From Troubles to Bubbles
Sharing a meal at a restaurant with family or friends is pleasant experience for most of us. Not so for Karlee’s family. “It was impossible,” said Karlee’s mom Lezlie, referring to their attempts to treat her family to a meal out. Karlee was born with autism and as a result developed only minimal verbal skills, demonstrated only limited eye contact with others and frequently injured herself when she couldn’t communicate her needs. Going to a restaurant would result in Karlee attempting to bite or “head butt” her mom and siblings, throwing items or sometimes even hitting herself. Karlee didn’t seem to feel pain.
Early on, Lezlie knew something was not quite right for Karlee. She had her daughter screened and tested by her pediatrician. Though treatment through applied behavior analysis (ABA) was recommended, Lezlie confided, “I was scared in the beginning [with ABA Treatment], I mean, how will Karlee handle it?”
After the proper assessments were completed, Karlee started sessions with MOKA’s Youth Autism Program when she was 27 months old. During the first six months, intensive work with Karlee occurred at MOKA’s therapy rooms focused primarily on increasing eye contact, responding to simple commands and improving communication. During this time, Karlee’s mom reported feeling badly about herself because Karlee was responding so well to the treatment sessions but still having major problems at home. Because Karlee was struggling at home, the treatment focus shifted there where MOKA’s Youth Autism Specialists started working on the situation where the family experienced the most difficulty—bath time. “Oh boy,” said Lezlie, as they watched Karlee’s challenging behaviors increase initially in response to bath time training.
For Karlee, and other children like her, this is a critical phase of treatment. Called “generalization,” it simply means that methods found effective in improving Karlee’s communication and response to simple instructions were to be taught to and employed by her mother and siblings. Karlee made steady progress for her mom with success in bathing, using the toilet, sitting appropriately at the dinner table, and requesting items from mom without her typical crying. Lezlie’s experience of success with her daughter buoyed lifted her own confidence.
Karlee advanced made dramatically improvements through the ABA training, the only currently known effective method for overcoming the effects of autism. When she first started training, Karlee knew 10 words and mostly pointed to communicate her needs. Now she is following multiple step directions and expressing herself clearly, even saying full sentences like, “No, I don’t want to do that.” Ironically, this is music to her mother’s ears.
Karlee’s social skills and abilities to either play independently or share appropriately with others also improved remarkably. Lezlie shared that recently Karlee was playing with toy ponies and she invited her mom to play asking, “What pony do you want?” LezlieMom stated, “purple!” That pony was not present so Karlee walked to her room, retrieved the purple pony, and brought it to her mom to play with. “I almost cried!” Lezlie exclaimed.
Lezlie shared that her biggest fear was how Karlee would ever be included or “mainstreamed” in school. But now her daughter no longer qualifies for special education and Felicia Hardy, MOKA’s Youth Autism Coordinator reports that Karlee will transition out of the ABA program in 2—3 months.
In the short run, Karlee is working on safety skills at home and getting ready for pre-school in the fall. When asked about her hopes and dreams for Karlee’s future, Lezlie paused. “Whatever she wants—to live life to the fullest, to never give up.” She went on, “I don’t stop at pre-school, now I’m thinking ‘what college will she attend?’”
“Just because she has a diagnosis of autism, doesn’t mean she cannot achieve,” adds Lezlie. We couldn’t agree more.
This cute little curly headedhaired little girl with glasses has a bright future due to your support. Thank you.This cute curly haired little girl with glasses has a bright future due to your support. But there are more children like Karlee, who need your help. Currently MOKA’s ABA Treatment program has a waitlist of 250 children. You can help drastically improve the life of a child with Autism by supporting the MOKA Foundation. Visit www.moka.org to donate.
P.S. Karlee and her family are now able to go out to a restaurant together for a meal. If you happen to see them, I’m sure they would appreciate it if you said hello.
Background information provided by Felicia Hardy, Youth Autism Coordinator
Karlee entered into the autism program due observed concerns of limited eye contact, self-injurious behavior, aggressive behavior, and minimal verbal skills. Due to this referral we completed her first assessment on 10/3/2016 using the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). Throughout the assessment she demonstrated the ability to identify items, verbally communicate, and make eye contact. However, it appeared that there were areas to focus on with speech articulation and interacting with others.
Based on the areas identified through the assessment the results showed that she was testing below her developmental age. Her average score was 28 out of possible 170, meaning she was scoring in Level 1 and she should be scoring in Level 2. To improve these skills, we developed a treatment plan that focused on peer interactions, skill acquisition targets, and Functional Communication Training (FCT) while including speech therapy.
In the beginning of therapy we started in-center to develop skills before transitioning in-home where it was reported to have an increase in behaviors. Therefore, the first 6 month the primary focus was skill acquisition and communication using the procedure of discrete trial training. Due to this intensive program Karlee engaged in an increase of tantrum related behavior of 3 instances per session defined as crying and yelling. Once she began to understand the expectation of our program there was a decrease in behavior of 0 instances for 3 months, with an increase in skill acquisition progress and speech. She began requesting for items that caregivers and staff could understand, demonstrated the ability tact (identify) common and uncommon stimuli, attend to instructions for at least 10 minutes, follow multiple step directions, and many now say she is full life and attitude telling caregivers and staff “no I don’t want to work today” or “NO, I don’t feel like it!”
Although, our treatment plans are typically written for 6 month Karlee made significant progress and mastered all goals. Therefore, we completed an updated assessment re-testing the VB-MAPP along with a speech re-evaluation. Her current VB-MAPP score is 83.5 out of a possible 170. Showing she made a 55.5 point increase from her initial assessment, super awesome! In addition, her speech re-evaluation stated she has letters T and B to complete until formally transitioned out of program. However, it is important to note her first speech evaluation was tested below average unable to make age appropriate sounds. (Due to this she was being evaluated for Early Childhood Special Education this coming spring.)
Based on the updated assessment and all the progress, we turned the focus away from skill acquisition targets and more to areas mom identified as difficult tasks. Therefore, our goals were developed for in- home such as allowing mom and her to properly bathe, toileting, sitting at table, and requesting items from mom in the absence of target behaviors (typical behavior crying until she gets what is desired).
The first 2 weeks of in-home therapy her behavior spiked however, her behavior is currently at 0 to 1 instance per session. Mom is doing awesome following the treatment plan and independently implementing all procedures with little guidance. Karlee is currently allowing mom to bathe, transitioning and completing task to independently toilet, has successfully produced in the bathroom, and eating at table along with appropriate requesting to leave desired area. We will continue to be in-home for a few more months to assist with mom but, due to her progress she will transition out in 1 to 2 months.
Parent report: Conversation I had with family, mom reports she has noticed a difference with communication and so excited to see all the progress with toileting. She reports there is a decrease in behaviors because she is using her words as a replacement along with accepting the answer “no” or “unavailable!” In addition, mom reported that Karlee is becoming more independent and playing by herself not as clingy (typically behavior in past).
An awesome story mom explained to me was about her ability to play independently and share appropriately with others. Karlee was playing with ponies and she asked her mom to play stating, “What pony do you want?” Mom stated, “purple!” That pony was not present so she walked to her room, retrieved the purple pony, and brought it to her mom to play with. She reported, “I almost cried!” In the past Karlee would not make eye contact, functionally play with others, share, and ask questions that others could understand, or have the ability to label colors. This just show how much progress she has made not just in our program, but demonstrating the ability to generalize the skills across environments.