1/25/08 Updates

The family was sick this week so Thursday's session was cancelled and we had an extra long session with Tyler today. We finally found a gluten free cereal that Tyler likes. Ben and I like many of them but until we found the GF corn flakes, Tyler wouldn't touch any of it. We are hoping he also likes the gluten free waffles we purchased. If so, then we have 3 quick breakfast items that he'll eat and we can move on to find 3 - 5 lunch items and then we'll move on to find 3 - 5 dinner items. Once we have all those in place we'll be fully functional on the diet and be able to start to experiment with other foods he may like while having the quick food on hand just in case. The last stage will be to transition out all the non-food products we have in our house that contain gluten. Sorry about the spelling errors, I'm typing fast and cutting and pasting.

Here are the highlights from the consultants session notes.

1/18/08: Child has mastered 6 objectives.
Caregiver has mastered 9 objectives

- Parachute: Introduced parachute as an activity and tyler really enjoyed it. He made clear requests and hand pulls and also pulled the blanket over his head to indicate he wanted to continue to play. The caregiver did a good job of creating opportunities for those requests and initiations.

- Ball drop: Tyler was very engaged in ball drop and utilized eye gaze to request a ball and followed the direction "put in" without any supports. Caregiver modeled key words and did a good job of balancing turn taking. Also did a good job of creating oportunites for eye contact by creating a flow to the activity and then sabotaging (showing choices and then pulling back).

Push Toy: The spinning push toy was introduced again. IN the past, Tyler has been difficult to engage with another person in this activity. However, the caregiver did a wonderful job of creating motivation to engage him with another person with this toy. As a result, Tyler engaged for multiple exchanges. Caregiver did an excellent job of eliciting eye contact.

Car Race Game: Although he was difficult to engage, Tyler continues to demonstrate appropriate play with the cards. Caregiver did a nice job of modeling appropriate play and vocalizations through the routine.

General Feedback: Continue to focus on beginnings and endings with TYler (one more time, etc.) Increase complexity of task with eye gaze AND handpull. Modify environmental arranagement to continually create opportunites where Tyler has to ask for items.

1/22/07 Video Review Feedback

Continue with creative transitions such as Night, night to the toys or that Tyler has to puy taway or bouncing Tyler from one activity to another if he is having trouble with the transition.

Upping the Ante: In order to up the ante, caregivers should begin to concentrate on more pauses to allow for more requests, eye contact, etc. The caregiver should incorporate more directive language such as "do this" " say..." when modeling appropriate play vocalizations.

Begginings/Ending: Continuye to think about the beginnings and endings to routines. Recommend that we figure out ways Tyler can assist with snack time. Have a cup in the fridge filled with miok that Tyler can bring to the tabple. Have him choose his own snack, possibly carry items (with lids) to the table.

Environmental Arranagement: It may be necessary to continue to put toys out of each or turn off in order to create requests. Example: Puzzles, We talked about putting puzzle pieces in a bin with a lid and base nearby on the shelf. THis may draw Tyler to the shelving area and create new interest based in getting into the bins.

Non-functional behavior: While the numer one priorty should be to always make sure that Tyler is safe, it is important that caregivers try to make sure that they are not reinforcing non functional behavior while it's occuring. Headbanging example: When tyler begins to head bang, the caregiver should avoid providing Tyler with attention while he is demonstrating the behavior (no eye gaze or vocalizations). Providing attention could inadvertently reinforce the behavior. Once tyler has discontinued the behavior, caregiver might begin to provide calming attention such as huge or head squeeze.

Working with an antecedent: When dealing with non functional behavior, the best strategy is to always try to prevent the behavior from happenings by implementing strategies prior to the behavior.
Diaper change: prior to diaper change, the cargivers should continue to provide Tyler with a preferred toy wityh assists in keeping him regulated.
Eating meals: on days when it is clear that Tyler is not going ot remain regulated during meals or snacks, I would recomend putting a video on before he even has to sit at the table.

Special note: It is imperative that these strategies not be implemented when Tyler is already demonstrating non-functional behavior such as head banging, as it may reinforce the behavior leading it to occur more frequently in the future. It is also important to note here that in the future once TYler has become more engaged intthese routines an has better communication system, we will being to fade out these antecedent strategies as they will not longer be necessary.

Sensory: Sensory activities such as painting, beans, water, shaving cream, etc. might be a great opportunity to engage Tyler and Ben in the same routine. During these routines it might be an optiomal time to have Ben engage Tyler in play by sharing items with him or providing him with apreferred sensorty input such as dumping beans on his head.

Create very clear beginnings and Endings for activities.