Developmental Disabilities

Autism » Personal Stories

Vana-Autism

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Description: Vana (Ivan) is a strong, tall, blond six year-old boy. Vana engages in a variety of solitary self–stimulation activities that are preventing him from establishing self-control of either his movements or his emotions.

Assessment:  Vana flails, crashes, bites his skin, climbs, tenses his fists and overextends arm and leg movements with intent to hide or escape from activities in the classroom. Lack of body and brain coordination and control are interfering with his progress. His sensory disabilities, sight, sound and touch, are a barrier to his intellectual development. His skin and muscle tone widely fluctuate, so that the skin around his mouth, tongue, cheeks, hands, knees, and feet feels dry, brittle and hardened by self-biting and knocking. His sense of touch is not helping him as it should. His motor skills are generally bilateral and smooth, and his small muscle control of his fingers and hands are restless as he engages in hand-to-mouth activity frequently. He bends both arms in a good position to attempt drawing or scribbling on a flat surface. He has no reaction to his mother’s praise when he attempts to draw, and collapses against her body with his full weight. These physical lunges and throws from area to area have the effect of insuring that children and adults get out of his way. He does not respond to auditory commands or directions. He has low tone and is under sensitive to touch, on frontal surfaces of the body and high tone, and hypersensitivity to touch on the backside. These complex tone problems are responsible for some part of his seemingly wild behavior and his inability to express himself with words and feelings.

In the classroom, Vana does not physically or emotionally contain himself, but appears to use his vision well to look over large size details in the classroom. He knows where the windows and doors are located and often moves toward them. He does not find comfort or calmness in the classroom setting, gravitating toward a singular stimulus-light from the windows.

At home the family accommodates Vana’s needs very well. There is a large room in which he sleeps with his sister, relaxes and plays alone, (hide and seek is a favorite) and where there are games and a computer along with favorite toys. Ropes and a swing for exercise hang in the hallway. The family reports that Vana weights 35+ lbs. and eats whatever is placed in front of him for as long as he sits there, so they take food away after he has fed himself for about five minutes without stopping.

One of Vana’s favorite rooms is a very bright space with a large window that provides privacy for Vana where he can watch video or TV and listen to music when he becomes unmanageable. Vana’s father is exceedingly supportive; he shows Susan the physical fitness area in the hall; his desire is to find behavioral methods of helping Vana develop mental and physical skills, so he can go to school.

Vana’s mother shows Susan how Vana speaks words to a song, a poem and a finger play. His speech articulation is very poor, due to an excessively wide jaw, general oral muscular weakness and lack of tongue control; these weak areas must be corrected by speech therapy but there is also a great deal the family can do.

Before eating, Vana’s gums need to be gently rubbed with a clean cloth; his lips, forehead, and jaw line should be gently rubbed to slow down his fast rate of food intake and decrease his need to bite down. Frequent brushing of the teeth with a very soft toothbrush and facial massage will all help to strengthen the small muscles in the face and neck. The biting problem can be helped by offering small amounts of cold cereal to him between meals and in the evening before he goes to sleep.

Vana’s mother demonstrates the intellectual skills that Vana should be able to accomplish. She is eager to learn how to motivate him. She is teaching him letter, numbers and helps him write with hand-over-hand assistance. She comments that the younger sister has little interaction with Vana because of his behavior. The father points out that Vana greatly enjoys the outdoors but he cannot be trusted to go to the park to play; he does not engage in meaningful play or exercise.

Recommendation:

Susan feels there is potential for Vana to make significant progress, but it requires a major effort by all family members to change the way they live with Vana. They will have to train Vana to break habits he has acquired during a span of six years. He will have to have professional intervention training in speech, mental skills and socialization. The family will all have to be involved; they need to agree to be consistent with the program they follow and change the way they think about and care for Vana. It will take a year, but if the family really wants him in school, there is a full year of work to do. Vana is a friendly, good-looking and personable boy who deserves a chance to learn how to learn.

Susan lists below a series of 11 steps you can try, as a start. Susan will help do these steps with the family on the return visit. Here is a sample of what to do at home. Remember all you need to do is try!

  1. Make a list of all the things Vana likes best – his favorite food, clothes, games, music, family person, etc. These will be rewards for cooperation for him later.
  2. Decide for yourselves on one day over a weekend when you do not have to go to work to start the program; you will need to have Vana with you almost constantly so you can see almost every move he makes.
  3. During that day, when Vana rips a paper, hits himself or someone else, bangs in to things, bites something or someone, or engages in hair pulling, go to him quickly, do not talk to him; make a distressed cry or gasp. Stand beside him, shoulder-to-shoulder, take his shoulder and march him between your legs to the darkest place in the house -  maybe a closet.
  4. Stand facing the open dark closet door, holding him by the shoulders so he does not escape; he is still standing between your legs, and no matter what he does, do not talk to him for at least two minutes and then say, “NO.”
  5. Repeat that activity all day without shaming him, or without other words, every time he acts in an unacceptable manner.
  6. After two minutes, say nothing, release him, and say, “you will not pull hair; you can not do that anymore.” Let him go and be sure he doesn’t go far from where you are
  7. Be sure he is given something to do right away, a game or television, and then observe him…when he is being good and cooperative, say, “good for you, you did it right, and give him something from the list of his favorites – something he likes to eat.
  8. Keep this up for several hours or as long as you can.
  9. Wait a few days and do it again. Have other people learn the routine and help you. The hard part is the part about keeping him in sight all day for a certain number of hours, so you can accomplish the same routine every time.
  10. Don’t expect a miracle overnight, but soon you will learn to observe him and praise him for “being good” more often than you observe destructive behaviors.

The goal is to get Vana to stop doing destructive things to himself. You will do this only by giving him attention for good behavior. You are changing the way you behave toward Vana an

Ask Dr. Susan