Nanny with concerns about charge with very long hours in therapy - Mothering Forums
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#1 of 11 Old 06-01-2007, 03:18 PM - Thread Starter
 
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I am a nanny for two special needs boys (3 and 5). They both attend the same preschool together and they are in the same class. They go for 3 hours in the mornings, 5 days a week. The 3-yr-old has autism (mild) and he will be starting up ABA therapy again. He has had a break from the therapy for the past 2 months. The first day of the therapy was an orientation with him, his parents, me and the therapists and program director.

I don't really understand how this therapy is going to be beneficial to him. The way the program is set up involves a lot of him switching cards on a schedule back and forth. It seems odd. He takes his name card off the schedule and puts it right back in the same place. (??) Then, he takes another card that has an airplane on it and goes to the bin with the airplane and plays with the toy in that bin. Then the card goes back and onto the next card. After 3 rounds of this, he gets a free choice - there are 6 cards with things he likes to do and he can choose to go outside and ride in his red push car, play in his rice bin, etc. This therapy is a 3-hr-solid block with one teacher.

Am I missing something? I do these things with him all day - he plays in his rice bin, plays with his train, we read books together, I bake with him, we go to parks and the library, we color, paint, I chase them and play tickle monster, we go for walks around the neighborhood. I read books and information on autism every chance I get. I have a B.A. in Child Development and I have known this family since he was born. I know this in no way qualifies me as an ABA specialist, but I just think the way they have this set up will be frustrating and stressful for him. Even the "free time" is more like - "pick a card and go do this thing."

His mom has the same concerns and would like to give the ABA a trial run and see how it goes. The therapist we ended up with his brand new and seems very passive and quiet. We have to do 15 hours of therapy a week, minimum. It just seems like so much for a little boy who is also going to preschool in the mornings. His previous ABA therapists were wonderful and he had small sessions throughout the day - still 15 hours a week, but broken up a lot more and he wasn't attending preschool at the time.

Like I said, his autism is very mild. He has very good eye contact and frequently comes to me for hugs and cuddles. He will take me by the hand to bring me outside or to a toy to play with him. He says about 50 words regularly. He has a very good attention span and, for the most part, plays with toys appropriately. We had a great routine going and we have bonded very well. I don't want to see him get overwhelmed with all this therapy and, honestly, I am going to miss him! I can't really join in on his therapy much because I will be with his brother during that time. I might be able to slip in for a few minutes now and then or bring his brother into the therapy if it is a group activity.

I guess I just wanted to express my thoughts and see if anyone has another take on this or any insight or personal experience.
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#2 of 11 Old 06-01-2007, 03:31 PM
 
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I'm sure some of the parents who've got children with autism will step in, but my first question is whether the parents have asked the ABA therapists what the goals of the sessions are and what the purpose of the exercises are? It's going to be hard for you and them to support the therapy unless they understand the goals and how the therapy is going to help the child reach the goals. A good therapist should be willing to take the time and explain that. If they can't/won't, that would be a huge red flag for me that perhaps this person isn't the right one.

ABA works well for some things (teaching discrete skills), but not others (teaching information about relationships), so it's usually best augmented with something else.

Since he's got decent social skills and some language, I'm wondering if something like RDI/Floortime (RDI = relationship development intervention) would be better. Maybe you could direct the parents to those resources too.

You sound like a wonderful nanny - that family is very, very luck!

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#3 of 11 Old 06-01-2007, 03:45 PM
 
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I agree that that family is very lucky to have someone like you. I also agree that you might want to ask the mom whether she's heard of RDI, which isn't exacly anti-ABA, but is something close to it. We just started RDI and are very excited about its potential. It's also something you could be a big part of if you're willing to learn about it, which it sounds like you probably are.

I'm not a big fan of ABA, and I was actually trained as a behavioral therapist. It has its good purposes, but in general I think its aim can sometimes be to produce behavior the parent and therapist wants, not the child. There's a tricky line in all therapies for autistic spectrum kids between helping the child be more successful and confident in the world, and wanting the child to fit our neurotypical molds. I'm not saying ABA is not sometimes the better choice, or that ABA is always about getting a child to fit a mold - obviously there's lots of good ABA out there that makes sense for individual kids.
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#4 of 11 Old 06-01-2007, 04:20 PM
 
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Well, I see your concerns. There are different approaches to autism therapy. Like the previous posters mentioned the mom might want to explore RDI or floor time.
I started with floor time and am now doing RDI. My son is also mildly affected and sounds similar actually and these seem more beneficial to him. Of course you are a tough spot because the parents are trying to do what is best and probably have had the ABA recommended to them. And I know there are parents here very happy with a behavioral approach. Hopefully they will chime in on your questions!

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#5 of 11 Old 06-01-2007, 11:28 PM - Thread Starter
 
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We are on a waiting list right now for RDI. I went to an RDI orientation one weekend with their mom and I really liked the philosophy, since it is more relationship-based and less academic stuff. The waiting list is pretty long, so it will be sometime before we get our turn.

He had is first official session today and it didn't go well. He cried pretty much the whole 3 hours. Crying to the point of his face being covered in snot and tears. It broke my heart. He kept trying to get out of the room to come get me. They did let him come out three times to see me and I cuddled him for awhile, but when it was time to go back he broke down again in huge, wet, soppy tears. He kept saying, "All done, bye bye, all done, all done." I listened in on the therapy and it seems very strict. There wasn't much playtime. They used flash cards and they forced him to do every activity until he was finished. I heard them say, "Color! Color! OK, just color three more lines! Three more! Come on, you can do it. One...... Two........ just do one more, one more and then all done.... Three.... yay!" Um, ok? What was the point? He was so miserable.

I called his mom toward the end of the session and she is very concerned. She wants to put a video camera in the room on Monday so she can see what is happening. She said that she didn't think it would be so academic based. She thought they would be playful and silly and that they would spend at least the first few sessions just playing and bonding with him.

She told me that it is always hit or miss with what ABA organization you get and what specific therapists you get. The first organization she tried was the same as this one and he started to regress a lot because he was so unhappy. The second organization was awesome and she thinks we will go back to using them. They are very playful and flexible and he was always happy to see them.

I also talked to the therapists today and they said this is normal and it takes a few weeks for the child to adjust and there is always a lot of crying at first. But then when I reported this to his mom, she said that's exactly what the first organization told her and yet he never improved after months and she finally gave up and cancelled the therapy. They kept telling her to wait and see and stick it out.

He was so sad when it was all over. I felt like I betrayed him. He only wanted me to hold him and cuddle for the longest time and then he fell asleep from exhaustion (he doesn't usually nap).

Therapy should not be like this. It just seems wrong. AP philosophy should apply to all children, including special needs children.
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#6 of 11 Old 06-02-2007, 02:02 AM
 
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This thread is getting me all teary thinking of what I would give to have someone (other than me) so concerned about my child's therapy. Especially someone who is educated and could really analyze different programs!

Ok - enough poor me.

You sound wonderful, the ABA program doesn't sound so good. My son gets services from an agency that is ABA based but nowhere near that rigid or boring. It is really a combination of therapies. Occasionally he has a few sessions where he doesn't seem to be enjoying himself - or he even gets upset. When that happens, I make everyone stop and try to figure out what's going on - is he getting sick? Is he tired? Did he eat lunch? Or are the exercises too difficult or boring? The therapists don't always agree with me - they think he could just "get through it" but they will respect my decisions and they are great about changing up the program if necessary.

That said, I'm leaning a lot more towards the RDI/Floortime stuff. We have an appt w/ a Floortime consultant in a few weeks. I think you should look into Floortime that you could do at home. Here is a link for a home program - http://www.floortime.org/ft.php?page...0for%20Parents
Good Luck!
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#7 of 11 Old 06-02-2007, 02:53 AM
 
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That makes me sad
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#8 of 11 Old 06-02-2007, 03:17 AM
 
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I do ABA therapy myself and supervise other therapists. We ALWAYS spend the first few weeks building rapport with the child and getting to know/him or her with increasing demands as we learn their skills and interests until we have built up a structured session. I would never have used those sorts of demands in a first session!

It may be true that there is a lot of crying at first with that agency, but that's not what an ABA program should be like. We spend the first few times figuring out what a child likes and using those items/activities to get to know the child and then as reinforcers and do a lot of Floortime.

How are you going to get a child motivated to work with you unless you know what their interests and needs are and they trust you?

I think the mom should get the other agency back.

Early intervention specialist and parent consultant since 2002.
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#9 of 11 Old 06-02-2007, 05:41 AM
 
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I can't imagine how difficult that would have been for both him and you. It sound horrible.

We haven't done ABA, but ds' main therapists follows TEAACH, which is a variant of ABA used a lot by schools. She also is very flexible and looks for other solutions that fit the child instead of trying to make the child fit the learning style.

My experience has been teachers that encourage me to stay in the room with ds until he seems comfortable, then watching from behind a one way mirror/window. They welcome me intervening if he is getting too overwhelmed. (this also depends on the situation...if he is frustrated because they are pushing something specific that we know he needs to work on, but is resistant, I will stand back a little longer. However, this is very situation specific and well strategized before hand so everybody is on the same page). I absolutely cannot imagine it getting to the level of sobbing though...that seems really counterproductive to me. If it is the norm at this place, it sends a red flag to me that this group isn't a good one.

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#10 of 11 Old 06-02-2007, 07:37 AM
 
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I think floortime, and RDI are good alternative options. I am slowly learning more about ABA, and haven't been pleased so far.

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#11 of 11 Old 06-02-2007, 08:42 AM
 
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Quote:
Originally Posted by PikkuMyy View Post
I do ABA therapy myself and supervise other therapists. We ALWAYS spend the first few weeks building rapport with the child and getting to know/him or her with increasing demands as we learn their skills and interests until we have built up a structured session. I would never have used those sorts of demands in a first session!
: I hope that therapists gets it together.

Also, the thing with the pitures and activities sounds like an activity schedule. The idea is for the child to be able to engage in a series of enjoyable activities with out adult direction. Many kids on the spectrum have a hard time with "free" time. Times when most kids would just get a toy or two and play alone for a little while. Having the pictures schedule gives them a chance to play independently in a semi-structured way without adult prompting and a chance to choose their own (very rienforcing) activity at the end. The child first needs to be taught how to follow the schedule and it can take a while.

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