Adam has challenges managing environmental complexity. He becomes easily overwhelmed with noise, change in schedule, emotional responses, challenging tasks, and unpredictable situations and variables. He is accustomed to a fairly routine schedule with limited outside events due to home schooling. Adam manges novelty by self-stimulation such as hand-flapping, running away from the stimulation, or tuning into the TV. Adam's ability to process and respond to environmental complexity depends on his state of modulation. If he is attending to the situation and not in high arousal state he is better able to deal with changes in the environment. According to Miller-Kuhaneck(177) it was reported that children with executive functioning impairments have a great deal of difficulty with combination of activities, new activities, and changing activities. Looking at Adam, it appears relevant and explains why he may use his self-stimulation techniques. Due to his inability to predict, analyze, and adapt he resorts to comfort measures. Adam responds well with priming, which I have recently utilized to a higher level, so he knows what is expected and functions the best in a predictable routine world.
Hi Kirsten,Is he home schooled because there isn't a classroom that his needs could be met? Is his brother home schooled as well? Are there opportunities to do your OT intervention in the park or other environment to increase his exposure with the support of you to him and the family in a new environment? - joan
ReplyDeleteJoan,
ReplyDeleteHe is home schooled because his mother home schooled her younger sister and this is important for the family. There is a strong group of home schoolers in our area. A lot are due to religious reasons. I cannot do OT intervention outside of the clinic. They tried gym at school but that was unsuccessful. Perhaps I should revisit that as an option and give them suggestions to make it more successful. Good thoughts.
Kirsten
HI, Kirsten,
ReplyDeletePriming is a good strategy.
You also will want to start focusing on the cognitive differences and some straight knowledge building skills.
Also, in terms of executive function, consider what his memory is like -- both short and long term; as well as his ability to sequence through tasks.
From an environmental complexity standpoint, I would take a step back, and look at things like:
1) how does he categorize things? if you had 2 different items and 20 of each of them, could he sort them? if they are very different? if they look similar but have different functions? How can you reduce complexity in task with respect to hisa bility to categorize?
2) Discrete vs. continuous -- trial tasks ONE AT A TIME :) and see -- does the clear start/do/end of discrete tasks work better for him? Or, does he need the rhythm and routine of continuous tasks? (like learning to ride a bike-- I've seen several kiddos who can't get the simplest of discrete tasks, and then we focus on the continous act of bicycle riding - and find that the act of figuring out the coordination of recipriocal motion for pedaling while stabilizing arms on the handle bars - and then the act of steering around obstacles.. it is INCREDIBLE how that continous task with added cognitive load once learned, translates into SO MANY things. Think about the "maturational" leap your own kids made after they learned to ride a bike independently...
Let me know what you think!
Amy