I began to exert a little more pressure on Andrew but I regretted it immediately. I felt Andrew's panic when I tried to keep him playing a game longer than he wanted to stay. The week before, I could keep him in a game after he had expressed a desire to be done for several more turns and even rekindle his enthusiasm for the game. I never felt any panic in Andrew while doing this. Valid point, Mom, I think, but I will need to problem solve this from your perspective at a later time. I went back to my original objective and tried to find a way for Andrew to participate willingly. In order to do this, I had to remind myself that I did not have to look like I was in control at all times and hopefully I would find a way to explain myself better when I was not so busy working it through with Andrew. Mom talked more, as the session went on about how she often just leaves Andrew to himself when he is like this at home and when she can. I guess I don't have the luxury of doing that, I told her. But it sounded like a reasonable strategy as each thing I tried seemed to alienate Andrew more.
In recent weeks, Andrew and mom and I have set up some great pretend play sessions where our pretend play characters engage in extended conversation and Andrew is right there playing cooperatively, flexibly, creatively. Today, Andrew seemed unable to comprehend even simple language and if I tried to extend a conversation for even a couple turns, he turned his head away and told me we were all done. I started thinking we needed a game with lots of sensory input because sometimes this kind of game improves language functioning and Andrew agreed to swing for a while. After a few swings, I tried a different approach to conversation--something more structured like I might do with a child who has far less language comprehension than Andrew does, or did, anyway, last week. I set up a routine where I would stop the swing every few pushes and ask Andrew to do something before I pushed the swing again. I started using very simple language. Touch your nose! Swing, swing, swing, stop. Touch your ear. Swing, swing, swing, stop. Andrew did what I asked for a few times and then said he was all done faces.
Andrew popped out of the swing and ran around the room a bit, stopping at a folded mat that was tied together with stretchy straps (pictured below). He climbed under the straps. Mom saw right away that he was pretending to be in an ambulance, strapped down on a gurney, on his way to the hospital--which really happened to Andrew last summer when he had a seizure. I wonder if he is about to have a seizure? mom asked, now caught up as I was in the mystery of Andrew's behavior. He has been going to the bathroom all day and that happened before he had a seizure last time. Like me, she was wondering if Andrew might have a very good reason for being unable to settle in and play.
I don't know how much more eloquent Andrew could have been in telling us that something was not right for him today. He started trying to tell us with his restless, chaotic behavior. In the end, he found a metaphor. Strap me down and take me to the hospital. I don't know how this story will go or if we will figure out what Andrew needs when he can't settle. My point in this story, though, is that I almost ignored Andrew altogether in my need to feel like a competent professional. This happens most often when a child who, like Andrew, seems like he should be able to do so, fails to comply with expectations. I should know better because I often end up learning a great deal and finding important ways to support a child or family after sessions that go badly. But, like everyone else, I can forget. After today, I am back at the drawing board, puzzling about Andrew. Right where I should be.