About this blog.

My son was diagnosed with PDD-NOS at 24 months. I created this blog to bring meaning to the often-confusing label. Sometimes I have answers. Other times, just more questions.

Thursday, December 10, 2009

One is Silver and the Other Gold

This is the third installment in a series on interventions. Installments one and two can be found here, here, here and here.


Part of PDD/SPD/A Little Bit Autistic, what have you, is a deficit in socialization. In my view, what to do about social impairment draws on medical science, treatment philosophy, but also norms, in the general sense. From a normative perspective, I'm of the mindset that it's okay to not be social. If Brad likes solitude, then I don't want to project my preconceived notion of happiness (having a lot of friends) on him. Also, if Brad is quirky, I have no interest in de-quirkifying him. Normal is overrated.

That having been said, I want Brad to be happy, and if Brad wants friends but doesn't know how to make friends, then I want him to have the facility to make friends and if school can further that goal, then I welcome the help. My goal then for Brad is the facility to make friends.

So that's a high level description of our goals, from a parenting perspective.

As for interventions, at school Brad's speech language pathologist joins Brad in class (including on the playground) and focuses on social pragmatics. In english, this means she facilitates play, including greetings, turn taking, sharing, and the like. Sample progress note, from his SLP:
Bradley did a GREAT job today on the playground! I was on the playground and I didn't even have a chance to go up to him to ask him if he wants to play hide-and-seek or tag. He came right up to me and said, "I want to play tag!". There were already two boys playing tag, so I told him to join them, and he just ran right up and joined in the game. He played for a few minutes and only needed a couple of prompts from me to keep going. Then, the boys started playing with a kickball, so I prompted him to keep after the ball in the group. The group then went over to play basketball and he needed prompts to keep up with the ball (someone throws the ball and all the kids run after it -- he just needed prompts to be more assertive and stay with the ball). He was actively engaged in games all of recess and feeling connected with the other kids. When you play tag at home, try having him chase you, and then teach him to run up to you and say in a nice loud voice, "Now you chase me!". After playing tag for a few minutes where he was chasing other kids, he wanted someone to chase him, and we practiced going up to a friend and saying, "Chase me!".
And this:
When I was in class today, I sat with Bradley and made bat, cat, and pumpkins with him out of play dough. We used the language for rolling, pulling, pushing down, etc. Then, I prompted him to show friends what he made, which he did when I prompted him to do so. I prompted him to use a louder voice when talking to friends. He also told his friend that he liked his cowboy costume!
To me, this seems like a nice, safe way to introduce Brad to social situations. I don't see any downside.

That having been said, there are a two social interventions which I disapprove of for Brad, from a normative perspective, and my disapproval is actually in Brad's IEP: (1) no "look me in the eye"; and (2) no social scripting.

Regarding "look me in the eye", at issue I believe is working memory. If you asked me to do long division in my head, either I wouldn't be able to do it, or I'd have to close my eyes or look away while I think about it. This is a normal response. For children who have a weak working memory, a lot of ordinary interactions tax them from a sensory perspective like long division taxes me. That's the way I see it. Also, I've read enough first hand accounts of autistic adults who recall being forced to look so-and-so in the eye, and it's a source of anxiety and instills a sense of failure. When Brad was two and a half, the specialty provider who came to administer Floortime starting doing the face touch, where the therapist gently touched Brad's face under the chin when he wouldn't make eye contact. I told her to stop.

As for social scripting, I just don't like it, and I don't think it's necessary for Brad. Social scripting refers to teaching a child to say, for example, "do you want to hold my hand and walk with me?" the idea being that typical children know to do this naturally and atypical children need to be taught. My thought is that holding another child's hand should come from a place of joy and affection, and not from a place of "if I do X, I'll get external reward Y." But, again, this is normative, in part, so I say live and let live. If another parent prefers that their child learn social scripts, that's fine. For me, I don't want that for Brad. As for prevalence, I don't know about other school districts, but I know that a few children in my district are taught social scripts (and it shows).


Kris said...

I completely agree with you. I don't like the "look at me" stuff either and to be fair, Alec has adequate eye contact. Since it isn't one of his "issues", I don't want to made a big deal out of it. I don't like scripting either, b/c I think it's very obvious when social skills are scripted.
One of Alec's goals on his IEP is to have on-topic conversations with adults and peers with at least 2 turns in conversation. His teachers state he has met this goal. I like what Brad's teacher does - going out to recess and helping him join in. Alec needs help/encouragement in this area. I have no doubt Alec wants friends, he often has a hard time joining in, keeping up with what is going on in a group, and generally just being one of the gang. If he doesn't care, I don't either. But he expresses an interest in having more friends and doing the kinds of things that his older brothers do which usually includes groups of friends. He has the mirroring thing down too (wanting to do what his older brothers do and imitating them). He just can't seem to put it all together.
Our social skills class was just that - a class. I am still searching for a group that is basically just a group of kids who gets together and practices having a conversation, a natural conversation with a counselor as a facilitator. Not so much teaching what you are "supposed" to do and say. Alec is floundering in this whole area of social skills.

Anonymous said...

I agree with the whole "look me in the eye" thing. In fact, I too have made my preferences known there but it's not been stated in the IEP.

And I agree about teaching scripting. Charlotte does a fine job of picking up scripts all on her own, I don't feel like any of us need to actually tell her what to say. That being said, I am in favor of giving her conversation starters. Like she has these two girls that she rides the bus with and I will ask her questions about them and if she doesn't know, I'll suggest to her that maybe she could ask her on the bus tomorrow.

Charlotte can get very repetitive with people and ask the same question, or make the same comment, over and over again, and so I'm trying to do a little part to encourage her to talk about other things. I don't know if she's being repetitive with them, but that is her history so I just wonder.

Sounds to me like Brad's SLP is doing a nice job with facilitating interaction on the playground.

Nyx said...

I tend to agree with you on everything, but I am still struggling to really understand what is going on under the hood. It's just my personality, I guess, but I feel like I can't figure out the right way to go without a better understanding of SOME sort of theory underpinning everything. Now see, the eye contact thing I totally get, I am with you and I believe that is what is going on, or maybe also some other weird stuff that I've heard about (like, being able to see other people's eyeballs wobbling in a way that is disconcerting, or maybe, not being able to adjust the focus of the eyes quickly enough, so that you're just looking at a blurry image!). Although, I DO sometimes ask my son to "look at Mommy." The reason is that sometimes it seems like he really is just refusing to give me his attention, because he is wrapped up in what he is doing and he wants to ignore me. It's hard to separate, but he IS still a 2 year old, and SOMETIMES he DOES make full contact when giving me his full attenion (like when I am telling a story he likes), so there is a discipline-type of issue to be teased out of rest of whatever is going on there. But the social stuff I am just kind of mystified by. I can't find an approach that makes sense to me because I can't find a model to base it on that I understand fully, not really. You know, I want to OUTLINE it, LOL! For example, I suspect there is scripting, and then there is scripting. I find in my own adult life that I need little scripts to get me by, for example, that awkward moment in an elevator with a stranger, or a business lunch (which I still suck at, btw). And it does seem that in some ways it's almost like my son needs more repetitions to really LEARN something. So there may be a kind of sense in trying to teach repetitive scripts, but yet there ought to be a more NATURAL way. I do something around here which may be kind of similar. I tell stories that I made up that feature repetitive statements that my son seems to like, and from hearing and retelling them, he seems to learn those "scripts," and then eventually he really has incorporated them. I think that it has something to do with this whole "gestalt" speech acquisition I read something about somewhere. But then, what is up with the losing interest thing? I completely recognized this description of how Brad would go up and engage and then quickly sort of fade away until prompted to get back in the game. Or am I projecting? That's what my son does. He just kind of ... drifts away. It's a theme. Another parent would tell you my son has had regressions, because although no one will believe me, I swear to you that when he was just a little over 4 months old he played a game with me one day where he said "Hey!" and stunned and laughing, I repeated it back to him and we did that back and forth for a long time. (complete with eye contact by the way) I have it on videotape. But by the next day that game was gone. Try as I might, I could never get him to play it with me again. He just kind of ... drifts away. I have to WORK to keep his engagement, both in the short term and in the long term, it seems. I have so many theories that I am convinced of one day, then the next I think, well no, there is this other fact that my theory doesn't explain. Like visual distractibility. Auditory processing causing hyperactive peripheral stuff. Anyway, I just ... can't figure out what's going on in there. How can I decide what to do when I don't know what's going on? {sigh} I'm so tired of my own thinking.

Jamrock said...

Hi. Wow. I really liked this post but only understood some of it. I think it's probably a UK/US terminoloy thing but it's given me some stuff to look up.


Anonymous said...

"If Brad likes solitude, then I don't want to project my preconceived notion of happiness (having a lot of friends) on him. Also, if Brad is quirky, I have no interest in de-quirkifying him. Normal is overrated."

Completely agree with you here. We are fine with our quirky kid. (though we do draw lines at public nudieness and destruction of property). I'd say our goal is to equip our girl with the tools she needs to navigate the world. Scripting? Maybe a few basics. Social rules? Yes, mostly for her own sake.
Preferences? - Friends or not, tea parties or mudballs, shoes or no shoes, footie jammies or jammieless, dressing dolls up or lining them up... Personal Choices. That's where we let our kids be our kids.

Laura said...

Kris, interesting, I can see that. I see the interactions my typical five year old has, even at this young age. I can't even imagine Brad in those situations!

goodfountain, helpful ideas. I think gender difference comes into play here too, right, if you buy into the generalization that girls are innately more social or relationship-oriented. Plus, if I had girls, I think I would be more emotionally invested, just having been a girl. You know.

Nyx, I follow. As for the drifting away, that's an abstract concept and it can mean a lot of different things. Brad withdraws too, but so do I. My dad and I both are creative types, known to be a bit spacy, "dreamers" and we talk to ourselves - for me, to the point where my friends in college hypothesized I had an imaginary friend I was talking to, going so far as naming said nonexistent imaginary friend. I'm sure that's not entirely what's going on with Brad, but I can relate to spacing out and preferring solitude, and being told "stop spacing out!". That having been said, when I expressed the "let it be" attitude to the specialty provider (when Brad was age 2.5), the provider made a good point invoking the almighty "bad mom card": it's a public safety issue, she warned me. If he doesn't attend to his surroundings, he's liable to run into traffic, unaware. And of course, I don't want him to be oblivious. I don't know. Sorry for rambling.

Jamrock, hi and thanks for the note. ha! I need a translator reading my UK friends' blogs.

blackknightsbrood, LOL, yeah, you have to draw a line some where. I can see teaching social rules, and I like the way you put it in terms of the basics versus the choices. Giving them the foundation, and then letting them do whatever.

Nyx said...

LOL, I can't believe you apologized to me of all people for rambling!! I tell you what, there is something to this whole spacing out thing. This is the point where I have to admit that I have on numerous occasions in my life been yanked back onto the sidewalk -- out of the street -- by a friend next to me, because yes, I actually failed to look both ways. when I was a teenager I was pretty widely thought of already as the absent-minded professor. I heard things like, "you'd lose your head if it wasn't attached to your body." and of course it was true. This is exactly why for the first 2 years I just didn't worry about it when son was "spacy." But you know what? I am starting to think that maybe it IS a problem if, for whatever reason, the child is just a little TOO spacy at the wrong time. I mean, I think it must take a certain amount of time to learn something as complicated as language, and there's something going on in there that's making it harder for him to get language. I think being wrapped up in his own daydream is okay, except if it's keeping him from acquiring important skills. As for the rest, I don't know. I am extremely organizationally challenged. To the point that I occasionally wonder if I could manage things if for some reason I lost my husband. When I was single I suffered a lot of power outages, you know. I don't know, I'm much better at these things now that I'm 40, but I wonder. I used to feel like these things were part of my identity and I don't like to think of them as an impairment, but you know if it were very much worse, it really would impair me, I think. If I lived in a commune it wouldn't matter, but of course I don't. So if my son has just acquired a double dose of these traits, what does it mean? I guess it means he's a little bit autistic ...

Queenbuv3 said...

I know I'm a bit late commenting on this. I personally relate to the spacing out and wanting solitude. I have always been content to be alone. That may have something to do with my ability to accept this in my son. My hubby is this way also.

However, when I do want to socialize I still feel very ill equiped. If I am interacting with a close friend or family members that understand and accept my quirks and shoddy social skills and know not to take my interrupting, rambling on, blunt statements, diving deep into hot topics and endless tangents than I feel comfortable. But after any social interaction with other people not close to me I analyze everything I said, my body language, what they said, their body language, etc. This after effect and the anxiety it produces makes me want to avoid socializing or interacting with other people that are not part of my inner circle.

Now, I am 37. I think I'm pretty intellegent, sensitive and articulate. I went to 3 years of college. I have had various types of jobs where I interacted with the public face to face. I have not spent my life living in solitude. Then why is it I still have these major issues with social interaction? Maybe because that is just the way my brain is wired. I really have to agree that you can't teach social skills. I honestly believe that there is too much "lying" "faking" and "deception" in what is described as "social skills". I am 100% me all the time. Lying is very hard for me. Being fake is not in my nature. I have always done what I want to do because that is what I like, not because everyone else is doing it or it's "cool".

I'm always going to be a square peg in a world of round holes and I'm ok with that. I have enough "social skills" to get my needs met and "function" in the world. I will never have a gaggle of friends. I will never enjoy the typical social events.

With all that said. I don't expect my son to have a lot of friends and I don't pressure him to socialize. However, he doesn't have enough "social skills" to navigate this world and "function" in it independantly. I hope that he will be able to but it's something that I think will have to develop naturally the way it does for other kids by observing and imitating.

Do any of you relate to my personal experience and do any of you agree with how "social skills" are learned or if they can ever be taught given the way a person's brain is wired?

Laura said...

I can relate to your personal experience. I think many of us have formed parenting philosophies based on our own personal experiences.

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