And, we’re back!  Life have been quite hectic here for everyone in our household, which hasn’t allowed for blogging.  Then I lost my camera cord.  (It was found, buried, in the living room shelves.)  That’s not to say that Nate hasn’t accomplished things in the past few weeks.  In fact, Nate’s little mind is exploding with new abilities!  There are so many stories to share but there is one that I want to write about today because it summarizes so much of what we’re working on.  There’s a lot of set up involved, so stay with me on this one.

Nate is now in Phase Two of PECS (picture exchange communication system).  Phase One is sitting at a table and passing a picture card to request an item.  Phase Two requires Nate to get his PECS card from his PECS book and walk to the “trainer” to request an item.  The biggest difference is that traveling is involved.  That might sound simple but it’s not.  It’s asking a lot of a toddler to focus, pick up a picture, walk with the picture, and release the picture.  Toddlers wander, meander, mosey.  There can’t be any of that during Phase Two.  Straight line and request it now!

We meet with all of Nate’s therapists monthly to determine how Nate’s programs are going, what corrections should be made, and what new programs should be introduced.  Two team meetings ago, we decided to introduce Phase Two of PECS.  To start, you need a really motivating thing for Nate to request.  With the help of a peanut butter chocolate chip granola bar, Nate scored 100% on his first try!  The next day, with the aid of his best friend Hobbes, Nate scored 100% again!  The main motivators to date have been Hobbes, the granola bar, and chocolate chips.  These things are very much of interest to my boy.

When we’re practicing PECS, there are occasional moments when we don’t have a picture of what we’re asking Nate to request.  Since chocolate chips aren’t in Nate’s daily diet, he doesn’t have a chocolate chips photo.  We figured that the raisins card looked close enough, so we substituted raisins for chips.  Nate was none the wiser; he just knew that this card got him one chocolate chip every time he delivered it.  We also weren’t too concerned about it because Nate seems to have only memorized one card: bubbles.  (P.S. The Bubbles card just bit the dust.  I hid it in my pocket and it went through the wash.)  So we didn’t expect Nate to begin to truly associate the card with the item until later on in the process.

Sometimes, Nate’s therapists try to jump ahead to a future phase just to see if he’s ready.  Phase Three of PECS requires discrimination: Nate must be able to pick out the card of the item he needs to request from a sea of other cards.  That way, he’s developing a vocabulary and will be able to flip through his PECS binder to truly request an item that he wants.  A few therapists have tested Phase Three with Nate using chocolate chips (aka the raisins card) and Hobbes.  For chocolate chips, he was able to get up to a field of nine other cards with 100% accuracy in picking the appropriate card and traveling to the trainer.  He got up to a field of five for Hobbes.

At our team meeting this past Monday, everyone was thrilled with Nate’s progress.  His ability to discriminate highly motivating PECS cards, his willingness to travel promptly to request an item – spot on!  We agreed that we would continue Phase Two and visit the possibility of Phase Three at a future meeting.  We also discussed Nate’s progress with distal pointing.  He is doing well with it at the table, reaching to request a specific puzzle piece or snack, but having difficulty transferring the skill to things further outside of his immediate area (like, oh, animals at the zoo or aquarium).  Our BCBA suggested that we now begin having Nate practice distal pointing on the 2nd to the bottom shelf of our bookcase.   His occupational therapist will continue to help build up Nate’s chest muscles so he is better supported when pointing at a higher level.

The morning of the team meeting day, Nate had 8AM therapy with Miss Alison.  Among other things, we practiced Phase Two PECS with chocolate chips.  That afternoon, following our team meeting, Nate had therapy with Miss Lisa, who had a different agenda for the day.  Nate began the session by taking a Preference Assessment Test, a tool that determines what toys and food Nate likes the most.  This allows us to build a list of highly  motivating items that will help Nate complete difficult tasks or start learning new ones.  We created a random list of twenty things that we know Nate likes and started with five: a clock (we removed the face so Nate can make the hands move), crayons, stickers, Hobbes, and raisins.  No therapy was involved; Nate didn’t have to request anything.  Miss Lisa simply held up two items and asked Nate which one he wanted.  He pointed to one, got to play with it for a minute, and then we moved on to two more items.  Over and over and over again.  Raisins won 100% of its showdown, quickly followed by crayons, Hobbes and a bottom tier tie for clock and stickers.

Miss Lisa decided that we should get a little PECS Phase Two practice in as well and suggested raisins since they were so highly motivating in the Preference Assessment Test.  (We also had them handy.)  So she placed the raisins card on the front of Nate’s binder and I sat on the couch with a bowl of raisins, waiting for Nate to request one.  Nate looked around, saw the set up, and realized we were playing the requesting game.  He toddled over to his binder and picked up the raisins card.  He was very thoughtful about it, staring  long and hard at the picture.  However, instead of coming to me on the couch, he walked the opposite direction to the built-in bookcase where all his toys are stored and nonsense is stashed.

Nate started to scan the shelves.  He then reached his pointer finger way up high and pointed.  Pointed high.  Pointed deliberately.  Pointed the furthest he ever had in his entire life.  If you drew a line from his finger, you’d realize that he was pointing at a pink bowl.  The same bowl that was used during therapy with Miss Alison that morning that, yes, held chocolate chips.  (Do you see it on the pleaseexcusethemess shelf?  Look really hard.  It’s in the upper right hand corner next to the star trophy.)

Miss Lisa was confused as to why I started to throw a parade since Nate didn’t do what she had asked of him.  Nate was nonplussed – he just wanted the pink bowl of chocolate chips.  My smart boy was requesting the item that was on his card and, because he had been told and shown what I had in my bowl (raisins), he knew I didn’t  have what that picture now represented.  Here’s the kicker: I stash stuff on those shelves all the time.  It’s a safe haven: out of reach from Nate and a quick place to put something so we can transition to another activity in therapy. That morning, I put the chocolate chips up there after we’d said “all done” to the activity with Miss Alison.  Nate was on the other side of the room when I did it, trying to sneak in a break.  He wasn’t paying attention.  He wasn’t focused.  I didn’t think he even saw what I did.  Clearly, I was wrong.

Lessons learned: Nate is really beginning to discriminate between photos in his PECS book and is assigning true and correct meaning (as defined by practice) to the images.  Nate can distally point to a high location if he really, really, really wants to.  And, most importantly, Nate corrects his mom when she’s got the activity all wrong.  He surprises me at every single turn.

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