I went out to breakfast with a really old friend of mine the other day. He has worked the majority of his working career with developmentally disabled adults, a lot of his clients were and are autistic. I mentioned something about trying to explain the importance of consistency and structure, and he said that’s “Autism 101”. It got me thinking, if there were an “Autism for Dummies” book, chapter one would be “Consistency and Structure,” and chapter two would be “Communication.” Yet still these issues comes up time and time again. With it being so easy to damage progress, these three concepts become so very important.
Holden takes the bus to school everyday. For some reason the afternoon bus driver is consistently the same person, in the same bus, but the morning person has changed so many times, as has the bus. Holden handles this change pretty well, to him a bus is a bus. However, the afternoon bus driver is very strict with him, only letting him unbuckle his seat belt when he tells Holden it is okay to do so, and only seats Holden in the “big boy” seats on the bus. The morning drivers were putting Holden in what ever seat he chose, and Holden preferred the child seat type seats. The afternoon bus driver was having a hard time getting him to sit in the “big boy” seats because he had been allowed to sit in the other seats in the morning. Not only was this frustrating for the bus driver, it was very confusing for Holden. Also the main afternoon bus driver was out a few days, and the sub bus driver was not only letting Holden unbuckle himself as the bus pulled up to the house, but then reinforcing him to do so by telling him “good job” for knowing where he lived. It was an innocent mistake, but still caused more confusion for Holden, especially when the regular bus driver came back, and was making him re-buckle himself, and wait for the okay of the driver before removing his belt. These little inconsistencies and breaks in structure are very hard for Holden to understand, and take a while for Holden to adapt too. The afternoon bus driver has attempted to communicate with the morning driver to get consistency, but with the driver always changing, it has been difficult. I have taken to putting Holden in the “big boy” seats myself in the morning, rather then let the bus driver seat him, despite some of the drivers not appreciating the help.
Once a friend was visiting us, and Holden had picked up this behaviour of clearing his throat. It was actually the sound one makes when about to “hock a loogie”. Holden has huge tonsils, and I believe the behaviour started due to post food phlegm, but turned into a behaviour. It would increase with agitation or anxiety, irrelevant of food consumption after a while. Prior to this Holden had had the far worse behavior of spitting. He never made the hocking sound then, he would just spit. For obvious reasons, his teachers and I worked very hard to eliminate this behavior. While our friend was visiting she was convinced that Holden just needed to spit out the phlegm he was trying to hock up, and encouraged him to “spit it out”. Once again this was a totally innocent thing our friend did, but all I could think was, “Oh know, he going to start spitting again.” Once again, these inconsistencies, caused by people truly trying to do good, can cause Holden to digress and can be confusing for Holden.
One summer Holden spent a two weeks with his mother out of state. His grandmother was helping to watch him while his mother worked. His grandmother tried to take on a behavior, and quite innocently made it worse by drawing attention to the behavior. It is so important for everyone who is dealing with Holden to understand how to deal with these behaviors, and that if they are going to try and teach Holden, to make sure they are not accidentally undermining his progress. Behaviours don’t just disappear, they have to be replaced with other behaviours. The level of communication between all of Holden’s teachers needs to be very thorough. We all look for behaviours as they appear, and compare notes on them. We look for possible obsessive behaviors before they become full on obsessions, and we all try to use the same methods to help Holden work through the behaviors and find better behaviours to take their place.
Recently a friend was in town visiting, and she was very sensitive to the fact that it is very important that Holden use language to communicate, and express his wants and needs. She was great about making Holden use his words, and prompting him to speak when necessary. However she also wanted to improve upon his pronunciation. She tried to get him to repeat something he said clearer. Certainly it is important that Holden speak clearly, but right now we are a lot more concerned that he speak at all, so we are always trying to promote speech, and when possible reward it. It is a major goal in his behaviour therapy to be able to express his needs, rather then act out in the form of a bad behavior, or even worse a melt down. So if we can understand him, even if it is not perfectly clear, that is the goal right now. At this point in Holden’s development, especially in terms of speech, we are only going to address pronunciation issues when his communication improves, not at the cost of it. So sacrificing pronunciation at this point for the sake of encouraging communication is a small price we are all willing to pay, to keep him talking.
Autism 101, chapter one, consistency and structure, and chapter two, communication, these things are so important to Holden. The more he knows what is going to happen, the better he can handle it. The more all of us who deal with him everyday can be “on the same page” the better for him and ourselves. Communication is not only vital for Holden to learn, it is something so important for all of us working with him to use to keep working on the same goals, and not cause contradictions. We all want what is best for Holden, and we all have to use Autism 101 in the same way, with the same goals in mind. Holden has shown us all, if we can give him the tools to learn, he will use those tools, so long as we are consistent and structured in using them.
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