Home Intervention Programme 4 - Playdoh

One of the key areas that we are focusing on developing Gerrard is play.

At this age, it is through play that children form friendship with others, improve their communication skills and enhance their creativity.

One of our favourite 'tools' is Playdoh. Of course, we roped in Gerlyn to be Gerrard's playmate. They like it so much that they can spend more than an hour on this on the table and can still go on. As I type this entry, they are playing on their own at the living room.

This reminds me of a conversation that I had with one of the teachers in the childcare centre. The emphasis should not be on handwriting or penmanship for children in preschool. They should be doing more handicrafts. This, I agree. In fact, at home, we refrain from writing or spelling. Though we do let them doodle a lot.

The Gers mainly play, doodle, watch TV (less than 2 h) and read. We have assessment books, which are given by my cousin. But we have not sit down and go through any one of them. With Gerrard's diagnosis, the activities we do tend to be those recommended by the therapists. Everything is back to basics - improving communication, attention span and reading skills. Hence, we can declare that we failed to be the modern Singaporean parents. But I am pretty sure we have provided the Gers with a totally different childhood experience!

惜福！

Brother and sister in action.

Look what I have made!

Gerrard's snowman. Daddy's takking a nap at the background...

Home Intervention Programme 3 - Sentence construction and picture description

Gerrard does not do well in description. One way to help him is to get him to construct sentences on his own.

1. Find simple pictures that a sentence can be used to describe it.
2. Write sentences and cut out the verbs and nouns.
3. Lay out a picture. Give options for the verbs and nouns, so that he can choose and pick the correct one.
4. Gerrard is to look at the picture, and read through all the options before choosing out the correct verbs and nouns for the sentence.

After trying many times with successful attempts, he is able to do simple sentence description without the helping visuals. Now we are into the next phase with simple connectors like 'and', 'using', 'with'...

The ultimate aim is to have him to do a picture description on his own (like what we had for English Oral). That, will have to take time and effort for Gerrard.

Gerrard trying out on his own.

Handwritten words are huge, hence making the sentence physically too long for reading....

Options are given for the sentence construction.

Typed and taped for durability.

Home Intervention Programme 2 - Listening, Comprehension and Attention

One of the things that kids with Asperger's Syndrome irritates the others is that they always talk at people, not talk with people.

Gerrard has this habit of doing so. He can be fluent with his speech in topics that engages him, e.g. anything about Dora or Mickeymouse Clubhouse. But having a functional conversation can be difficult for him.

So, the first thing is to get him to listen to people, especially to questions that people ask.

The following is recommended by the speech therapist:

Strategy:
Say a sentence and show picture to Gerrard. Example: Say "The boy is playing with the swing at the playground" and show a picture showing a boy playing with the swing at the playground. Repeat 2x. Then ask questions e.g. 'Who is playing with the swing?', 'Where is the boy playing?'. Each time Gerrard answers, show him the card and check the answers. If the answer is wrong, repeat the sentence again as the answer to the question.

Tips:

• The picture must be as simple as possible, with no other distractors. Example, if the picture is for the sentence shows the sentence "The boy is playing with the swing at the playground", then only show the picture of a boy at the swing, not the scene of the entire playground.


• The questions are the basic 4W-1H (What, Who, When, Where and How) questions.

Discovery:
Gerrard was inconsistent with the answers to the questions. It makes me wonder whether he was not listening, or he did not understand the questions.

After giving feedback to the therapist, she further recommend the following to check on this issue:

Strategy:
Lay out 3 coloured cubes in front of a paper with boxes numbered 1, 2 and 3. Say out a sequence, e.g 'blue, red, green'. Gerrard is to place the coloured cubes in the respective order.

The simple and low-cost setup of the memory game.

Discovery 1:
This is to check Gerrard's attention. To encourage him and to keep track of his answers, I came up with a sticker reward system. Each time he gets a correct answer, he gets a sticker and he is to paste this on a paper. So far, he is good with this. Out of 20 trials, he makes only one mistake, proving that it is not an issue of him not paying attention. I will show the therapist during the next session and will work on how to get him to answer to the question.

Gerrard's results.

Discovery 2:
I also played this game with Gerlyn. Gosh! She could not place the cubes according to colour properly. For a short while, I thought she had colorblindness. Luckily, it was verified through the memory chess (mentioned in Home Intervention Programme 1) that she just cannot name the colours correctly, as she can match the coloured chess correctly. Luckily these coloured blocks have alphabets on them. So I played with her using sequence of the alphabets.

Discovery 3:
Gerrard and Gerlyn really liked to be praised. Sometimes, I will give them a hi-five, rather than the stickers. And they are actually contented with that. I am glad that they do not need physical rewards. So, for those who have kids at home, have you praised your babes today? And for colleagues, have you praised the students today?

Home Intervention Programme 1- Boardgames

I decided to start a series on the intervention programme that was done at home. Hoping to share, because these activites are beneficial for any kid too.

In playing boardgames, there are a few deliverables to be achieved:

Play with others

Learn to take turns

Specific aim of the game

Playing with others. I made full use of the home environment. Good thing for Gerrard is that he has siblings, more than a typical Singaporean family. Hence, he has playmates at home. Also not to leave out the other kids, games is a very good activity. We roped in Gerlyn, whose intellectual level is not too far behind.

Learn to take turns. Actually this is the key objective for Gerrard, for him to learn proper social behaviour. Few things that he has to reminded:

• Hands and legs down


• Eyes look


• Mouth quiet

Besides these body language while waiting, he is also to recognise everyone gets his or her turns.

Specific aim of the game. I like these games a lot because there are other meaningful aims to the game, e.g. enhancing memory skills, teaching math.

And most of all, I feel playing boardgames is a good activity to foster family togetherness. Hope Gerry can join the gang soon!

Aim: Teaches colour and enhances memory skills

How to play: All the coloured pins are to be placed into the holes. Roll the dice and find 2 matching pins.

Where to buy: Learn-thro-Play, Bukit Panjang Plaza

Interesting discovery: Gerlyn has not been able to name the colours correctly. This game confirms that she is not colourblind, just not able to name the colours correctly. -_-"

Aim: Teaches counting How to play: Put the cherries onto the tree card. Spin the wheel and follow the instructions. The first person to put all cherries from the tree into the bucket is to shout 'Hi Ho Cherry O!' and wins. (See the setup in the photo below.)
Where to buy: Action Toyz, IMM
Interesting discovery: Because the cherries are pretty small, it also trains the kids' fine motor skills as they pick and drop the cherries. Gerrard has more problems than Gerlyn though he is older.


This picture appeared in the post dated 11 May. This game caters for 4 players. Hope one day, all 4 Gers can play together.

Asperger's Syndrome

Felt an impulse to post this after a wallpost on a friend's fb wall and a few interactions with some friends through fb messages.

I have no religion, but I believe things happen for their own reasons.

Through my 10 years of teaching, I encountered 2 students with autism, one diagnosed and undergone intervention, the other was just labelled as a special kid by the parents. No one in the school knew how to handle them properly. So when the course for Special Needs was offered, I signed up with a few colleagues and decided to specialise in autism. The course had 3 modules and it took me more than 3 yrs to complete it! Module 2 was deferred as my father-in-law passed away, while I postponed Module 3 as Gerrard was suspected of having HFMD. Module 3 is the life-changing module. That module specialises on the Special Needs area that we had enrolled. Through the course, I realised that Gerrard fits quite a number of the characteristics listed. Around the same time, the teacher in the childcare centre recommended for a developmental check as she commented that Gerrard was facing friendship problems because he couldn't communicate well.

When Liat brought Gerrard for a check in the polyclinic, the doctor just felt it was slow speech development. I do not blame the doctor. No doubt that the level of awareness has increased over the years, doctors who long graduated from medical schools are not proficient in this area. And not many can admit that they are not sure... Luckily Liat insisted for a referral letter to KKH. Then came the long wait. This is a clear sign that more and more special needs children are being diagnosed and yet the professional help that was required is lagging behind. Out of desperation, I even tried finding out about the private practitioners, but, GOSH!, the price difference with respect to the KKH is ridiculous! So, while waiting, I read up on my own. From the references recommended from the course and books recommended by friends, I gathered a clearer picture of what it is about.

Here's what I had taken from the info that KKH had given and some other sources, to create a little bit of awareness of what it is...

WHAT IS ASPERGER'S SYNDROME?

• Named after Hans Aspergers in 1944



• Life-long developmental disability (There is no cure. Intervention programmes only attempt to 'normalise' these kids.)



• Falls inAutistic Spectrum Disorder, with some calling it 'High Functioning Autism', while others felt it should be taken out of this family and be totally regarded as a behavioural problem.



• Key difficulties in communication, social interaction and restricted interests



• Usually diagnosed during the 24 month developmental check (Gerrard was diagnosed at age 4, which makes me filled with anguish at first, because that meant he missed the months of intervention possible for him.)

WHAT CAUSES AUTISM?

• Genes - usually from the father. (Some papers said MMR vaccines play a part. That doctor was charged of professional misconduct and struck off the register, as the data in his papers was manipulated, causing a MMR scare.)



• In families with 1 autistic child, the risk of having a 2nd child with the disorder is about 1 in 20. (Gerlyn's good with her social interactions, so no Asperger's. Gerry and Gervin, still have to watch)



• Abnormalities detected in several areas of the brain, which will result in several of the signs and symptoms. (It is said that kids with Asperger's are found to have exponential brain development during the infancy stage. Yes, Gerrard's head circumference is always 75th percentile, while he was only 50th percentile in terms of weight.)

WHAT ARE THE CHARACTERISTICS THAT GERRARD DISPLAYED? (This is not the full test. These are the things that I find Gerrard matches. There are some that he does not have. Long wait for the full battery of tests in KKH...)

1. Impairment of social communication

• Slow language development (By age 2, his speech is still quite limited. Now, he is seeing a speech therapist to work towards having a functional conversation.)



• May speak in formal or monotonal voice (He speaks in an American accent, which he picked up from the DVDs that he watched.)



• Usually talk 'at' others (This makes him appear tohave low EQ, care less of others' feelings.)



• May be able to express needs but may have difficulties expressing emotions or thoughts. (Mummy: How is school today? Gerrard: School is fun! Mummy: What did you do? Gerrard: .....)



• May have fascination with and excel in words, but may not use as a tool for social interaction. (He reads a lot and loves reading. But unable to carry outa conversation, or do a picture description.)

2. Impairment of social interaction

• May accept social contact, although may not initiate contact (Since young. Not playing with others.)



• Stilted and formal way of interaction as adults (He's acting very matured for a 5 year old. Cool, is what some others may describe him as.)

3. Impairment of Imagination

• Play tend to be copied, repetitive and stereotyped (The very 1st one was '噢！土豆！', Chinese of 'oh! toodles!' from Mickeymouse Clubhouse!)

4. Sensory Issues

• Intolerance to noise (Shavers, vaccum cleaners, rain...)



• Intolerance of certain textures (Sand and grass)



• Insensitivity to temperatures (He likes to wear jackets and refuses to take it off at times.)

5. Uneven patterns of intellectual functioning

• May have unique skills (At age 2, he was able to count to 100.)

I shared in my friend's fb wallpost, that the signs and symptoms could have long appeared since infancy. Just that, they are ignored or disregarded. Gerrard has been a compliant child. In fact, too good. When he was an infant, he did not cry when he pooed. There was once that his diaper was not changed for a very long time and he had a boil as a result. Babysitting him was easy. There was once that I brought him out the whole day for a Scrabble friendly match. He was really manageable.

I read much about the causes. Now, I have to focus on the remediation. Good thing is IQ is not impaired. It makes the journey less painful. In fact, Gerrard is very cheeky. Yesterday, He purposely constructed a 'naughty' sentence from the nouns and verbs that the therapist gave him: The cat is making a snowman. Then he went 'Oops! That's so wrong. Hmm.... Let's change this.' Then he went ahead to change it into a proper sentence. He kept on making mistakes, exclaimed and corrected his mistakes. Until the therapist realised that he had done it on purpose. When a 5 second completion rule was implemented, he got all his sentences correct on all the first attempts! Mind games, that he was playing!

Home Intervention Programme

Following Gerrard's diagnosis, came a series of long waits for professional intervention.

Occupational therapy, wait for 3 months. You have got your dates, if you miss, it is your own loss. No make-up. Reappointment is possible if the child is sick.

Psychological assessment, wait for 4 months.

Speech therapy, wait for 5 months.

Shorten the wait is possible, if the financial backing is strong enough - consult private therapists...

So for every trip, I always make a point to ask for things that we can do at home. Time spent at home is on all these 'games' that will help him. I bought games that can teach him to wait for his turn, teach him to pay attention and memorise the coloured pins. There are also days to train him in paying attention to others talking. Then also have to teach him imaginative play (yes, teach, cos he can't). Also getting him to join dots and tracing to train on his fine motor skills. All these, within that 2 h window period after coming back from school and before going to bed.

While some parents are busy doing curriculum stuff, we have to redirect to basic neccessities 1st.

These takes a lot of energy...

Pictures of the 3 kids playing Hi-Ho-Cheery-O with their dad. This game teaches taking turns and basic counting. Notice Gerry in the background, who was left out in the game.

Special Kid

Gerrard has been diagnosed of having Asperger's Syndrome.

I picked out several signs when I went for the Autism course earlier in the year. I signed up for the course because I met 2 diagnosed cases in my career and many of us do not know how to handle these children with special needs.

Somehow I felt relieved. Knowing the diagnosis will help in the remediation process. Just that it takes a very long time in government hospitals, while the private practitioners are very expensive. Meanwhile, we just do what we can at home and in school.

I am very hopeful we can help him, although a cure is impossible. He's fortunate, that we picked out the signs and insisted a referral although the doctor at the polyclinic felt he was ok (maybe just slow in speech).

The route is gonna be long.

As the Liverpool slogan goes, You Will Never Walk Alone.

He's a happy boy. What's more important than this?

Classical Cheese pose from Gerrard.

Went to the playground while waiting for the clinic to open for functioning.