Punkin's IEP went very smoothly yesterday, even though the papers we were looking at were a rough draft. His teacher, his school-based occupational therapist (OT), and I had sat down Wednesday to discuss a sensory program that would be included in her report, which is part of his IEP.
Since Punkin goes to the before-school program every morning from 7-8, he's already hyperaroused when he enters his actual classroom. But since I'm with him for that hour, I can implement some of the things both of his OTs suggested even though it isn't actually IEP (or school) hours. Basically we're going to do some large motor/deep pressure work in a game with other kids, then he goes for his usual walk with another teacher to pick up the breakfast cart -- although we will now incorporate some heavy work such as pushing a buggy full of wooden blocks, and then he will come back and have computer time for visual stimulation. The hope is that this will alleviate the self-stimming he's engaging in after breakfast, specifically when he bangs Duplo horses against the table so he can 1) hear the noise 2) feel the input in his joints and 3) watch their heads bob up and down.
He will then receive a break of some sort about every hour. At first we considered recess to be a break, and then the more we thought and talked, we realized he needs a break FROM recess, which is generally indoors these days. So at first the large motor time is pleasurable because he can run and yell, but then he quickly becomes overwhelmed when all of the kids from the other classes join his class. When I've been in there, he often lays down in a corner to escape/watch the madness. Our thought is to try and get him out of the gym with another student and "squish" him under a mat or a bean bag chair for a few minutes. Then he's getting a break from the gym itself as well as some much-desired deep pressure.
Now, his speech pathologist, his teacher, and I also met a few weeks ago to talk about his progress and how to better meet his needs. Our consensus was that video modeling would be our best bet for teaching play skills, social skills, and a slower rate of speech. I'm very excited about this -- I think he will really respond well. The only hang-up is trying to figure out the scripts and getting permission from parents to use their children to act out the scenes.
So what are his goals? Well, I do not envy them having to come up with these. When we're focused so much on functional behavior, it is difficult to come up with academic goals that aren't the same as every other preschool child. However, there are some areas, such as prewriting, where he clearly struggles. So one goal is to make a circle, a diagonal line, and a plus sign. He can scribble in a circular motion, but doesn't have a clear stopping point. This is where we will use Mat Man to help him be more motivated to work. At this point, the word "struggle" would be a gross understatement. Even with his other OT, in a fun room in front of a MIRROR covered in shaving cream where he could STAND UP -- didn't have to sit -- he still pitched a fit about using "Mr. Pointer" to make a circle.
The next goal is about play skills. His teacher would like him to try at least 2 appropriate attempts at play with a child. So when he runs up to a kid and says, "HI!" and they do nothing, she would like him to then try again by say, bringing them a toy. This is one example where the video modeling will be implemented.
The next goal is somewhat related in that it has to do with play. She wants him to explore toys and figure out how they work. Right now if he saw a new toy, he would pick it up, bang it against a hard surface and/or make it spin, and then throw it. Not so much a desirable behavior in any situation.
His speech goal is to have his intelligible speech increase from 60% to 85% (with a familiar listener). In addition to video, we are going to model a slower rate of speech, use fill-in-the-blank sentences (I want ___. The book was about a ___.).
One big thing we talked about with his OT was his constant chewing on his hands. I haven't been too concerned, although he sometimes gags himself (on purpose) and leaves bite marks (though doesn't break skin). I never thought about how when he bites his hand, though, that it releases endorphins -- he's not just getting oral input this way. So she suggests I use no verbals and just bring his hand down and replace it with a chewy tube. And yes, this will take constant monitoring. So far I've been cutting the chewy tubes so he doesn't gag himself with them, but she's going to order the ones that are in Q shape as well.
And finally, we are going to meet at least two more times to write a behavior plan. I'm glad we're breaking this all up -- my goodness! His poor teacher deserves a foot massage and a chocolate bar the size of Mount Rushmore.
Do you love the photo? It's from his first winter -- I think he was 10 months old.