Tuesday, November 17, 2009

Slow Progress for Tortuga

Carmel had asked a while back how our Halloween weekend "test" results for Tortuga would change what we were doing with him and a couple of folks asked me to say more about his routines in general. It has taken me a while to figure out a coherent approach or plan but thanks to a Christine I have been able to institute multiple short "practice sessions" (I'll get back to this) that seem to be helping. It took Tortuga about a week after our visit with P. to get through the constanct defiance, meanness, rudeness, dysregulation, etc. He didn't get over it completely and he had that horrible meltdown I wrote about in my last post but even that experience showed a few elements of improvement. So, skip this post if you don't want the boring details but I am going to try to pin down his current routines for those of you who might be interested.

When I get Tortuga up he goes through his morning routine (toilet, teeth, shower, dressed, combed, make/change bed) then he comes down to stair landing to get his daily writing journal prompt and goes back to his room to do it. If he finishes before breakfast is ready he brings his notebook back to the landing and picks up his next school assignment. All of this should be done without him interrupting me in any way. This process used to include 12-15 interruptions for redirection, reminders, or unnecessary questions/comments ("Do I really have to brush my teeth today?", "There is pee in the toilet." or maybe "Is it daytime outside?"-as the sun streams through every window!) He comes down and hugs me good morning then he has breakfast on the landing or dining table, brings his plate down to the kitchen, goes back to the landing and practices patience ("strong sitting"), taps and/or rubs.  The landing is his "safe space" where he can "be" with the family without having to "be" with the family. After breakfast, we check in about the school schedule and assignments he needs to focus on and he goes back upstairs to do his work. This will vary slightly when I have a lesson to teach, a progress meeting, or a group lesson/experiment (these he doesn't handle well so we don't do them often) or if I have to explain something. He is expected to save his questions until I call him to check in on his school progress. Lunch is the same as breakfast and this is followed by "activity" and/or "mom" time. This can include playing basketball outside, walk, brain gym exercises, yoga, time with me, etc. This lasts until 2 pm or so when we have to go pick up Pollito from school. Depending on the day we are out for awhile or come right back home. If we come back home he spends the time until dinner doing activities (which I choose), schoolwork, reading, drawing, puzzles, outside play (structured), etc. He has 4 snacks throughout the in-between times because food issues have been present for so long but he is now declining snack once or twice each day. He practices patience after each meal and each time we return to the house from being outside (play, pickups, errands, etc.) Dinner is with the family twice each week (the other days it is before the rest of the family and I keep him company). After dinner he does his evening routine-wash hands, brush teeth, pick 2-3 short activities (I give him the options), change into pjs, put clothes out for the next day, etc. We also do another round of one-on-one time here but the time varies depending on when C. is home from work. C. will check in with him for a few minutes each night and he reads for at least 30 minutes before bedtime. He isn't "allowed" to go to sleep before 8:30 p.m. (nightmares for the rest of us!) but unless he has had issues he can stay up reading until I go upstairs for the night (usually between 10-10:30 pm). That is his current basic routine.

This routine has had a few changes recently. He can ask for more food/drink/etc. without waiting to be asked, bring his plates down all the way to the kitchen, and he can check in with me/ask questions/tell me his dreams/etc. Now instead of my company,  2-3 times per week he gets the company of Milagro OR Corazon for breakfast, where he "practices" having "normal conversation" rather than a captive audience. He also "practices" being nice to his sisters and listening to them and asking them questions. He has begged to do family chores so we have added a few. As part of his morning routine he must wipe down the tub, sink and toilet daily. He is doing this to show he can be thoughtful to his brother and sister who share the bathroom with him. For the most part they avoid that bathroom because he manages to leave a mess in the shower, pee on the seat/floor, soap scum and toothpaste on sink, counter and mirror. It is pretty gross in there so for a few months we have been having him wipe it down on the weekends before C. or I clean it. That clearly wasn't enough so we have made it a daily occurrence and linked it to being a good "family kid." He also gets to do the change the kitchen trash and take recycling out to the big container after he finishes eating. Doing chores was one of the things we "took away" from him when we started this new process with him and he has asked to do them again for quite awhile. He is now up to 3 dinners/week with the family and just this past week I have introduced letting Corazon or Pollito keep him company for dinner 1 other night each week. I have also

Whenever he is doing his schoolwork, chores, activities, etc. I have just started to do many more small "practice" sessions where I introduce something we need to work on (facial affect/expressions, talking to the baby, doing a short "errand" in the house, "helping" me with something I don't really need help with but want his company for, folding laundry, looking for something, selecting a book for nighttime reading, engaging in a quick conversation about plans for school, errands, etc.) These are designed as interruptions in his day that require small transitions (transitions are very difficult for him especially going from interacting with Corazon/Pollito/me and then back to his work or room. These used to lead to rudeness, meanness, impatience, attitude and even full-blown meltdowns so we are working on making these transitions smoother. This is a new thing this week so I don't have much to report about how that is working. The other thing I am trying this week is to "run errands" every single day. No, I  am not a glutton for punishment but I am trying to create more practice sessions for things that cause him trouble (being in the car, sitting near Pollito when Pollito is being 5, watching Corazon do something he cannot do, doing errands where there is high stimulus, behaving appropriately in a store, not sulking when I say "no" to whatever he asks for that he isn't getting, etc.) I. do. not. like. shopping. so doing this everyday is going to be a big "test" for me :-) So far we have had 1 day of this and he did incredibly well. Throughout all these practice sessions and tests I will talk to him before and after to help him be mindful of trouble spots, redirect and/or praise (which we have to be really careful with!) We have also increased his dinners with the family to 3 times/week and 1 dinner each week he is having with either Corazon or Pollito keeping him company. We are also reintroducing him to "family time" for short periods of time after dinner. Sometimes it is a family meeting, planning for something (holidays, visits, etc.), music, game, and/or story time. He has missed out on this entirely for a couple of months and each test has pretty much ended on a negative note. But we are trying again in small doses and seeing what happens.

I am sure I have missed something but really didn't want to bore anyone with the details. Let me know if you have questions or want to hear more.


carol said...

Wow, good luck. Sounds like your life is very busy. Good job with the routine.

Carmel said...

I really appreciate you taking the time to type out your routine. I am learning so much for you. It is wonderful the amount of time you have and C have put in to setting up a routine to help Tortuga succeed in your family.

I am in awe of your patience and dedication. :-)

Brie said...

can i PLEASE drop my daughter off with you for a few months?!? Your routine sounds fabulous and you must have the patience of a saint.

i do have a question. you mentioned Tortuga needs to do his morning routine without interrupting you. How did you do away with the 12-15 interruptions each morning?

Dia por Dia said...

It's funny (not ha ha) how easy and hard this has been to do with Tortuga. Easy because we ran out of options and when I finally thought about how we treat young children who can't handle the stimuli of so many people/things/activities, etc it just made sense. Hard because it is SO time consuming and requires alot of planning and replanning. But it actually isn't more time consuming than the hundreds of interruptions/redirections/etc each week.

Dia por Dia said...

Sure...drop her off! :-)
I think the two things that worked for reducing the interruptions during each routine (morning, car, meals, after dinner) were sentences and writing it out. We use sentences not as punishment but as "reminders." My logic was that he couldn't remember to do/not do what he was supposed to when we reminded him so I made him responsible for reminding himself by WRITING it. First time he interrupted was 5 sentences, second time 10 sentences and 10 sentences each time after that. We started each routine by me writing it down in steps. Him having a LITTLE control to change order/sequence if it made sense and then I would rewrite it for him. Then he would write it over (neatly) and post it on his door. If he "lost, destroyed, or damaged" it he had to rewrite it 2x, 3x, etc. Each time he didn't follow the routine he had to rewrite it (once, then twice, then 3x, etc.) Once the routine was in place we have been dogged about no slip ups. He forgets and interrupts or misses a step and he gets to do sentences. Does this make sense?

J. said...

wow, thanks for sharing all that, I always love to hear specfically what is working for others because it gives me new ideas/stragies for my monkeys.

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