Art Without Boundaries
F O U N D A T I O N
Noell's e-journal of Cara's progress
In November of 2007 I was approached by Cara's mom, a podiatrist who had seen the amazing results with Alzheimer's patients in a local assisted living. She asked if I would try the process with her daughter, a 10 year old girl with autism. I was thrilled to have the chance to try. My previous experience with a 21 year old autistic male was very positive and I was anxious to try it with a younger child.
Cara
First Session
Although I read what I could to prepare myself, I was a bit overwhelmed with Cara's impulsive nature. She barreled into the house and zoomed around like a bumblebee, picking up and exploring everything. When we finally got her to sit down at the table, she grabbed everything in sight on the table.
Here are the things I observed:
- No eye contact, little expression
- Didn't want me to touch her
- Had trouble getting her to the table
- One-two word sentences: "paint! paint!" "Fish!"
- Didn't sing with me
- Her swinging was uncoordinated and jerky, she kept trying to take her hands away and didn't like to be touched
- When presented with the butterfly catcher game, she didn't respond
- Didn't know right from left
- Grabbed the paintbrush with her fist and swirled, rather than a left to right line
- Didn't respond to directions at first
- Grabbed the paint and squirted it onto the painting
- Would follow the stroke instruction, then swirl it all together
- Jumped up and left the session several times and when the painting was done wouldn't return to the table
- Wouldn't name the painting or respond to a story about the butterfly
No photos were taken during this session.
Session Two
Cara's mom reported that they had their first two 5 word sentences in the week following the first session
Here are the things I observed at this session:
- More eye contact
- Allowed me to touch her more
- Speaking more
- Sang a few words with me, but plugged her ears and wouldn't participate.
- Her swinging was a bit more coordinated and smooth
- When presented with the butterfly catcher game she responded with the wrong hand, and mimicked the butterfly, rather than be the catcher
- Painted left/right, right/left with much less swirling
- Followed directions better
- Still grabbed at things, but showed some improvement
- Stayed seated for the whole session, jumped up at the end, but returned to the table to name the painting.
Session Three
Cara's dad reported that she sat through an entire movie for the first time after the second session. Her parents noted improvement in verbal skills and impulsive behavior
Here are the things I observed:
- Eye contact and more facial expression
- Much more calm
- She voluntarily gave me a hug
- Multiple word sentences
- Her swinging was more coordinated and smooth
- When presented with the butterfly catcher game, she responded with the correct hand and caught the butterfly instead of mimicking it.
- Painted left/right, right/left with minimal swirling
- Had no trouble following directions
- Less impulsive about grabbing things. When asked to wait for the brush, she folded her hands (see picture, right)
- Stayed seated for the whole session, but jumped up as soon as the painting was done.
- Came back to the table to name her painting and wrote the title with only help with spelling
Session Four
Cara's mom reported that everyone was amazed at her new verbal skills and smiling face. She seemed much happier.
Here are the things I observed:
- Much more facial expression
- Verbal explosion! She greeted me when she came in, "Hi, how you doing?" Gave me a hug and went to sit down at the table without prompting
- She used longer sentences and spoke with ease
- She initiated the sing and swing and her swinging was more coordinated and smooth
- When presented with the butterfly catcher game, caught the butterfly quickly and responded with the correct hand.
- Painted left/right, right/left- straight with no swirling
- Followed directions with ease, did not swirl at the end of each stroke
- Less impulsive about grabbing things.
- Stayed seated for the whole session and didn't jump up when it was over.
- Named her painting herself and wrote the title with only help with spelling.
- After the session, said to her mother, "Look, Mommy, a frog!" (improvement in joint attention dysfunction)
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We'd love to hear your comments:
Comment from Cara's parents:
"The past few weeks have been just amazing since we started working with Noell. Cara surprises us, at least once every few days with something new. Yesterday, she said, " Look Mom, Barney stickers". If you know about joint attention you know this is major. This is a process, and Cara is having fun while she is doing it. We can't be more pleased with her improvements."
The Normal Case
Joint attention is a family of social
abilities ("social pragmatic abilities")
that help individuals regulate, respond
to, and engage in social interactions
with others. Of particular interest to
the study of autism are joint attention
behaviors (JA) that regulate social
interactions between a child, an
interactive partner, and other aspects
of the environment.
Throughout the first two years
of life, infants develop increasingly
complex nonverbal, vocal, and (sooner
for some than others) verbal skills that
can be deployed to meet the demands
of social interactions. There are a
number of different ways to view the
repertoire of social pragmatic behaviors
in this early developmental period.
Infants may initiate social interactions,
or respond to social bids of others.
Social-communication episodes may
also vary with respect to communicative
function. Children may use nonverbal behaviors to request an object out of reach, or they may request help with an object. The means to this social end may vary, with some acts involving pointing, others involving eye contact, others simply a reach,and some combining a number of
behaviors. Whatever the form, however,
these behaviors serve as requests, for
they have some instrumental value
and function to elicit aid from a social
partner.
Joint Attention in Autism.
Autism is characterized by severe
deficits in both IJA and RJA.
Children with autism show deficits
in the frequency and complexity of
joint attention behaviors, as well as
differences in the qualitative patterns
of strengths and weaknesses in joint
attention as related to other social
pragmatic behaviors. Autism is
characterized by generally poor social
and communication skills. But there is
a particular weakness in IJA and RJA
skills. Thus, children with autism show
severe deficits in the frequency with
which they initiate joint attention
bids (I}A) as well in their ability to
monitor and respond to joint attention
bids of others (RJA). These deficits
contrast with a relative sparing of
requesting skills.
This is not say that the children
with autism show completely normal
and age-appropriate abilities to request
and to make their needs known.
Indeed, children with autism may
show deficits in the complexity of
requests (e.g., failure to use pointing
or poor coordination of eye contact,
vocalizations, and other communicative
means when making requests). Instead,
the pattern of social pragmatic skills
seen in autism, particularly in young
children with autism, reflects a greater
propensity to regulate the behavior
of others for instrumental gain and a'
diminished tendency and/or ability to
coordinate attention with others for
social affiliative functions.
To read the whole article:
Photos used by permission
Joint Attention Dysfunction
by Stephen J. Sheinkoff, Phd
Additonal observations from Cara's parents:
- Cara seems more aware of her body. She cut herself and asked for a bandaid
- She seems more aware of those around her. She asked about the babysitter's son by name
- She's trying and enjoying new foods
- She's using the word "my"
- She's playing with two dolls and giving them different voices
- She's much more loving and enjoys hugs
- She's helping make the salad for supper
- She's sleeping in a bed instead of the floor.
Listen to a session where Cara works on sentence structure (time 3:12)
Noell Hammer, Founder, AWB
Cara's Gallery
Autistic Program
Cara works on "Winter in the Woods"
Her mom reported they are continually amazed at her progress. She has started using the word MY for the first time. She is now surfing the internet and enjoying playing programs. (This is a child that, just two months ago, couldn't remain seated for more than a few minutes.)
- Today she "called" the hand in our high five game, something she couldn't do last session.
- She still struggles with making eye contact when I talk to her, but her conversational skills are improving. Today we made up a whole story for the first time.
- She uses complete sentences without prompting. "That's an orange tree." and asks for paint and brush with "May I have the paint brush, please." We have been working on sentence structure, which is still a bit of a problem.
"High five" game
Want to send a message to Cara? She'd love to hear what you think of her paintings!
Hamming it up for the camera
