Okay, class; it's time for an autism lesson.
One of the many, many things that can go along with a diagnosis of autism is "poor motor planning." This can mean anything from being clumsy, to the inability to cross the sagittal or the transverse planes. The sagittal plane, or mid-line, is the imaginary line that divides the left and right sides of the body. When you walk, you alternate left and right feet. When you cut your food, you coordinate left and right hands. Difficulty in crossing mid-line makes anything that requires coordination of opposite limbs difficult. The transverse plane is the imaginary line that goes from top to bottom. This effects anything that requires you to coordinate top and bottom like jumping jacks or even just bending over. Now think about the shower you took today. Bet you held the shampoo bottle in one hand while you poured the shampoo in the other. Then you rubbed them together and scrubbed your hair. You effortlessly moved the washcloth or luffa from hand to hand alternating sides of the body until you were clean. If you can't cross sagittal or transverse planes, you have poor motor planning to even know where to start, and you have difficulty initiating actions, showering is a major undertaking.
I once had a parent say to me that her daughter with down syndrome "wore her disability on her face." When people encounter someone with paralysis, they recognize that daily living skills may be difficult. Sam isn't paralyzed. It's hard for people to understand that for him, showering is almost impossible. It has made finding someone who could help me teach Sam how to shower almost impossible.
FYI, independence in daily living skills = nicer living arrangements as an adult. That is what makes this such a big deal to me.
I started my search when Sam was maybe six. He turned 15 in May. There was zero success between those two points. It's not like I hadn't asked! Last summer, I specifically made an appointment with the occupational therapy department at our local hospital. I had to keep redirecting them from "sensory diet" back to "acts of daily living" during the assessment. At the end of the evaluation, they informed me they didn't have any appointments to provide therapy available until the Fall, when I was back to work and couldn't bring him which is why I had brought him in May. Guess how happy I was to hear that after getting up at 7 am the first day of my summer break? So I went to my back up plan.
Years ago, an organization known as CITE (which is an acronym I can't recall) taught me how to teach Sam to use pictures to communicate. I am not exaggerating in the least when I say it was a life changing experience. Sam's behavior changed dramatically and it ignited his academic journey. It was also my first step on a path that would lead me to become a speech language pathologist. Naturally, after the hospital failed me, I called CITE to ask for help. The team assigned to Sam is Mary and Justin. Last week was our planning session. Today was our trial run.
I love CITE because they always use data. I know a lot of people think that's a drag because it takes extra time, but I love it because it is proof positive you are making progress. Or that you are not making progress and should change to something better without wasting a lot of time. The baseline data was that Sam spent 30-45 minutes in the shower with me using maximum prompts (repetition of directions, modeling the actions, or just giving up and doing it for him) to complete the routine. BTW, Sam takes a shower every day, so my water bill is OUTRAGEOUS!!!!! Today, with the introduction of a social story, Sam completed his shower, head to toe, in 10 minutes with moderate (referencing picture cues) prompts. That is pretty amazing when you consider it was our first try. Best of all, I could tell he liked doing it on his own. He is fifteen for goodness sakes. He is so over mom being....you know, a MOM!
Thank you Mary and Justin for helping Sam achieve greater independence and making more progress in a week than we have made in the last nine years.
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