Sunday, September 28, 2008

Aaron's Story, The Beginning

My colleague, Angela Fellman M.A., a newly graduated Speech Language Pathologist, has just started working with a little guy, Aaron. Aaron is a young child with autism. He is not yet talking nor intentionally communicating beyond crying when he is upset and running when something does not appeal. He moves rapidly and constantly. He dashes from one side of a room to the other, switches on and off lights, ducks when Angela reaches for him even to save him from falling and bolts out the door if she stops being vigilant for even a moment. Aaron may be making Angela re-consider her chosen profession. After an hour, she looks sweaty and discouraged. But, she keeps trying to find activities that will win him over. Are there any activities that would win Aaron over? He seems unwilling to meet her half-way. But if he could talk and explain his position, I think the conversation might go like this: Angela would say, Aaron come play with me. Aaron would replay, I don't understand what you want me to do.

The games seem appropriate; Angela wants Aaron to pop bubbles with her, knock down blocks, swing in a swing, drop balls down a length of gutter. Aaron has shown the ability to do all of these things. He pops a couple bubbles but then tries to mouth the bubble wand and she ends up wrestling it away from him. He knocks down one block but then lobs the next one across the room. He drops one ball down the gutter and then runs toward the unguarded exit door. He swings for a moment and then wants down. If Angela starts to direct him toward another activity, he instantly melts to the floor, morphing into a thousand pound puddle. He is doing these activities for an instant but never for long and never with any apparent enjoyment. He seems unable to sustain any activity for long enough for it to become social, playful, or pleasurable.

I often wonder, with a child like Aaron, if he understands any activity as an Event. Does he perceive any time frames in his life as having a beginning, a sequence, an end. It is a trick of the mind to slice up the continuous stream of life into events. Children learn this trick over time with more and more complex sequences coming to feel like distinct events. Children learn to call one period of time, taking a walk and another period of time, eating, and still another period of time driving to the store. Children learn to see one moment as the beginning of an event and a series of moments as part of the event and a distinct moment as the end of the event. Maybe with driving, for example, it is opening the car door and getting in or getting out that defines the driving event. But what if a child never mentally grouped moments into events? What if the child just bumped into one moment after another without ever having a sense of starting, being part way done, or ending--well, anything? Well, then a child would behave just like Aaron does.

How could we tie a series of moments together in Aaron's mind so that he could begin to perceive a group of moments as an Event?

The way we usually write this goal is: Aaron will willingly engage for three to five turns in a variety of games with an adult.

We write goals so that they are measurable but it often helps to try to imagine the way a child understands what he or she is doing (even though we can't directly measure this) and so Angela will try to help Aaron understand each game as an Event with a beginning, a middle and an end. As Angela finds a way to engage Aaron in several new games, as I am sure she will, I will let you know how she does it. To be continued.


Niksmom said...

Am DEFINITELY looking forward to this story! THis sounds very much like my Nik; he's better now that we've stopped his seizure meds (seizure free since March) and is receiving loads of sensory integration work w/OT.

Tahirih said...

Seizures are often an issue with children who look like Aaron. I am definitely looking forward to this story too. And I should also say Thank-you to Angela, who is willing to let me write this story.

Beth Up North said...

Wow, I know we have worked with Alex on lengthening his ability to attend, but never fully understood why he could not. This Event theory makes total sense. Also why routines are SOOO important. Also makes me think about myself as a less than routine person...
Thanks again Tahirih!!!