One day one of my son’s tutors was running late to school. Instead of just dropping him off, I stayed to prompt him through his “morning routine”. He had on a coat. He could not really get it off because the elastic around the wrist area is kind of tight. Instead of asking for help, he did something else.
He was swinging the coat from side to side with his arms at his side, kind of using the weight of the coat, each swing, and gravity to shake it off. Simultaneously, he was looking up and off to the left. He was smiling. He was talking to himself, oblivious to all around him, uninterested in what was going on around him.
His classmates were present. They were also being prompted through getting their folders out of their backpacks and getting seated but their prompts were different. The lack of attention of the other kids was because they were talking to each other or saying goodbye to a parent.
The morning routine is written out with words on paper. Each step has a box next to it for my son to check off as he completes each step. The problem is that he doesn’t use that list. He could care less about the list, or taking any of the steps on it. He was absorbed in his own thoughts about what he’d been playing on the iPad during the car ride to class.
I helped him get his coat off. This alone took several repeats of his name to get his attention. Each step (hang up your coat – backpack, etc.) required me to regain his attention and focus. He mindlessly sat at a table. The teacher told him (and me) that he had just switched groups and he was at the wrong table. Again, three or four attempts to get his attention later, he moved.
At this point, his tutor walked in and I left. But the impression in my mind was impossible to shake. My son is not in step with the rest of his class. His mind works at his own pace, in his own way. He tunes in and focuses like he’s in a time warp.
At home, I often overlook the multiple times I try to get my son’s attention. In writing this post, I wanted to test his attention. He was on the floor, playing with a remote control car. I said, “Tootles, go to the bookshelf and get Llama Llama Red Pajama” and bring it to me.” He looked up at me. After a couple of seconds, he got up walked over to the bookshelf, took a baby wipe out of the dispenser and started to walk toward me. He stopped. He wiped his face. He looked at me like he knew this was not what I wanted. We both laughed. He then started to walk toward the fridge to get a soda (sometimes I ask him to get me one of these). I repeated the instruction. This time he headed to the bookshelf. We found the book together and read it.
The thing about my son is that he has “book smarts”. He can read. He can memorize. Academically, he knows more or the same as the other children in kindergarten. He cannot focus. He is more often than not, not with the group, not with me, not with other people.
This lack of “common focus” is what one can see that sets him apart from his peers. It’s what makes communication with him difficult. It is one of the “tells” of his delay. Once his focus is obtained, he can follow directions, read, write, answer some questions, learn new information or perform a simple task. But getting to the same page is a continual, never-ending struggle.
I can get his attention only to have it disappear. He leaves and, not necessarily physically, although that is also a problem. His mind goes elsewhere. More time is spent again obtaining his attention. It wears you out. It’s frustrating.
As part of the 100 days of school “celebration”, his homework was to count 100 things and put them in a paper bag. I used pinto beans. I dumped them into a shoebox and had him count them in groups of ten into the lid.
He had no idea where or how to start, even though I gave him both visual and verbal instructions. Instead, he wanted to grab handfuls and throw them into the lid while counting to 100. He did not, at first, grasp the concept of counting each bean until he got to 100.
Even when he did catch on, he counted too fast, counted two as one and did not visually watch what he was doing. Eventually, after several tries, he did count the beans in groups of ten to 100. This is because, each time he counted it wrong, I made him do it over.
The way he got through the task was by lining the beans up as he counted. The lining up helped organize his thoughts. Interesting that, eh? Even more interesting? He has never been one to line up of toys, blocks or any other object during play.
I read an interesting article this weekend about a study that found that autistic children (and adults) do not use an “inner voice” to talk themselves through complex tasks. The study asked both neurotypical adults and those with autism to complete a task of moving some colored disks to different arrangements on pegs in the least moves possible. The subjects were then asked to do it while repeating the word Tuesday or Thursday throughout the task, out loud. The saying of the words out loud is called “auditory suppression” which prevents them from using that inner voice to plan their moves. The NTs did much worse when they had to say the word, while only a third of the autistics were affected at all.
The conclusion was that, if the study can be duplicated on a larger scale, children with autism who are taught to use the inner voice will have a better chance of learning planning skills and living independently as adults.
Judy Ragan, Headmaster for the Queensmill School in London, a school devoted to those with autism, said this:
“Complex planning ahead is not a strength of people with autism which means, for people most severely affected, that they can only comprehend the here and now. This can be hugely stressful and at times quite frightening. Everything that we do in an ASD specific school is to help our pupils recognize when something they are doing might finish, what might happen next and so on. Encouraging inner speech is very much part of that as it can work as a life-long support.
“In order to encourage children to use inner speech, we start with visual timetables when they are in [preschool]. This will have pictures for different activities, such as a [diaper] for toilet time and a spoon for lunch. We will change this as the child progresses, to symbols, then symbols with words and then words only. By the time we are using written tick lists for the child to know what they are doing when, this will be accompanied by speech to begin to build the foundations for inner speech to solve problems.
“We can then ask the child questions such as ‘What do you have next Tim? What will you need for that? Which room is it in? What happens after that? This is all scaffolding for inner speech which is naturally a more ‘normal’ way of planning and one that we would want a child to move to if they have the ability to do so.
“We also use ‘parallel talk’ whereby we play alongside the child and talk through what he or she is doing. That way, we are teaching them in a playful way to talk things through. We know that neurotypical children learn a great deal about how the world and social interaction works by naturally talking whilst they are playing but children with autism do not normally do this. It is important for us to show them how they can do that.”
So perhaps my Tootles needs some inner dialogue for planning his school routine. To maximize his potential as an adult, it may be important to have language for his inner dialogue modeled instead of giving my son a morning routine list and saying, “Do your morning routine” and saying “No.” if he is not following through. It should be something like this:
“Here I am at school. I’m taking off my coat. I can shake my hand out where it is tight. Now I will hang it on my hook.
I’m going to take my water bottle out of my backpack and place it in the crate with the others.
Now, I’m going to take out my folder and put it in my cubby.
Today, I’m in the orange group. I’m going to sit at this table…”
Could it improve his planning? Apparently. Will he then be in focus? Probabilities improve. Can we get there without an ADHD diagnosis? I don’t know. Either way, it’s worth a try.