Monday, February 22, 2010

Learning a Route Game

Young children with autism often appear to be living in the perpetual now with a mental focus that is only the width of one sensory experience at a time.  If the child is seeing then seeing is all.  If the child is touching then nothing but touch exists.  The child sees a stick on the ground and picks it up looking intently at the length of it.  But if the child then notices a bright patch of grass in the sunshine and moves toward that, he drops the stick as though it has ceased to exist.  Placing the child in a sandbox may inspire the child to run sand through his fingers over and over, consumed by the feel of the sand and oblivious to the child sitting a few inches away digging with a plastic shovel. It is as though each sensory experience is so all consuming as to cause everything else to fade into nothingness.  This is, I have heard and I believe, because the child has a sensory system that takes in information at ten-fold the typical intensity.  Being so caught up in each sensory experience is one of the neurological hazard of having a sensory system that is so acutely sensitive. None-the-less, it is the aim of every kind of intervention to help the child with autism learn to detach mentally from the clutches of such sensory experiences enough to begin to connect a set of sensory experiences into a larger framework. Eventually, we want the child to know that "Going to play at the park" includes the experience of picking up sticks, running on the grass in the sunshine, playing in the sandbox and we want the child to know that the park includes activities that can be chosen like swinging, sliding, climbing or drinking from the drinking fountain. We want the child to learn to shift attention between what he is doing in the sand box to watch what other children are doing and eventually to imitate and then join in when a different activity looks like fun.

Route Games, for a child at this stage of development are little routines, typically a sequence of sensory treats that occur in order, one after the other so that the child can learn how to detach from one sensory experience intentionally and move on to another sensory experience.  Below, you can see a little boy learning over the course of two therapy sessions, a three location Route Game.  He has learned how to go up and then slide down a slide.  He can jump with dad on a trampoline.  He has learned to put a ball into a basketball hoop.  Now, we want him to learn how to move intentionally from one of these activities to the next.  We use a photo of the trampoline to help him move from the slide activity to go and jump--which is an exciting thing for him to learn.  We then use the ball to help him move toward the hoop.  Here is the Route Game as he learns it:


Joeymom said...

Interesting. My experience with my ASD child and my SPD child is that instead of focusing one at a time, they have no filters at all- they are bombarded with everything at once, so they try to pick something to help them shut out the extra "noise."

Tahirih said...

Joeymom, I like your description of what is going on as well because this also helps me think of what to do to be helpful. I think that there are several different useful ways of describing how children with ASD process sensory information. It might be that the lack of filters is the underlying problem or perhaps the intensity of a child's neurological response to sensory input would cause any of our filter systems to fail. I have no choice but to notice and focus on a Police Car Siren as it screams by my office--for example. The intensity does not allow me to filter it out but if I had to deal with it all day, I might learn to focus so intently on things as to "shut it down". I guess we are all speculating but we need to in order to think of new ways to help our kids learn. I believe that our colleagues who are able to investigate the brain in more and more creative and insightful ways will help us both understand and treat these issues better over time. Meanwhile, many of us keep trying strategies that we hope will help our children learn to manage a neurological reality that I know we don't truly understand yet.

EJ Willingham said...

"Young children with autism often appear to be living in the perpetual now with a mental focus that is only the width of one sensory experience at a time."
I'm not sure exactly what age this is intended to describe, but my experience is that young children of any neurodevelopmental status do this.

I understand the attention to teaching a child to detach intentionally from an activity, but I also do not (a) see anything inherently wrong with the behavioral scenario you describe in your opening or (b) see this kind of behavior in every child or even many children with autism relative to children without it.

The sensory behaviors that I've witnessed in my own son, for example, are more related to his wanting to tune things *out*, rather than being overly tuned *in* on one sensory channel.

Jordan Sadler, SLP said...

This is an interesting one, Tahirih, I always love your posts when I am catching up on blogs!

I see an activity like this through yet another lens, and would wonder about the impact of motor planning challenges on this little guy. I would probably say that he is automatically going back to the slide again because it's pleasurable and he knows the sequence of motor skills to make it happen with confidence. By supporting him through the different activities again and again, you and his dad have helped him learn the motor sequence of all three pleasurable activities in a row, which is fabulous! You've used visual support and motor support to make the activity predictable (it has a beginning, middle, and end that he now knows) and so he is transitioning from one activity to the next with a lot more ease. This is probably my SCERTS lens that sees it this way. ;-)

Thanks for all your interesting posts, we all read your blog at my clinic!

Tahirih said...

There is no doubt in my mind that motor planning difficulty is a very useful lens to look through for this child and many others. In the slide game, for example, if I move the slide to the right or to the left, it may become harder for this child to initiate the slide game. If I turn it around, he may be completely disoriented. At this point, he can initiate the slide and the trampoline regardless of where they are located but there was a time when he could not. Still, moving between two activities, this may be a struggle for him still. For many children, I measure progress not just in how many steps a child can move through but also whether changes like the orientation of the slide no longer cause the child difficulty.

Jordan said...

Yes! There's so much to consider. I wish more therapists realized the breadth required in teaching these skills rather than moving in a straight line forward. It's okay to stay on one rung of the ladder for a while to make sure the child can stay on that rung, even if it's backwards or in another room, before moving up to the next one. And so many ways to look at things.