Why is the child hitting? Escape Behavior or a result of child's dominant emotional state? WHY?

Yesterday was an eventful day. I will share about an incident that left me with a number of thoughts. 

I began taking a child named 'Kunal' (4.5 years, verbal child with diagnosis of Autism) in for therapy. Parents came in with the concern of expanding Kunal's language and his social communication skills. Another big concern was that he shows a lot of negative behaviors at his other classes and school. When asked to elaborate- They labeled his behaviors as resistance towards the therapist or teacher, crying or disrupting the activity.

We have had 8 sessions together till now, 2 sessions in a week for 45 min each.

I could see bite marks on child's hand and so asked about his self harming behaviors. The parents shared that he would engage in self harming behaviors earlier which has stopped for a couple of months now. I even asked for any hitting or biting behaviors with others since I could sense it with his body language. In the 8 sessions I have had with him, He reached out to bite me twice but I was quick to respond.

I engaged the parents thrice in a discussion of my observations about Kunal. I wanted to filter my observations and also wanted a clear picture about the child from his natural environment. I tried asking about his hitting and biting behaviors indirectly and directly a number of times. None of the discussions revealed the true picture of Kunal.

Yesterday, Kunal came in happy along with his mother. We sat and began playing some tickle games and sang a rhyme together. He enjoyed and I could see the smile that clearly indicated his enjoyment in the game. The child has low sustenance and doesn't know how to exit a game. He tried getting up and I didn't physically restrain him, I used my strategies to elongate the game adding one element more to it. It didn't take a fraction of a second and Kunal poked my eye with his finger. I could feel his finger in my eye.

It pained so badly. My eye turned blood red And I couldn't open it. I kept sitting for a few minutes at the same place. Then got up and washed my eyes. As I came back to my room my friends and colleagues became protective and asked me to suspend the session and carry it forward some other day.

The mother then began saying that Kunal is a terror at home. He bit her yesterday on her back while she was cooking. I couldn't get into a discussion with the mother at that point because of the pain.

I am only wondering what was stopping the parents of revealing their child's natural self to a behavior therapist. Are they ashamed of their child's behaviors since they have not been able to handle them till now. Are the parents fearing that the child will be looked down upon? The child will be treating like an animal and kept at a distance if their therapists know about the issues of the child. They might have had a bad experience in the past?

Now I can recall one thing both parents reiterated with the child is that he dislikes doing any and everything. If any work is given to him he rejects it and wants to escape. Mother confirmed with a yes when I asked that 'Kunal doesn't like doing anything? He doesn't enjoy anything apart from stimming with things from his sensory box?' The child's affect is negative most of the times. 

Imagine a day or many day or months where I don't enjoy doing anything. I am only provided with tasks to do which I am bored of. I run from one class to another without having 'My Time' in the day. And if I reject something, my family and teachers call it escape behavior. I listen to this so often that "I don't like doing anything."

I will write more on this. Still wondering about the dominant emotional state of the child when he can't express it clearly for anyone to understand.

Boys Brigade Celebrates Together- Joy of being Together

Hey all, yesterday we had a birthday party of a little one who turned 4. The tinny Minnie's who got together to party were a group of 4 children, 3 boys all age 4years with a diagnosis of Autism Spectrum Disorder, and a 4 year old Girl with Global Developmental Delay. For the boys brigade it was the first ever exposure of a birthday party.

Such social exposures are so important for children to display the skills they have learnt through therapy. Such interactions if viewed an analysed with a clear focus can help us know our next plan of action in therapy with children. I have been taking therapeutic play groups for the three boys in pairs.

One of the children showed great skills of observing peers, identifying them, taking their names and even taking them in the room by holding their hand. Another child showed delayed imitation, trying to blow the whistle or saying yeyeye to express his excitement after observing his peers. With another child I noticed that though he imitates in a one on one individual therapy session, he couldn't become a part of the group of three children and imitate his peers whom he is otherwise comfortable with. I haves list of things that I have noticed for these children and I am ready to update my plans and strategies for them in the coming months.

I always encourage parents to expose their children to natural setting and social gatherings. These places can become wonderful training grounds for our children.

If you feel inhibited to take your child out to a social setting, please break through your inhibitions. Human Beings can't grow in isolation. Like we find our nurturance amongst others like us, the same stands true for our children. Please go all out for your child and give him the experience of being around an with friends and playing there. Please plan a play date for him/ her with one cousin, friend, and neighbor and give him the joy of play. A child must play. Please go all out to gift your child the Joy of play.

For consultation please email at Kanica2011@gmail.com

A TRIBUTE TO THE MOTHERS - THE UNSUNG HEROS :)

Mothers are ones we are the closest to. They bring us to life, then love us and cherish us; they do everything possible so that we become happy. Mothers have two broad tasks to accomplish. They are the very mission of each mother.

Two tasks every mother has are

1. To make sure her children are happy.

2. To ensure they become very capable individuals

A mother will go all out to ensure the child is fine, his needs and wants our fulfilled to the best of her ability and he becomes the most capable individual.

I work with children with developmental delays, language delays, Autism, Asperger's, Down's syndrome, Fragile X Syndrome, Cerebral Palsy, GDD, ADHD, etc. Most of the children come in for therapy with their mothers. Mothers are the ones who come in asking their concerns, sharing a vision they have for their child, challenges they face each day. A supportive family and an understanding father only makes things easier.

These wonderful Mothers are the Unsung Heros. Thanks to all of them for taking complete responsibility of their children. If the parenting goes right today, the love and affection is in perfect balance, I am over joyed to visualize what wonderful individuals will arise taking lead in 2030.

Thank you mummy for being my mother, loving me so much and always being there when I fall, loving me despite my mistakes, hugging me and reassuring me ‘I am there for you’ when there was no one else at my side, listening to me blabber when you really didn’t want to hear, cooking the yummiest food when you yourself were tired, getting me the best things and cutting down on yours. This list is endless.

I love you Mom for helping me to become the. best version of me : )

I promise to make you proud each day

Being Fun Therapist is Fun: Working with a 11 year old boy with Asperger's Syndrome

I am working with a child, 11 years, diagnosed with Asperger's Syndrome. He loves football and plays for his school. We talk about everything under the sky. We do crazy experiments like putting Mentos in Coke to see the effect. We blow bubbles with straw and make mountains of it, we sit in a pool of balls and have ball juggling competitions. We dance on songs and even tried ball dance with each other. Lots of laughs!! He dared to do it. Our present interest is Musical Instruments. He Is learning tabla, and I am learning mouth organ using you tube. It's not easy to learn something new, but it's fun. So why not try!! He asks me what kind of a therapist am I? I say I am a fun therapist. 

One of the therapy sessions, we were playing Truth and Dare. So I got to ask him a question in Truth, where in I asked him "Do you like coming to me for this class? If Yes, why? "

There was a long silence. So I redirected after a while saying, I asked Do you like coming to me? The answer can be a yes or a no. Feel free to say what you feel. He said, "I like talking to you.”

Another session, he said something and I said, "you can share anything that comes to your heart with me. We have become friends. I like it." And he said, yes Ma'am, you are my diary." I felt so overwhelmed when he said it. I told him I feel so happy you said that.

Co-creating Joy together through Play and increasing positive experiences together is the foundation. A dialogue, without judgments and with opinions and suggestions works well in therapy also. Thank you Ikeda Sensei for helping me learn this.

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.