Monday, 14 September 2015

Meet Lucy

Lucy is a delightful 5 year old who has just started at Bright Futures School this September.  Her parents have given permission for me to blog about and to publically share footage of some of the work we do with Lucy at school – I am very grateful for this (thanks Rachel and Paul) and very excited to have Lucy at our school……not only because she is lovely, engaging and has a great sense of fun but also because working with her will present us with an opportunity to work with a very young child, and to document her (and our) progress on our social communication journey together starting from very early developmental milestones.
Lucy is quite different to our current cohort of pupils – our other pupils are verbally articulate and have mastered the basics of social interaction: joint attention; co-regulation; social referencing; experience-sharing.
Lucy has some functional speech but hasn’t yet fully mastered the crucial competencies above, which, in typical development, we would expect to be mastered at between 9 months to one year.  She is still very much ‘on her own agenda’ and is unaware of the needs of her communication partner/s.  She does not generally look to communication partners for information that can help her work out what to do when faced with uncertainty.
Here is some footage of my second session with Lucy.  I had observed her working with another member of staff previously so had an inkling of what to expect.  My mental goal when I went into the session was to join Lucy in whatever activity interested her and to try to establish a simple turn-taking pattern.
We knew that she liked toy animals so we had those available on the table.
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You can see from this footage that Lucy doesn’t orient to me when I use her name.  Neither does she pay attention to the noise of the lion that I am trying to share with her.  She is unable to co-regulate by making the noise of the horse (the noise may be too difficult for her or she’s not interested in making animal noises).  Lucy puts the horse on the floor and then takes my lion (breaking the co-regulatory turn-taking pattern).  I spotlight to her that it’s my lion and hold out my hand but this doesn’t register with her.  She becomes distracted by the pictures on the wall and identifies Nemo.  I remind Lucy that the horse has gone on the floor and this seems to re-gain her attention – she puts the lion on the floor.  I quickly take control of the animals so I can put a turn-taking pattern in place.  Sarah and I take our turns and Lucy picks out the giraffe to put on the floor.  We take turns again and then Lucy picks out the mouse.
It’s lovely when Lucy initiates sharing emotion around the mouse noise: ‘eeek, eeek’.  She has remembered this from her last visit, and she does reference me around this, which is good.  It’s clear that Lucy’s receptive language is ahead of her expressive language – she has no trouble responding to me when I ask her to sit more stably in the chair.  The rest of the session after the clip ends continues with us taking turns to place toys on the floor and then taking turns to put them back in the box.  We do try out the books and some other toys but Lucy wants to stay with the putting and placing, so we go with that.
I wasn’t sure where to go from here so I did what we all do/need to be able to do when in a state of uncertainty – I referenced someone who I trust……my fellow RDI Consultant, Sharon.
Sharon works with Bright Futures School to support some of our staff in their ‘guiding’ (RDI) training, as well as mentoring my guiding (RDI practice).  She is very experienced and highly intuitive (much more so than me) about using the principles and practice of RDI.
Sharon suggested that we start right at the beginning stage of co-regulation with Lucy – a stage that in RDI, is called ‘synchronous co-regulation’.  Here is Sharon’s guidance:
Synchronous Co-Regulation refers to an important component of synchrony, involving feeling one's bodily connection with others. Through joint synchronized, rhythmic & patterned movement we pleasurably experience ourselves and others functioning as a single entity.
So what does that mean?  With babies they are rocked & gently bounced to soothe them.  As they get a little older parents/carers will use movement & nursery rhymes whilst adding anticipation i.e. with Humpty Dumpty the child will be on the carer's knee, anticipation will be added before they are dropped & pulled back up again.  In Ring-a-Roses anticipation will be added before the 'all fall down'.  Before a child is picked up, movement will take place i.e. holding out arms to child, child hold arms out to parent... anticipation can be added before picking the child up by pretending they are too heavy to lift etc.
Where can we take this?   Find & use Lucy's favourite nursery rhymes.  Do those action songs in which there is body contact i.e. as above or ‘Row Your Boat’, 'This is the Way the Ladies Ride', 'Round & Round the Garden', 'This little Piggy', even 'Peek-a-boo' with just hands to begin with....any others you can think of.   Add anticipation in whatever you use.
Although the above are without objects I also wonder how successful using bubbles would be.... most kids love bubbles!  If using these, I would suggest that either you direct Lucy to sit on a chair, or on a mat/cushion on the floor, before blowing.  Build anticipation around a pattern of you blowing & Lucy popping but each time before you blow, have her sit back on the chair/mat/cushion before you start the pattern again.
With any of the above we are looking for Lucy to recognise that she has a role to play.
So with this in mind, I went into my next session with Lucy armed with a list of nursery rhymes and early years action songs (it’s a while since I’ve used any of those!).
video
We are now in Lucy’s room at school.  Distractions have been minimised and we have started off again with the game of throwing the toy animals.  Lucy had thrown 4 animals so I pick out 4 to throw.  I build anticipation by giving ‘ready, steady, go’ a shot and it pays off with Lucy co-regulating by saying ‘go’ when I pause.  She comes in with ‘go’ again with the dog and I make sure to throw as soon as she says this so that we are building up a co-reg pattern.  We repeat this with the cat and then with another dog where she whispers ‘go’.
video
I try out ‘The Wheels on the Bus’ and I’m really happy to see Lucy co-regulate by joining in on the actions to the horn, chatter (bit of a tricky manoeuvre but she approximates it by moving her hand), up and down, wave and repeat horn.  This is great as we are establishing a connection :)
video
I do Incy Wincy Spider and on ‘rain’ she does a ‘washing down’ action and follows it with a 'climbing up the spout' action.  I celebrate by clapping and it’s lovely to see Lucy join the ‘we did it’ celebration.
So….we’re really happy with these little bits of co-regulation and connection as they give us a great base to build from.  As Sharon said, slow and steady for now whilst we build up trust and get to know each other.  We’ll add in ‘just noticeable differences’ and variations as we get to know Lucy’s edge of competence.  We don’t want to tip her over into withdrawal if the challenge is too big and we need to make sure that the activities we are using as the vehicle for our ‘goal beneath the goal’ (our developmental objectives) are activities that she is interested in and in which she has a competent co-regulatory role to play.
Over the coming weeks I’ll share some footage of other staff working with Lucy too.  I hope you enjoy joining us in our developmental journey.   

7 comments:

  1. To all involved: Thank you so much for sharing. I love the brave 'step back' approach!

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  2. Glad you liked it. More coming soon!

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  3. Zoe, Sharon, Lucy and parents, thank you so much for sharing. It was great to see how you took on board what was evident in the first video as 'too overwhelming', 'distracting' etc and quickly adapt to create a more optimal environment for learning. It reminds me to refer more people to your blog, Zoe, expect some increased traffic in the weeks ahead :-)

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  4. Thanks for the positive feedback :) More traffic always welcome!

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  5. These are really interesting - enlightening - videos, thank you (and Lucy and her parents!) for blogging about them. My son is autistic but very high functioning and (generally) articulate; I can see in Lucy's behaviour some of the problems he must have had, and still does, in co-regulation and connection. Sadly, although he was diagnosed fairly early (at age 4) it's taken until now (8 in March) to build up everyone's knowledge and understanding. We basically missed opportunities when he was Lucy's age to try these kinds of activities which I think would really have helped to lay the foundations of social behaviour for him; and now he would find them boring and babyish and wouldn't want to play along. So much that we take for granted and teach NT children by instinct is so difficult for the lay parent to put together into a manageable lesson for an ASC child!

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  6. Thanks Fledge :) I think you're right about this type of activity being inappropriate for an older child/young person......but there are other, more age appropriate activities that could be used as the 'vehicle' for working on social communication. With older kids at school we use a lot of cooking/baking; craft and woodwork; board games etc. There is an online summit coming up in Feb run by the Connections Centre (RDI HQ) that will feature presentations and webinars on working with different age groups and different profiles of autism. Might be useful? http://www.rdiconnect.com/project/rdi-autism-summit/

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    1. Thanks that looks really useful, I'll keep an eye out!

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