today was our first home visit of Roz and it was really nice to get to meet her finally to see another part of the picture here was Roz'z notes.....
January 25, 2008
Psych Consult Notes
In attendance: Jes, Christine, Roz
Meet and greet with Christine, Dallin and his siblings, Josh and Sarah. It was wonderful meeting you all! The following areas regarding behavior were discussed, along with provided suggestions.
1) Frustration Tolerance
· Dallin has a low frustration tolerance to having other(s) in his play space. Dallin does use his words to tell (for example) Josh to “go away” but it can escalate to aggressive behaviors if his words are not honored. Aggressive behaviors include punching, biting, sometimes spiting, head-butting.
· Dallin also has low frustration tolerance to not getting his way/ being told “no”.
Suggestions:
-Honor Dallin when he uses his words by responding, (for example) “Thank you for using your words. Josh, please play over there”. May need to physically prompt Josh to move. This will prevent escalation.
-During programming, work on building his frustration tolerance by starting with CDT (child developmental therapist) to use a visual timer and let Dallin know they will be playing together for this (e.g., start with 1 minute) long , then Dallin can play by himself for this (e.g., 1 minute) long (CDT to sit back and observe, no interaction). Once Dallin has success with 1 minute (i.e., 5 out of 5 times he can tolerate with minimal prompting or meltdowns), build on the time by 1 minute.
*Note: The duration of time should be something that would be easy for Dallin to start with, where he can tolerate the other with little difficulty. It’s important to build on success. The adult can always increase the time once Dallin understands how the visual timer concept works.
-The cue can be “When red all gone….all done/play on your own/time to play with me”
-Use a first-then visual to support. For example, may want to have a “play together” visual in FIRST box, and a “play alone” visual in THEN box. Or can be more concrete and have a picture of Angie and Dallin in first box, and Dallin alone in THEN box. What ever you think would be more meaningful to help him understanding.
-A Social Story to support. I have attached one for a sample. If you would like to use it, feel free to adapt it to Dallin.
-A calming script can also be created to teach Dallin to calm. It should be kept visually simple. An example of a calm script:
I’m mad (mad face)
It’s ok, I can calm.
I can:
-go to my calm spot (usually room or corner with bean bag or couch – somewhere neutral and away from high activity)
-have a visual list of calming activities (e.g. read book, deep breaths, deep pressure, squeeze a ball – include behavioral and sensory methods)
I am now calm (calm/happy face).
2) Community Outings
· Tied to frustration tolerance with not getting what he wants.
Suggestions:
-Social story in helping him understand that he can’t always have what he wants, and how to deal with this. (Jes, anything like this at the office?)
-A powercard to support his understanding (see http://www.autismspectrum.ilstu.edu/resources/factsheets/powercard.shtml for more info on powercard)
3) Safety
In home: Dallin is engaging in dangerous activities:
-turning on stove (he enjoys watching the red light up)
-dumps things in fridge (currently fridge is locked)
Street safety: -walking onto street without looking for cars
-running towards area of interest without looking for cars
Suggestions:
-Social story on home safety, implementing a natural consequence (e.g., time out).
-Support social story by using visual signs of “NO” or “STOP” on stove, door, fridge.
-Teach and review daily with Dallin (and siblings)
-Important to be consistent with consequence if they don’t listen (e.g., time out).
-Be sure that time outs are NOT in the same area as calming spot and are not reinforcing in any way. As I am sure you know, no interaction (positive or negative) should take place during time outs.
4) Cognition:
Dallin will benefit from learning about “yesterday/today/tomorrow”
Suggestions:
Use visuals, calendar
5) Sleep
Currently Dallin has difficulty sleeping (Christine, I can’t remember, is it with falling asleep or staying asleep?). Josh shares a room with Dallin, and he is afraid of the dark. Currently, the light in the room stays on, which probably makes it more difficult for Dallin to fall/remain (?) asleep.
Suggestions:
-lava lamp, tent cover for Dallin’s bed
-Christine is currently making heavier blankets.
-Please consult with OT for further suggestions- may want to consider having a calming sensory routine if that would help – again OT will know more. J
6) Transitioning
Dallin has difficulties with transitions, especially going into the weekend (i.e., Fridays) and coming out of a weekend (i.e., Mondays). These days tend to be tougher for Dallin to progress through the day, as demonstrated by more meltdowns.
Suggestions:
Consider giving Dallin more downtime and more breaks on Fridays and Mondays. So for example, that might look like he gets time alone more often and longer than other days. During programming, this also looks like he will get more breaks and self-regulation/sensory exercises (please consult with OT).
-Family is in process of building sensory room in basement J
7) Cognitive Flexibility
Dallin is very rigid at school. However, at the office, he does not demonstrate the same rigidity as he is quite excited to play. It sounds like he is rigid about being on his agenda, but not the routine itself. Is this correct?
Suggestions:
-Less following his lead, more adult directed during programming. Work on building his frustration tolerance. If he has a meltdown, redirect him to calm (i.e. calm script). Be sure to bring him back to original activity to finish (even if only for 30 seconds) after he is calm.
-use a visual timer to let him know how long he has for each activity. Include using for preferred activities as well, so that he does not associate visual timer only with non-preferred activities.
I think those are the areas we touched upon! If I missed anything let me know. Any questions, please contact me!
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