The Family Room

Map It!

By Jordan Sadler, SLP

Last week, a post at the blog From Here to There and Back prompted me to suggest that the blog's author create a visual map of a challenging situation her son experienced at school.  The subsequent off line conversation about this with the writer - and comments from her readers showing great interest in the topic - led me to think that perhaps this is a topic worthy of further explanation.

There are many ways to use visual strategies to map out a social situation for children.  What I do in my work is ultimately a combination of ideas I have picked up over the years at numerous workshops given by Michelle Garcia Winner, SLP, who runs The Center for Social Thinking and Carol Gray of The Gray Center for Social Learning and Understanding.  I give both of these amazing women full credit for the way I approach the teaching of social understanding and social thinking to children.  Their work fills gaping holes in what is considered best practice for kids with social-pragmatic difficulties right now.

The ideas proposed by Ms. Gray and Ms. Winner make perfect sense once you've heard them explained, but are not, apparently, intuitive to many therapists because so rarely are children (or adolescents or adults) taught this way.  In effect, we - therapists, teachers, and parents - are encouraged to approach social-pragmatic awareness not as a series of skills to be trained (as has been done in social skills groups and traditional ABA-type therapy), but as a process in which we help people to understand why we communicate the way we do. We want children to understand what kind of impact their behavior and language has on others.  We don't say, "Look at my eyes!" to teach eye contact but rather explain, "People's eyes are a window into what they are thinking about - if Ben is looking at the clock, he might be wondering if it's time to go home."   Non-verbal communication is explained in such a way that it carries meaning and becomes motivating to our clients.  Of course, there is so much more to this, and I highly encourage those interested to seek out books and workshops with the experts in this field.

I am going to provide an example of a behavior map, and in order to maintain confidentiality for my clients, I will use an experience from my own family. 

When my neurotypical older son was about 4 years old, we were at a neighbor boy's home.  Now the neighbor boy's parents were both early childhood educators, and there was no place in the world as fun as their house.  They had a big climbing structure right in their living room!  It is no surprise that my son didn't want to leave.  Ever.  On one occasion, after ample warnings (the "5-minute countdown", I call it) it was time to depart.  My son refused and became quite belligerent.  After trying every strategy we well-trained adults could think of, I ended up carrying him home as he kicked and screamed; I was hugely pregnant, exhausted, and incredibly frustrated.  I know we've all been there in one way or another.

When we got home, I was at my wit's end.  We were infuriated with each other.  I did all I knew how to do in that situation, which was to sit silently on the floor and pull out paper and a marker.  I quietly started to draw.  Now, let's get something straight: I am no artist.  That is not a requirement for this!  In this situation, I sketched out the scene like a cartoon, and my son immediately sat down to watch.  It started with two boys playing happily.  Always show emotion on the faces throughout a social map!  In the next frame, there was a smiling mother giving a 5-minute warning and the boys were still smiling.  As we got down to the 1-minute warning, I showed the expression on my son's face start to shift into anger. 

When the stick-figure mother announced in her little "speech bubble" that it was time to go, I drew a boy with the angriest face I could muster and limbs out of control.  But I think what was critical here was that I also drew the neighbor boy and his parents - all with concerned, sad faces - and myself looking angry.  In the midst of a tantrum, our kids are not generally aware of how their behavior is affecting anyone else.  If you can represent visually to a child the ways in which his actions affect how others think and feel, you are giving him the key to social thinking, or theory of mind.   I pointed out to my son that he did not say "thank you", nor did he say "good night" to our hosts and that when we left they were all feeling sad.  He was really impacted by this.  I explained that when you leave nicely, you are more likely to be invited back soon.   

I then pulled out a new sheet of paper and we started with the same beginning but recreated the sequence of events as he would like them to unfold in the future.  He decided that he could say, "I don't want to leave!" and he could feel as angry as he wanted to, but that he would leave without a tantrum, and we drew the whole thing as he described it.  This sounds like a very long process but we really only spent about 10 minutes doing it.  It's not about the art - it's about keeping the child's attention focused on the unfolding events - so it can move fairly quickly, depending on the situation and the child's processing speed.

We went back to that friend's house a great many times after that night and we never, ever had a problem leaving again. 

There are as many ways to create a visual map of a social situation as there are different social situations for our kids to experience.  There is no required format for this.  Depending on the situation and the age of the child, you could create a cartoon strip, a flow chart, or any other picture that shows a sequence.  The important part is that you visually and simply represent the ways in which the child's actions impacted other people's feelings and how they thought about him, and led to a specific outcome.  Having the opportunity to remap the situation is critical!  Your child will not learn enough from simply seeing the unsuccessful scenario portrayed; he needs an opportunity to think through an alternate ending in order to use different behavior the next time something similar arises. 

Michelle Garcia Winner has a recent publication called Social Behavior Mapping which will undoubtedly provide many terrific strategies, and Carol Gray (who came up with the concept of Social Stories) has a great little book called Comic Book Conversations which outlines another means of using visual support to aid understanding of language within social situations.   There is always more to learn about helping our children and clients improve in their social thinking; we are so fortunate to have these experts as resources.

Those of you in the Bay Area might be interested to know that Michelle Garcia Winner and Carol Gray are running a workshop together December 4th and 5th in San Francisco. They are very parent-friendly speakers!

Composed a Few Miles Above White Plains, On Revisiting the Grandparents, August 2007

Back from tantrumland, at least for the moment. Was it Wordsworth who said that poetry is "emotion recollected in tranquillity"? If so, our lives are pure poetry these days. In my more disoriented moments, I find this thought mildly reassuring, even though I doubt that's what old Will had in mind as he was penning Tintern Abbey during that lazy summer back in 1798.

***
On the train to the city yesterday (grandparents generously having offered to watch the boy), J. and I did some recollecting ourselves, some talking each other off the ledge, some vague rationalizing, but we mostly just gazed out the window and read, save for the occasional "He did great this morning. Did you see how he..." And then our voices would trail off, and we'd read a few more pages as the landscape flew by.

Many blocks, a triple-marked-down jacket (ah New York summer sales) and a rushed and mediocre pedicure later, I am feeling a little more myself. Is it that sometimes I need to hit the pause button? Is it the exertion of managing my feelings through every meal, moment, transition, wondering what's around the next corner? Mostly Isaac has been terrific here--affectionate toward his grandparents, connected and happy--but the twice-yearly visits always feel momentous in some way, as if we need to demonstrate, in five short days, the arc of his progress and the gorgeous 45 degree trajectory of his future...so everyone else will be happy? So they'll stop worrying? So I can relax and feel like a good mommy?

No one is asking me to feel this way. It's my own doing, and it feels somehow as traitorious as it is pointless and exhausting. He is not a science experiment, after all, just my own sweet boy, who is who he is, who learns and grows and changes with each passing season. So I need to, as a certain colleague of mine would say, put on my big-girl pants and deal. Here it is for your reading pleasure--me dealing.

***
Tomorrow we get on a plane and go home. I'll share some of my newfound travel tips for those of you contemplating a plane ride anytime soon (#1: If you have a sound-sensitive and newly potty-trained child who has never been in an airplane bathroom, you might consider a pull-up for the ride. We did okay after a four-hour nail-biter when I finally convinced him to go with the door open and his hands over his ears. I'm sure the whole cabin appreciated that memorable sight).

***
But, back to the moment. Dinner, which came from the farmer's market at the Rockefeller Preserve, is done, and the dishes are washed and put away. Nonna is upstairs, Grandpa is on the couch, and Isaac is sitting on the floor with J, who is trying to tempt him with a variety of delicacies--blueberries, carrots, strawberries--to go with the ubiquitous crackers. Then they get silly, J. suggesting a range of other options for the meal: crackers with hummus, with hair, with cars, with blocks, and Isaac starts to giggle. It is our own sort of tranquillity, made a little melancholy by the fact that we return home tomorrow. And so we'll see what home, and daily life, and a new school year, will bring.

***
While with an eye made quiet by the power
Of harmony, and the deep power of joy,
We see into the life of things.

- William Wordsworth, "Composed A Few Miles Above Tintern Abbey, On Revisiting The Banks Of The Wye During A Tour. July 13, 1798.

Playdate Series Part 2: The Playdate

Interview with Fiona Zecca, Early Childhood Development and Behavioral Specialist

So, yesterday we talked about setting up the initial playdate. Can you elaborate on what we should look for in choosing a potential playdate partner?
Start by picking a child your child is interested in. Your ultimate goal is to have your child interact with another child, so pick someone who motivates your child. If you are unsure of this and your child is in a school or child care program, ask his/her teachers. If your child hasn't had many opportunities to form interest in another child or simply is not interested in other children, pick a child that is easygoing and willing to go on a playdate. Pick someone that you know is a good match for your child's temperament and sensory system - someone who will not overwhelm them. If your child is typically the leader, pick someone who can follow. Note that some kids that do not seem like they would be a good match sometimes bring out the most in each other. Probably it is most ideal to pick someone in your child's same age range.

What should be the format for the playdate? Where should you do it and for how long?
To start with I would have the playdate at your house, for no more than an hour, ideally once a week. Your child is going to be comfortable at his/her own home and this allows them to feel in control and possibly have the opportunity to show the other child some toys/activities that interest him/her. This is also beneficial for the partner because kids typically love going to someone else's house to check out their toys. Also, a park is the worst place to have a playdate because the children are not natually motivated to stay togetehr and play the same activity. You often will find one child on the swings, while the other child is going down the slide.

How do you choose the right activity?
I recommend choosing an interactive, high-interest activity that you will lead with the two children, such as baking/decorating cookies. If possible, playfully guide the partner to involve your child by transferring any directive you might give to your child on to the partner to keep your child an active participant. For example, you might ask the play partner to be in charge of the M&Ms by having him ask your child how many he/she wants for each cookie and what colors. This way they are having constant interactions. Eventually you will fade out as the playdates progress and the children are able to interact without so much support. I would recommend doing the same high-interest activity each week to give your child the opportunity to practice his/her role and because most children love predictability and repetition. Change the activity when it is clear they are bored and want a change. Other ideas might be: putting together a ginger bread house or painting a large cardboard box to make a train they can ride in together or an interactive structured game such as "Don't Break the Ice" or rocket stomper or large bubble wands or balloon pumps, etc. What you will choose will depend on your child's interests. Just make sure it is motivating to both children, and, naturally interactive.

So how do you tell if it's not working?
Give the partners at least four consistent times before giving up. Look for small amounts of progress. Certainly you should reevaluate if either child is having a horrible time, but be sure to not give up easily. Even if your child doesn't seem to be getting anything out of it, he/she may be getting more than you think. You may want to take some photos of the playdate in progress and post them on your refrigerator so your child can look at them during the rest of the week and anticipate the next playdate. If you find you just can't bear leading the playdates, it is just not your thing or perhaps you are too emotionally involved, see if you can get someone else to do it, an aunt, your child's dad, a tutor, a social coach, perhaps an aide from your child's school who wants to earn some extra money.

If you would like to ask Fiona a question, leave a comment here or contact her directly at fiona [at] fionazecca [dot] com. You can also check out her Sensory Social Playgroups website here.

Playdate Series Part 1: Finding the Right Partner

Interview with Fiona Zecca, Early Childhood Development and Behavioral Specialist

The very thought of playdates strikes fear into the hearts of many parents of children on the autism spectrum. Who should I ask? Should I tell them about my child's challenges? Should I choose a typically-developing child or one with similar challenges? Will it be awkward? Will it benefit my child? Will he or she participate? Will the other parent agree? And what do we do when we're there? I asked Fiona Zecca to talk about the very first step: finding the right playdate partner for a child on the spectrum. Here is her answer:

I think it is probably more beneficial to match up with a typically developing kid for a playdate. The "expert" player is then able to more easily take some direction from you and keep the interactions going with your child. Of course you could have a playdate with two kids on the spectrum but probably the expectations would be very different--it would be more for exposure to peers and hopefully some interactions. I think the latter would be a lot of work for the mom/dad facilitating the playdate and bring on frustration, like "what's the point of doing this?"

In the past when I have helped organize playdates with some of my clients, the mom of the child on the spectrum has explained to the other mom that her child needs some practice socializing, that this is done best in a 1-on-1 playdate setting and she has been told by the child's teachers that these two kids seem to enjoy each other. She could then suggest picking up the child up from school once a week and have him to their house for an hour. In other words, making sure that the family pursuing the playdate does as much of the work as possible (pick up, drop off, etc.) so that the play partner doesn't feel burdened and want to bail out. With this format it will be very clear whether the other parent is a good match or not. Either they will agree to participate--or not.

As far as matching up two compatible kids, you have to take a chance and try different partnerships. It will be kind of obvious whether it is a good match. If your child is not in distress and it seems that both children are enjoying the activity, it is a good match. If you are matching two spectrum kids together and it feels too intense and too much pressure for each child (and each parent), this is probably not a good match. Even if your child feels some anxiousness anticipating the upcoming playdate but then slowly progresses each week by participating more, or being more interested in the partner each week, this is success. Remember that typically it takes children time to get used to everything. The more you do the playdates, the more he/she will be able to predict the routine, etc. Stick with it, if possible. You know your child and how long it usually takes him/her to get used to a new situation, if he/she has exceeded this typical timeline, probably not a good match, try another partner.

We'll go into more depth on this topic tomorrow. Stay tuned!

If you would like to ask Fiona a question, leave a comment here or contact her directly at fiona [at]fionazecca [dot] com.

Daily Life, a Day at a Time

I've been thinking about the big things lately: the past, and what it means, the future, and what it will bring, and, most importantly, what's happening now. For a long time after the diagnosis, we lived in a sort of siege state: running from evaluation to evaluation, therapy to therapy, hoping for the magic sign (or someone) to tell us it was alll a big mistake; he's just a late talker, he's just shy, he's just on his own schedule.

Isaac is in many ways at the edge of the spectrum: he's become verbal, he's blessedly free of medical issues, he's social (with adults), and sometimes we even forget a little that he's different. But if he's tired or ill, or going through a growth spurt, or in a new environment, or around other children, he can become very stimmy and remote, and it all comes rushing back: yes, he is a different kind of child.

At a certain point, we moved from the initial period of crisis into something new, something that felt a little different. Oh yes, I finally realized, this is autism. This is your life on autism. And that has brought a whole host of realizations along with it. Sure, some things are better. Isaac continues to learn and grow and surprise and delight us. We're no longer obsessively over-analyzing everything he does. We've moved into a state of acceptance, and of (generally) knowing how to deal. But there are some other important realizations too. A simple cold can throw us all into chaos. I was starting to look, and feel, tired and haggard all the time. We need to eat better, get more sleep, exercise and generally take better care of ourselves. We need to find time to enjoy what we're doing, right here and right now. We need to move past the siege state into something more manageable for the long term.

And that is the crux of it: learning how to live, really live, with an autism spectrum diagnosis. Last week it included a trip to the steam trains for Isaac, a trip to the gym and record store for Daddy, and a cool new pair of jeans for Mommy. This morning, J. will take Isaac to the local farmer's market, where he'll eat fresh peas right from the pod and demand a challah roll from his favorite bakery. Tonight we have a babysitter and we're going to see the new Harry Potter movie and then have dinner together. Oh, and actually talk. To each other. In about five minutes I'm going to do three sets each of sit-ups and push ups, and a few yoga stretches, to get my blood moving and welcome the day. (How can I do this, you ask? Everyone else is still sleeping). It's small, but it's progress, and that makes it feel huge.

Take care, my friends. Do something nice for yourselves this weekend.

Learning to Spell, Our Way

This morning, I awoke to the following snippet of dialogue emanating from the dining room:

Young Boy: S-T-A-L-I-N. Daddy, what does that spell?
Daddy: Isaac, you know what that spells. What does it spell?
Young Boy: S-T-A-L-I-N spells STALIN!
Daddy: That's right! STALIN!
Young Boy: K-N-O-P-F. What does that spell?
Daddy: K-N-O-P-F spells KNOPF. It's a very well-respected publishing house in New York. KNOPF!
Young Boy: (giggles)
Daddy: KNOPF! Isn't that a funny word? KNOPF! KNOPF!
Young Boy: (more giggling). KNOPF!
Mommy: (groggily). What the heck is going on in there?
Daddy: (in a rather droll tone of voice) We're reading the paper.
Young Boy: KNOPF!! KNOPF!!

Honestly, sometimes I think that the neurotypical world is overrated.

Serendipity and a Fine Pizza Pie

Kristen's comment to my last post reminded me that, for a while now, I've wanted to write about expectations: you know, those critters that look cute and harmless, but can really turn nasty if you let them. Last weekend we took our expectations to the zoo, where we left them, damp and crumpled, under a pile of elephant poo. By which I mean that Isaac did NOT have a good time, whether because of the heat, a bout of four-year-old cussedness, or the buzz and unfamiliarity of the place. Who knows? And it doesn't really matter, because the "big fun" places (anyplace that costs more than $20 to get in and/or ends in "land") rarely work for us: too noisy, too loud, too much. But we still find many, many ways to have fun. But it's mostly when we don't plan; when we let serendipity take its course, and then, as it happens, fun finds us.

This afternoon I took Isaac to lunch at our very favorite pizza restaurant. I called ahead and ordered a pie to go, and when we got there the place was jammed with 20-somethings, plus a crew of hipster parents enjoying a pie with their similarly hip-looking kids. We stood in the cramped doorway listening to fairly loud hip-hop while we waited for our pie to finish baking. And you know what? I began to sway a bit, and Isaac swayed along with me, and soon we were sort-of-dancing along to the music. And then Isaac caught a glimpse of us in the mirror on the opposite wall, and turned and gave me a look of such delight and love that I vowed on the spot to exorcise those $#!@#% expectations forever. I am not so delusional to think that's actually possible, but I try, my friends, I do try.

Finally the pie was ready, and we took it, and a nice big cup of milk, outside. We sat on the wooden bench and munched while we people-watched: a parade of dogs and their people, kids and their parents, and a glorious rainbow of haircuts, colors and tattoos on young and old alike. It was our city, and it was heaven.

Later, I dropped Isaac off with J. for a few hours and went in search of my long-lost mojo. I treated myself to a frozen yogurt, a pedicure, a summery lip gloss and a pair of jeans, and, by the end of the afternoon, I am happy to say, I felt sort of like a girl again.

Highs and Lows

So we went to the zoo again yesterday, lunch packed, all sorts of best intentions, and you know what? He hated it. HATED IT. Didn't want to see the animals, didn't want to do much of anything, in fact, but sink to the ground and wail, "Naaaaah!!!" Was it the heat? (It was pretty hot, after all.) Was it the subtle (or not so?) pressure of a "fun day out?" Was it just a bad moon phase? Dunno. So we left after much heroic effort to have fun, drove down the hill and went for ice-cream and a walk closer to home. And you know what? Fantastic mood for the rest of the day: giddy, silly, loving, talkative, the whole bit. If only we could parse out these $#@!#$ moods and see what they mean.

Three hallmarks of this current phase, at age 4 years, 0 months: obstinacy, limit testing and joke cracking (of a sort). Is it possible we're in early puberty?

Another Post About Searching for Perspective

This past week I've been a blogging deadbeat. All sorts of things happening, can't figure out what to say about it, want to be cogent and offer perspective, but it's not always easy from the eye of the storm. And it's been a little stormy around here lately. As usual (and we are lucky for this), a lot of happy and harder stuff all mooshed up together. On the good side: after many stops and starts, Isaac is now quite close to functionally potty trained. It's really adorable to see how proud he is, too. (In deference to his dignity, I'll spare you the earthier and cuter details). Today, he actually let the doctor examine him--imagine that. And he's learned how to use the computer mouse, which is probably a mixed blessing, but for hand-eye coordination you can't beat it. And the lullaby thing is going well, which has made bedtime a little easier. But boy, the moods on that kid. He is really resistant to therapy lately, and we can't figure out whether it's him...or the therapy. And did I mention the tantrums? Every. Little. Thing. In deference to my better nature, I am trying to convince myself (and J.) that it's just four-year-old stuff, and stop with the is-it-or-isn't-it game that we used to play so relentlessly. Is it a typical kid tantrum, or an autistic spectrum tantrum? Try saying that three times fast.

My big revelation of the past week: we are in a new phase. We are past the initial shock, past the initial crisis period, and well into daily life, with all its bruises and little victories. But sometimes it all comes rushing in, and it's hard to sort out how and what to feel. And that's the eternal kicker, isn't it? What is his, and what is ours, and where it goes, and what it means. My short-term plan for this, all kidding aside, is to organize my closets and maybe even have a garage sale. It won't answer any of my questions, but sorting something out, however trivial, always makes me feel better.

I Want More Mockingbird!

A few weeks ago, Jen Graf Groneberg wrote a lovely piece on ParentDish called Singing to My Children, in which she recounts her gradual acceptance of the power of her own singing voice as a way to connect with her boys. It's such a sweet post, full as it is of her insecurities and how she ultimately shrugged them off as she discovered how much her kids loved music--her music. I sent her a note afterward, a little ruefully telling my own story early on with Isaac. I had decided on day one that I would be a lullaby-singing kind of Mom, and hoped that it would bring Isaac and me closer together and represent a sweet, intimate moment of peace and communion between us before he fell asleep each night. Ahh, romantic sap that I was. Then one night, as I softly sang the mockingbird lullaby ("Hush little baby, don't say a word..."), Isaac raised his head from the pillow, pulled his damp thumb from his mouth, looked me straight in the eye, and softly whispered..."Noooo."

This led to a lullaby recession, in which we focused more on made-up bedtime stories (latest favorite is about a large pink monster with two noses and two mouths, named, according to Isaac, "Very Mad"). But one night a couple of weeks ago he was having a rough time getting to sleep, so I asked him if he wanted me to rub his back. "Yes," he whispered from underneath the covers. So I starting rubbing his back and in a moment found myself singing "Mockingbird." Oh the excitement. "I want Mommy sing Mockingbird again!" A few weeks have gone by and we have added Toora Loora to the playlist. If you don't know it, it's a sweet Irish lullaby that my Mother used to sing to me when I was about Isaac's age. We have absolutely no claim to it, seeing as how not a drop of Irish blood runs through our veins, but we're hoping we can borrow it anyway for at least another generation. It's just lovely, and very, very soothing.

So now I'm on a little bit of a lullaby bender, looking for the next candidate. Jen likes "Edelweiss," which I have always loved, but it has the distinct disadvantage of making me cry nearly every time I hear or sing it. So who knows? We may have to get a little creative. Not long ago, I overheard J. singing Isaac to sleep with "I Want You to Want Me" by Cheap Trick (a sentimental favorite: the first album he ever bought). So while we may diverge from the tried and true, at least I am secure in the knowledge that, just like Kajagoogoo, I am ready for my comeback.