Looking Inside a Bubble

Robert does not explain himself.  He does not ask for explanation either.  It is not that he doesn’t want to know. Because he does.  He does want to know.  I realized that during Holiday Season when Robert was seven years old.  At that time, our Christmas ornaments were  made  of brittle, beautiful glass and Robert broke them all.  He already knew that when such ornaments fell from the tree, or slip through the hands, they break.  He also knew that he couldn’t make them whole again.  What he did not know and wanted to learn  was what  precisely was happening in the exact moment of change, the moment ornaments broke.  So sitting on the floor and tilting his whole body to the side so that his  cheek was almost on the floor he watched the glass as it was shuttering.  He also tried to figure out the breaking height.  First, he released the ornament from  just an inch or two  above the floor.  It didn’t break .  So he kept increasing  the distance  until the sphere split into a few pieces. The conclusion as to what precisely took place in the moment of this metamorphosis must have escaped Robert because as I rush to clean the glass, Robert ran for the next ornament to perform another experiment.

Whatever he learned, Robert did not share with me. I was left to my own guesses. At first, I thought that he wanted to establish the critical distance from the floor that leads to breaking of the glass.  Lately, I suspect that he wanted to slow the process hoping he would catch some sort of entity escaping from the glass bubble.  Or that he wanted to see the inside of the whole ornament.    And he hit an epistemological wall.  To see the inside of the ornament  he had to break it.  When he broke it he couldn’t see the entire inside of the sphere.  Did Robert realize the limits of knowledge and, in his wordless world, formulated his own uncertainty principle?

 

 

Pulling Out of Helplessness

I cannot help myself.  I want Robert to answer correctly whatever is there to answer.  So I give him signals. I don’t know what those signals are. But Robert deciphers them anyway. I catch my fingers  moving themselves toward a word that completes the sentence, or toward the  correct estimate of a number on a number line.  I put the hands under the table so they stop interfering.  But inside my mouth the air position itself in anticipation of the word that is an answer to the question I have just asked my son. My lips don’t say the word yet, but are shaped already for the first sound.  Robert knows what I want him to say because I am already saying it, even if I don’t hear myself.  I catch my tongue conspiring with  my lungs and my mouth to help Robert demonstrate to me that he knows the proper response. To prevent my mouth from meddling in Robert’s learning I leave Robert at the table and go to the kitchen.  Before I go I tell Robert  to read carefully each phrase printed on  one of 12 strips of paper, decide if it relates to the sun, the earth, or the moon, and place the strip with the sentence in a proper space.  From the kitchen I look  back and see that Robert doesn’t touch the strips of paper.   He waits for me to return.  “Use your own mind.  You know it.  You know that all”  I repeat from time to time as I watch Robert’s hands. I see pieces of paper slowly filling empty spaces below “sun, earth, and moon”.  Very slowly.

I ask, “Are you ready or not yet? ”

“Not yet”.

A few more minutes and a few more encouragements from the other room I ask again, “Are you ready or not yet?”

“Ready”

I return to the table and we are checking together if the phrases properly relate to the objects.  Seven correct answers, five wrong. Enough to assume that Robert hasn’t assigned those strips of papers completely randomly.  This is a success.  Because the goal for Robert is not to be correct yet, but to TRY to be correct without help.

In the past when Robert knew something well, like  multiplying two digit numbers by one digit, he could work alone on the whole page of problems.  He automatically followed a simple algorithm.  When, however, Robert was not completely sure how to respond, he would wait and wait and wait for me to come.  He wouldn’t touch the problem without me being present and giving him those unnoticeable  to me  cues.  The fact that today Robert worked independently, not afraid to make mistakes was a step out of learned helplessness.  The fact that in, at least,  a few instances he used HIS knowledge was a small  step but the step into independence.

Medals for Bravery

Today, Robert went to see his allergy doctor at Children’s Hospital.  He was due for his RAST tests to check and recheck his susceptibility to old and new allergens.  I was afraid of how Robert would react to a needle entering his vein. Robert was afraid too.  I told him about necessity of the tests before the visit.  He didn’t show fear, but  was clearly anxious during the whole stay at the doctor’s office.   Although in the past, he learned to tolerate regular allergy shots, he might still not be prepared for for the blood test. Drawing blood  can cause apprehension for many reasons:   syringes lined up on the counter,  a rubber tied around an arm, a phlebotomist looking for the vein, and…

The phlebotomist’s assistant held Robert’s left arm.    I held the right one and embraced Robert’s head hoping he  would not  see the needle.   But Robert  wanted to watch everything: his arm, his vein,  the needle, and the syringes in action.   He was anxious but resolved to bravely confront the anticipated pain. And he did.  He waited patiently until all the syringes were filled.  Then he unwrapped  small, circular band-aid and placed it carefully over a small puncture on his skin.

In the beginning of 2006 Robert started a series of allergy shot to address some of his environmental allergies.  For the first two appointments my husband took him to Children’s Hospital. I was told that three experienced people had to hold Robert during the first visit.  He also strongly protested all throughout the second. However,during the following three appointments,Robert behaved like a typical teenager, if not better.   I decided to switch, just for the sake of  vaccines, to the allergy office closer to our home and spare ourselves cumbersome, frequent  trips  to Longwood Medical Area in Boston.  Because the specialist  in my town refused to treat Robert  I had to find  another one in a nearby town of Needham.  The visits went smoothly.  Waiting for a shot, getting it, and  hanging in the office for 20+ minutes afterwards to make sure that there was no allergic reaction to the vaccine, were never a problem.  At some point,  Robert was walking with the nurse alone while  I  stayed in the waiting room hoping that Robert learns to be more independent and that the nurse would  feel comfortable with  Robert on her own. After each of the two shots he received, Robert insisted on unwrapping two circular bandages himself and carefully placed them on his arms.

At home, I kept finding those band-aids on the rug in Robert’s bedroom. After I removed them a few times, I ignored them until the day, I realized that the adhesive bandages were attached to the rug in a consciously planned manner.  They formed a long line of little circles almost exactly  six inches apart from each other. It was clear that after each appointment,  Robert placed one or two band-aids on the rug as if he wanted in this symbolic way to record  his experiences.  As uneventful as those appointments became to me because of Robert’s  calm demeanor, for him they were not the ordinary events.  The  circles with tiny squares in their centers confirmed that.

To warm up the floor in Robert’s bedroom during the following winter,  I placed a washable rug on top of the first one.  It covered all the little circles, but Robert continued to add them anyway. He formed a second row.  Even when he stopped getting  vaccines, he still kept all his bandages in place.

Today,  Robert added to the rug another band-aid, his well deserved, unpretentious  medal for bravery.


Looking for Self in the Hundred Acres Woods

One day, when Robert was two years old, I found him sitting on our dining table. The table was new and  smelled of pine wood  it was made of.  Robert’s  little legs surrounded a sugar bowl while his hand, with all fingers glued together, traveled back and forth between the bowl and his mouth. Robert’s face radiated with a calm contentment.  I had an instant impression of Winnie the Pooh using his paw to eat a Little Smackeroo of Honey.  Although the association  was insanely strong and vivid (I wouldn’t remember it 18 years later if it weren’t) I didn’t dare to assume that Robert was enacting the scene from Disney’s Winnie the Pooh.

A few months later I was baffled by Robert’s habit of purposefully breaking balloons taken from his favorite restaurant, Applebee’s, by falling on them.  I usually threw away little  pieces of rubber left from the balloons, but one day as I was rushing to the dinning room after hearing yet another “POP” sound, I saw Robert placing the remnants of the balloon in a drawer under  a china cabinet.  This time, the connection between Piglet, Eeyore and Robert seemed obvious.  Robert was breaking balloons like Piglet and placing them in a a container (a drawer instead of an empty honey jar) just like Eeyore  did. Not much  later,  Robert found a piece of thin string with a bow tied at its end.   I don’t remember where it came from and what had happen to it later.  I do remember how contemplatively Robert was assessing this object and how he attempted to attach it to himself as,of course, a tail.  First, he tried this with his pants on.  Since it didn’t work, he started to take the pants off.  I didn’t let him.  First of all, we had a guest for dinner.  Secondly, he had already made his point.

He convinced me that  those episodes were not accidental. He was searching for his identity among the Hundred Acres Woods crowd,

In the end, Robert settled for  Tigger.  How could he not? Although not socially savvy Tigger, the bouncy ball of energy, is the most alive character among  the inhabitants of Milne’s masterpiece.  So Robert chose Tigger .  And from that time on, bouncing like a ball and flapping his bent arms Robert reminds me, over and over,  whom he decided to be.  “A Tigger’s a wonderful thing.”

Outback! Outback! Outback To the Rescue!

Robert, like most of us, uses words he knows to label things which have names he is not familiar with.  Once, as he was looking for a bath mitt, he used the phrase “two rags”. I didn’t have any idea what he wanted.  Finally, he led me to the bathroom and pointed to the place where the mitt was supposed to be. Robert didn’t use the word “mitt”, he also knew  because  this mitt had a shape of a rectangle without a separate compartment for a thumb. So it didn’t look like a mitt.   Another time, he was looking for “snake, door” .  It took me a while to realize that he was searching for a draft protector, which, as I learned later, is often sold as a “door snake”. During our trip to Disneyland, my husband and I learned about another idiosyncratic way Robert uses words.

Star Wars Tour was the first ride we went on.  We took our seats in the  row second to the last.  Robert sat, as always,between my husband and me.   Since he had never been before in  Disneyland, he felt a mixture of excitement and anxiety so, just in case, he held on firmly to our wrists.   Judging by the spark of recognition in his eyes, the first scenes of the movie seemed vaguely familiar to him.  He also must have recognized the music because he loosened his clutch. But when the chairs started jerking us around he became unsettled and tighten his  grip on our wrists.” The spaceship”, we were in, accelerated and centrifugal forces tilted our chairs to the right, to the left, forward, and backward in unpredictable, forceful ways. The roar of the spaceship’s engines replaced the music in a menacing racket. The floor seemed to be moving under our feet and seats.

The terrified call cut through the noise,

“Outback! Outback! Outback!”

A moment later another desperate plea filled intergalactic space,

“Fries! Fries! Fries!”

Robert screamed for Outback and fries with eyes widen with horror. Rather embarrassed, I hoped that the noises coming from  spaceship tearing through galaxies would muffle Robert’s screams and spare other travelers from the confusion my husband and I felt. I was  quite perplexed not understanding why Robert, who just had a good breakfast, demanded food in such a dramatic way.

To calm Robert down, I quickly promised, “Outback later”.  As soon as I did that I realized that Robert did not demand food, but salvation. He wanted to be immediately transported to a safe place.

I assured Robert, ” It is only a movie.  Just a movie.  Like in IMAX , or like Hitchhikers’ Guide. Just the chairs are moving too.” Robert understood.   He removed his hands from our wrists and laughed.  He glanced at me with a proud expression signalizing the  fear conquered by maturity and relaxed. He watched attentively to the end of the presentation and appeared disappointed when the show was over.

Robert knows the word “help”.  He was  taught to say it and to use it in a few appropriate situations.  Yet, he had never been in a position which would require calling for help. Until, of course , during this thrill ride.

I  have mixed feelings about  Robert using words “Outback” and “Fries” to express the sensation of being in a danger. On one hand, I do wish that Robert could ask for help in a typical way  so we would  react properly.  On the other hand, I understand that in an assumed danger, Robert wanted to be transferred to a safe and known environment of a favorite restaurant and comforted by food that  would calm his turning upside down stomach.

Isn’t that what we all want one way or another?

Unlearning

Before Robert’s third birthday, he and I played with Duplo blocks. We built  simple structures by lining  the blocks along the edges of the base or stacking them on top of each other.  To make those structures  a little more interesting I began to  alternate blocks.  White, red, white red.  Soon, Robert followed building white and red towers or white and red paths.  It seemed  such an easy task to learn  that there was no point of practicing it over next year or year and a half.  During that year, Robert was practicing matching by color, matching identical pictures, or matching pictures of the same, but differently looking,  objects. (For instance, differently looking tables.) .   When he was already four and a half years old, I noticed that he couldn’t complete a simple ABABA pattern.  So I brought back Duplo blocks assuming that Robert would recognize the task he had already mastered 18 months before and build the tower alternating white and red blocks. But he was unable to do that.  He placed red on red and white on white.  The paths could be all white or all red. Moreover, this time, I was unable to teach Robert to alternate colors  I tried many times and failed.  ( In the end I used Robert’s strong urge to match by color by having him to match the path I built with alternating colors.  Later, a friend of mine advised me to use a kindergarten level computer program where the skill of  completing patterns was taught by matching the pictures in the top row by placing identical ones in the row below. When the identical matching was completed, the pictures from lower row were immediately transported to the top row to extend the pattern.)

When I realized that Robert could not alternate blocks by colors, I began to doubt my memory.  Could Robert really complete white and red pattern before?  Did I make it up? How could he unlearn the skill that came to him so easily before?  Where his resistance to alternating colors came from?  Did too many months of  identical matching resulted in Robert’s strong conviction that this is the only way to go?

I can only hypothesize why Robert lost the skill he had.  Yet I strongly believe that had I continued working with Robert on varying the tasks presented to him, he might have not developed this rigidity in thinking. If the matching of “same with same” were interspersed with practicing patterns, the learning of a new skill might take longer but the “unlearning” might not happen.

Importance of Little Words

There are long words like “multiplication” and “reciprocal” . Robert has difficulty saying them but understands their meanings.  There are also little words like “instead”.  Robert can say them, but is not sure what they mean.  When I advised, “Multiply instead of dividing” , it was the word “instead” that confused him.  Many speech pathologists  suggest to teach children with disabilities  those important little words  such as “First… Then, If, Before, After”  to give the children tools to mentally organize their space and time.  The word “instead” should join the list of such words.

The concept of replacing one thing with the other was unacceptable to Robert.  When he was younger he refused to wear new shoes or a new jacket. He screamed and tried to get out of his car seat  when I changed the route home.  He protested going on a different trail in the park he visited often  although in any new park he could follow any path. He had extremely hard time throwing away broken dishes or toys.  He didn’t want to buy anything new with a smart exception of food, balloons and bubbles. He , simply, didn’t condone replacing  one thing with another.

As  he grew, he became more flexible in accepting unavoidable substitutions.

Yet, they still confuse him. When Robert couldn’t follow my verbal advice on multiplying and yet was able to apply written algebraic  formula, I assumed that he didn’t know the word “instead”.  It is also possible that he knew the word’s meaning but was reluctant to replace a sign for division with a sign for multiplication.  He might perceived the very act of doing one thing (multiplying)  IN PLACE  of another (dividing) as utterly wrong.

Interestingly, when he saw written formula, his resistance disappeared.  With the support of the algebraic equation he divided fluently and soon mastered this algorithm.

What does the problem Robert encountered with the word “instead” tells  about language – thinking connection?  Can a person understand the essence (the act)  of “instead” without learning the term for this concept?  Does the knowledge of such words as “before, if, next, and instead” help elicit thinking or ‘only’ organize thinking?

Or, vice versa, does Robert’s dislike of replacing one thing with another results in diminished understanding of the word “instead”?

To what degree those of Robert’s behaviors which look like they were caused by  Obsessive Compulsive Disorder would decrease if Robert was familiar with the concept of “instead” ?

Those are important questions.  Since, however, I cannot answer any of them, I have to concentrate on finding a way to teach word and and the concept behind it.

As Robert applies written formula to divide fractions I interject the word “instead” every time he changes division to multiplication.  “Instead, instead, instead.”  Then I start the sentence and wait for Robert to finish, “You multiply….” Robert continues, ” Instead of…”

The hard to understand his approximation for “divide” follows.

Teaching While Learning How to Teach

In one of the previous posts I wrote about three steps in teaching Robert a skill.  The first step is the hardest to explain.  I don’t expect Robert to learn the skill.  I lead him step by step through the procedure, I talk to him knowing that he doesn’t understand most of what I am saying, no matter how simple they seem to me.  It is as if I asked him to look through the window of a moving train and notice an object we were passing by.  I wouldn’t expect Robert to notice any of the specific features of that object.  For now a realization that there is something out there will suffice. We will study it intensively another time.  That would be a second step. Next we would proceed to finding the same object in its different manifestations and various environments… In other words Robert  would generalize the skill.

When I described those steps  I omitted the most important function of the first step. Besides exposing Robert to an existence of something new, this step is for me to learn how to teach Robert. I observe Robert to know  which of the steps I am leading him through he can climb on his own, which words he recognizes, which he doesn’t, and what other support I will need to provide to assure learning.

There were times when  I skipped this first step.  I jumped into intensive teaching without strategic reconnaissance.  I expected Robert to learn something I didn’t know how to teach.  I was putting pressure on Robert not on myself.

What I am writing is not about a teacher being prepared  for a lesson (for instance by writing a lesson plan).  The lesson plan is an important tool, but for children like Robert it is just  like a hypothesis.  It doesn’t assure learning.  It only sets the stage for testing of the hypothesis.  The first step, as I understand it, is about checking the hypothesis. You don’t know how to teach before you start to teach and analyze responses – good and bad, complete and partial. The teacher has to learn from those responses and then develop  proper strategies, check them again, revise them again until he or she finds the best approach to teaching this specific skill to this specific student.

Just yesterday I tried to teach Robert to divide fractions. I had a lesson plan.  I had already practiced with Robert prerequisite skills like finding reciprocals.   I used simple words.  The words he knew – multiply , divide, flip the fraction over, reciprocal, reciprocal..

He couldn’t grasp the division.  That should be fine. The mistake was that I expected him to learn and consequently subjected him to the same method over and over.  That lead to more errors and repeated failures.  The failures lead to frustration and learned helplessness…

I shouldn’t pressure Robert  to learn during that phase.  I should be the one who was supposed to learn during that time. I had to take a breath and think about this failed attempt.

When I did,  I noticed  that although Robert understands when I say, “Multiply four by seven.  Divide 42 by six”  he doesn’t understand me when I say, “multiply instead of dividing”.  I observed that for Robert finding reciprocal to the separately standing fraction is not the same as finding reciprocal during division. I came to a conclusion that relying on language concepts that Robert used only in limited numbers of applications was not working. I understood that I would have to to experiment with different methods of presenting the new information.

In the end  I used abstract algebraic formula: “a/b : m/n = a/b * n/m .  This approach I would use with “typical” students. It seemed much too abstract for  Robert.  But since  I was only experimenting it was no harm in trying it. I introduced this formula not expecting Robert to learn it and use it.  I pointed it to him as if that was that object we had  seen from the passing train.  Somehow this formula seemed for Robert easy to follow.  Much easier than my verbal directions. I found a way to teach.  The phase one was over. Let’s move to the next.

One might point out to me, that even during a failed phase of intensive teaching I  was still learning how to teach.  That is true.  Yet I was also subjecting Robert and myself to unnecessary frustration by rigidly sticking to one approach instead of investigating its effects and being ready to flexibly adjust it.  I should have taken a breath, led Robert through the activity (just stopping it without finishing would leave negative residues which also should be avoided) as calmly as possible.  Then, I should have taken time and rethink the whole process in connection with everything I knew about Robert and started over.

Pica, Rumination, and Other “Behaviors” 2

I learned about Robert’s rumination during a meeting with Robert’s teacher and her clinical supervisor at  ABA school. Before that meeting I had never noticed that Robert tended to bring  the food back from his stomach, “play” with it in his mouth, and return it to the stomach.   I knew neither what ruminating was nor that Robert was doing it.   I assumed that it was a different name for pica. It took me a while to realize that the teacher and I were talking about different things. I credit the teacher for stating that the causes and treatments of rumination could be behavioral and/or medical. Robert’s school took upon itself to deal with behavioral aspect of rumination.

It was my responsibility to deal with medical side of rumination.  Yet I didn’t do anything about it until Robert was almost 18 years old.  The reasons/excuses why I didn’t take any radical steps to address this syndrome immediately are as follows:

1. The rumination seemed to (almost) disappear during Robert’s stay at ABA school. The way the school dealt with it worked so well, that I didn’t observe it at home. I forgot about it.

2.Rumination flared up during periods of Robert’s increased anxiety, specifically his second year in Collaborative program and the fourth year in Public School. Unfortunately, during those times I encountered  severe problems with both educational settings and needed to address the serious consequences of those problems. The rumination seemed less important.

3. During more visible periods of rumination I gave Robert 1-2 calcium tablets a day following the advice I received on Me-List.  Calcium (Tums) seemed to reduce the problems slightly. I had a feeling that I was “treating” it.

4.The gastroenterologist, who had seen Robert a few times for painful gases, constipation, pica, food intolerance (beside food allergies), and rumination, suggested endoscopy and colonoscopy to clarify medical picture.  I thought Robert couldn’t do it.

Well, I couldn’t .

Then I felt we had to.  The tests pointed, among other things, to acid reflux. Robert was put on omeprezole.  At first he received a stronger dose to  break the habit of “playing” with the food and to heal his esophagus.  Later the dose was reduced.  This treatment helped a lot.

Although I am not sure if we were able to do the tests sooner I regret not even trying.

The earlier diagnosis could bring Robert very needed relief.  It would also allow Robert’s teachers and me  to separate those “behaviors” that were reactions to discomforts of various degrees from those which had different causes.

If a teacher/parent  knows that a child is screaming and hitting his own face because he/she is in pain the response is empathy and understanding.   When the child does the same things because she/he wants to escape demands or  doesn’t accept changes to the environment the reaction is different and depends on a previously chosen strategy. (It might be based on Functional Analysis of Behavior.)

When I suspected that Robert might be  in pain but wasn’t sure of it, my reactions were chaotic and ambivalent and as such didn’t address Robert’s behaviors in any case.

On Language. His and Mine

A few months ago Robert was classifying vehicles. He was supposed to place  a picture of a vehicle in one of the three categories : air, land, or water.   I didn’t anticipate any mistakes.  Based on my previous experiences with teaching Robert, this activity should be almost mechanical.  I was using it only as a visual support for practicing speech.   While placing each object in a proper column Robert was expected to say for instance, ” Airplane goes in the air” . To my dismay, Robert was making mistakes.  Many of them.   I couldn’t understand. He should have known. Yet he didn’t. Why?  I decided to present Robert with just two categories . I removed “land” leaving only “air” and “water”.  No errors.  “Air” and “land” many errors.  “Land” and “water” no errors.

It was clear, Robert couldn’t differentiate between objects  moving through the air and those moving on land. Did he forget? I showed him proper answers and repeated the task.  No improvement.   Was I mistaken in assuming that he knew what vehicles could fly?  I decided to check if he could hand me all the flying objects. He could.  No errors.

I replaced the word “air”  with the word “sky” . Now the categories were: sky, land, and water. Robert classified all the vehicles correctly.

I understood my blunder.  I assumed that if Robert knew what flew in the sky he should have known what traveled through air.  Since he knew that airplanes flew in the sky he should have known that “air”, in this context,  meant “sky”.  But then I recognized that he also knew that the airport was on the land. So…

How confusing!