This weekly blog is about change, development, and growth and recognizing them. Not only recognizing them, but attending to their significance in each individual. Sometimes when working with special needs children, most specifically in this case children on the spectrum, there comes a point in which growth appears to have come to a stand still, and work with the child seems to feel like blind wandering, leaving the dedicated professional to wonder if he/she know what he/she is doing. The bothered therapist will have to search, and think: What do I do now? What should I be doing?
This week while working with Derick, a nonverbal, autistic seven year old boy whom I have worked with for approximately three years, I had to ask a couple questions: Where was this going? Was it going anywhere? At the end of this week’s session, was I hearing or seeing what I thought I would? Had there been real work, was this making progress? Three years and was this non-verbal boy developing, growing? One of my earlier blogs was entitled “Why give up on speech?” I still feel very strongly about this, but Derick continually challenges this belief. Although I have worked with Derick for three years, “pop-out words” have been very few and far between. Progress at times makes me wonder. When the session was done, I had to look back and research.
Looking back after the session. two things stuck out in my mind. 1) When Derick was seen individually this week was when I questioned progress, when his autistic symptoms were all I could see. Yet when I saw him in a small group with another little boy – Charles, who is three years younger with similar symptoms – I saw something else I had never noticed. Sometimes Charles is somewhat intimidated by Derick because Derick is bigger. Although because I realize this intimidation factor, I tend to be slightly more attentive to Charles in this group. As I was maintaining that attentiveness, I noticed Derick being very perceptive and not just with listening to my directions (which, because I have seen Derick for a while, I forget that that in itself, is very significant for Derick). As I was giving structure to the session, Derick watched me and waited to see what came next or what to do next. It appeared to me as if he was filling the role of the older child, being more responsive and considerate of Charles. I had never noticed this about Derick before.
Then came the individual session. Derick had pulled out two books we had put to song: “Brown Bear” by Eric Carle, and “Ten Wigley, Wiggly, Caterpillars” by Debbie Tarbett. Derick taps out the name of the animals on a drum as I finish singing “Brown Bear, Brown Bear, what do you seeeee….”. Then we sang the counting book where he points to each caterpillar as I count. Later, he threw down his plastic mirror as I sang: “It (G) is (D), then he sings “me” (C) over and over. (Derick had learned to make the “eee” sound from repetitious play with “eee” such as in “Brown Bear”. I repeatedly held “see” as he first matched pitch, then vowel sound.) Lastly he laid on my piano bench as I sang about his feet, his knees, and his hands while tapping those body parts with my lollipop drum as I sang. We had done this and done this over and over again, were we wasting time?
I looked at my developmental book (“Music Therapy, and Early Childhood: A Developmental Approach”, by Elizabeth Schwartz) and in the stage of developing independence, all these things were listed. The following skills were listed along with the need for repetition in this developmental stage:
– Extending the child’s world through vocalization. (Derick had played with babbling and was now filling in the appropriate word sound- “me”.)
– Attempting at gesturing and spoken language. (Derick was showing me what he wanted.)
– The need and craving for repeated sounds and movement. (Steps towards word formation).
Two of the most important points at this stage of development were:
A) “At this level children absorb more than they produce”.
B) “Allow the need for time for child to move on their own to music”
I had forgotten six months ago, I did not hear specific vowel sounds such as “-ee” and when I did hear them, it was at random times – not at the end of the same phrase (“it is me”). Also, Derick goes and gets the mirror himself. Wanting to hear those same two books over and over was not random: Derick chose those books from a pile, and instead of flipping pages, as he would have six months ago, he waited patiently for the singing to finish. Derick now enjoys listening to me count/sing repeatedly as he counts caterpillars with his fingers consecutively.
His vocalizing isn’t the “ERKSH” sound he had first come to me with. Now Derick’s sounds had definition. I wanted to see more. I had lost track of progress, that this independence was developing. He had to move on his own time, not mine.
I flipped the pages to the next stage of “Control” to see what might be next. Another phrase “Gaining Control takes WORK and PRACTICE, and there are many times when “success” is difficult.” While Derick was singing “meee” and getting out the mirror, he was now repeatedly demonstrating the skills of listening, processing, and responding. This was carrying over to the small group session. Derick was listening to the direction and responding and then looking to me for what came next. He was “absorbing the external information”, the chord progression and words (it is me). He was not only controlling his understanding, but also controlling his reaction to it (singing “me” and getting the mirror as he happily looked at himself).
Derick was also recently learning how to control his breath and mouth by making a sound on the recorder. This was yet another skill area described in the book; “blow and sustain sound on a simple wind instrument”. At earlier sessions, he was practicing and becoming more successful as I played the recorder after singing “my turn”, then following suit after I sang “your turn”. Derick was physically learning how to control his mouth to get it to do what he wanted.
What I also had forgotten, over time, was that I was now waiting for Derick to show me, by gesturing or by leading, what he wanted to do in Music Therapy. Previously, I had given structure to his responses, sounds, and movement. Now Derick was choosing what we did.
I have become much better at watching and being able to see a child as he/she processes things instead of demonstrating new skills. One has to watch subtle things like a change in posture or the child’s facial expressions. However, at times I struggle with allowing a child to move on their own. Usually with a bit of reflection and a check on what is happening developmentally, I regain my vision and know exactly where the child is. Our society today has difficulty waiting. Our society wants to see us produce, produce, produce. One has to be able to look and see if there is forward movement. Is there growth? Where is the growth and what are the changes? What direction are we headed? If I can answer these questions confidently, then I know I am not aimlessly wandering. Sometimes I need to look specifically at the child and see what he’s doing: what has his path been? How has the Music Therapy facilitated this? Competency will be demonstrated in the carefully prescribed goals, objectives, and methodologies set forth in the paperwork. Then at the end of the day I need to give the credit to the child and see that this child, this individual, did grow and is growing. He may not always grow on my timeline though. When I can say that this child got from point A to point B. and demonstrated (through my paperwork) how the music has facilitated this growth, then I will be satisfied. Growth for the child and competent therapy have been procured.