Support What Is Given , Then Give It Structure

I have written on “The Importance of Giving Processing It’s Own Time” http://backmountainmusictherapy.com/2012/09/the-importance-of-giving-processing-its-own-time/ , but this week one particular example displayed a reason I had not yet considered.
I have 2 severely autistic clients that are brothers. The younger “Eddie” appears to have slightly more difficulty with sensory issues. When he gets frustrated, it is very visible and unpleasant. He lets out his discomfort in a frustrated cry for help displayed in lashing out (if pushed) or non-compliant, tantruming behavior. His older brother “Frank” is just the opposite. He does not appear to have as many sensory issues, but I believe is quite aware and intuitive of what people want, are like and what different situations are like. Both boys are currently non-verbal;. “Frank” often knows and realizes he can not get his point, his thoughts, his wishes across. Anxiety seems to be a large issue for this subdued child. When “Frank” can’t get his point across, he shuts down and gives up. You can see the sadness on his face. In Music Therapy, he tends to head for the door. I assume this is because he knows a) he gets a response to change the situation, and b) it gets him out of the discomfort of not knowing what to do next. I have made the mistake of coming in, feeling or thinking I need to keep presenting him with new things to get him to be more responsive. What I am actually learning is that yes, he does feel this anxiety of not knowing what to do – but that is ok in the Music Therapy environment.
In school, professionals teach and observe or test to see if a new skill has been learned. I believe he understands this expectation, but would like to avoid the anxiety of not being able to respond. This repeated expectation of no response creates more anxiety . In Music Therapy he heads for the door.
At his last 2 sessions, I did not allow the door to be an option, we worked through it. I realized my assumptions were correct because not leaving the room did not seem to be an issue. Instead, he sat back, rocked in the glider to the music and began to play with the instruments and his voice. (The videro is taken after the door option is closed, this is what happens next:

No expectation, in the moment, creative play. If there is ever a hope for language, first “frank” must be comfortable using and playing with his voice. This is where the aim should be. My experience and belief tell me that when non-verbal children believe that they will not be heard, they stop using their voice. The expectation then becomes the reality. (who then is the ones having trouble reading facial expression?) The outcome of the play then is two-fold a) it decreases that self-choking anxiety, creating space for curiosity and learning, and b) it gives “Frank” opportunity to just relax, and play out of that curiosity. It unlocks that self-choking anxiety and creates room for spontaneity, creativity, relaxation and play.
In my eagerness to be a good therapist, presenting new things each time, I have created that anxiety, plugged that “Ready for Take off” curiosity http://backmountainmusictherapy.com/2012/07/disconnect-to-self-regulation-all-systems-go-ready-for-take-off. I do not know how things are processed in “Franks” brain; only “Frank” experiences what he can work, how, and what he can not. I need to help him relax by eliminating that heavy expectation bar, let him show me what he’s got and support that. If I can support that musically, give it some structure in repeated experience, he can play with it, experience some predictability and control on his own and that is where the path that we take lies.

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  1. David Pike October 9, 2012 at 5:24 am

    ‘Frank’s’ behaviour for me is an outward expression of exactly what any person or child feels in a situation where the preconception is: “I’ve never done this before and my performance is going to be judged”. It is only the most confident or well experienced people who will feel calm in themselves and can just ride the situation. The scenario you’ve described would work just as well with people and children who are not ASD. All the best teachers recognise this and will use similar techniques that you’ve described to place their students at ease. One of the very effective approaches I’ve experienced is when the learning is carried by a game ie it becomes fun – do much easier to learn things when it’s fun to do and you don’t have to be a child to appreciate that!

    • Antoinette October 9, 2012 at 1:15 pm

      David,
      You have hit the nail on the head exactly. This boy is also quite the people pleaser. Although I try very hard to keep things like game, I think I have a few years of previous experience and his expectations to undo. i literally just read this comment right after his session (Which happened to be the next one following the one you read about) Your comments confirmed what I was already thinking.He truly does not know what to do with this behavior of mine, he is not use to it. I think this is the next emotional process we have to go through before seeing more functional development occur. Any thoughts?

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