Friday, June 4, 2010

The Power of First/Then and Bye/All Done

Since Ethan's made it out of his rough phase and is now still challenging, but more just two-year-old strong-willed challenging, we have started implementing a picture schedule in therapy. The picture schedule most of all is to help him in what I'd call his weakest area -- sitting and attending to a task for more than a moment.

I can't believe how much of a difference it's made. I'd heard about the schedules forever and knew they'd be useful, but I guess I didn't understand how to Ethan, the schedule would be downright reassuring. Right now they're working on him having 2 tasks before going to mom for a hug or just some "moral support." By next week they may bump it up to three tasks. So they get out the board, take out the pictures Jessica took of various toys, and then the picture of mom and voila! Order has been brought to Ethan's universe.

"Ball, puzzle, MOM!" he'll say, pointing at each picture, and savouring the mom picture with such a look of affection it cracks us all up. That's not to say there isn't still some wrangling on the therapists part at times. He'll decide that he doesn't particularly care to do what's on the schedule on would rather make a sneaky run past them for mom anyway. But 99.9% of the time, if they can just go back to the pictures ("Wait, Ethan! It's first puzzle, THEN mom") he settles down and gets to the task at hand. It's as if, with the pictures there, he has to obey them. The pictures dictate the order, so that's the way it must be done.

I started doing that at the beginning of the day, letting him know what's happening. Again, I didn't realize how much he'd care. A typical conversation goes something like this:

"Ethan, today is Friday. Daddy's going to work, and Anna's going to school. Then we're going to see Ms. Diane (outpatient OT) and Ms. Karen (playgroup)."

Ethan will say something like, "Church done."

"Yup, no church today," I'll answer. Then sometimes I'll hear, "Y done" (as in Big Y).

"You're right. No grocery shopping today," I'll answer.

Later in the morning, I'll start up with the reminders again. "We're going home for lunch now. Then it's time for nap, and then Anna will be home from school." This running dialogue goes on all day. And I can almost see the wheels turning as Ethan tries to order each day in his head.

Along the same vein as the pictures, I'd heard about the First/Then phrases for quite awhile. "First eat your corn, then you get a cookie/"First clean-up, then go outside." Again, I didn't realize that using them often would help ward off many a tantrum and help Ethan stick with many a task. Something about First/Then, I guess the promise of the reward; the reminder of the respite on the other side of the undesired work he has to do, is a mighty motivator.

First/Then is a big part of our lives. So is "Done" and "Bye." Ethan has trouble with transitions sometimes. He's not crazy stressful like some stories I've heard, but he has his moments. Case in point: this weekend, climbing Talcott Mountain. On the way down, he was tired and getting cranky. He wanted to throw rocks off the cliff. We did for awhile, but then it was time to go. I would have been better off giving a little warning and then taking a moment with him to say goodbye. "Bye rocks!" "Bye cliff!" I should have said in the sing-songy voice we always use. "Rocks are done." I did none of that, and a five-minute tantrum ensued. This method doesn't always work, but it makes a great difference, particularly with storm drains. Ethan has a deep affinity for throwing things down storm drains and can get quite obsessed about it. Nearly every day we pass them, inevitably, and even in the car Ethan will ask for them. "Drains are done," I'll remind him kindly. "Bye drains."

"Bye," he'll usually say softly, and yeah, he may ask for them again in a little while, but whining and tantruming are averted.

This happened on the trails in Windsor yesterday, when Ethan kept wanting to throw rocks off the bridge. I tried grabbing his hand to move him along, and he wasn't having any of it. After about a minute, I realized I needed to take a different approach.

"The bridge is done, Ethan. Bye bridge! Bye water!" I called.

"Bye rocks!" Ethan added, and slowly started to come rather than going limp when I tried to grab his hand. He kept looking behind him sadly, and he put up a fight in another spot on the trail later. But I've found if I can remind myself to stay in the pattern, to not get emotional, and to throw out the key words, it can often make a might difference.

The world can be an unsettling place sometimes to my little guy. I've got to remember that, when I'm tired of saying goodbye to storm drains or making my hundredth first/then promise. He NEEDS this, just as he needs a hug when he's hurt or praise when he's done the right thing. Order for Ethan means security and safety, and most of all trust. I'm fiercely proud to be able to give him that.

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