Week 1 Update

First of all, here's Quince (and I) hanging out at the beach:

Since this week is the first week of my project, I have been adjusting to my new schedule. I am realizing that my project can really be broken into three separate segments. In this post, I will describe these three segments. Then, I will explain what I did this week.

The first part consists of shadowing Quince's ABA therapists, both at the CARD office and in our home. I am paying particularly close attention to the exercises that focus on verbal communication, since my project focuses on this aspect of therapy. These exercises are usually what CARD calls echoics. In Quince's version of echoics, his therapist holds up a picture (out of a pile of pictures that we have taken of items and people he encounters regularly) and names what is in the picture. Then they pause and wait for Quince to repeat what they named. If he doesn't say anything or says something wrong, they will prompt him again with the name. If he repeats it correctly, they reward him with praise, a token on his token board*, or sometimes even a treat like a piece of candy. An example echoic program might go something like this:

Therapist: Quince, look. (Holds up picture)

Therapist: This is Dada. Can you say 'Dada'?

Quince: Dada

Therapist: That's right, Dada. Good job Quince. High five!

Since Quince struggles with the clarity of his speech (which we believe is due to his apraxia), sometimes what he says doesn't sound anything like the prompt. For example, he can't pronounce the letter 's', so for him, Casey is 'cuh-cuh.' Because of this, it's very difficult to decipher what he is saying, particularly if you aren't familiar with him. Quince just switched CARD locations, which means he has an entirely new team of therapists. Thus, it is particularly useful for me to shadow them for the next couple months, as I can identify what he's saying for them until they become more accustomed to his vocabulary. Quince's ABA sessions are extremely long, usually four hours in the morning and sometimes two or three hours in the afternoon as well. In these sessions, his therapists are trying to reinforce all kinds of functional behaviors, including but not limited to this type of verbal communication. 

The second part of my project is centered more specifically on speech. It consists of accompanying my mom to Quince's speech therapy sessions at Pediatric Speech and Language Associates. These sessions are half an hour, four times a week, usually right after his morning ABA. Since they are only with Quince for a short amount of time, the speech therapists have to be focused and fast-paced. They do a lot of flash cards, and books interspersed with breaks for toys, tickles, and jumping. Quince's attention span is extremely short (sometimes a span of seconds) so these breaks have to happen often. Although to me this initially seemed similar to what CARD does, I soon realized that they do emphasize how Quince should be producing the speech. For example, they will model a word, and then prompt him both verbally and physically with a touch on the throat or the chin, depending on the sound they want him to produce. This seems like a really good idea, since forming speech is one of the hardest things for Quince, and is something I'm looking forward to learning more about. 

The third part of my project involves the work I am doing at ASU with Dr. Ingram. There, I am studying phonetics and will be learning to analyze speech samples. I will then apply what I learn to specifically analyze Quince's language. 

This week, on Monday, I shadowed at CARD for Quince's morning ABA session. It was very rewarding to see how excited he was that I was coming with him. I soon saw how I could help to provide consistency among therapists and also between CARD and our family by interpreting his speech. For example, one of Quince's echoics is a picture of a lollipop, and in our family, that's what we call it. However, his therapist was asking him to say sucker, which was confusing him. By letting the therapist know that we say lollipop instead, I was able to prevent this confusion. After the morning session, I accompanied Quince to speech, where he produced the long e sound on command three times. This was an enormous accomplishment for him, since this is a particularly difficult thing for him to say. 

Unfortunately, on Tuesday, I came down with strep throat, and was unable to work with Quince at all for the next couple of days. Quince tends to get sick easily as his immune system doesn't always work properly, so I had to avoid him. By the time I was recovered, on Thursday, I went with my dad to ASU, where I had my first lab day with Dr. Ingram. In preparation, I had studied some basic phonetics and taken a brief inventory of Quince's language to show him. Once I was there, we talked a lot about my project and Dr. Ingram's expectations and training that I'll have to complete in order to work with human data. Then, he introduced me to Dr. Beate Peter, an expert in apraxia, which was very exciting. 

On Friday, Quince had clinic at CARD. Clinic is where my mom meets with Quince's head therapist to review his goals and progress on them. I accompanied my mom to clinic, and played with Quince during the meeting. After clinic, Quince had two more hours of CARD, and then it was time for an hour of music therapy. His music therapy isn't very focused on language development, so I probably won't talk about it a lot here after this, but I'll provide a rough overview. His music therapist, Mary, plays the guitar and sings to Quince while he drums. Sometimes she plays the piano and he jumps on a trampoline. It's less demanding and thus more enjoyable for Quince, so he looks forward to these sessions. 

Sorry for the lengthy post. I'll try to break it up next week.

*Quince's token board is a piece of laminated paper with ten velcro circles on it. His tokens are laminated pictures of surfboards (because Quince loves to surf) with the opposite velcro circle. When Quince is working on a program, if the token board is being used, every time he gets a trial right, they give him a token to put on the token board. Once the board is full, Quince knows he is 'all done', meaning he gets to take a break and run around. They use this board so that he can visualize the reward and exactly how much more he has to do to get it.