Here are the latest whats and hows of Leo, from his most recent team meeting. Leo himself left for week-long sleepaway this afternoon. I am trying not to freak too much, or worry about the sniffly nose his camp nurse said was fine as long as he avoids a fever. I am also convinced he'll lose his first front tooth while he's away -- it was flapping in his mouth like a broken gate. I hate to miss that. The camp crew said they'd try to save it, if possible.
Leo’s Team Meeting Notes 7/30/09: Squid, Therapist V, Supervisor E, Supervisor M
Does about 15 min per session, needs prompting to keep on task and not click mouse randomly, working on consonant-vowel (CV) and CVC words and simple sentences.
ACTION: continue with adult facilitation (not independent work)
Pants up: working on buckling at school, next step-transfer skill to belt on waist; Leo now using briefs (not boxers)
ACTION: get mirror in bedroom to increase Leo’s ability to self-monitor and manage his own pants; be sure to slow Leo down when he is dressing so underpants are pulled up neatly first, then pants. Keep pants short (e.g. cuffs)
Nice, steady improvement at home and school, except when very hungry- frantic, grabs food.
Update from Therapist V
Nice progress re: folding laundry, following directions w/traveling; getting attention using name, giving a play idea; walking- fading out holding hand.
Action/CAUTION: - Leo may bolt into street without clear warning/provocation, be sure to reinforce his walking beside you and be ready to grab him if he runs into traffic.
Action: next step for getting attention and giving a play idea- Leo needs to further expand these requests (currently fluent with tickles, hugs, physical play and affection); consider as next steps- requesting books and activities, using visual choice board prompt or the actual materials. (Therapist V, Therapist E, Therapist M, Squid and Seymour)
Aggressive behaviors include: hitting, pushing, pinching, scratching, kicking, elbow grinding, head-butting others, throwing materials
Self-injurious behaviors include: slapping self on face and stomach, hitting head against surfaces, hitting hands against surfaces,
Precursor behavior: stomping
Responding to target behavior: (Therapist E and Therapist M modeled)
Aggressive: MOST IMPORTANT: EVADE (step back/away, do not approach or touch)
- “Stop” + visual
- “Sit Down” + gesture
- “Check schedule” +name card
- Leo transition to next activity +schedule icon
Self-Injurious- prompt more appropriate replacement; redirect; ignore; remove straw if he is chewing/holding.
If blocking, do NOT make eye contact. In general, minimal eye contact when problem behavior is occurring.
Social interaction and play, and problem behaviors with siblings
Squid expressed concerned about safety, and is currently emphasizing preventing problematic contact, and keeping Leo engaged to reduce aggression;
Therapist M- Leo needs to develop a repertoire of positive ways to interact with Mali, Then, he needs to practice positive interactions with Mali at least 5 times as frequently as he is aggressive with her. So- if he hits her 3 times in a day, there should be at least 15 opportunities to practice some more appropriate way of interacting with Mali.
Leo also needs to be able to control himself (vs us managing his aggression by keeping him engaged, limiting his world to those environments that do not occasion aggression).
Supervisor M continues to recommend that Therapist V work with Leo to greet/hi-5 etc. Mali at least 5 times during their session, and that they do at least 1 table activity/game together, with Leo and Mali across from each other (e.g. try Eric Carle picture-imitation game), or an obstacle course (they have done this together in the past). If necessary, 2 adults can facilitate to ensure safety.
This activity should be a regular part of Leo’s visual schedule with Therapist V, so it becomes routine for Leo.
ACTION: Squid and Seymour to communicate with Therapist V, Therapist E and me around this, so that we can develop a comfortable plan for working to reduce Leo’s aggressive behavior at home.
Next steps- Action: Squid elected to continue working on standing while peeing at the toilet at home and in other locations. Therapist M will facilitate at school.
ACTION: re-visit toileting initiations and night-time continence in 2 months.
Independent Work/Leisure at Home
Continue to manage materials- variety, novelty, high-interest, systematic rotation; and to do in various locations
ACTION: keep adult prompting to a minimum; if prompting is necessary (e.g. if Leo gets off task, needs help) , it should be a physical prompt or a gesture, and NO EYE CONTACT. (Therapist V, Therapist E, Squid, Seymour)
ACTION: store weekly supply in big bin- let Leo chose from these to set up own materials. Then rotate out each week. (Therapist M set up this week)
Visual Supports at Home
Family reports consistently using mini-schedule for 3-5 activities, or “first-then” situations, especially helpful when out of house, changes in routine, etc. Using mini-binder for storage (alphabetical).
ACTION: more name cards needed, and icons for going on trip (Therapist V, Therapist E)
ACTION: fade out picture on “snack” card to increase sight word vocabulary (Therapist E);
Put meals, snacks, and straws on schedule to reduce behavior problems (Squid, Seymour, Therapist V)
Therapist M met with new Teacher C and former teacher M to facilitate transition. It is likely one para from current class will move to Teacher C's class with Leo.