Even though I’m describing some of Nate’s therapy in this entry, don’t try this at home. For the love of God, it’s taking six therapists, two teachers, and two parents to help Nate—this isn’t a do-it-yourself manual!
The only proven weapon against autism is therapy—and the earlier in life the better. (The fancy term is “early intervention.”) Nate started therapy when he was nineteen months old (he’s now a grown man at twenty months of age). The plan is to start at ten hours of therapy a week and, as he builds tolerance, expand it to fifteen hours. This is in addition to the fourteen hours he spends at daycare a week, where he spends times with kids his age. Nate has eight appointments a week, two of which are at school, Most sessions are 1 hour in length; his longest sessions are 1.5 hours.
The first question I had was, “How the heck are they going to get Nate to do anything?” Nate’s non-verbal and he doesn’t respond to his name. Nor does he follow directions. And, magically, these strangers are going to get him to do things? Do you know what? They do! All of Nate’s therapy is play-based, meaning it involves the toys he already loves. Some of his therapists bring in their own toys (which Nate loves to root through) and some use the toys in Nate’s playroom. But with the play-based therapy, there are rules. Rules that must be adhered to.
When we started therapy, rules were news to my nineteen-month-old babe. See, he lived the life of a normal tot. Sure, there’s always been structure in Nate’s life, like snack time, lunch time, nap time, diaper changing time, etc. But we’ve never implemented structure around each and every activity that occurred between those periods of time. If he found a toy he wanted to play with, he’d play with it. If he was done, he was done. If he wanted me to join him, ok. If not, that was fine, too. See? No hard and fast rules.
Nate (and I) learned quickly that, in therapy, these rules went away. Sure, he could pick out any toy he wants to play with in therapy—but once he picks the toy, he must play with it. And he must play with it properly. He must finish the entire activity and, most importantly, he must clean up every last piece of the toy. My best friend, Aimee James, laughed when I told her this. She’s got two sweet boys, ages 2 and 4. She said her four year old son isn’t a stellar cleaner-upper. And this expectation was being placed on nineteen-month-old Nate? Pshaw. Surely, these therapists are looking at a curriculum for older children. You know, the one for teenagers.
Nate and I quickly learned that this is not the case. This is the curriculum for his age group. I suddenly feared there was going to be a giant learning curve. However, it wasn’t as bad as I thought. Nate adjusted quite well. First, he likes his therapists—all of them. And, while communication isn’t his strong suit, I do think that, in some small way, he wants to please them and he strives to do his activities well. Second, he’s just a fluid kind of guy (remember his ADOS test?) so he goes with the flow, though he does sometimes, especially in the beginning, he puts up a fuss.
So, what’s an activity? Take Nate’s shape sorter. He’s given a shape, one at a time, by his therapist. Sometimes, he receives the block after he makes eye contact and sometimes he’s given the choice between two blocks and he gets one after he points at it (thereby making a choice). To get eye contact, we talk to him and wait him out. Because he wants the block, his therapists occasionally hold the block between their eyes to get him to look at them. When he has two blocks to choose from, I usually have to take his hand, push out his pointer finger, and make him point at each one. Then we hope and pray he copies what I made him do and picks one. If he doesn’t, I smush out his little pointer finger and help him select one. After all this, Nate’s got to get the block in the right shape. Once he does, we throw him a literal parade. There’s lots of cheering, hand waving, hooraying, and tickling. Nate usually claps for himself, too. Then we start the process all over again.
It’s a little tedious because there are eleven shapes in his little bucket. That’s a lot of shapes. This task doesn’t require clean up because, once you dropped the shapes through their appropriate holes, they’re stored away. Most toys, however, require clean up. Take a puzzle. We go through all of the above with selecting each puzzle piece. Then Nate’s got to get them in the right spots. After the activity is completed, his teachers take out an empty Ziploc bag, the kind with the zipper on the top. He has to take each and every puzzle piece, put it in the baggie, and zip it shut. Then another parade ensues.
Cleaning up is aided by a song. A dreaded, dreaded song, originally performed by a giant purple dinosaur. It is called The Clean Up Song and every therapist knows it. When the concept of “cleaning up” was first introduced, his therapists started singing this glorious tune. I had never heard it. I couldn’t even fake hum it; I had no idea what word or note was coming next. I had been outed as not knowing the song, which seemed to be a gigantic parental sin. When Nate first heard it, he looked at his therapists like they had two heads. And, when we first tried to get him to clean up, he freaked. He kicked and screamed but the rules say Nate has to complete the task. So I put the toy in his hand and, with Nate kicking and screaming, I guided his hand to releasing the item in the bag. All I could think was, “How the heck is this going to work?”
I asked Miss Lisa why Nate has to clean up. I mean, come on. He’s only one-and-a-half. Does he really have to do this? She explained that, since autistic kids lack social and communication skills, they have a tendency to just get up and leave during the middle of an activity. Say Nate’s playing with a pal (we’re working on that one….but let’s just say….) on a puzzle. When Nate’s done, he’s engineered to just get up and leave, even if his pal isn’t done. Even if they just sat down and popped in one puzzle piece, he would just get up and go. And when Nate decides he’s done, he won’t bother to say “goodbye” or “see ya” or “I had a nice time. Let’s do this again real soon!” He’ll just shuffle on off to Buffalo and leave his buddy hanging. So, through therapy, he’s learning to a) start an activity, b) complete an activity, and c) clean it up and d) end it in a socially acceptable way. Additionally, it’s also teaching him that something’s over. If he loves the activity a lot, he can come back later but this skill helps him conclude activities without meltdowns.
After two weeks of therapy, I was stunned see that Nate cleans up his toys. And now, four weeks into therapy, he continues to knock “cleaning up” out of the park. This skill is inextricably linked to The Clean Up Song. In fact, if you start singing the song when Nate hasn’t done an activity, he starts looking around for something to clean up. And he doesn’t just “clean up” (i.e. shove stuff out of sight). If he’s cleaning up his stacking bowls, he endeavors to nest them in the right order. Most importantly, Nate knows that the activity is over and it’s time to move on—and he’s happy about it! If only some adults I know could follow suit….