Our little STAR looked quite normal in the first 1.5 years of birth, but as he grew towards 2 years old, we had noticed his delay in communication without suspecting anything amiss as some kids do learn to talk after 2 years old. It was his wierd behavior at his own agenda, with poor eye contact, lack of imagination, pretend play & social interaction that had triggered us to seek help from child behavior specialist. After he was diagnosed with ASD, we starts to learn more about the culture of Autism that every child is different & unique in their own special ways. We had also witnessed his behavior evolution until thus far.
Back in the early days of EIP, when I did the eye-berg analysis on his observable behavior, my little STAR was seen as a Sensory Seeking child, with his active, always on the move, disorganize/distructive in his play, difficulty staying still/seated, short attention span on one activity and easily distracted characteristic.
But as he progressed in his learning journey, we also noticed that he also has some characteristic of an Over-Responsive child as he prefer rigidity to changes, may have difficulties with transitions such as in Term 3-4 '09 in the new school environment or may seek certain sensations as a coping strategy like appear hyperactive running or jumping about.
While some of his other characters also resemble that of under-responsive child with his passive reaction, or appear self absorbed in his own repetitive actitivies, difficult to get attention at time and response better when given extra and sufficient sensory. Our little STAR seems to have a combination mixture of these 3 sensory modulation issues.
Tearing tissue and let it free falling down, open and closing of door, turn on/off switch, looking at spinning wheels are some things he found motivated in the early days of EIP. Due to his limited skill in functional communciation, he appear to have more melt down and temper tantrum back then. Fortunately, all these were reduce as he developed verbally from own agenda into
requestor after 3 terms of EIP.
However, new behavior was observed as he starts to do simple visual stim using pencil or block. On 1 Oct '09, we finally engaged OT to help provide intervention strategies & optimize this sensory regulation.
The goal of OT for an ASD child is to optimize his sensory regulation and arousal level for learning and engagement despite the presence or absence of sensory-stimulatory behaviors. In cases where total elimination of the sensory-stimulatory behaviors is not possible, learning (cognitive, gross and fine motor, social skills, activities of daily living) can still be facilitated as being observed by OT in our little STAR case. It is also important to recognize that even for some children who have appeared to stop sensory-stimulatory behaviors, there may be occasions that would trigger the behaviors
Possible reason for visual seeking behavior, could be because he does not have sufficient visual stimulation or sensory stimulation in general (visual, auditory, proprioceptive[body position, muscle & joints], vestibular[movement], tactile[touch]). He now may even use his own hand or books to self arouse his visual sensation.
Some general calming strategies(for over-responsive child) involve increasing vestibular input such as jumpx10, spin or run few round about or eve rolling fast on the floor, so as to increase his level of arousal for attending to tasks and it will also give him some form of visual stimulation which he often seeks. Best given before the starts of program or selective routine interval. Alternatively, may apply deep pressure touch using firm touch to massage child's limb or back or give the child a bear hug.
For general alerting strategies(under-responsive), we may also choose to increase his propriocetive input via heavy work by creating activites for the child to push against the wall, pulling via tug of war using scarf or lycra cloth, crawling through tunnel to retrieve toy/object, hanging from playground equipment or even help carry heavy object like stacks of book from one table to another or wheel barrow walk. If not, may also apply oral strategies like sucking from straw and blowing toy whistle.
Feedback from OT:-
"Fabian has shown tremendous improvements since he 1st came for OT with extremely poor motor coordination, attention, engagement, articulation and understanding. He is making steady improvements every week, but he is someone who needs 1-1 attention, and lots of repetitive practice in order for his potential to be maixmized. Using the "shadow teacher" approach will greatly benefit Fabian"
Where he doesn't comply with verbal prompts from teacher, shadow teacher can then apply physical prompts like placing her hands over his hands on the table, gesture in telling him "No, stop", and continue putting her hands over his, so that he understands that this is an expected behavior. A reward system via behavior chart with token/sticker reward to motivate him on the right behavior can be effective when apply correctly with IMMEDIATE, DESIRED reinforcements, and a system of fading needs to be in place.
"Thank you for the prompt feedback and your invaluable help in assisting Fabian through this challenging time. Fabian has been progressing well througout the past year with a significant reduction in self-stimulatory behavior (visual and verbal) during OT and Kindermusik group session. However, there has been an unexplainable increase during the last 3 weeks sicne Term 4 starts. I am also concerned as this has caused him to have poorer sustained attention and engagement in both individual and group OT sessions. An increase in self-stimulatory behaviors is common in ASD children during periods of boredom, insufficient sensory stimulation, stress, changes in routine, changes in diet and medication, and illness (as discussed during last Thursday's meeting). It is important to find out the primary reason in order to tackle the issue of increased self-stimulatory behaviors. As he is still coughing and on medication, we will have to wait till he is fully recovered so that we can re-look at possible causes. "
It is true that my little STAR is still on medication for his cough as of writing even though his frequency has reduced but still hope to clear his phlegm
Recently, my little STAR also tend to speak at high tone or volume not ony at home but in public places, he does seem to care less about his surrounding envronment and will not even pay attention to people staring at him. To help him, I had also constructed a volume thermometer to train him to associate each level with a description that he can understand or we can relate to him when situation arises:-
In managing my little STAR with ASD, I have learn & will continue to learn & manage 2 things that could bring hope to his future success and independence: Understanding his needs & Strategies through the various professionals within his Special Education Team.
lways telling my HEART to CELEBRATE my child's progress! LOVE who they are today, not who I'd like them to be.
I love my son for who he is in his own special way but I also hate how much it forces him to struggle so much in several aspects of his life. Nevertheless, in resilience, hope is what we have in showing Autism we have 10 times more reason to smile everytime it give us a reason to cry.
Winners Statement:-
"Anxiety is a thin stream of fear trickling through the mind. If encouraged, it cuts a channel into which all other thoughts are drained." ~ Arthur Somers Roche
Still in his early communication stage, he is able to not only to make request for variety of things, make choices but lately able to comment and extend his sentence construction. We will try create opportunity for his turn taking during people games like chasing, playing balloon or even during meal or snack time.
Had made 2 more visual support for "No silly Noise" & "Quiet Hand" to reinforce his verbal stim & to regulate unnecessary hand
Wanted to bring our little STAR to the usual Indian barber shop in our neighbourhood but unfortunately it did not open, decided to let him try the hair dressing saloon next to the shop instead. Our little STAR seemed anxious at first, but we had managed to reinforce with him and transit him in and glad that all went well. Just try to share some background information to the hair dresser about our little STAR special needs but coincidentally discover that she too, also has a friend with child in the spectrum also, getting prevalent these days, we are not alone in these special walk.
I was delighted to be able to join my wife and the little STAR for his Term 2nd outing in late Oct. It was another fruitful and enriching learning journey taking the Hippo Bus & Duck boat ride which involve every children in the EIP. It has never been easy managing the little STAR in the public as he is usually over responsive to the open environment and will run about exploring places where he desires. Glad that he still follow the day's agenda while waiting to board the Duck Boat.
The Duck Boat ride was an eye opener where it sailed us through some of the important landmark of Singapore like the Flyer, MBS IR, Floating Stage, Esplanade, our very own Merlion & the Financial District. Also manage to get a glimpse of another new landmark in the making, looks like a shape of a Shell, reminds me of Sydney Opera House, look forward to its completion.
We are proud of our little STAR achievement thus far, no matter what he may become, we will always rejoice in his presence and embrace his imperfection.
