A speech-generating device may improve behaviors in children with autism who cannot speak.
This case report describes the use of a speech-generating device by a 7-year-old boy with autism. The boy could not speak, but he did make sounds with his voice. Sometimes the sounds were not appropriate. He also had problem behaviors; for example, he would use aggression when he wanted attention or wanted to play with someone. The boy was taught how to use multiple options on the device. He used the device on the playground and during gym. When he used the device, he had problem behaviors 0 to 20% of the total time (for example, while on the playground). Without the device, he had problem behaviors 40 to 80% of the total time.
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Teacher's pet
Sep 12, 2008 by dankohnHere I sit, at my computer, without anybody to interrupt or deter me from my cathartic writing! That’s right; both Thomas and Hayley are at school and I have approximately one hour before I have to fetch Thomas and then Hayley. Hey, it’s better than a poke in the eye with a sharp stick, as my father-in-law used to say.
The waterpark last weekend was a success! The kids (and we, the parents) had a great time riding the slides and splashing around. Thomas liked the wavepool the best. He really enjoyed diving under the waves and letting them wash him ashore. The only problem with that was that he liked to float, face-down in the surf like a drowned person. He got more than a few concerned looks from lifeguards, but I waved their concern away and they saw Thomas stand up a few seconds later. Thomas got really upset at one point, actually. I was with him in the wavepool and Jonathan wanted to float down the Lazy River with Hayley in an inner tube. They needed help being shoved into the current and I told Thomas that I was going to help them. He didn’t hear me very well because he kept going underwater and was really upset when he couldn’t see me when he came up for air. He started crying, even! It’s such a comfort to know that he does worry when he can’t see Jonathan or me. It cuts down on our anxiety about him just wandering off.
Another issue we discovered while at the waterpark was that Thomas is not especially assertive with other children. There were kiddie slides that were being “monitored” by a lifeguard. Thomas stands in line okay with Jonathan or me, but when he’s in line by himself, he tends to dance around a bit. He was waiting in line for a turn to go down the snake slide and other kids were just going right in front of him. Jonathan was up at the top of the slide helping the kids go down, and he came down after a few turns and said, “Go up there and see! It’s Thunderdome! No rules! ‘Two man enter, one man leave!’” The lifeguard wasn’t especially strict with the whole turn-taking idea, so we explained to Thomas that when it’s his turn, he should go down and if another kid attempted to “cut” in line, he should say something. The fallout of this was that on the playground on Wednesday, after we picked Hayley up from preschool, he was pretty snippy with a little girl who wanted a turn on the teeter-totter. He said, “Hey! No, it’s my turn next!” She wasn’t really attempting to cut in line, but Thomas perceived her presence as such and was a little pushy about it. So we have to work on that. But the waterpark trip was a success and the kids enjoyed spending the night in a hotel. It was very romantic for me and Jonathan as well. I slept in one bed with Hayley and Jonathan slept in the other with Thomas. As usual, no making-out.
School is going great for both kids. I will be volunteering in Thomas’ classroom on Tuesdays now. I helped out this past Tuesday and I was concerned that Thomas might behave differently in class if I was there. Hayley came with, of course, and now has a little boyfriend. They kept holding hands and putting their arms around each other’s shoulders. We’re going to have to watch her, apparently from now until her wedding day, which she is already planning.
I did some filing for the teacher and cleaned up the coffee she spilled in the hallway on our way to the library. The teacher and library staff were so nice to Hayley, letting her participate and even check out a book although she’s not technically a student. The librarian thought that Thomas and Hayley were twins. I’ve been getting that a lot lately.
I was really worried that Thomas wouldn’t react well to my being in class. Jonathan and I explained to him that he would have to act like I wasn’t even there; just do what the teacher told him and that she is the boss when he’s at school, even if I’m there. To tell you the truth, I had a harder time ignoring Thomas! Every time he didn’t immediately follow the teacher’s instructions, I wanted to say, “Do what your teacher said! Go put your folder in the tray!” I had to stifle my own words on more than one occasion. Hopefully, I’ll get better at it. I know that his teacher appreciated my help and she said that I’ll be helping the kids with reading eventually, and learning computer programs. She told me that she feels like she’s known me forever, and I kind of feel the same way. We have a very easy manner between us. We discovered that she is exactly one week older than Jonathan and we were all at NIU together. Far out!
Oh yeah, the Focalin. We had to take Thomas off the Focalin because he developed a facial tic. He kept opening his mouth as if to yawn before speaking. It was becoming disturbing to us, so I called the doctor (who is out of the office this week) and the nurse called back to say “Stop the Focalin!” Remember how I said that the Focalin wasn’t doing anything for him? Well, it seems that it was. I’ve noticed an increase in rambunctious behavior and general nervous energy since stopping the meds. I was concerned about that. I thought the Focalin wasn’t helping because he was being better, but I didn’t notice until we stopped it. I’m supposed to call the doctor later today and tell them how he’s doing. I’m not sure what we can do now; all of those Ritalin-type medications carry the risk of developing a tic, and it appears as though Thomas is susceptible to that. We’ll see what they say, but he is still doing okay in school, I guess. I’m not going to ask the teacher until next week if she’s noticed a change in Thomas. If I tell her that he’s stopped the Focalin, she might be looking too hard for a behavior change and I’d rather wait until I see her again on Tuesday to mention it.
This weekend will be quiet. We’re doing nothing tomorrow and Sunday we’re going to what will most likely turn out to be an indoor BBQ if Hurricane Ike makes its way up to Chicago.
Orientation frustration
Apr 24, 2008 by AnonymousSomething happened to the apostrophe key on my keyboard. One of my darling little children seems to have pried the plastic apostrophe key off the board so now I have to press this green rubber nodule when I want an apostrophe or quotation marks. Such fun!
It’s been a busy week for us. I went to that kindergarten orientation that I was urged again and again to attend. We ended up leaving halfway through. It was basically a reiteration of what Jonathan and I heard at the special needs kindergarten orientation a few weeks ago, only this was in the middle of the afternoon and without complimentary childcare. I asked the principal if they were going to have an MLP classroom at our home elementary school and she replied that yes, they were going to have a bi-lingual MLP there. So most likely, Thomas will not be attending that school. She urged me to stay for the remainder of the “registration” - they handed us a flyer saying that registration would be in August. I was so ticked off! Like I’m going to hand over all the registration papers and monies so that the district geniuses can lose them when they transfer them to whatever school in Timbuktu Thomas will be attending. They lost all of his stuff last August and he wasn’t even changing schools! So I stormed off (the kids weren’t being great, which didn’t help) in a huff and the principal asked about Thomas before we left – like she’s going to do something about the injustice of it all. The thing that angered me the most was that the special needs kindergarten people who gave the presentation a few weeks ago insisted that it was of utmost importance that we all attend our home school’s orientation. It was completely unnecessary and I’m going to mention it at Thomas’ IEP meeting on May 6th.
So after walking to this school and playing at the playground and explaining to Thomas that he might go to school there next year, he’s not going there. The silver lining to this cloud is that the district starts school at 8:30 a.m. so Thomas will be on the bus and off to school in plenty of time for me to get Hayley to pre-school at 9 a.m. I have to register her on Saturday morning and then get her over to her make-up dance class at 10 a.m. Finally, Hayley will be able to start school and then, dare I even write it, I will have a couple of hours every Monday, Wednesday and Friday to myself to do “stuff.”
Thomas is still doing well at school. Yesterday, a police officer came to visit Thomas’ class. The kids got to try on handcuffs (Thomas refrained from that particular activity), sit in the police cruiser and listen to the sirens. Thomas loved sitting in the car and he was able to actually tell me the officer’s name when I asked! I said, “Thomas, what was the policeman’s name?” He said, “It was just ‘policeman’!” I explained that the officer had a name. “What was his name, Thomas? It was Officer…” And then he told me! I couldn’t believe that he could remember, but he did give me a plausible last name of the police officer. I thought that was great!
I’ve had it with the bed-sharing again. I finally had to mention “sleep study” again to try and whip things back into shape. Those kids come in every night now and I wake up sweating with someone’s (not Jonathan’s) elbow in my face and knee in my rear. I mentioned sleep studies in the bathtub tonight and Hayley said she’d like to do one. Thomas looked at her and said, “Hayley, you don’t know what you’re talking about!” Too true. We’ll see who comes in tonight.
So I’m waiting for that IEP meeting to hopefully find out where Thomas will be going to school next year so I can go to THAT orientation instead. Or maybe I’ll just show up the day before school starts with a greasy birth certificate, coffee-stained immunization records and a dubious-looking check to hand to whatever poor sap is behind the desk that morning. That may be what happens just because I bet they won’t know where the MLP class is going to be in early May. I just hope that Thomas doesn’t have to be bussed too far. Our school district is fairly large and sprawling, so he could have to ride the bus for quite a while every day, depending. I’m a little concerned about that.
I’m excited for Hayley to start pre-school and get some socialization at long last. I’m hoping they’ll teach her a little about how everyone is different and it’s not polite to stare, point, or loudly say, “Mommy! Why is that old lady’s hair blue?” (Luckily, that old lady’s hearing was apparently not what it used to be and I escaped that situation.) She’s just like every other kid when it comes to pointing at someone who looks different, walks differently or has any characteristic that doesn’t jive with Hayley’s definition of “normal” which is probably a bit skewed, to say the least. I’ve been trying to tell her, after we’re home or in the car, that it’s not polite to point or talk about how people are different when they can hear us. How do I do this? Does anyone have any words I can use that an almost four year-old will understand? If you read my blogs regularly, you already know that I have a tendency to get a bit wordy and use some goofy vocabulary. Unfortunately, I find myself doing that with the kids and I don’t notice so much when their eyes glaze over. Sometimes, Hayley will say, “Mommy? I don’t understand your words!” At least she can tell me when nothing is getting through.
Compare and contrast
Mar 27, 2008 by AnonymousThomas has been enjoying a very busy week off school. The Easter Bunny came with lots of candy, as promised. The kids had chocolate eggs and jelly beans for breakfast on Sunday and it was very apparent. Sugar really seems to affect Thomas a lot more than it affects Hayley. We went to Jonathan’s aunt & uncle’s house for dinner that afternoon and the kids had a lot of fun there too. When did Easter turn into a “gift holiday?” There was quite a haul to bring home that night, but the kids weren’t part of it. They went to my mother-in-law’s house for the night. That was fine with us. Everyone spent the day filling the kids with candy; we thought it fitting that one of the feeders deal with the fallout. Grandmas never mind that kind of thing, though.
I was supposed to bring the kids home on Monday, but only Hayley wanted to come home! Thomas wanted another night with Grandma and we didn’t have any plans for Tuesday so I said that it was fine for him to stay. Tuesday came along with another phone call saying that Thomas wanted just one more night at Grandma’s house. I know that Jonathan’s mom loves the company and I really had no good reason not to let Thomas stay, so I spoke to him briefly on the phone about it before consenting. I went to pick him up Wednesday morning and we went straight to my parent’s house to visit with my mom. We went out to eat and to the park since it was such a nice day. Yesterday evening, however, the affects of Thomas’ sojourn with Grandma were beginning to show. There was a certain amount of disregard for authority. There was also a distressing attitude about bedtime schedules. Hmpf. So we’ve decided that two nights at Grandma’s house is the absolute limit in a non-emergency situation. More than that and Thomas begins to get used to the leniency. Not that there’s anything wrong with it! That’s what grandparents are for! They get to be the good guys.
This morning we went to a neighboring town’s park district to play at their little indoor playground. It was really neat, but there were so many kids there that it was like Romper Room on uppers. Thomas did really well with the large number of kids and I was very surprised! We went with Grandma and my sister-in-law and her daughter who is fifteen months old so I wasn’t all alone in uncharted waters. This park district also has an indoor merry-go-round; not a huge one but still an official midway ride that Hayley really liked. Thomas finally went on it and he liked it but wanted to - you’ll never believe it - pretend-drive the little kiddie cars they had in the play area. You know, the one with the red car body and the yellow roof that the kids use their feet to make go? Thomas was almost too big for them, but they were his absolute favorite things to play with. The rest of the play area was set up kind of like Chuck E. Cheese’s with all the tubes and climbing stuff. Thomas was actually really nice about taking turns with other kids and waiting for a turn himself. Every time I asked him to get out and let someone else have a turn, he did it without a fight. Sometimes he’d get out and walk around the car for a minute and if there were no takers, he’d ask if he could get in again!
As I said, he did really well listening and staying in-control of himself despite the fact that the place was overrun with excited children. This is a big deal for him because one of the reasons that Thomas’ teacher thinks he wouldn’t do as well in a regular classroom next year is that there would be a lot more kids and Thomas might find that difficult to handle. He didn’t mind it today and did a great job. Until it was time to leave. I’d say that he really had a fit, but he didn’t have a tantrum. He just cried and was sad. He kept saying, “Mommy, mommy, mommy! Please!” He was really upset and I think it was because I gave him no warning about leaving. Looking back on it, that was really stupid of me. My mother-in-law and sister-in-law were kind of ready to go out to lunch then because Thomas and Hayley’s little cousin could only handle so much of all that before getting over-stimulated and cranky herself. I kind of just walked over to Thomas and said that we were leaving. God, how dumb! What was I thinking? Isn’t it funny how you can look back on something and things are so obvious – it’s so obvious what you did wrong – but at the time you were confounded? I wasn’t exactly confounded; Thomas was having fun and didn’t want to go. But, duh! I could have told him “Okay, five more minutes!” That at least would have been better than what I did! Okay, bad mommy moment. Minus ten points. I did donate an old pair of glasses to a charity box yesterday though, so maybe that good deed balances my bonehead move out just a little bit.
Since I was so lame, I decided that we could go back to the little “inside playground” as the kids call it, tomorrow. Thomas is very excited and he asked me if he could drive the “baby cars” again. He was so nice about it today that I said he could. Playing there costs three dollars per child and that includes all the vomit-inducing carousel rides you want, so you can’t go wrong. It’ll be a little harder by myself with the kids, but I think it’ll be okay. The kids promised to let me do my house work (Friday is my cleaning day) when we got home – wasn’t that nice of them?
Luckily, there are only three more days of “spring” break left. This has been such a crummy winter that has held on until today and will continue; we could get 1”-3” of snow tomorrow. We had an insane snowstorm two days before Easter! What kind of spring is that? Finally, there is a sixty-degree day in the forecast; next Thursday. All of us really can’t wait for the cold and snow to be over with. And we have no plans for the rest of the break (except the inside playground tomorrow), which is a blessing, believe it or not. The kids are both so over-stimulated that a little routine is going to do us all good.
Did anyone see “Autism: The Musical” on HBO the other night? What did everyone think of it? We’ve only gotten through the first few minutes of it. I have a hard time watching that stuff with Jonathan because EVERY SINGLE CHILD Jonathan sees who is on the spectrum is “just like Thomas.” At the very beginning, the boy Neal is throwing chairs and turns a table over. Jonathan says, “Geez, that’s just like Thomas.” I looked at him coldly and said, “Thomas does not turn over tables and chairs like that.” No inflection in my voice, no intonation. The next kid does something and Jonathan says the same thing. So I get very frustrated about that, even when he’s right because I don’t really want to watch something that forces the two of us to constantly compare our son to other kids. That’s what you do when you see other kids on the spectrum like that. The whole time, I’m thinking, “Oh, Thomas is better than that kid, but not as good as that one. Thomas knows how to sit still in circle time, but he doesn’t seem as high-functioning as that kid.” It makes me feel like I’m dissatisfied with Thomas when I’m really not. And I just get tired of playing compare-and-contrast. The other thing was that we weren’t really sure (just from the first five minutes, mind you) why this woman decided to put on a show with an all-Autism cast. Some of the kids who were participating seemed so uncomfortable and eager not to be a part of it that we weren’t sure why they were being made to join in. Jonathan and I are focused on trying to get Thomas to engage in more normal behavior and socially acceptable behavior. For us, not being in a play is perfectly socially acceptable. Anyway, I don’t know if we’re going to finish watching the show or not.
Back to school on Monday! Woo-hoo!
What are YOU doing here?
Nov 6, 2007 by dankohnCold weather has arrived and I’ve just dug the kid’s hats and mittens out of the nether regions of the closet. As if Thomas will consent to wear a hat! He did put his hood up this morning as we waited for the bus because it was apparently too blustery even for him. The weather was actually pretty good for Halloween this year. Last year, I remember that it had snowed before Halloween.
I went to Thomas’ school on Wednesday and quickly realized that I could have and should have skipped it. Hayley (who was also dressed up) and I went into the classroom and the kids were in circle time. Thomas seemed okay at first but it quickly became apparent that he was not really thrilled that we were in class with him. He kept coming over to me and telling me that he wanted to go home. The Halloween parade consisted of the kids walking through the halls and trick-or-treating with the non-teaching members of the staff. After they did that, we just went back to his class where there was unfortunately a lot of time to kill before I could take Thomas home so his teacher did some activities with the kids that Thomas was not into. He was really upset by me and Hayley being there! We were completely out-of-context to him and he didn’t like it. Hayley enjoyed it, though. She was allowed to participate in circle time and the “freeze dance” activity. She had a ball with that. She kept trying to hold hands and dance with other kids but she found no takers. I was kind of laughing to myself because Hayley is so social and the other kids in Thomas’ class are not necessarily. The other thing is that Thomas kept grabbing his crotch in his racecar driver outfit. It must have been irritating him somehow, but it was a little embarrassing to me and not him, of course. I had to promise him on the way home that I wasn’t going to be in his class the next day, but that I would come to school for the Family of the Week projects (when we’re the family of the week) and the Christmas Show. Actually, I’m sure that’s not what they call it. Whatever it is, it’s more politically correct than that.
Trick-or-Treating went okay. Thomas was already so hopped up on sugar that he needed to blow off some steam and kept running away from us on the sidewalk. He didn’t go in the street, but we had to chase him down a couple of times because he gave no indication that he would stop running, ever. We went with my brother-in-law and his wife and daughter (who was dressed like an elephant – so cute!) and the kids got the hang of ringing the doorbell ONLY ONCE and then when the door opened saying, “Trick or Treat!” and then saying “Thank you” when candy had been given to them. A couple of times, both Thomas and Hayley mixed up “Trick or Treat” and “Thank you,” but at least they said something. We were only out for about forty minutes and in that time, the kids were given far more candy than I was comfortable with. Luckily, they’ve made their way through all of it (I threw away a few bottom-of-the-bucket stragglers) and we’ve been brushing teeth five times a day since Halloween. Actually, the school nurse handed out little toothbrushes instead of candy. I thought that was a good idea. The OT/PT department gave away Play-Doh…and whole Hershey’s bars! I told the kids that we’d take the chocolate to Grandma’s cottage and use them to make s’mores.
Thomas has lately been telling us all about what happens at school. We get sheets almost every day (filled out by Thomas) but Thomas’ stories tell us far more than the sheets ever could. I heard a tale today about how one of Thomas’ classmates got a timeout for playing with the teacher’s Scotch tape. Now, a story like that has got to be true! I asked Thomas if he was the one who was playing with the tape and got the timeout but he said no, it was one of his classmates. We realized that Thomas has a tendency to tell us stories about himself getting into trouble at school, but he removes himself and inserts another innocent classmate. It’s kind of comical. Those things are the things that he tells us about when he gets home. Not what he played with or whom, not what art projects he worked on but who got in trouble, who got a timeout and who didn’t listen. He’s apparently very stimulated by discord and unrest. It burns itself into his memory. Actually, Jonathan was asking Thomas about what he did at school today. He asked Thomas if he played on the playground and he said, “No.” Jonathan asked if he went into the motor room and Thomas said, “No, I had gym class today.” We thought that was really cool – Thomas understood what Jonathan was getting at; what Thomas did at school for physical stimulation today.
We had a really great time seeing my sister and her boyfriend from California last Thursday. I actually got to spend time with her on Friday too as my mom graciously agreed to come over and watch the kids for me. They were very excited to see “Aunt Tiffy.” She really loved seeing them, too. We’re going to miss her over the holidays but hopefully she’ll be back sometime next spring or summer. And hopefully she’ll keep sending the kids t-shirts and candy, continuing to “buy” their love. Hey, it works! The kids always know who Aunt Tiffy is!