Leelo Rosenberg’s Program Update (10/10/06)
Data inclusive from 7/26/06-9/28/06
Note: Important new skills have been added to Leelo’s program, specifically expressive language skills such as asking questions and asking for attention. These will help Leelo to participate more fully in his social world. Another critical goal for Leelo is generalization of mastered skills to other settings and people, including family, school, play dates with peers.
GREETINGS:
Leelo consistently says “hi” to therapists using a 2 to 4 second time delay, and “bye” with no time delay.
Generalization: Increase fluidity in greeting siblings, parents; begin greeting teachers and peers in new classroom; greet Alys on play date;
EYE CONTACT TO “Leelo” AND “LOOK AT ME”; REQUESTING WITH EYE CONTACT:
Leelo’s eye contact is inconsistent, averaging about 40% in response to his name and when making requests. To increase eye contact, therapist now using discrete trials to practice early in session, and then practicing in context throughout the rest of the session. Use reinforcer at eye level for 1st trial in massed trials and in context.
Generalization: practice with family, school, play dates, to increase eye contact when making requests, and responding to “Leelo”.
MOTOR IMITATION:
Leelo imitates 1-step generalized motor actions 100% of time, and 1 step imitations with objects 80% of the time, both in the context of play. Imitating 2-step sequences of gross motor movements and imitations with objects continues to be challenging. To improve, begin working on imitating repetitions of the same actions (e.g. clapping 4 times, tapping the table 3 times, tapping a drum with a stick 6 times, etc). This will encourage Leelo to attend more closely, and may prepare him to imitate 2 different actions in sequence. Leelo should also work on imitations in the mirror, so that he can see what he is doing while he imitates.
Generalization: continue 1-step imitations with family, at school, with peers.
Next steps: imitate various intensities of actions (e.g. stomp vs tiptoe, clap loud and then soft) imitate 2 different actions in sequence
CATEGORIES and SORTING:
Leelo has mastered expressive and receptive category labels for instruments, and can sort instruments. Leelo is currently working on labeling and sorting pictures and objects into the category “toys”.
Generalization: practice labeling and sorting with family during household activities (e.g. cleaning up toys, sorting laundry, sorting silverware, etc).
Next steps: Begin working on features and functions of objects (e.g. “what do you do with (object)?”)
RECIPROCATE INFORMATION/COMMENTING:
Leelo is working on comments beginning with “I like…” using pictures and objects in his environment.
Generalization: continue practicing other comments mastered in dtt (I have, I see, it’s a, I hear, and describing actions of others “she’s (verb-ing)”. Do on play dates, with family, in school.
SOCIAL QUESTIONS:
Leelo has mastered answering “who is your teacher” for his current classroom teacher S. He knows at least 15 social questions in therapy, and needs to learn to use this skill in a variety of contexts, with many different people. He also needs to slow down his speech and clarify his articulation.
Generalization: practice with family, on play dates, at school with staff, peers.
Next steps: Begin asking social questions, using video modeling and echoprompt/fading to teach new skills.
FOLLOWING DIRECTIONS:
In therapy, Leelo is working on following 2 step directions, and 1-step directions that require traveling (e.g. go get a towel from the bathroom), and transfer of information (e.g. “go tell daddy to give you a hi-5”.)
Generalization: Practice traveling and transfer of info directions with family, peers, at school.
PICTURE AND TEXT SCHEDULE/PROMPT CARDS:
At home, Leelo is currently working on responding to a card with “stop” written on it. He is using a 2-card picture schedule which shows him what he is currently working on and what comes next. (E.g. first, then). During transitions to the bathroom, back to the table, etc, he takes the picture card with him and posts it at his destination.
Generalization: use at school throughout day, especially when making transition; use with family in form of daily schedule storybook to help Leelo understand and anticipate his routine each day, and to make specific transitions.
LEELO TIME (independent time):
Leelo is now working on 3 consecutive activities, with the first 2 being the same and highly reinforcing (e.g. preparing snack). Procedurally, Leelo checks his Leelo-time book to see what he should do. He then gets the materials pictured in the book, brings it to the table, uses the materials, cleans up the materials when done, and then comments to his therapist “I did it!” He can do this with about 1 to 2 prompts for each activity pictured, working through all 3 activities. Now he should begin to vary the comment when finished e.g. “I’m all done”, or “look at me!” etc.
Generalization: Leelo should do independent work with family at home, and at school.
NAME RECOGNITION:
Mastered- practice as maintenance, and across settings.
Generalization: be sure Leelo can read his name at school, around the house, in different sizes and prints/fonts, etc.
PHONICS/BEGINNING READING:
Leelo is working on naming the sound for letter Gg. He knows the letter names for all upper and lower case letters, and has mastered naming the sound for 7 letters in upper and lower cases (a,b,c,m,p,s,t). He becomes confused when 2 similarly appearing letters are presented close together (e.g. f and t), and when 2 sounds are similar.
Next steps: explore computer phonics programs; continue introducing single letter sounds. After Leelo has mastered about 15 sounds, begin more consonant-vowel-consonant (cvc) blending, probably introducing very DIFFERENT words (e.g. sat and mom). Very similar rhyming words which are traditionally introduced together appear to be confusing for Leelo.
JOINT ATTENTION- RECEPTIVE:
This involves someone calling Leelo to show him something. Leelo should look at the person, look at where the person is pointing, and look back at the person. Leelo has mastered the first 2 steps. Continue working on looking back at the person once he has looked at what they have shown him.
Generalization: practice in variety of contexts, e.g. looking at paintings /photos on the wall, looking at things in a tree outside, looking at things up on a shelf;
Next steps: do at school and home with teachers, family, peers.
JOINT ATTENTION-EXPRESSIVE (Also called “mand for attention”)
Leelo should call someone’s attention to show them something; Leelo is currently practicing “look at me” while swinging in a hammock, playing outside; he is also practicing calling someone by their name in order to get their attention.
ASKING QUESTIONS (Also called “mand for information”):
When presented with a container with something in it, Leelo should ask “what’s that?” Leelo currently working on this with video model, in discrete trial context.
Next steps: ask variety of questions, with multiple exemplars (e.g. “what’s in the bag?’ “What’s in the box?”); practice in variety of contexts.
PREWRITING and FINE MOTOR: Leelo continues to enjoy writing, drawing, and painting activities. Recently, we have added some supports recommended by Therapist LI, (Occupational Therapy) including wrist weights, slant board, and textured surfaces for better discrimination (e.g. writing with sandpaper underneath the paper). When told to “write your name” or “write Leelo”, Leelo can approximate writing his name with large letters (e.g. about 2-3 inches tall). Leelo is also working on snipping strips of paper with scissors
Next steps: refine writing name by writing inside a box, improve pencil grasp, coloring pages, writing alphabet letters and shapes; cutting larger firm paper.
TOILETING: Leelo uses the bathroom when prompted, and consistently urinates into the toilet when sitting on the toilet. He continues to have accidents when he is distracted, or when he has not been taken to the toilet in 1.5 hours or more. Continue to work on Leelo’s initiating toilet use (use picture prompts, and pair the statement “I need to pee” with transitioning to the bathroom and getting ready to pee into the toilet). Due to recent problems (possible anxiety and/or discomfort) associated with bowel movement and toilet use, his team has decided to wait for a few weeks before encouraging Leelo to use the toilet for bowel movements.
Next steps: After a break, Leelo will be encouraged to have bowel movements in the bathroom. (No sitting on toilet, pulling down pull-ups, etc required. Just being in the bathroom…) Family and therapists will make this as fun and comfortable as possible, always reinforcing Leelo for having his BMs in the bathroom. Once Leelo is comfortable doing this, then we will gradually shape doing BM’s into the toilet.
PLAY GROUP: Last week, Leelo began having play dates on Wednesday afternoons with Alyx, an old friend from Iron Gate Nursery who also attends Cloy Roud Elementary. Most importantly, Therapist L designs the groups so that both children enjoy being with each other. Other goals for the play date are for Leelo to increase his social interaction skills with Alyx, including greetings, asking and answering questions; increasing observation and imitation; and playing games with Alyx. During the play date, Alyx will also learn how to get Leelo’s attention, be persistent, ask questions and give directions to Leelo. Both children will learn to give each other complements.
NLP, SPONTANEOUS LANGUAGE, REQUESTS:
(S=spontaneous, P=prompted/modeled) Leelo’s spontaneous language appears less varied and frequent since beginning the medication Adderupp. He also has had difficulty imitating 4+ word phrases, which previously he had been doing. Using a sort of “warm up” procedure, where we practice one word, then 2-words, gradually increasing the length of the prompted phrases, he is again imitating 3 and some 4-word phrases. He continues to generalize language taught in discrete therapies to his spontaneous language (such as commenting “I like”, calling someone by name to get their attention, and requesting a break).
S tub has towel S- take a bath
S I want to take a break (therapy goal) S I’m making a straw
S I like glasses (therapy goal) S It’s the truck Therapist L
S Want to go watch Cookie Monster S “Therapist L” (therapy goal)
S Turn off the light S What’s that?
P I like the light P Do it again!
P I’m Tinky Winky P Jump in water
P Tape is sticky P Hi teacher S
BEHAVIOR:
Leelo’s behavior during therapy has been mostly appropriate. He continues to hit himself on the head when frustrated, tired, or for other (sensory?) reasons. This behavior is now usually a brief episode (2 to 10 seconds, compared with extended hour+ episodes this spring and summer. His mother reports that he is also much calmer and less volatile on the weekends since on 5mg extended release Adderupp. During therapy, Leelo continues to practice using more appropriate language to meet his needs, including:
Requesting a break
Requesting affection and attention by saying “Let’s hug” and “Hi (name)”
Requesting more of a preferred activity as it ends
Saying “No (item)”, when something is offered that he doesn’t want
Leelo is now occasionally spontaneously requesting a break, and consistently requests a break when shown a break card. Leelo has also been learning to stop whatever he is doing when someone says “Stop”. He needs to practice this and his above ‘replacement skills” in a variety of settings, and under both relaxing and stressful conditions.
MEDICATION: Leelo has been taking 5mg extended release Adderupp since July 18 2006 [SR: Changed to 5 mg Fukalin XR on October 19 2006]. The medication appears to reduce his hyperactivity, distractibility, and impulsivity; improve his attention; improve his ability to walk around without bumping into/stepping on people and things. On the negative side, Leelo seems socially more disconnected and less interactive with people, his spontaneous and imitative language is less frequent and varied, and he has what appears to be increased ritualistic behaviors. Squid will be communicating with Dr. Sheyenne about these developments, and exploring options to increase the optimal effects of medication treatment and reduce the problems/side effects.
KINDERGARTEN AT Cloy Roud ELEMENTARY SCHOOL: Leelo began attending the autism kindergarten in Deadwood City School District on August 21 2006. The teacher is S, Leelo’s one-to-one aide is Rosie, and the other classroom aides are Ms. B and Lois. Leelo is learning to follow the routine, and was observed to independently transition from the door to work at the table, and from table time to circle time. He needs help packing up his backpack and putting it on- this should be practiced at home as well as at school. He also is using the toilet at school, with frequent prompting to transition to and complete the toileting steps. I am currently consulting with his staff around reinforcement, including the introduction of a token system like the one he uses at home during therapy. Leelo’s current classroom can be considered a generalization setting, where he should be using skills learned in home ABA therapy. To facilitate this, I will share information such as this program update with his staff, and work with them to create opportunities for Leelo to use his skills many times throughout the day