Monday, January 31, 2011

The Lights Went Out

The whole family gets nervous when the lights go out.  Without electricity, Michael can't spend his time watching DVD's or YouTube.  The family has to endure Michael's anger and Michael has to endure being without his primary way of keeping himself "happy".  Because Michael's anger has been extreme in the past, the family bought a portable generator for the garage, and they send electrical cords from it through the house to Michael's room. 

Since he can speak to us through typing, my approach has been to help him understand how to handle his feelings more effectively.  What if we let him experience the difficulty and then teach him the sequence of steps involved to deal with the situation?  After all, he wants to be employed.  He has said, "I want to have a job and be normal."  He's thinking about shelving books with the help of a one-one-aide.  Realistically, he can only have a few meltdowns in the middle of a library if he plans to keep his job.


S: when it snowed the lights went out you were afraid because
M: I could not watch you tube

S: did you worry they would not come on again
M: yes

S: was it easy to fall asleep knowing the lights were out
M: no

S: how did you manage the worried feeling
M: I think you me

S: what
M: happy thoughts

S: happy thoughts like
M: think I them

S: them what
M: friends

S: friends such as
M: thomas the tank engine

S: so when you are worried and sad you can think of Thomas right
M: yes

S: what is Thomas doing in your thoughts
M: he says nice things to me

S: we are happy that you have a way of feeling good. what kinds of things does Thomas say to you ... describe a nice thing he says
M: he says that I am very useful

S: we totally agree! does he say other nice things
M: he says that everything the really really really ok

S: we are very glad you have a friend like that. he helped you get through being afraid when the lights went out. what would you have done if the lights were still out when you got up in the morning?
M: ok

S: I don’t think you would just be ok
M: I would angry

S: and how would you handle your angry
M: I want the lights on

S: I understand but if the lights could not come when you wanted them to and you were angry what could you have done?
M: easy set I have waited just waited until the lights came back on alright.

S: so mom and grand mom will help you remember that you know you will wait until the lights come back on.  so is it ok if they say... Michael, you know you have to sit and wait until the lights come.  is this okay?
M: easy they need to be kind

S: I understand

Sunday, January 30, 2011

Using Michael's Interest in Thomas the Tank Engine

I've been writing stories using Thomas the Tank Engine as the main character to help Michael talk about what he is thinking and feeling...

Thomas the Tank Engine moves on his track and the track takes him to different adventures.  When Thomas travels on the track, he meets other trains along the way.  He is always curious about what is happening.  During every adventure, Thomas has a certain feeling.  Most of adventures Thomas has make him feel happy, and some adventures make him feel sad.  Some adventures make him feel really really really angry.   No matter what happens, Thomas always knows the other engines are his friends. 


S: tell us the things that make you scared
M: really really really fear when the storm comes thunder and lightening that fear happens

S: tell us the afraid fear part of thunder and lightening
M: fear the thunder and lightening the storm and the thunder and lightening and the rain the rain gets me wet and the thunder and lightening put the lights out and the computer out and the tv out and I can not watch what I want to I get afraid because I can not easy feel happy without the Thomas and friends treat me to be happy I easy they the friends that in

S: that makes sense to me. tell us your back up plan if the lights and the tv and the computer go out. what do you do to pass the time until they come on again?
M: say to mom to get lights on again

S: this is one of those adventures just like Thomas has on his track. your track is I need the lights back on.
M: the lights back on the track I do not like to be on.

S: I understand. you are on a track that makes you feel afraid and angry because the lights won't come back on when you want them to. in that case, your backup has to be to get on a different track. any ideas?
M: easy not to be on a different track

S: I understand. one idea I have is that I remember that the lights will come on again sooner or later. the light track will always be there. in the meantime since I want to feel happy at least a little I need to get on a different track... unless I want to keep feeling afraid and angry.
M: the really really really angry the feeling not easy to have and go to different track

S: you are absolutely correct. just because it's not easy, it still is possible. it means that you have to be okay with being afraid and angry for awhile until the lights come back on. in the meantime you can go on a different track. like mom just said. you might can go on the nap track or sit on your recycler on some other hobby.
M: I feel the anger too much to the different

S: ok. like we talked about before... sometimes you can switch tracks easy and sometimes there are days when it's a lot harder for you And ME to switch. we just have to remember it's possible so it will always be an option for us in our brains.
M: that sounds better get really really really angry lot of the time

S: do you think you can notice when you can easy switch tracks? that's all that any of us can do.
M: typing the words is easy yes

S: I totally agree. all we can do is do our best as best as we can. ok
M: really really really thank you that was help and easy to think about the day comes when thunder and lightening here I will try to remember this

Friday, December 31, 2010

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

Thursday, December 30, 2010

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

Thursday, December 23, 2010

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

Wednesday, December 22, 2010

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.

Thursday, November 18, 2010

Who is an Independent Typer?

Since it was introduced in the 1970’s, facilitated communication has developed a following of parents and professionals who view it as helpful to non-speaking individuals with disabilities such as autism.  Some of these parents and professionals describe that FC users construct complete sentences and paragraphs, hold open conversations, write poetry, chapters in books, and obtain bachelor’s and master’s degrees.  By the conventional standards, many of these individuals don’t appear to be competent enough to ever achieve this kind of accomplishment, yet to the parents, professionals and the individuals themselves, these accomplishments are real and indisputable.  These same parents and professionals acknowledge that there would be no dispute if an FC user could type without physical support from a facilitator and be identified as an independent typer.  In the meantime, knowing that independence is the primary goal, they have no hesitation in continuing to support FC users to share their voices in the interim. 

Until you meet FC users in person, it’s easy to suspect that the parents and professionals who believe the FC user is capable of typing sentences and paragraphs are deluding themselves.  It’s possible to conclude the parents and professionals are projecting their hope that non-speaking children, teens, and adults can finally speak using an intervention that’s been called everything from a hoax to pseudoscience.  If you adhere to the predominant research about FC, you might discount the entire experience as lunacy or at least a sad example of the extremes parents will go to save their children.  However, if you meet an FC user in person, you might have second thoughts about your disbelief... unless you adhere, without question, to the predominant research.

There are a number of studies involving individuals using facilitated communication who have not been able to demonstrate that they are typing their own words.  These studies have contributed to the American Psychological Association’s decision to adopt its resolution dated August 14, 1994 which takes “the position that facilitated communication is a controversial and unproved communicative procedure with no scientifically demonstrated support for its efficacy”.

However, there are also a number of studies of well-controlled and carefully designed studies involving individuals who were able to demonstrate that they are typing their own words.  I’ve outlined some of them in my blog post called: Researching Supporting FC Authorship.  It is these studies along with testimonies of actual FC Users that contributed to FC being added to the TASH Resolution on the Right to Communicate (click Communication Rights).  TASH is an association of people with disabilities, their families, advocates, and professionals, which has supported equity, opportunity, and inclusion for people with disabilities since 1975. 

TASH’s Freedom to Communicate states that no person should be able to veto the augmentative or alternative communication which another person has chosen to use.  This includes all forms such as communication devices, specially adapted keyboards and pointers, computerized equipment, picture and sign systems, gestures, sign language, and facilitated communication.  In any instances where such use is forbidden, there should be recourse to the legal and protective systems.  People with communication disabilities must be allowed to use the communication system of their own choice in all communication interactions in any setting. 

One publication speaks directly to the controversy:

Beukelman, D.R. & Mirenda, P. (1998).  Augmentative and alternative communication: Management of severe communication disorders in children and adults.  Baltimore: Paul H. Brookes Publishing Co., 327-329.

“Sahrisa (a facilitated communication user) joins a small group of people around the world who began communicating through FC and are now able to type either independently or with minimal, hand-on-shoulder support.  There can be no doubt that for them, FC ‘worked,’ in that it opened the door to communication for the first time.  In addition, hundreds (or even thousands) of individuals use FC with physical support.  To many observers, it does not seem clear whether or not these individuals are authoring their own messages.  Thus, FC has become controversial and hotly contested as a valid and reliable technique.  We include FC here because of Sharisa Kochmeister, Lucy Blackman, Larry Bissonnette, and others who now communicate fluently and independently, thanks to FC.  For them, the controversy has ended” (p.327).

Wikipedia's entry on facilitated communication has a comprehensive list of research studies and publications, a majority of which do not support FC user authorship.  The entry, however, includes the topic of independent typing which describes when a FC user is able to type without physical support from another person.  A main principle of FC is that the user is given the support he/she needs to develop more efficient pointing skills, but that the support is systematically faded so the user can type independently.

In the section subtitled “Independent Typing” the Wikipedia entry cites a statement from the following article:
Calculator, S.N. (1999). Look Who’s Pointing now: Cautions Related to the Clinical Use of Facilitated Communication. Language, Speech, And Hearing Services in Schools. 30 (October) 408-414
Critics complain these cases (of independent typers such as Larry Bissonette) have not been objectively verified.  Such verification is absent in peer-reviewed studies.  

The paragraph in Wikipedia goes on to read:

However, a few individuals have in fact been cited as independent typists in independently reviewed publications:

Broderick, A.A., and C. Kasa-Hendrickson (2001). “SAY JUST ONE WORD AT FIRST.” The emergence of Reliable Speech in a Student Labeled With Autism. JASH, 26(1). Speaking of Jamie Burke

Tony Atwood; Lucy Blackman (2001). Lucy’s Story: Autism and Other Adventures. London: Jessica Kingsley Pubslishers. Speaking of Lucy Blackman


With the presence of independent typers who were initially supported to type using facilitated communication, we cannot say that FC has never worked for anyone.


 
In May 2006, Claudia Wallis from Time Magazine published her article "Helping" Autistic People to Speak in which she described her attendance at a conference in Syracuse University about Facilitated Communication.  She wrote about meeting Jamie Burke, an independent typer.  She also met  Chandima Rajapatirana and other FC users.  She wrote about how she tried facilitating Tracey Thresher to type.  “At no point did I feel that I was leading him toward the keys, nor did I know the answers to the questions I was asking him.  He answered some clearly and others less coherently”.  Wallis spoke to James Mulick, professor of pediatrics and psychology at Ohio State University and co-author of research debunking FC.  She asked him what she should make of what she saw and experienced at the conference in Syracuse.  Mulick replied, “You were simply being deceived. But don’t feel bad. Even some behavioral scientists have been deceived.”  



I attended a similar conference about FC at Syracuse University in 2009.  I met Jamie Burke, Tracey Thresher, Sue Rubin, Larry Bissonnette, Kayla Takeuchi, and many other FC Users.  My encounter with them led me to create a video about Kayla Takeuchi because I saw for myself how - in their case - their lives were transformed by facilitated communication. 



I recognized that it would be easier if FC users quickly and naturally became independent typers.  There would be no controversy.  Even after meeting them. I maintained my profession reservations at viewing FC as a valid intervention because it is clear that parents and professionals might be deliberately or subconsciously driven to pretend they were facilitating an individual to type, not typing for them.   But, what if it is true that there are facilitators who, given the right training and guidance, can and do remain objective?  Do I have the right to say that parents should not attempt to use FC as a possible intervention… especially since I’ve personally spoken with FC users… users who type independently? 
I met Marilyn Chadwick, a speech therapist who specializes in FC at the 2009 conference in Syracuse.  She later agreed to conduct assessments on 6 of our 100 clients.  Michael’s mom wanted to find out whether giving Michael physical support would help him learn to type to communicate.  Michael used to type with the support of his teacher’s assistants when he was 8 year old.  His school administrators made his teacher’s assistants stop.  Now over 11 years later, Michael is typing again, and we continue to use Marilyn Chadwick's professional guidance to keep us on track.



I decided to become one of Michael’s facilitators because I wanted to experience the process for myself and support Michael to the extent he benefitted from it.
  • After months of working with him twice per week and watching him literally run to his iPad to type to talk, there’s no way I could say he isn’t enjoying the activity.  Michael is not a person who can be forced into doing something he doesn’t want to do.
  • After months of feeling him pull away his arm from me when he’s finished typing a statement and then giving his arm to me when he’s ready to type another, I cannot tell him I will no longer be there to support his arm to type. 
  • After months of watching Michael’s eyes scan each letter he types on the keyboard and pause to think before he types another word, I cannot tell him that I disbelieve he’s typing. 
  • After months of feeling Michael guiding my hand (not vice versa) to each letter to type, I cannot say he is not typing his own words.
  • After months of watching Michael smile when he starts typing something funny, I, as well as his mom and grandmother, know he has a terrific sense of humor.
  • After months of typing with Michael, his behavior has changed.  The intensity and frequency of his meltdowns have decreased. 
And two final thoughts:
  • Michael and I will continue to undergo “message passing” tests to show that he is the author of what’s being typed.  He is enthusiastic during these “experiments” because, he says, he wants people to believe him. 
  • Michael is starting to type words and answers to questions without physical support from me of any kind.  The vision is that is he becoming an Independent Typer.