Nate’s six therapists used the first weeks of therapy to get to know my boy and, most importantly, get Nate to trust and like them. All of Nate’s therapy is play based so we used Mr. Potato Head, his Magnadoodle board, and other fun toys to help him learn basic concepts like making choices and sharing, as well as to work on improving eye contact. Some of Nate’s therapists bring a giant bag of toys and others use the toys that Nate already has. When Nate expresses an extreme interest in one of the new toys that his therapists own, we go out and buy it – so Nate’s got a hefty toy collection in our home. In fact, we gave our living room over to Master Nate ages ago. It’s decorated with a giant foam ABC mat in primary colors, a rug with a road on it (for car racing), a Nate sized kitchen, a Fisher Price playhouse an IKEA egg chair for time outs (the ones Nate gives himself – more on that later), and more toys than I can count.

After a few weeks of therapy, therapists started to ask, “Did you get your binder yet?” or “Where’s your binder?” “Do you have a binder yet?” and “Where’s your binder?” I had heard of this mystical binder and explained we hadn’t received one yet but suspected that it would arrive at our first team meeting, a gathering of every therapist on Nate’s team plus Chad and me where we discuss Nate’s progress and strategies for improvement.

Lo and behold, at our first team meeting, I was bestowed with the binder–a three-inch, three-ring green holder of papers that Miss Lisa lovingly personalized for Nate with a picture of Curious George. (To make it even more special, we added two Curious George stickers that Nate earned at the pediatrician’s office.) Inside, there are no less than sixteen sections, each assigned to a different mode of analyzing Nate’s overall performance in therapy, based on the goals that we established with Lisa when we started therapy.

The analysis is seriously detailed. Nate’s performance on each activity in therapy is scored in the binder: a “+,” which I call a cross, if he did what was asked correctly, and a “-,” which I call a dash, if Nate didn’t do what was asked is bestowed upon my child for each and every step of a task. Usually, there are ten trials or steps in each activity, which allows it to be easily scored. Oh yes, scored. We know what percentage of an activity Nate gave us eye contact, what percentage he pointed at items, and what percentage he correctly communicated through PECS.

And then? It’s graphed. Seriously. GRAPHED. (The graph above is how Nate’s doing on pointing to make choices.  As you can see, he’s hot and cold about pointing.)  It offers an amazing visual of how Nate is responding to a particular “program” – or strategy to help him – and how he is improving (or not improving) over time.

If Nate’s not improving, then his monthly team meetings are used to plot a new course for learning. If he is improving, then his monthly meetings are used to discuss how we can help him grow into expanded requests or into new tasks. For example, out of the blue, Nate started to give me kisses. (He’ll give them to anyone, really, but let’s just say he’ll only give Mama kisses….) If I say, “Nate, give me a kiss,” he gives me the sweetest, kindest, and driest kiss ever. Also when asked, “Nate, give me five!,” he’ll slap his little hand against yours. Two commands: two appropriate responses giving something to his Mama. So, knowing this, we’re going to slowly expand into other commands, like “Give me your cup” or “Give me your shoe.” And his ability to respond to those requests will be measured, scored, and graphed.

This scientific system also allows us to know when Nate has “mastered” something. Thus far, Nate has mastered three things: giving a high five, ringing the doorbell to get Mom or Dad’s attention (again, more on this awesome system that our BCBA created later), and properly identifying Mom, Dad, and Nate in photographs. I think he should get a wee gold certificate for each mastered item but I suppose the greatest reward is that he has capacities that are in his toolbox, it seems, permanently. Since starting therapy and mastering these things, they haven’t waivered or faded. They’ve only become stronger. And that’s awesome.

The stinky part is that it takes time to get everything in order at each session. Each therapist reviews the binder to see which programs the previous therapist ran (especially if he has two sessions in one day), sets up a program for the day (which activities Nate will do, in what order, and establish what we are testing for – decision making, eye contact, communication etc.), and sets up his PECS schedule. That takes about five minutes. The crosses and dashes are written down as each activity occurs. The scoring of them takes place at the end of therapy, which can eat up another ten minutes. Then Nate’s session report has to be written, about five minutes. So all told, fifteen to twenty minutes can go to the minutia of the binder rather than to hands-on therapy with Nate. I recognize the importance of the tracking but I want it both ways – a full hour of therapy for Nate and the goodness of scoring. Chad, who works in information technology, swears he’s going to come up with a program for autism therapy. While we love the binder with its Curious George decorations, there here has to be an easier way….

In the meantime, we celebrate that the binder documents Nate’s mastery of three things, his growth in many other areas, and the future goals that we have established for him. And we love that we can literally show you how Nate’s growing. Pretty awesome, right?

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