Friday, August 18, 2006

A Couple of Bear Updates

Sometimes you lose, and sometimes you win.

On Wednesday the Bear had another PECS session. She was doing so well at home, demonstrating that she understood which card to use to request ‘milk’, or her soother, or the swing, and she was also showing signs that she was starting to understand other cards as well (for various videos and games we play with her).

So at the PECS session, I set up her binder with three cards on it (nose, spoon, and ‘milk’). She selected the milk card and handed it to me. I held it up to show her, said ‘milk’, and then handed her the cup with a couple of ounces of milk in it. While she drank the 'milk' I put the binder out again with the soother card. When she finished, she handed me the cup, looked over, grabbed the soother card, and handed it to me. I again showed her the card, said ‘soother’ and gave it to her. So far so good.

The therapist then said, what would happen if you gave her a choice of milk or soother, and then had her choose the right item after giving me the card? I was confident that she would get this right. We put both cards on the binder, and she pulled the milk card. I then showed her the card and identified it, and put both options in front of her. She scooped up the soother and walked away.

We repeated this three times, and each time she selected the milk card and then took the soother. Apparently ‘milk’ is the first card to choose in any situation, followed by soother, and then by something else.

We’ll keep working on this one. At least she can distinguish between the cards. Now we just have to link them to the correct object/action.


When the Bear goes to IBI we always pack her a snack. Today was sliced organic strawberries and kiwi. The goal is to get her to use a pincer grasp to pick up the fruit and eat it. If they put the food in her hand she will put it in her mouth, but getting her to pick it up herself is not easy, and a pincer grasp is harder still. Most of the time she will grab the tutor’s hand and guide it to the bowl to signal that she wants them to pick up the food for her and put it in her hand. We and they also put food on her spoon and try to get her (guided) to put it in her mouth. She has never attempted to do this by herself.

Today, totally unprompted, she reached over by herself and picked up the spoon, which had a piece of fruit on it, and put it in her mouth, as if she had been doing it for years. Her school is closed for vacation for the next two weeks. In the meantime, you can bet that she will have lots of access to a bowl of sliced fruit and a spoon.

Sometimes you get a win, and sometimes you don’t. I’ll put this week in the win column. Tonight we’re off to Canada’s Wonderland to celebrate.


Frog's mom said...

A spoon!!! That's great bear! Little frog will do this too. I always give him a spoon or fork with his meal and he usually ignors it. But, out of the blue, when he is not being pressured, he will pick up a spoon and eat his entire bowl of yogurt with it.

Was this your first attempt at discrimination (more than one card) with PECS? It might help to start with one item she really wants and a second that she doesn't like. Little frog still has problems when we reach this level in PECS. After he has chosen incorrectly several times, he takes the offending item or card to another part of the room and leaves it there so it won't "distract" him from getting what he wants - he's one smart little frog!

kyra said...

yay for picking up the spoon! yay for bear! i know i'm not a PECS person but it seems to me, it's still unclear if she didn't get it or did. who's to know if this is the one and only way to 'test' her in this area? you know? hope you have a wonderful celebration!!

Ian Parker said...

Hi All,

We tried again with the spoon on Saturday with a bowl of mushed prunes and pears (it tastes better than it sounds). Once I put her hand on the spoon she picked it up and put it in her mounth on two occasions, which was great. Onward and upward.

As for the PECS, she mastered the first two stages (taking and handing over a card, and persistence) very quickly, and we thought she was moving through discrimination quickly too. We tried with a card and a blank (mastered almost immediately) and a preferred and an unpreferred (a bit slower but still quick), and thought we had this nailed. We heard that full mastery of discrimination can take up to a year and a half, so nailing it in under two months was probably a bit too good to be true.

Unfortunately, I'm guessing that a) by not having enough card variation, compounded by b) the fact that the milk and soother cards are pictures, while the others are coloured line drawings, and c) she was using the milk card on its own at school for so long, we taught her a card hierarchy or 'currency' instead of 'matching', e.g. the 'milk' card is worth 10, the soother 5, etc. So when she saw both cards she would assume that the highest value card would get her what she wanted. At least she was distinguishing between the cards. (BTW, we're stuck for now with the milk as a picture card because the school originally used a picture and she learned this connection - we have a transition strategy to move it to a line drawing)

I tried yesterday with both the 'milk' and soother cards together to get her to select the soother (which she was reaching for), and it took seven times for her to get it right. When she selected the milk card - on some occasions despite guidance to the soother card - and we offered her the milk cup she rejected it, looking quite perturbed that she was not being offered the soother instead. But with some practice (we build it into her everyday activities rather than set aside specific PECS occasions), by the end of the day she was getting it right the first time for both 'milk' and soother.

At least we know that we have to do a better job of setting up the occasions, to ensure that we're teaching matching and discrimination instead of a card hierarchy. In this case the issue was with us, not the Bear.

mommyguilt said...

Ian, I'm very glad to meet you and the Bear. Thanks for stopping by, and for your commentary. I think the consensus about Ex is pretty much the same as yours. Feel free to lay in, whenever yu like. He's , well, not worthy of editing.

I've seen you at Kyra's and have always meant to stop in, but since I'm usually blogging on the fly at work, I don't always get to what I want.

Congrats to you and the Bear for making steps, no matter how big or small. She sounds like she's got her own agenda, and got her daddy wrapped around her finger! It's great to see such love and understanding!

mumkeepingsane said...

Big congrats to you and the Bear. Sounds like she's got the spoon thing down. Glad you figured out what was going on with the PECS. I have those "gee, it was me doing something wrong" moments all.the.time!

Kristina Chew said...

Charlie's used PECS on and off since he was under 2 years old and we have veered away from it. He learned to sign when he was 3 and then to communicate verbally and I think he has ever after thought that PECS just took too long.

You wrote: "Apparently ‘milk’ is the first card to choose in any situation, followed by soother, and then by something else." Might she have learned a "chain" of behaviors (my ABA hat is slipping on.....). Perhaps she has, unbeknownst till now, learned that that is how I do this PECS thing, I pick up 'milk' first than 'whatever.'" (Just speculating---Charlie has often fallen into these sorts of chains of behaviors.) Is she working on receptive object ID in her IBI program?

Charlie struggled to identify the PECS pictures. I found them very abstract (the verbs and prepositions....argh) and Charlie would learn about a dozen and then plateau. We use photos now for his schedules etc. and the occasional picture.

Way to go Bear on the spoon! You never know when progress will strike....

Ian Parker said...

Hi Mommyguilt, Mumkeepingsane and Kristina,

Thanks for stopping by and for the nice comments.

Yes, the Bear definitely has Daddy wrapped around her finger. And given her explosion in gesturing, it is becoming increasingly easier for her to let Daddy know what she wants.

As for PECS, it won't be the last time that we screw up. I don't think it is a chain of behaviours, in that we still separate every communication into a one card discrete event, and 'error' results in us pointing out the correct card ('Oh, did you mean soother?", pointing to the correct card) and then terminating the communication for a few seconds and reshuffling the card order to attempt to make the next try its own discrete event. And until we offered two preferred cards, she usually used to 'get it' on the first try. The Bear is working on receptive object ID in IBI, and we do this at home naturally, but there are still gaps in her understanding of what objects we’re trying to identify or reference. Some of the pictures are pretty abstract too, so I’m sure that this doesn’t help matters.

As an update on the spoon, my wife has been putting out plates and later bowls with cut up peaches, and the Bear has been using both her pincer grasp and the spoon quite successfully. Sometimes the spoon ends up in her mouth without anything on it because she doesn’t keep the surface of it upright, but she’s getting much better. Her gesturing to communicate that she wants more peach is getting pretty good too. When she runs out she has no trouble letting us know that she wants more. We’re also using strawberries now. She prefers peach, but likes them too. I’m just dreading when certain organic fruit will become harder to get, since we’re moving out of season soon, and availability will be an issue. Organic peaches are now becoming scarce and the quality is declining. Strawberries will probably be next to go.

Kristina Chew said...

Charlie will not touch either strawberries or peaches! He used to love blueberries; now it's all green apples.

What do the IBI therapists think of PECS? It sounds like she's getting it, slowly but surely........ After starting at too many of those PECS cards for too long with Charlie, I do think they are quite abstract. Charlie has always struggled to figure out what line drawings are---some of those PECS cards must have seemed like different colored blobs and shapes to him, I suspect.

Frog's mom said...
This comment has been removed by a blog administrator.
Joseph said...

Testing autistic kids is tricky. She might have realized she was being tested and was selecting a quick response, or perhaps the response she expected the testers to expect, and not necessarily thinking through what the "right" response might be. Isn't that one of the problems with ToM testing too? Can she do the PECS thing well in a real-world situation?

Ian Parker said...

Hi Kristina,

The IBI therapists were the ones who originally taught the Bear how to do PECS, and were successful enough to move her quite quickly through stages 1 and 2. But progress was initially slower on stage 3 (discrimination) and so they moved on to other lessons until they thought she was more ready to continue.

In the meantime, we and the local Development agency picked it up, and she now seems to be doing well with it. As an update, she is now getting much better at selecting the milk card for milk and the soother card for her soother. This was the next stage anyway - after card and blank and card and non-preferred, she's now mastering two preferreds, and it is time to introduce more vocabulary.

Hi Joseph,

Thanks for stopping by. I can see how in some cases that kids may easily respond to the tester rather than the test. But in the case in question the test was pretty much real-world - the binder was just left out, with both objects in sight, and she was free to do as she pleased (including ignoring the whole scenario before her). Also, in opportunities at home (PECS is firmly established in our house for certain situations) she chose incorrectly when offered both 'preferreds'. But as above, she now seems to be mastering this 'two preferreds' scenario, so we can continue with more vocabulary building as a prelude to stage four. In the meantime, her use of gesturing is also exploding, as is her uttering of sounds, so we're also trying to start attaching these sounds to actions.

As a further PECS note, we're signed up for 10 week of PECS training that is conducted with a group of children (instead of one on one) in a play environment. The development agency has been monitoring a similar program in a nearby region, and it has worked well enough (the kids apparently learn from each other) that the agency wants to try it too. I'll post about this in the future.