonders. He has started expressing his choices across a range of material. His father shared that earlier he would eat whatever we gave him. But now, he spits the food out, if he doesn’t like it. I loved the smile on his dad’s face. Kian is finally opening up to become aware how who Kian is, what he likes and what he doesn’t like.

I love it, now when he is happy choosing and playing what he wants to play. He laughs out loud. I also love it when he gets angry on something, pushes things away or tells me in his own unique way, I don’t like this. Yeyeye!!!

Yes, we will now be working on refining his communication skills and integrating his existing skills with the new found Kian.

I am so happy. I just love the wonders of “Eye to I”.

Work and Play

I am a Child Psychologist, working with children with special needs for last few years now.

After completing my post-graduation, I have been working with a private organisation engaging in therapy with children with ASD, Down's Syndrome, Learning disorders, ADHD, Cerebral Palsy, social anxiety etc. I have had a major experience in working with children with ASD, from ages 1.5 years showing red flags, early intervention with children for ages 3-5 years, for diagnosis to 16 years of age.

My work profile involves taking one on one sessions with children working on their intention to communicate, purposes of communication like asking, sharing of emotions, sharing information, leisure time interaction etc. pre-speech skills- , babbles, jargon, sounds etc, language (words, phrases and sentences); communication with others (verbal and non-verbal); expressions and sharing of emotions, emotional regulation, executive functions, and group therapy with 3-8 children.

I am skilled in working with toddlers since I enjoy working with them the most. We use play as a medium of work with children. The philosophy is all about playing with the kid with ASD to connect to the play partner, and then coming closer to knowing one’s own self.

Play is the most exciting part of my work. I have seen play working wonderfully with children with ASD. In the last two years, play has enhanced my personality for good. I have become more confident of myself, now am more comfortable while using my body space etc. Play excites me, as I enjoy everything about it. It compels me to think out of the box to create play of the smallest of and not so obvious things, for example, thermocol balls, sand, water; boxes etc. Through play I have been able to break my inhibitions and enjoy myself in the last two years. It gave me the joy of being me.

I am excited to research the powerful positive impact of play with different populations.

Eager to explore, study and learn more and more