Applying the Back Up Plan to Another Situation

Michael got angry yesterday when a DVD wouldn’t work and his mom couldn’t fix it.  Michael’s mom told me that Michael accepted her suggestion to watch a different DVD.  That was good news.  People with autism, in particular Michael, aren’t easily redirected away from what they demand.  We call this “having trouble with transitions”. 

Michael got angry today, though, for a different reason.  The “Marty Stouffer’s Wild America” DVD set hadn’t arrived in the mail yet.  It wasn’t that a DVD couldn’t be fixed.  This time, the DVD wasn’t in the house for him, and it wouldn’t be until next week.  Now we had to explain that he could use a back up plan in this situation, too, not only when a DVD couldn’t be fixed.  We had to help his brain make the leap... or at least consider it.

S: You heard your grandmom and mom talking about you getting so angry today?

M: I think I was that way because I can not have that DVD that the funny think that the DVD has not get that time I need so I get angry

S: Grandmom and mom told you it will come either tomorrow or Monday or Tuesday.

M: Yes

S: So why stay angry?

M: That is that truth byes that is the truth but I can not stop being that way fit yes I have I have fit that I get that way I get very very very angry

S: I understand you have a fit of anger. The problem is that you make everyone else angry too and get them upset.

M: I think I am help them to understand me that I am angry

S: Yes I understand that you want to help them know that you are angry but you can let them know in just a short few minutes. instead you let your anger out for a very long time.

M: I think I really really really think that no body care in the first first place

S: They do care. It may not seem that way at the time. Mom ordered the Marty Stouffer Wild America DVD seasons one through twelve. You have to wait. If mom didn't care she wouldn't have ordered it.

M: I think that you think that the DVD is coming good to hear that but I want it really really really a lot you understand how I think right

S: Why not watch the Marty Stouffer VHS tapes you have until the DVD comes?

Can you go get the Marty Stouffer and his Wild America VHS tapes?  Mom doesn’t know where they are in your big collection of tapes and DVD’s.

M: Yes

He went into his room, looked around for a minute or two, and then walked back to the iPad with two Marty Stouffer VHS tapes.  He put them on the table and sat down to type again.

S:  Thank you Michael.  Here you had the ability to watch the Marty VHS tapes and instead you let yourself feel really really really angry and let your mom and grandmom be upset for all that time.

M: I think that you are you that know then I feeling get the DVD

S: And in the meantime while you wait for the DVD to come what will you do.

M: I watch the VHS tapes

S: That's what's called a back up plan. You are doing something else so you won't have to stay angry and you won't upset mom and grand mom.

M: That is a back up plan

S: But what happens if grand mom or mom says what's your back up plan while you are angry? you can just get more angry at them.

M: I think that happens the I that you get that the way to handle that is to tell me to the room so I can get calm.

S: So do you think this idea will help you?

M: think it will

Michael Agrees to Have a Back Up Plan

Maybe it’s the change in seasons or maybe Michael needs an adjustment in his medication, but for whatever reason, Michael is experiencing another cycle of destructive and aggressive “episodes”.  That means his family has to endure his cycle, too.  This time around though, we can help him type to talk about his anger in ways he couldn’t express before.  Our intention during our conversations has been to help him develop a greater awareness of his beliefs, feelings, and behaviors and to support him to come up with ways that he can handle difficult situations using his more productive thoughts and strategies. 

One of his major stressors happens when his mom can’t get a DVD to play.  He’ll hit the wall, throw his computer monitor or computer, and as a last resort, he’ll hit his mom.

S. So do you understand that sometimes mom and grandmom do not have the ability to give you what you want?  They can’t always fix a DVD to make it play.

M: yes

S. What can we do to help you to understand that before you get out of control?

M: I think they get want that I need I that will get calm

S. I see that you think you need the DVD to be fixed in order to calm.  You are going to need a backup plan.  Do you know what I mean?

M: I think so

S. A back up plan is when you can't get what you really really really want so you agree to get something else in its place.

M: Right then I will have a back up plan

S. When mom can't get a DVD to work what is your back up plan?

NO ANSWER

S. Let me see if I can help you understand.

M: ok

S. If the DVD won't work what will you do?

M: Then I ask mom to fix it you I play the DVD

S. If mom can't fix the DVD what will you do?

M: I think I will much angry

S. Ok that is true.  Remember, though, you can be angry but you need to keep your hands to yourself and off the monitor and computer and TV.

M: That I easy if the DVD get fix get easy calm

S. I understand that you swear you need the DVD to be fixed in order to be calm but if you always depend on the DVD to be fixed and it can't be fixed you will be stuck feeling angry and lousy.  Would you like to be calm even if the DVD can't be fixed?

M: yes

I believe Michael may have made somewhat of a breakthrough.  I believe it has never occurred to him that he didn’t absolutely have to have the DVD fixed in order to get calm. 

S. What if mom reminded you that you want to be calm even if the DVD can't be fixed?

M: I think that sounds all right good have that feeling even when the DVD can’t be fixed

S. So if the DVD can’t be fixed and since you want to get calm you need to let mom and grand mom remind you to do something else to stay calm. That is a back up plan.

Examples of back up plan choices are go on YouTube, watch TV, play x box, play a different DVD, eat a pretzel, drink some milk, rest for a while in your recliner.  These are choices of a back up plan. Doing one of these choices will help you get the calm feeling if things don't go exactly the way you want. The lights might go off or the DVD might not get fixed... but you can stay calm.  What do you think?

M: I think that sounds have to really really really get back up plan you understand I you really really really trying to help me

Michael’s typing is inconsistent but informative.

November 9, 2010

S:  do you know that you have a dermatologist appointment tomorrow?

M:  I want to and really really really to right not go.

S:  I know you don't want to go but the doctor needs to look at your face and your chest. you really really really have to go.

M:  type this that I do not want to be at the doctor tomorrow I want home you understand.

S:  it's really not an option. you have to go. why not take your squeeze ball and squeeze the whole time?

M:  I want to talk the palm look have you your house.

S:  my house isn't really that interesting trust me. let's just figure out a way for you to feel comfortable going to the face doctor tomorrow. we know that going to the doctors is not fun for you. tell us where you would like to go after the doctors so you can look forward to something fun.

M:  I easy gets have remember the thomas the tank engine that I want today them I can have the one I want. Thomas the tank engine.  the title is help me get he's you the Thomas the tank engine.

S:  unless you can give us the title you are going to have to give us another idea... like why not go out for lunch with mom maybe macdonalds.

M:  ok

S:  the plan is you'll go to the doctors and then to macdonalds with mom. ok?

M:  ok

Mom emailed me the next day.  Michael went to the dermatologist.  He was much more relaxed while he was there.  He let the doctor examine him without being restrained in any way.  He and his mom and grandmother went to MacDonald’s afterward.

December 2, 2010

S: elephants noses are like straws. they suck up water or milk. what do you know about straws.

M:  straws are for drinking

S: do you know how to use a straw?

M:  yes

S:  which do you like better? drinking milk from a straw or just drinking with your mouth?

M:  I like drinking milk with mouth

S: do you use a straw or your mouth when you drink soda at friendly’s.

M:  straw

S:  I hear you love to drink milk.  do you like the taste or something else about milk?

M:  I like the taste.

S:  you certainly are talkative today. what makes today different than the last couple times we typed when you didn't seem to want to type clearly?

M:  I am more aware of my thoughts and so I can type what I want to type you understand what I am saying Steve

S:  so if am I hearing you right, somedays your brain is cloudy so it's harder for you to concentrate. can you tell me more about what it's like when your brain is cloudy?

M:  yes talking is harder when I can not think as in the way I am doing now

S:  wow. I understand. is there anything we can do to help your brain get unclouded when its cloudy?

M:  the is and in that I can stay that way for about three days and the clouds go away for a while and I can think for a while that is what I can tell you for now

Supporting Michael to Express Original Thought

I type with Michael for one hour two times per week.  His grandmother types with him for shorter periods on days when I’m not there.  When I arrive, it only takes a minute or two for him to pull himself away from watching Thomas the Tank Engine, his number one passion, and sit down in front of his iPad.  We’ve developed a routine for our time together.  He completes “set work” the first half and then he engages conversation with me for the rest of the session.  I create the set work, which for him is essentially a series of short worksheets, based on the level of understanding Michael has illustrated in the prior session.

Michael is for the most part consistently accurate when he completes the work sheets.  In the beginning, he needed my physical support to type every answer.  Now he types the answers independently.  His mom and grandmother are always in the room with us when Michael types, and they are as amazed as I am that Michael gets the answers right.  He’s been given the same kind of “circle the right answer” work in school for the full 15 years.  None of his school work involves him typing words on a keyboard. 

No one figured out until now that Michael has a greater capacity to think.  I wonder how different his life would be now if someone discovered they could have challenged Michael.  In order to do that, they would have likely needed to trust that by giving him physical support to help with his motor planning while he typed, it would have directed him to access his brain to expand his use of a keyboard.  They would have had to explore Facilitated Communication as a possible intervention. 

Michael could already copy words and sentences, but he couldn’t fill in the blank word from a list or give a one-word answer from his own thoughts.  After typing together regularly for the past 6 months, Michael can now generate a one-word thought and type it on his own.  Michael’s most recent display of his intellect involves him copying a sentence and filing in the last word.

For example, I give him the sentence “when I think of the word girl the first word that comes to my brain is ______” and he needs to copy type it and fill in the blank. This is a copy of his latest work:

• M.  when I think of the word girl the first word that comes to my brain is friend
• M.  when I think of the word book the first word that comes to my brain is read
• M.  when I think of the word hat the first word that comes to my brain is head
• M.  when I think of the word library the first word that comes to my brain is book
• M.  when I think of the word iPad the first word that comes to my brain is type
• M.  when I think of the word snow the first word that comes to my brain is white

It may not seem like a great accomplishment, but Michael has been treated as though he’s not capable of creating original thought.  It’s been assumed that the most Michael could do is shake his head to acknowledge what he wants from choices that others suggest for him, choices that center around food items, movie titles, or tasks that he needs to complete.  He can also point to picture symbols, but his collection of symbols is small.

Now he is being given the chance to express his personal thoughts… and he is showing us that he has personal thoughts.  Copy typing is not seen as a means to generate self expression.  That makes sense… it doesn’t require must thinking energy to type someone else’s words.  Michael has been able to copy type long before he and I started to type together.  I decided to pair his ability to copy type sentences with a fill-in-the-blank.  This way, Michael gets to complete a task he can do independently as well as illustrate his intelligence by adding the “one-word answer” without needing physical support from someone else to type. 

I can’t overstate the importance of Michael’s accomplishment.  Before we started giving Michael added physical support to type, Michael only used the keyboard to ask his mom to download episodes of Thomas the Tank Engine by copy typing the titles from YouTube.  He is developing skills that only a few people in his life suspected he had.  He continues to surprise us.