Module 8 Transition To Adulthood

1 Strategy for Promoting Skills for Independent Living:

Now that Cindy is more tolerant of environmental stimuli, she is able to sit and attend to task for longer lengths of time. My primary goal now is to develop appropriate social skills and reciprocity. Because social reciprocity is dependent upon several other factors like appropriate eye contact, anticipation, joint attention, theory of mind, ability to understand verbal and nonverbal communication, and more, it is difficult to come up with a single strategy to work on. I continually find that when I engage Cindy in silly play and movement activities, like swinging in a blanket, playing "airplane", or zooming across the living room in a laundry basket, that I can work on array of skills. Stopping and starting facilitates eye contact, communication, anticipation, and fun. We incorporate asking for more, i.e. "I want ____?", work on action words, i.e. "What are you doing?" Answer: swinging, flying, ect., or incorporate fast and slow. These activities are alerting and motivating and seem to naturally spark social and communicative reciprocity, an essential skill for most occupations throughout the lifespan.

1 Strategy for Advancing Vocational Awareness (Family) or Skills (Client):

I think that several families in the Early Intervention Program are apprehensive of dreaming about their child's future. They are often wrapped up in a new diagnosis and the high demands of the here and now that they can not project what there child may be capable of at a distance point in time. They may underestimate their child's future skills based on current behaviors. On the other hand, they may fear disappointment from expectations that are too high. I think that it is important to discuss possible future scenarios with families, focusing on the child's strengths, and explaining how the mastery of current goals will lead to greater independence and success in the future. When a family can understand the meaning of current goals and dare to project future occupations for their child, they will be empowered to carry over with current goals, help to develop future goals, and advocate for their child based on their desire for their child's future.

Module 7: Family- Living with Autism: Impact on Family and Siblings

Description of Family's Well-Being:
Cindy lives alone with her mother. Her father was granted supervised visitation rights but after two meetings with Cindy, made no further attempts to visit her. Cindy's mother has a history of depression and suicidal attempts. She has few friends and of the two she has spoken of, both have ended up in an intimate relationship with Cindy's father. She has a sister who babysits for Cindy periodically but who reportedly, demonstrates minimal patience. Cindy's grandparents do not offer a great deal of support. Her grandfather will occasionally stay with Cindy and her mom when he has been out late and doesn't want to drive home. Cindy's mother tends to share much of her personal concerns and joys with Cindy's therapists, who tend to be her primary support system at this time.

Cindy's mother was working outside the home when services were first initiated. She appeared to demonstrate pride in her work with reports of a possible promotion. Cindy's mother had, and continues to have, difficulty managing life responsibilities . This consequently, caused her to lose her job. Her car was "falling apart", it was not licensed, and it was not insured. Cindy's mother was stopped by the police and the car was impounded. With no transportation to work, Cindy's mother was forced to quit her job and apply for social services. Because of the time lapse between government aid and her last pay check, Cindy and her mom ate very scarcely for a few weeks and received eviction notices in their door. They have since worked out a payment plan with the landlord and are receiving food stamps and WIC. They are also in the process of applying for SSI for Cindy.

Strategy to Improve Family Lifestyle and Communication Dynamics:
Considering Cindy's mother history of depression and her lack of social supports, I think a local autism support group would be very beneficial. This would allow Cindy's mother to share and explore solutions with other families who share similar difficulties. It would give Cindy's mother a place to go to develop friendships and it provide a place where Cindy would fit in despite any unusual behaviors. Hopefully, the acceptance Cindy's mom would receive from this group would help to build her self esteem and empower her to advocate for Cindy in the future.

Module 6: Social Skills and Perspective Taking, Mental Flexibility

Topics:

1. Social Referencing: Cindy does not typically look to her mother to determine if a situation is safe or not. She appears to have minimal awareness of safety and would easily run into the street, touch a hot stove, or walk off with a stranger. Cindy has recently demonstrated an increase in joint attention during pleasurable tasks however. When being bounced on a ball during an OT session, Cindy actively looked between her mother and her aunt to express her excitement for the activity.


2. Perspective Taking: Cindy tends to demonstrate preference for details (local processing) and has demonstrated rigidity in the past as to toy/object preferences and activities. Resistance to participate in less desired activities appears to have been influenced by sensory processing differences and lack of anticipation. With an improvement in these areas, I have seen an increased interest in what others are doing and an increase in attention to previously non-preferred tasks. Cindy recognizes me upon arrival. As soon as I arrive, she pulls her child's size table and chair to "our spot" to work. During sessions, she is fixated on the task at hand and demonstrates minimal initiation and maintenance of eye contact. During sensory based play however, especially on the ball and especially when I am working on anticipation like "ready, set, go" or "wait, wait, go", I see a huge improvement in eye contact, engagement, and emotion! We also play a game where I say "good night", when she says "good night" back to me, I pretend I am asleep. If she touches me or makes a sound, I wake-up and shout "who woke me up?!" She loves this and quickly says "good night" to indicate to me that she wants to start the game all over again.



We have been working on the formation of circles. To make the task a little more motivating, I add facial features inside the circle to address emotion. Cindy enjoys "happy" and "scared". Once, when demonstrating what sad looks like, she stared at me and appeared to become upset..... I think that this is a good indication of the emergence of perspective taking by Cindy.