Reality Check contd.

Yesterday I emailed Tal to see if she could meet with me - I wanted to discuss the doubts and disheartenment I described in the last post. Fortunately she had a cancellation at noon! By the time I went in I had a decent idea of what I was hoping for: concrete guidance on how I might monitor our home Floortime sessions to insure that I actually work towards defined objectives and gauge progress (or lack thereof) in concrete ways. Of course, I was also hoping for some degree of reassurance—as in, “things are better than you think.”

Tal didn’t exactly come through on the latter. In fact, she told me that she had been having some concerns about the level of engagement I was achieving with Uma in our home Floortime sessions. This is because Uma has been doing a lot of rather rigid scripting lately during her playgroup sessions (a lot of “first we’ll do this, then that”; “Goldilocks will do this but she won’t do that” etc.), and it is almost impossible for the therapists to intervene or redirect her when she’s on one of these jags.  At the same time, Tal and the other therapists have noticed that Uma seems less anxious too – a good thing, of course, except that she is using scripting to allay her anxieties and regulate herself. The fact that this is also occurring to some extent at home indicates (again!) that the developmental fundamentals of attention and emotional co-regulation still aren’t solidly in place. (Incidentally, Tal thinks that many of the semi-structured RDI activities that aim to foster attention and regulation are well suited to home use and encouraged me to keep experimenting with them.)

Tal also agreed with me on the need for guidance and monitoring at home, but went further: she thinks that Uma’s current program of interventions (school, developmental therapy, ABA social skills, home-based activities) is too fragmented at present to add up to the kind of intensity that Uma requires. And until some level of coordination is put in place, this intensity is likely to elude us.

I have to say that I completely agree. But then what?

One possibility—which Tal said she has desisted from bringing up in the past because she sensed John and I might balk at taking on additional expense—is for Tal do start working with Uma’s school team. As it happens, Tal “owes” Special Start some consult time, and she might be able to use this to work with Uma’s team (which would save us quite a bit of money).

Secondly, I could start keeping a brief daily record of notes and observations on Uma’s social and emotional interactions during our activities together and then review these periodically—perhaps every few weeks—with Tal or perhaps with Ellen or Elizabeth, with whom we have an hour of dedicated consult time every month as per our IEP. The most cost-effective way to consult Tal would be to use her Monday “drop in” sessions for this purpose. It could also be helpful to keep making brief videos for consult purposes as I did once before.

I think that these are really good ideas. Over the past few months I’ve tried to stay abreast of what’s going on in school and coordinate it with the home front, but I think Tal is much better placed to do this more effectively. The second in particular would requires time and effort on my part, but it is something I’ve long thought I should be doing anyway.

Let’s see what John thinks.