Guest Author - Bonnie Sayers
A year has been completed in the home for ABA with much success in the eating areas. Matthew now knows how to use a fork and spoon and has increased his food choices to anything and everything. The issue of eating slower and taking bites instead of just inhaling food is still being worked on.
He regularly eats fruits like pears, melons, apple slices, bananas and grapes. Next step is to expand his vegetable picks from carrots to other options. He is eating cereals, but does prefer cinnamon and peanut butter varieties. Drinks include rice milk, V8 strawberry and banana light fusion drink, orange juice and yogurt drinks.
Matthew is a big meat eater as well, with turkey burgers being his favorite. Pancakes and macaroni cheese round out his favorite meals. Steak, chicken, meatloaf, pastas, porkchops and ham steaks are consumed with no hesitation. Gone are the mozzarella sticks and finger foods that he would snack on. A favorite snack now is peanuts.
Progress reports are done on a six month basis. Behaviors have changed over the course of time from banging walls and stomping feet to grabbing my arms. Holes in walls and broken windows hopefully are in the past. The rigid behaviors have all but ceased where before they were a daily constant.
I've been given choices on what adaptive living skills to work on and have added some that I find needing assistance with. At this point in time I prefer to focus on self help skills than on social or play skills. Because tying shoes is the goal on the IEP for Occupational Therapy I wanted to add that to our ABA in-home program. This has just started in the past week.
We have been working on Matthew not trying to bite me when I clip his fingernails. We now soak his hands in a container at the sink to soften them before I attempt a few clips on each hand. I always have to end the session with the emory board. Many days before the bus we are at the door with me filing his fingers. I decided it would make more sense to have Matthew learn to use the emory board on himself instead of all the steps and drama associated with cutting his fingernails. This was well received by the supervisor of our program, so we started this last week as well.
Tooth brushing is working quite well with Matthew able to do this with prompting, but the task of teaching him to spit is not working out. I have searched online for suggestions.
For years now I have been opening a capsule and putting it in his drink twice a day for his medication dosage. I asked about trying to teach Matthew how to swallow a capsule. We have started this but it is quite confusing to Matthew as he does see me break the capsule and has chewed vitamin capsules, caplets and opened them up. I am also looking online for guidance on this task.
I can always tell when Matthew has eaten his school lunch by looking at his pants upon exiting the bus. He has the habit of wiping his hands on his pants so this goal is being worked on in the ABA program to get him to use a wet napkin or towel to clean his hands. I think the food at school is a lot messier.
For tying shoe laces in the program they are using backward chaining. Matthew is able to remove and put on his shoes independently. He can put on his jacket and zipper it plus he is now comfortable wearing the hood in cold weather or when raining. He prefers that to holding an umbrella. Whenever he wears a jacket it needs to be zipped all the way up. This is something we may tackle at another time once the shoes has been mastered.
In the last year Matthew has met the goal for cup drinking, hand washing, putting his shirt on, his pants on and expanding his independent leisure skills by coloring for ten minutes. I did have to remove the crayons and pencils to a cabinet since he was drawing on furniture and walls.
I declined when asked by the ABA program supervisor if I wanted them to teach Matthew how to use the microwave. I suggested teaching him how to wash the dishes would be more appropriate for his level. We are now working on him doing his plate after eating and he is rinsing his cups and silverware before putting them in the sink bin.
We are still in the throes of toilet training with Matthew wearing boxers during session and sitting on the toilet for 5 minutes every 20 minutes. There were many accidents when we moved the time to 25 minute intervals three different times, so twenty minutes is his threshold. This is only being done three times a week during the 2.5 hours of ABA. This has not expanded beyond the program for home or school. It is a long process.
Once the toileting has been accomplished the next step will be learning to swim and hopefully go to a summer day camp.
Examples of task analysis for skills
A pill swallowing cup