The ideal service provider?

Had First Aid training today, for work, and at the end of the day I got into an interesting discussion with a couple of co-workers. I didn't get to really expound upon why ABA isn't the best way to go (we don't do ABA at the agency I work for), and I definitely couldn't have done it scientifically anyway, but the chat got me wondering just what sorts of things I should be focusing on as I move through my career. I'm thinking again about school, and what I would study if I went back, as well as what kind of services I would focus on if I were to open my own agency and become a service provider.

I obviously have my own ideas, but I'm curious: what would you want in a service provider? As a parent, as an autistic person, as a professional in the field - what would you like to see being offered? Don't worry about whether or not things are already offered elsewhere - this is "in an ideal situation", what kinds of things you've been glad to see provided and what kinds of things you have sometimes wished you could access?

In which Janna experiences, first-hand, just why point #6 in her booklet is so important.

The title of this post, is, of course, referring to the sixth point in this post.

Take care of your child's physical body.

• Vaccinate him. Take him to the doctor regularly. Have his vision checked yearly, for eye health and other such things. Take him to the dentist regularly.
• Pay attention to your child's body language. If he has poor body awareness, he may not realise that he is in pain or where, but there are certain behaviours that will indicate it to you if you are watching carefully.
• Teach your child how to wash himself in the bath or shower. Teach him how to brush his teeth. Begin these "simple" hygenic routines (including when & how often) when he is young.
• Pay attention to your child's diet and his reactions to food - including toileting, if possible. Any changes or abnormalities should be met with a visit to a doctor and probably some modification of his diet. Do your best to discover if your child has any food allergies or intolerances.

So here's the punchline: I am getting a root canal done on Thursday, February 28, at 12.00 noon.

The story itself is a relatively good one, in my opinion, and it illustrates just how important it is to teach that when & how of good hygiene, as well as just what poor body awareness can result in.

Keep in mind that my diagnosis is ADHD, not autism, and that my ability to communicate and look after myself is very good (seeing as how I've been on my own for 13 years and have managed without too many disasters).

At some point last week, I realised that my tooth was hurting. I have no clue when it actually started hurting. This is the second molar from the back, on the top left. Half of the tooth is a filling anyway, because of my poor dental hygiene (about which I have written elsewhere).

I know the pain was really bad Friday night. It was tolerable Saturday night, but horrible Sunday night. On Monday, Juniper and I invested in a small bottle of clove oil, which worked quite well until sometime Tuesday. Tuesday night, the pain was unbearable.

Wednesday morning, I bit the bullet and called the dentist. I got in for 11.00 a.m. that day.

The dentist diagnosed me after some x-rays and tapping my sore tooth with something frozen. (That didn't hurt at all.) Turns out that the tooth is dead, and the roots are all infected (which is why the tooth is dead), and the infection has spread into my sinuses.

The upshot of it all is that I'm taking Amoxicillin three times a day for the next week and getting a root canal on Thursday. In case anyone was wondering, dental care is not covered under Alberta Health, and I'm in between benefits at work, so I have to pay the $1300 (plus another $1000 for the crown) on my own.

The thing is, this is not likely to cause my dental hygiene to become what it should be. Executive dysfunction will make this difficult; a healthy fear of the dentist and lack of funds will do nothing to overcome that obstacle!

So, I've added 'hygiene' to my Palm Pilot, as part of my morning and evening routines. I'm hoping that I'll be able to make this happen, the way I used to make things happen when I was working at the church, by printing off a daily to-do list.

So here's the breakdown on how point #6 fits this story, in case you haven't figured it out on your own.

Take care of your child's physical body.

• Vaccinate him. Take him to the doctor regularly. Have his vision checked yearly, for eye health and other such things. Take him to the dentist regularly.
• Pay attention to your child's body language. If he has poor body awareness, he may not realise that he is in pain or where, but there are certain behaviours that will indicate it to you if you are watching carefully.
• Teach your child how to wash himself in the bath or shower. Teach him how to brush his teeth. Begin these "simple" hygenic routines (including when & how often) when he is young.
• Pay attention to your child's diet and his reactions to food - including toileting, if possible. Any changes or abnormalities should be met with a visit to a doctor and probably some modification of his diet. Do your best to discover if your child has any food allergies or intolerances.

Obviously vaccinations and vision care aren't a factor here, and neither is regular doctoring. However, regular dental appointments are vital, and are supposed to be spaced - at most - six months apart.

My poor body awareness means that I didn't realise that I was in pain until the pain was severe. This means that I also have no idea how long it hurt before I clued in to the fact that this was more than the usual "sensitive tooth" thing. Basically, things got a lot worse than they had to before I called the dentist.

And my lack of routine for dental hygiene is probably what caused the situation to begin with.

I don't blame my parents for this, by the way. They taught me how to brush my teeth, and they did make sure I did so every night before bed when I was young. It's just that they didn't know they had a child who would need more help and more supervision in order to make that a routine. They didn't know that they had a daughter who needed to have everything all chained together and drilled into her right from the start (yes, I mean from the start, as in from infancy). My opinion is that all parents should do so regardless, but that's not really prevailing wisdom, so we won't talk about that right now.

My mouth still hurts some. The antibiotics should kick in sometime tomorrow; I don't know if that means I will be in less/no pain, or what; the doctor didn't say. But in the meantime, I still have the clove oil, and massaging my gums with my finger or drinking cold water or juice seems to help.

Oh, and I wrote about this now because I know that I won't be able to write about it at all next week; I'm not sure how functional I'll be after spending an hour and a half in the dentist chair, having drilling and whatnot going on. A regular cleaning takes a lot out of me; a regular filling is worse... this is bound to be the worst thing ever.

I worry about the state of the world.

Some people really don't "get it".

Over on ISCABBS, in the Medicine forum, there was a discussion going on about vaccines. Specifically, the HPV vaccine that is being given to 12yo girls in the USA.

Some people think it's ridiculous, others think it's fine. And then there's this guy:

Nov 14, 2006 14:09 from Knightshade
Except carriers die eventually. The disease would be gone in a generation or two if everyone were vaccinated and the vaccine were highly effective.

Notice how nobody gets polio around here anymore?

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So I responded with the following:

Nov 14, 2006 21:43 from Jubilee
Knightshade> "Notice how nobody gets polio around here anymore?"

Not strictly true.

The reason why we still get polio vaccine is that polio still exists in the world, and people coming from other countries can carry it.

My mother's sister married a missionary surgeon, and their kids grew up in Angola and Canada (4 years one place, 4 years the next). My youngest cousin in that family missed his polio vaccine because they ran out in the place they were, and he *got it and nearly died*. He was 2. He's now 24 or 25, and still has some problems popping up even though he got better. (Basically because polio doesn't actually go away completely, it just goes dormant.)

And THAT is why vaccination is important. Just because "nobody gets that anymore", it doesn't mean NOBODY gets it anymore.
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And then the conversation got a little bit ridiculous:

Nov 15, 2006 07:58 from Knightshade
Err... I said around here.

As in in the US.

Because the vaccine has wiped it out.

If the third world nations had also had full vaccination for a generation or two it'd be wiped out there too.

That's how we got rid of smallpox too.
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Nov 15, 2006 10:33 from Jubilee
My point was that if we stop the vaccine, then there will be outbreaks because there are people who go to the countries that still have it. And they bring it back with them.

Why else would there be whooping cough and measles outbreaks happening since people have stopped allowing their children to be vaccinated? Those "don't happen anymore" either.
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Nov 15, 2006 11:13 from Knightshade
Here's my original post. I still can't figure out what part you're trying to disagree with-

Nov 14, 2006 14:09 from Knightshade
Except carriers die eventually. The disease would be gone in a generation or two if everyone were vaccinated and the vaccine were highly effective.

Notice how nobody gets polio around here anymore?

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(context- it was in reply to someone suggesting vaccinating everyone was silly since there's still "carriers" out there today)

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Nov 15, 2006 11:50 from Jubilee
I don't know that we're actually disagreeing so much as saying the same thing in different ways.

The point is that vaccines are important to continue until the disease is no longer anywhere *in the world*. I took issue specifically with the "around here" part, because if that mattered, we'd all die fairly quickly of things like measles.

If there's a vaccine, it should be used. Period. I think I'm behind on my boosters; I should check that out. I refuse to get the flu shot, but that's mainly because I almost never get sick (my last bout with the "flu" was actually an adverse reaction to my new meds - no Wellbutrin for me!) and also because I haven't seen anyone give a good reason for me to be vaccinated against last year's flu when I didn't even get *that* last year.

However, these other vaccines all make a lot of sense to me. I am worried, though, about the mentality that seems to come up time and again, that says "Nobody gets anymore, so my kid doesn't need to be vaccinated against it." The thing is, if you have children who aren't vaccinated against something going to school with kids who are, and then a new student comes in who perhaps is an immigrant from one of those countries that doesn't have a vaccine program and is a carrier of that disease, then you're going to have an outbreak. And the parents who didn't get their kids vaccinated might (might - that is, it is possible to die from these diseases, which is why there's a vaccine for them) end up with dead children instead of live ones. I don't know about anyone else, but I'd rather have a live child than a dead one.
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I don't follow the science stuff really closely. I freely admit that. But I know enough about it to know that this sort of thing is the result of the ridiculous campaigns of the anti-vaccine crowd. Ignorance, too. In this day and age, when it is as easy to fly to Nigeria as it is to fly to Vancouver, it's better to be safe than sorry, don't you think?

Personally, I'd rather have a live child than a dead one. That means vaccinations, unless someone can prove that my kid is highly likely to die (I mean physically, by the way) if s/he gets one.

Granted, that's moot since I have no children.

This post saved as draft and added to as the conversation progressed.
Posted once the discussion had scrolled out of the forum in question.

ABA vs Play Therapy.

If you've been reading for long, and if you've looked around this 'blog for information about me, you'll know that I was once a fairly good ABA therapist. That's ABA as in "Applied Behaviour Analysis" - more specifically, the type of ABA developed by Ivar Lovaas as an autism treatment.

This type of teaching requires one-to-one interaction between the autistic child and his or her therapist, in a room free of distractions. All of the teaching is done in a very clinical, discrete style. Once a skill has been learned in isolation, it is generalized with other, similar skills, and later moved into the "real world". The specifics of the program - what is taught, how it is taught, and how one knows something is learned - are laid out in the program binder by a consultant. Everyone working with the child is expected to run the program in the same way. Deviation from this program will result in confusion for the child, and the skills will not be learned as quickly, if they are learned at all.

Again, if you have been reading long or have delved into the personal information on this 'blog, you know that I have moved away from the discrete trial type of teaching and am currently employed by an agency that adheres to what they call a developmental play-based approach to autism treatment.

Play therapy of the type I do now is done wherever one happens to be, with whomever happens to be there. Siblings are included, as are parents. Teaching happens in the kitchen, in the living room, in the bathroom, and in the bedroom. There is no isolation of skills being taught; everything is generalized right from the start. The specifics of the program - what is taught, how it is taught, how one knows something is learned - are laid out in a program plan, which contains goals and strategies from behaviour therapists (who only tackle behavioural problems), occupational therapists, physiotherapists, and speech-language pathologists. It is up to the individual working with the child to create and recognise learning opportunities during the sessions, and to help the parents incorporate strategies into their daily lives.

This morning, as I followed my client around the house, imitating his vocalizations (trying to show him that we might converse someday), squeezing his feet (he's a deep pressure junkie), and taking the sudden opportunity to teach waiting (he wanted into the kitchen for a cookie but hadn't had lunch yet), I thought about how the work I do now is so much more challenging than the work I did as an ABA therapist.

As an ABA therapist, I was not required to be creative. In fact, it sometimes seemed to me that creativity was actively discouraged in some of the programs I worked in. An ABA therapist, when it comes right down to it, must simply do as he or she is told, without question.

I don't know if you've noticed, but that's not exactly my personality.

As a play therapist, I have to be creative. It's up to me to come up with lesson plans and ideas for teaching skills that we have on a child's program plan. My job is to actually get down on the floor and play with the child, relating to him or her as if I, too, were a child. At the same time, I have to retain that level of control, so that the child does not become confused about my status and authority.

I've been thinking about the difference between the two for a while now, and I am interested in trying something here on this blog.

I would like to take some goals - IEP goals, perhaps, or just a random goal - and write up a sample of how an ABA program would teach those goals and how a play-based program like the one I currently work for might tackle them.

If you would like to see the difference and have some goals to offer, please e-mail them to me at janna@thehoskincentre.com. I'll change the names, of course. If you're offering a goal that you or your child has achieved, I would love to know how it was achieved and how long it took!

Thanks, everyone!

Coming Up...

Well, as noted in my news section and in the sidebar, I've just published a booklet about "What You Can Do to REALLY Help Your Autistic Child". The booklet can be downloaded and printed off for free, to distribute to parents of newly-diagnosed children.

In some discussion about the booklet, I've been asked to create one for professionals (teachers, therapists, etc.) and one for adults to give to their friends & family members. I will begin working on these booklets once I have an idea of how to address things.

I have also been taken to task for the wording used regarding Facilitated Communication in the section on communication. I admit, I did not give the correct caveats regarding this particular method of communication. I will publish an edited version when I publish the next booklet, and I will correct the mistake at this time.

This posts' icon created by hobbitseeker, of the LJ community Big Damn Icons.

Domestic Bliss.

I'm going to take a moment now to write about relationships. Specifically, I'm going to write about my current romantic relationship. There are a lot of types of relationships - siblings, parent-child, work, friends, etc. - but I think romantic relationships are the kind of relationship many people find most interesting.

Since I began writing on this blog, I've been involved in a total of three romantic relationships (the current one being the third). The first was a long-distance relationship with an autistic guy who was much younger than I was. The second was a short-lived relationship with a man I had attended high school with. My current relationship is with a man who is a self-diagnosed Aspie. He has been married before, which is not a quality I thought I would be okay with when I was younger. But we are well-matched in many ways, and that is far more important.

Because we both have some trouble with communication, we have decided from the outset that we should be as open and honest with each other as possible. We don't really think in the same way, but often our thought processes follow the same progression (just in different styles). There have been some difficulties, of course, primarily because I don't always have words for things I am thinking or feeling, which means I can't explain myself - and my dear Aspie man has an innate need to understand things and find out everything he can about something he doesn't understand.

We met in October, at the Asperger's Meetup group I've been a member of for a few years now. It was rather strange, as we both realised from the beginning that we would be together and be married. It wasn't "love at first sight", though; love definitely grew as we got to know each other. It was merely an instantaneous knowledge that we were meant to be married.

I have recently moved - with the guinea pigs - into his house. I have taken over the kitchen (getting rid of his excess - why would anyone need 30 mismatched dinner plates and four blenders?) and turned the second bedroom into my office. The three-month old kitten (who thinks I'm her mother) sleeps in my hair every night. (You do not want to know what kitten hair looks like in the morning.)

And we are definitely happy. Life is settling into a kind of routine that I have long desired. From what we eat to how we discipline the kitten (she hasn't quite figured out yet that she shouldn't try to eat our dinner or climb our legs), we work together to get things done. I never really thought of myself as being tremendously domestic, but I seem to be turning into someone who actually cares about housework and the like.

Someday, I will be posting here with news of our engagement and pending wedding. We are merely waiting for him to be hired in his field (he is a hardware engineer) and for us both to get some of our finances straightened out before we take that step. We want children someday, too, and I plan to stay home with them and homeschool them.

In the meantime, we have Roy the kitten and Napoleon and Katonia the guinea pigs. Quite the little family. :)