Out of Focus.

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.

The famous tilt of the head, I'm not here, look...

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.

Focused, but in the right direction?

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 secret to bean counting - lining them up.

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.

About solodialogue

I'm a lawyer and the mom of a 6 year old boy with autism. I work part time and spend the rest driving here and there and everywhere for my son's various therapies. Instead of trying cases, I now play Pac-man and watch SpongeBob. I wear old sweaters and jeans and always, always flat shoes to run after my son. Yeah, it's different but I wouldn't change it for anything. The love of my child is the most powerful, beautiful and rewarding aspect of my life.
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16 Responses to Out of Focus.

  1. kcunning says:

    It took Jake a long time to understand two step commands. Even now, I know I’m throwing the dice if I give him an instruction with more than one action in it. It’s not an ADHD thing: it’s totally an Asperger’s thing.

    Just so you know, Jake was heavily tested for ADD and ADHD, and came up clean. He can focus on things, but steps can get muddled in his brain, especially if couched in all the unnecessary words us neurotypicals use. Example:

    “Oh, honey, could you go to the bathroom and get Mommy a washcloth, please? I need to clean your face.”

    That’s come out of my mouth, but out of those twenty words, only seven were necessary. They muddied the waters. I learned to cut down my commands to the bare minimum, and if they had to be repeated, to repeat them without elaboration. Jake needed to hear the same thing, exactly, so he could process it.

    My daughter, on the other hand, can listen to the above sentence, and run screaming upstairs, as she understands exactly what I need, and knows that there’s no way in hell am I washing her face.

    • solodialogue says:

      Thanks, Katie, for getting me on this one. I wonder if there are programs that can be run through ABA that will sharpen their ability to process of if it’s just the nature of it all. I try to keep it to a bare minimum but I am quite wordy – have you noticed? 😉

      • kcunning says:

        There should be. My son didn’t get ABA (he’s one of the ones that it actually harms rather than helps), but it was on his IEP. Basically, they started with one instruction. Once he was following that consistently, they added another instruction. We never took it past three instructions, as that’s fairly normal for his age to cap out on.

  2. blogginglily says:

    Does he have a visual schedule? Or is he beyond that? You said he has a check list at school, and he can read. . . so maybe it is just working on the routine with him and getting him to commit it to memory.

    • solodialogue says:

      Thanks for the suggestion, Jim. Our tutors have been working on this routine for months with no success. I’m trying to figure out why. Maybe the inner dialogue spoken for him will help.

  3. Broot says:

    getting a one-to-one correspondence for math is not something that most children get before they are 5 Many don’t get it until they are 6. It’s one of the things we discuss the most with over-achieving parents who want their children to be “School ready.”

    One bean equals one number is a very important math concept. I’m not surprised Tootles doesn’t have that concept yet, and I wouldn’t worry about it. Want to know more? http://s22318.tsbvi.edu/mathproject/ch1-sec3.asp

    LOL I know that wasn’t really your topic today but it stood out to me because I talk about that one with my parents at Playcentre.

    • solodialogue says:

      Hmm. I guess that means I may be an “over-achieving”parent?! Lol! But really, thank you Broot! It’s nice to have you give me perspective where I haven’t got any. I did check out the link. I’m not so sure that rote memorization does not have it’s place in mathematics. I’m quite sure I memorized my times tables before understanding the concept. It does help to have friends who bring me down from the “tiger” mama stance… 😉

      • Broot says:

        LOL yeah I didn’t mean it that way (on the over-achieving bit… that’s the preschool mamas) I do think rote memorisation has its place, but it’s also important to give children space to learn important math concepts… like the one-to-one correspondence. 😉

  4. OK, is it bad if the whole time I’m reading this I’m thinking more about Brian than A.? I’m pretty sure he could benefit from some of these strategies…. 🙂

  5. Jen says:

    This has been a huge part of K’s therapies, using that inner voice. Our kids just don’t have it. It is something she is specifically being taught to do through her many social skill groups. Thinking about what other people are doing, what she is doing, what needs to be done, etc, etc. K is the same way, where academics are not the problem, but not being as focused, and also not having the emotional regulation of her peers, are getting in the way. It is definitely one of the key deficits.

    • solodialogue says:

      Has K been evaluated for ADHD? Because, underneath it all, the focus issue as a facet of either the lack of inner voice or the ADHD is what this post is about. T and K sound a lot alike on the focus thing. Katie (above) believes it to be totally an Asperger’s thing for her son. Because T’s focus is accompanied by so much fidgeting, I’m leaning ADHD. To be continued…

  6. ElizOF says:

    It is fantastic that you are documenting all of this as I believe it holds great value and insights into autism… TY for sharing your heart with us. Love to you all. How’s your mom doing?

    • solodialogue says:

      Thanks Elizabeth. My mom has a g-tube and receives all her “food” through a tube. It is a hugely different life, but it is still a life, with joy and sadness mixed. You never really realize how central food is to life, until it has been taken away.

  7. Lana Rush says:

    This is fascinating to me, Karen. T and Lily are soooooo much alike in that lack of focus, that constant being on the move, and that utter un-awareness of stuff going on around them. The inner voice thing is interesting. I have a meeting at Lily’s school tomorrow and I’m going to bring this up and see what our BCBA thinks…

  8. Pingback: Self Help Radio - Your Inner Focus | Self Help Made Simple

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