I have had autism dads on in the past but never for a Hot Seat. For this episode I am talking with Vikram, a father of two in Melbourne, Australia. Just after his son’s 1st birthday, concerns for autism were brought up by a pediatrician friend. After some time of denial, a period of waiting on evaluations, Vikram’s wife Leah ordered my book, Turn Autism Around. For their family this was the light that sparked understanding, and they have since joined my online course and community, and seen some notable gains in their son.
Speech Delay or Autism
It can be concerning when noticing speech delays in your child, whether that means no or very little communication for their age. Speech delay doesn’t always mean autism but with or without a diagnosis, the early learner materials in my book and courses are really important for making gains in these skills. Vikram and I spent some time discussing Nahum’s Language Sample. We go over the importance of creating Number One and Number Two word lists, practice and repetition at table time, echoic control, and articulation.
Autism Dad on Denial
If you’ve been a listener or a part of our community for any time, you’ve heard me discuss my denial when it came to Lucas’ diagnosis in ‘99. I truly think in any two parent household, there is going to be one who sees the concerns and another facing denial. Vikram, spent a lot of time in denial about his son’s delays and concerns. Any type of evaluation that landed on the side of non-autism, he held onto. It wasn’t until he read my book, Turn Autism Around, that he realized his son had 8 of the 10 deficits outlined and knew he had to get to work. Vikram says that taking the online courses, and consistently working on table time with his son and now his younger daughter has really made an impact and encourages others on the fence to take the wheel and become the captain of their own ship!
Articulation Delay and autism
Is your child really saying a word even if they’re not pronouncing it correctly? Yes. Articulation delays or errors can occur for a variety of reasons. Nahum pronounces his number two words, Pig and Star as Pih and Stah missing the hard G and R ending sounds. These are difficult sounds and can definitely be practiced by utilizing words with the sounds at the beginning of the word. However, echoic control should be more primarily focused on before prioritizing articulation. I shared about Lucas’ development of the Schwa sound by adding a long uh to the end of words because I was too heavily pronouncing and articulating letters, like Cup vs Cupuh.
Vikram and I touch on a lot of burning questions as well as direct information from his son’s language sample and one page assessment. Be sure to download and check the documents, as well as tune into the podcast episodes and videos mentioned if you’re sharing some of the same concerns.
Vikram on the Turn Autism Around Podcast
- Is it common for parents to be in denial of autism?
- Does speech delay mean autism?
- What is echoic control?
- Should you focus on words or articulation?
- What self care skills should you focus on?
- Can mealtimes and feeding affect other skills and goals?
- Why table time is important for early learner skills.
- Workshops – Autism Mom, ABA Help for Professionals and Parents
- Autism Success Story with Michele C.
- Autism Case Study with Michelle C : From 2 Words to 500 Words with ABA Online Course
- Case Study: Online Parent ABA Training and Expressive Language in a Toddler Diagnosed with Autism
- How to Get a Parent Out of Autism Denial
- Autism Dad Advice | Interview with Dr. Charles Barbera
- Autism and Constipation: Can Constipation Cause Potty Training Accidents? with Dr. Steve Hodges
- Building Echoic Control in Children with Autism
- Autism and Family Stress: Autism Dad Reflects on Marriage & Coping with Autism
- Improving Pronunciation & Articulation in Children with Autism
- When To Tackle Weaning Off Pacifiers with Pediatric Feeding Specialist Melanie Potock
- Talk Tools & Speech Therapy for Autism with Mags Kirk
- Should You Use Chew Toys for Kids with Autism?
- National Autism Conference – Session 7- Dr. Barb Esch
- Mary Barbera on Facebook
- Mary Barbera on TikTok
- Mary Barbera on Instagram
- Vikram’s one page assessment, planning form, self-care checklist, and language sample
Vikram – Turn Autism Around Podcast Transcript
Transcript for Podcast Episode: 184
Solving Speech Delays in 4-year-olds and Autism Denial: Hot Seat #6 with Vikram
Hosted by: Dr. Mary Barbera
Mary: Many times, kids who have speech delays are often evaluated for autism. And there is some debate whether or not they are on the spectrum. Today we are talking to a dad of a four year old who has been kind of on the autism journey for a while, but his son is still not diagnosed. And we are talking all about what you can do for a child who has a speech delay with or without autism.
Narrator: Welcome to the Turn Autism Around podcast for both parents and professionals in the autism world who want to turn things around, be less stressed and lead happier lives. And now your host, autism behavior analyst and bestselling author, Dr. Mary Barbera.
Mary: Okay, Vikram, it is so nice to meet you and thank you for joining us. You're in Australia, so it's morning for you and more on the late afternoon side for me. Thanks for making time.
Vikram: Thank you, Dr. Mary. I'm super excited. I can't wait to have this conversation. I've been waiting with bated breath for a few weeks. I've been telling my wife, I'm going to speak to Dr. Mary, I'm going to speak to Dr. Mary. So be calm for this video, but I'm jumping out of my skin. So thank you.
Mary: Well, you can just call me Mary. No need for formality here. And you're going to be a part of hot seat number six. So this is the first hot seat with a dad. I've done a couple interviews with dads, but never a hot seat. And I actually saw some video footage of you where you were attending some unstuck calls and asking great questions and always going on camera. And sometimes it's the middle of the night for you. You're still there and you're asking questions and talking about the progress your son's making. So let's start out by describing your fall into the autism world.
Vikram, Autism Dad
Vikram: Yes. So obviously with my current role, we have a number of people that we get in contact with. So I'm working as a pastor. One of my members is a pediatrician and he's young. We've known him for a number of years. And so we invited him for our child dedication one day for my son, who's now close to turning four. Back then, he was about less than two years old or maybe about 12 months old at that time. And so he came for that and he noticed that my son, for whatever reason, his weight gains were not up to the milestones. So he immediately expressed a concern. We were very new to everything. We thought everything was running smooth, but we went to visit him and he stopped to track his progress. And we realized my son was at a 3% on the three percentile in terms of his weight gains. And I was in a bit of denial because I didn't know what was going on at that time. And eventually he kind of suggested to us, have you considered that this could be autism? And I was really blown away. And I've heard your story about Lucas as well. And I was in a bit of denial. And. Yes, so I.
Mary: At what age was he saying it might be autism?
Vikram: Yes. I'm trying to think back. We're looking at maybe about, you know, anywhere like 15 months, 15, 16 months, yeah.
Mary: And I mean, it's kind of, you know, failure to gain weight isn't really a sign of autism. So he must have picked up on other things.
Early Autism Signs and Concerns
Vikram: Yeah, there would have been other things that he would have picked up on. And one of them is was the really the speech delay aspects. So he he wasn't saying that it is this, but he just flagged it out to us as a consideration. And so he was encouraging us to get him into playgroups and all these things to help develop his social skills. At that time, one of the public universities here in Melbourne where I live, they run an autism detect center and my wife somehow heard about it through our maternal health nurse and so she decided to pursue it. And I thought my wife was crazy because I thought he didn't really have any problems. So we decided to go ahead with the tests. I'm very close to my son. I'm very involved with his life. So I did the test with him and ran for about 3 hours with a professional. And so there's a whole bunch of toys, different activities. And I thought he did really, really well. But when the feedback came out, she was telling us that and this took roughly about close to maybe less than a year for them to give us feedback. For whatever reason, they got a year, less than a year because of COVID and they didn't have professionals on site.
Mary: So you went for 3 hours and you thought he did okay? He was, what, two at the time? 18 months, something like that.
Vikram: Between two and a half to three.
Mary: Oh, he was two and a half or three. And then you go and then you wait a year to get feedback on that three hour visit.
Vikram: Right, right. So it wasn't quite a year. I was probably say about nine, nine, ten months, but during the midst of the pandemic, so the people were on leave. So the whole situation kind of got put on the backburner and we didn't know what was going on or being in contact with anyone. Finally, we were able to chase them up and get the results. And so either the results came up when he was between two and a half and three, I think that's when the results came out. So he probably went a little bit earlier than that.
Vikram: Yes. So it was a bit of a challenge and I was waiting with bated breath. I was just praying he wouldn't have autism. And she told us that they scored him on two different aspects and you'd be very familiar with this. One was the social communication aspect, and then the other aspect was repetitive and restrictive behavior. So she said the repetitive and restrictive behavior. He was about three years old at that time. She said she didn't observe anything on that angle, but on the social communication aspect, she said if she was only focusing on that, she would have concluded he had autism. And so she gave us a very, very detailed report. We were then able to show that to our pediatrician, and I was over the moon because I oh, he doesn't have autism. So but that only fueled further denial in my mind because I thought, hey, the professional is saying no autism. So we're in the all clear. But that wasn't really the case. And so we were stuck. We didn't know what to do from this point of time. But she did tell us that signs of repetitive and restrictive behavior can come up after the age of three. And he was turning three around that time when we got the results. So she said, just be mindful that these sort of symptoms can come up. And so, you know, we haven't really noticed a lot. There was a bit of light switching on and off when he was around three years old. Before then you just do it over and over again. But just for two or 3 minutes, we asked him to stop. He would move away from it. He wasn't fixed on it. Now he doesn't really do it at all. Anymore. And I really believe a lot of that is credit to is really your program. My wife somehow, you know, she was in tears. She was really trying to figure out how to help him when I was thinking he was fine. And so she would stay up late at night, Google searching, trying to find stuff. And she came across your book and your resources online. So she never told me and she just ordered your book and your book arrived and she showed it to me. And the moment I saw the title turn autism around, it just really sank deep. It just connected with me because I said, This is what I need, this is what I'm looking for. Because all this time I've been told that if your son has autism, you just kind of got to stick with it. And he, you know, that's just his life and you're going to have to accept him for how he is. But when I saw that there's hope in your book, I jumped into I started reading the first couple of chapters and I said, this is it, because out of the ten signs of autism you mention, I could count maybe eight for him, eight out of the ten. So that's that's when it really hit me. I was out of denial mode at that time. I said, this is very serious. We're in serious issues here. I better do something about this. I've got to be the captain of the ship and steer him onto a better path. And so I'm so thankful your book came in a very timely manner. And I heard Michelle C.'s I know you don't have the last name there.
Mary: Yeah Michelle C. You heard the first one podcast 78 probably, and we can link these in the show notes. And then we just did a recap with Michelle two years after podcast 164 and we also did a white paper with Michelle's Daughters Progress that we just published, so we can put all those in the show notes. But yeah, Michelle sees podcast because like you during COVID, when the world shut down, she was kind of caught with nothing. And so she found she didn't buy my book because actually I was writing my book and she got my online course, which you took, and you're in my online courses now. That's how I found you through my community. But yeah, it doesn't matter. That's the subtitle of the book is even more important. It's an action guide for parents of young children with early signs of autism. So your son and I also, before we get back to your son and whether he has a diagnosis or you're waiting or what the deal is, I do want to make a couple of points. The the denial that I was in, which is really outlined in my first book, Verbal Behavior Approach. My husband first mentioned the possibility when Lucas was 21 months old, I shut him down and told him I never, ever wanted to hear the word autism again and then went into a really deep state of denial. That was back in 1998. He was diagnosed in 99 year, year and a half afterwards when he started treatment. And, you know, he was but he was making it look like he was okay. He was going to typical preschool. He was going to speech therapy. And back at the time, I had no idea. So we can link the denial video blog I did, which was one of my first video blogs. We can link that and also my interview with my husband. I don't know if you listen to that, but we talk a lot about his perspective versus my perspective and how he dealt with me in denial, which wasn't really good because I wasted a full year, year and a half. But in the end. I do think that when two parent households, it's very common for one to to be in denial and the other one not to be in denial. And there needs to be something. And in this case, it was my book with Michelle C., she was searching the Internet on a Facebook ad and found my online course. But, you know, you're in there in the community with Michelle C, who's now a Facebook adviser and with Kelsey, who is a success story. And so you are experiencing and you're experiencing the success that you've had so far with your son now. But he does not have a diagnosis of autism yet, right?
Vikram: He doesn't have a diagnosis yet. We have another test. We're going for an ASD test in September this year, 2022.
Mary: By that time he'll be four and but in the meantime. Like it doesn't matter if he has a diagnosis or not. It is the exact same methods work and about half of the people that introduce themselves in our community do not have a diagnosis yet, which is, you know, in some ways empowering because you're like, Wow, I am reaching the people that I want. Like, it is a lot easier to turn things around, whatever that means. Like, you know, turning it as good as possible, making gains, making progress, empowering the parents that they can do it with or without a diagnosis. It's always better the earlier, but it's never too late either. So. Yeah. Do you have anything to add about that?
Vikram: Yeah. So, I mean, yeah, through this community, we've obviously got to know Kelsey and Rachel and Michelle. You know, they're the main people there to provide support. And yes, it's been phenomenal. You know, the Facebook community, these online Q&A questions is just fantastic because it covers all bases. We really feel supported through this whole journey. And that helped me to go from the toddler course to the VB bundle. And so we're enjoying that a lot. And I'm just constantly learning, changing things all the time for our kids, making sure that they're benefiting to the best of their ability.
Mary: And you also have a two year old daughter, almost two year old. So they're they're two years apart. And you shared with me before we started that she is is developing okay. But she is very speech delayed and so you've been using these same techniques for her which is which is awesome. So we do want to dive into that to the, you know, the forms you provided which are going to be linked in the show notes. This is podcast 184 so MaryBarbera.com/184. If you're running or driving or whatever you're doing, this is one to actually go to the shownotes download these forms. This is hotseat 6. I if I were you a parent or professional, I would listen to a lot of the hot seats because this is really great that Vikram has kind of raised his hand and agreed to come on here to share his assessments and language samples and to get my direct feedback. I also want to, you know, so definitely you want to look at those and we are going to go through those also before we start, even though I looked at these forms, taken notes, and I'm going to give you some real feedback, this is not medical or behavioral advice. I know, you know, very small percentage of what I need to know about your child to really give you any serious advice. But, you know, like even through our courses and our book, my book is we are giving real good guidance, but we always say we can't give you actual advice, but, you know, this is as good as you're going to get because we need to empower you to learn how to fish, not feed you fish. And you are learning. You and your wife are learning how to be the captain of the ship. You're taking the course together. You're both attending the Q and A's, and you're really getting from point A to point B and then onwards. So the first step of the Turn Autism Around approach is assessment. So you have provided is your son and how do you pronounce his first name.
Mary: Nahum. You have provided his language sample. And it's so funny because the language sample you provided has scribbles all over it. And I have this book that literally I show and it has scribbles all over it. So, you know, we're that's what we have here. And at the time in February, he was three years, seven months. He really just had some babbling sounds, no words that at least during those sessions. So that's fine. And then you provided his assessment and plan when he was two years, seven months, two years, six months. But then you also provided his assessment more recently at three years, ten months. And so that's the one we're really going to look at, because he has made a lot of gains. Why don't you tell our listeners what kind of gains, just very briefly, he made from the time you started the course until now.
Vikram: Right. So I feel like his awareness of his environment around him has grown tremendously as a result of table time. He's and like you said, table time teaches multiple skills at one moment. And so he's able to man, he's able to now speak a few words maybe about I'm being a little bit modest here because I want to be a bit more conservative on the side. But we're looking at maybe about 12 to 15 words, but not the full word. It could just be the first syllable of the last syllable. So you've kind of got to be his parent to understand what he's saying. And it often just comes at prompting. So when we show him the picture during table time and we ask him what it is he's able to see, if I sing Twinkle, Twinkle Little Star with pause on Star, he's able to see Stop Our Time or something like that. So yeah, that's been a huge gain for us for since we started doing this program. And so there's been other things as well, which we mentioned in the assessment notes too, but been very thankful for his gains.
Mary: Yeah, and you did. We just recently did a podcast a couple of weeks ago. Maybe by the time this airs, it'll be a month or so ago. We can link it in the show. Notes on the frequently asked questions regarding table time. And you were on a Q&A call and you said, I think table time is my secret weapon. Which I was like, Oh, I like that. I like that quote. So what do you say to people that are like, no, follow the child's lead 90% of the time away from the table. No, no table time for a little two or three year olds doesn't work.
Vikram: Yeah, well, I've got to say that outside of reading your book and going through the course, yes, we did kind of get that sort of feedback as well. Follow the lead of the child, which some extent is important. But once we started table time, I found his focus, his attention skills, his ability to, you know, to attend in one place. It just grew dramatically. We didn't see that in the past because when we were allowing him to take the lead, it was scattered. It was everywhere. And it is exhausting because you're jumping from one thing to another. It's physically impossible to do that as a parent, but when you're at table time, it's a focused time. It's a closed, sealed environment. And like you said, sanitize the environment and try to follow it to the tee. And it's been so helpful for him. Yeah, I can't speak highly enough of that because he's just grown tremendously as a result of it. His ability to follow prompts, directions. He's able. His receptive language has grown a lot. So all these things have been very, very helpful for us. I don't think he would be at the stage he is at now and we wouldn't have known even what we were doing. We kind of would have been totally lost without table time and without the other resources in your book and the online course.
Mary: Yeah. So a lot of people post and in fact, just this weekend I think somebody posted and said, you know, they have a small house so they fold up the table and they put it under the bed in between sessions. And now the child literally is trying to drag the table out. You know, Alissa, who is on one of the podcasts recently, she's Hotseat 4, I think we can link it. She said she had to put a lock like a lock on the door to keep her daughter out of doing table time. Like we always want to make the table fun. We never want to have the child there if they're not happy. But like literally these kids can't wait to get to the table. That's how much reinforcement is going on. And the other really good thing about table time is and the early learning materials, which I talk about in my book and in my courses, is that you get a lot of trials. And so it's, you know, Mommy, mommy, mommy, you know, the child maybe echoes it, maybe puts it in the box. But you have, you know, 50 or 100 trials of something in 15 minutes. And it's also easier to train parents and staff to do table time than it is for them to get creative with all this natural environment away from the table. So we basically combine natural environment, child's motivators and sanitizing the room with intensive teaching. And you combine those and you have a really great, great thing going, okay, one thing before we get so step one is assessment. So you have the one page assessment, you have the language sample. I don't have a recent language sample, but when I go into, you know, some parts of the one page assessment, I see that he can say or has said Mama Dada some approximation of his sister's name and baby. And then he also has like word approximations, saying STA for star, leaving the end off PI for pig, DAH for dog. And it's really important. A couple of things about that, about those things, those clues. Because what I'm looking at this assessment, I'm looking for clues not to say, oh, this is bad or this is good. Two clues to go like you're here to get here. I would do one, two, three, or maybe do one, two, three. One of the things is and I talked about this in Grandma Tina's hotseat, number five was, did you have a chance to listen to that one?
Vikram: That one? Yes.
Mary: Yeah. Okay. So number one, number two word list. And so I just quickly wrote number one word and this might not be true. Like maybe he doesn't say mama, but he probably says my least. And if he says Mama clear and dada clear and baby clear and baba four sheep clear. Those are number one word lists. And so you I could make your number one and number two word list PI for pig. DAH for dog and BI rd. Mm hmm. And STA for star.
Vikram: Mm hmm.
Mary: So number one and number two, wordlists. I probably don't talk about that enough. I don't think I talk about that at all in my new book. I might talk about that in the verbal behavior approach, but not positive. I think I do. I think I talk about that in the first book, but I don't think I talk about it in the second book. But that's really important. I've had people create Excel sheets and have number one, number two word list. So you can print it out, you can put it on the refrigerator, you can have in alphabetical order. You can also, if your child's going to speech therapy or ABA therapy, you can share the sheet, you can update the sheet every week or two or every month or two. And then that way it's not like a big Whac-A-Mole where you're constantly like, Well, I used to say, Baby, but now it's Bobby. What happened? Well, people didn't keep baby up there. Maybe there's no baby shoebox materials. Maybe there is no practice of baby. So you want to make sure everything on your number one list has double pictures for matching, has multiple pictures for the shoe box. You want to keep number one words as solid as possible as you work on number two words. Number two, word should be 1 to 2 syllables. And if you have a speech therapist available who is willing to work with you, then that would be amazing as well because that, you know, I'm not a speech pathologist, so I know the G ending on the end of words and the R on beginning and end of words is tougher then. You know, I forget even what you call this CB, CB or something like that. Mama and Daddy are actually easy because they're both just the same syllable twice. So that's one thing. The other thing which we are going to link in the show notes, it's about articulation, it's about this number one, number two word list is I was a BCBA from 2003 until currently, but in 2016 I attended a workshop, three hour workshop with Dr. Barbara Esch, who is an SLP, BCBA-A and she is the creator of the Echoic part of the VBmap known as the ESA. And that lecture, even though I had been a BCBA for 13 years at the time, was like life changing. I went today because after I did my little, you know, looking for clues, I was like, That lecture is amazing. I found it. We're going to link it in the show notes. It's 3 hours with Barb Esch talking about like neighborhood vowels like ah is not ah, it's Ah, AA, A...There's all these different ways. And if you think about even the AH, A...Your tongue, your mouth, everything is kind of different. And so you need a speech pathologist to really do that justice. But in the meantime, focusing on more, number one, number two word list and that sort of thing is going to be key. So we're going to link that in the show notes as well. We also, because you're in the verbal behavior bundle, we have a couple of bonus videos. One is I work with an SLP and we did a non vocal to vocal, which is a lot of the things I learned at Barb Esch's work and continued on with that. So you're going to want to dive into that. We have a bonus video. We have also a podcast on echoic control and how to gain echoic control. So it sounds like at this point your son doesn't really have true account control, like he might repeat some of those words that he knows, but it's not consistently. Is that true?
Vikram: Yes. I wouldn't be consistent every single time we ask him, but majority of the times, yes, if we do ask him, he does say DAH for dog or PIH for pig. So majority of times he does do that. I know in your previous podcasts you have mentioned that there's something that happens before the floodgates to speech open. So I'm just trying to wonder if you could remind me what that is. Is it when they have echoic control, is that when it....
Mary: Yeah. And the thing is, is that you really want echoic control over the words that he's saying pretty clearly because if we it's just say you thought it was a good idea to teach a bulldozer and it was "duhduhduh" like the practicing "duhduhbuh" doesn't really, isn't really leading to good echoic control. You know what I mean? So the other thing Barb Esch said was when babies learn to talk, you know, it takes six months a year for them, you know, too much focus on articulation. He's a new talker. He just went from sounds to words within the last three months. So in that three hour lecture, you'll learn like don't focus on articulation. And in fact, in my first book, I talk about how Lucas's articulation, I think when he was four, kind of fell apart. Instead of saying water, he started saying warrior. And then all of a sudden he started saying, Pigga, cuppa. And I realized I didn't know what that was. I didn't know what why he was doing that. It was because that's called a Schwa ending. I don't even know how to spell that, but it's like an A at the end. And I talk about this in my first book because I had a speech therapist help me. She said, Oh, that's a schwa ending. And you know why that's happening? Because you're saying say cupPA and because I'm emphasizing doGA and I'm saying and a and he's imitating me and so now it's dogga, cuppa and it happens it happens to kids of all ages who are new talkers if we focus too hard. So it's very common for kids to leave off the ending to sounds, especially R's and G's and other things that are hard. So that's why I think it's going to be really helpful for you to watch the Barb Esch, to watch the non vocal the vocal bonus video within the verbal behavior bundle bonuses and then to really keep track of number one, number two word lists. And while we're on it like your daughter's speech delayed, do the assessment, do the plan, do the language sample do the number one number two word list to her to you know, we've worked with twins, siblings, siblings on the spectrum. One speech delay, one on the spectrum. It's important. Oh, yes. So go ahead. Do you have a question before we move on to the...
Vikram: Yeah, sure. I did actually have a list of questions because.
Mary: They don't give me a whole list, just the language sample articulation, because we're going to move on to the assessment like.
Vikram: Mm hmm. Yeah. I just had a question just to clarify what Echoic Control really means, is that just when they're able to you ask them, what is this word? For example, it's a fish on a pitcher, and they're able to say fish. Does that mean?
What is Echoic Control?
Mary: That's a tact. If you hold if you hold up something the early learner.. This is a great question you hold up something like fish and you say fish and they say fish. That's part echoic. But they also want the fish to match it or to put it in the shoe box. They also can see the fish and so it's tact. So it's multiple control, which is what we do to gain echoic. We use multiple control procedures as a table usually. Okay. But you can do it also when they want to go out, open, open, open if they say open. They want to go out to its part mand. They can see the door and they can see the open. It's part tact and they're echoing you. So that's great. We want to keep with that every at the table, away from the table, up the steps, up when you pick them up. Constantly bombarding them with the one word times three strategy in that multiple control to gain echoic control, which is what we used to do back in the nineties, is sit across the table from a child or standing without any materials. I say ball. You say ball.
Vikram: Mm hmm.
Mary: I say fish. You say fish. I say Mama, Come. You say, Mama, come. So I say, I love you. You say I love you. As you can see, we're going from one syllable to solve all three syllable, those sorts of things. Barb Esch does an amazing job talking about the syllable length. We have more of that in the intermediate course as part of the bundle. More videos about that. What to do when the child says...you say, Say banana. They say, say banana, which is a whole nother thing to get rid of. But that's why you have to build language systematically so pure echoic control is. I say it, you say it. No materials, no mand.
Vikram: So. No, no support.
Mary: And no part mand, no part tact. It's just an echo. So if. If I hold up something new and I say bone well, obviously it's not new, but if I, you know, hold up a marker or don't hold up a marker, but if the child if I say say marker, they'll say marker. But the way kids learn is marker. He says marker. Good. Then he you know, if you're a one trial learner, you'll learn this is a marker. You'll learn to say marker, but you can't really prompt a child. Like when you get to an intermediate learner, you know, where's the marker? We just did a thing on advanced manding, like, you know, I have something in the bag. You know, we need to prompt sometimes for some kids. What's in the bag? If the child can't say what's in the bag eventually, you know, I mean, that's echoic like saying what's in the bag? What's in the bag? Oh, it's a marker. You know, like we can't go up the mountain until we get echoic control. So we can't control does open the floodgates. But that's basically like you say something, they'll say something. With, with or without materials, a length of utterance will come. And that's really when the floodgates opened. Because kids typically developing kids learn through imitation, which is verbal imitation and gestural imitation. That's how they learn to do things. And so kids on the spectrum don't imitate physically and a lot, you know, as well as typically developing kids. And then they also once you get echoic control, he'll be in much better shape. But you don't want to get echoic contorl and you don't want to expand the language too quickly like by using carrier phrases, by saying, you know, I want blah, blah, blah or more cookie when you already don't have cookie. So you can't add other words until you can. But I don't recommend it because it'll mess up your articulation even further.
Vikram: So focus on those core words and help them along with that.
Mary: And one syllable, like without endings, like hi, mama, bye... You know and accept star and work on g's with the beginning g like. Ready, set, go. I mean, if they can't do go, they're probably not going to pig without the a.
Mary: Got it.
Mary: All right. So that was a lot on language sample. But, you know, there there are basically with the one page assessment, there are basically three main areas. And your son has deficits in all three of them. Probably every Hot Seat we do, we focus on these three areas. One is self-care and activities of daily living, which we're going to talk about. The second area of concern usually is language and learning skills. And the third area of concerns is problem behaviors. And so for each child there are different, like your son sleeps through the night in his own bed. That's like a home run for many kids. You know, for many families that would be like a home run. So that's not an area. But that doesn't mean he doesn't have any self-care issues. He's got other self-care issues that we need to work on. So that's why I like the one page assessment, I created more than a decade ago. We've been revising it. It's in the course, it's in the free book resources at turnautismaround.com. Okay. So just quickly, I'm just going to go down the left hand column. He is does not have a diagnosis. He is on vitamin D and Iron, he does have safety awareness concerns. So that would be your first need on the planning form. He does eat mostly everything now and you said you started off with he does he does did have low weight. Is that resolving?
Vikram: 100%? Yeah. Well, that's one of the things that is now a potential problem behavior because he's constantly hungry.
Mary: Oh, right. I did read that. Okay.
Vikram: No matter how much we give him, he's just always saying he's hungry. He's knows a few words and sign language now. So he'll communicate by doing this, saying, I'm hungry, like I need food. But the reaction is not always positive. That's why I call it a problem behavior. But yeah, he's very good with vegetables. He loves lots of vegetables. He loves lots of fruits. The main concern is probably carbohydrates. He has bread, but if he's got peanut butter or something on an avocado, he's open to eating it. There's no real issues, but he's a bit slower with carbs in comparison with veggies and fruits.
Vikram: It's an area. Yeah.
Mary: And then he feeds himself but he needs help and mean he can get into a routine where he wants you to feed him and then he's hungry. The other questions I have is, is he drinking out of a straw and does he use an open cup.
Vikram: He can use an open cup. We do give it to him sometimes. His current water bottle is not a it's not a straw, but it flips. It's a plastic flip open thing on the cap and he sucks from that.
Mary: Yeah. So you're going to want to listen to and we can link this in the shadows. Just these shadows at 184 are going to be like amazing. Melanie Potok did a podcast interview a few months back. She's an SLP who focuses on feeding and and sucking and swallowing. And I've done a lot of work with that as well. Right. Do not articulation and language and everything. We want to really get kids drinking through a straw. Yeah. And or drinking out of an open cup. So any kind of sucking is going to affect articulation. So that would be one of the things I'd look at. We, I think in the Melanie Potok episode on her show notes, we actually have like sample cups that are okay and not okay.
Vikram: I remember us that material that she put together with Melanie and so so the water bottle he's currently using has a plastic nib on the top, but it's connected to a straw. So he's not drinking directly out of a straw, but the straw is connected to this plastic nib on top that folds up and down.
Mary: Yeah, well, it might. It might be a straw, but we want and we want kids to be drinking out of open cups like frequently throughout the day. Not well, not when they're walking around. But, you know, when if a kid goes to day care, at least in the United States, drinking out of an open cup is like a big marker for, you know, graduating them to the next class. It's a big deal. And it also, you know, it sounds like with articulation and talking and feeding that I would improve the oral motor. We also have a podcast with Mags Kirk, who's in SLP, BCBA on talk tools, which revolves around sucking, blowing and something else. And I've used talk tools. I'm not certified in it, but I've worked with SLPs who are certified in talk tools to really help talking, eating and drooling. So you definitely look into that. Also in terms of feeding and stuff, he is mouthing things. So you may want to look at zinc, magnesium, those kinds of deficiencies. We've done some podcasts and a video blog on that. He does sleep well, the toileting he will go but he's not manding and that seems to be a concern of yours, you know, and as kids approach four, you know, you kind of panic I think, a little bit in terms of potty training. But I do want to say that if I were you, I would really look at hands up and down fluently, independently. I would look at hand-washing, which is an easy prompt from behind. We have a bonus video on handwashing, and I think we have that as a free resource as well. We can link that and brushing teeth independently, those kind of things. You can prompt from behind. He can get independent and especially pants up and down and hand-washing. They are part of their routine. So before I would focus too intensively on potty training, I'd probably continue to pair the potty you know, a few times a day and that sort of thing. But I'd probably focus on the other things as well. So those are some of my self-care activities of daily living. Do you have any questions about that before we move on?
Mealtimes and Problem Behavior
Vikram: So yeah, I do have questions. One is regarding mealtimes, but then also in potty training as well. I just and it's better to start off with but yeah, one, one of the questions we had more in terms of problem behaviors, I guess that we're seeing is usually surrounding mealtimes. It's always around that. Like I said before, in between meals Nahum tends to sign language to us that he's hungry. And so he will start jumping up and down. We'll try to reason with him, which I know you say we shouldn't be doing when the child is presenting with problem behaviors, I'll say, you know, we have to wait. It's not meal time yet. And one of our concerns is that if we reward him, we're kind of rewarding that behavior by giving him food. And it's just going to encourage him to keep crying and keep stomping his feet until he gets what he wants.
Mary: So and in terms of his height and weight, is he is he 50 percentile? Is he 20 percentile or what is he.
Vikram: He's doing really well now. I think he is. Yeah, not sure but I think is between 60, 70%.
Mary: Oh so he's on the end. He's taller and bigger now.
Vikram: Oh yeah. He's much taller. He's growing fast. His weight is good. He's come out of those issues now. He's doing really well in terms of how he's growing.
Mary: Because I mean, there are some things like there's some weird things not weird, but, you know, more rare things like Willi Prader syndrome, which causes kids to like I'm not saying that he has that, but I mean, there are some metabolic issues that could be causing signs of autism and causing signs of wanting to eat too much. Like you said, he is not eating a lot of carbs. So maybe he is, you know, kind of going through things like do you have standard snacks and meals or just meals with.
Vikram: Yeah, we try we try to avoid snacks in between meals just so that he can eat more during meal time.
Mary: I mean, have you tried like feeding him six times a day instead of three meals?
Vikram: No, we haven't tried that.
Mary: I would definitely add snacks. And what is he drinking in his cup throughout the day?
Vikram: Just water.
Mary: Okay. You know, maybe for one of the snacks, it could be like a protein shake or something more with more substance. You might want to meet with a nutritionist or, you know, even talk to your pediatrician. I would definitely feed him in between meals, like as a standard snacks, like. So people, even adults, eat six times a day. And like you said, he's growing. You know, he if he's manding to eat, he's you know. I would prevent the problem behavior by adding meal snacks in their standard snacks, not letting them graze or walk around eating Cheerios out of a bag like sit down. This is your snack time and go from there. And also keep records of, you know, like that's where I might seriously meet with a nutritionist because maybe he needs, like, a protein shake. Or will he drink, like, milk and juice and that sort of thing?
Vikram: He does, yeah. He's very flexible that way. He'll drink. He's his palate is quite wide. He's willing to experiment with things. He's willing to try new things.
Mary: So I, you know, it seems like he is really good. Yeah. Yeah. Okay. So you had just let's just do one quick question about Potty, because we have a lot more to cover here.
Potty Training and Self Care
Vikram: Sure. So, yeah, with the potty, we find that. So he is he's able to mand now, but that comes with prompting. So I say, you know, name is time to go to the potty you know, like you say and I've got a picture of the potty, of the toilet on our wall and start showing the picture and I'll say, you know, do the sign for potty and he'll do the sign for me. Then I take him to the potty and most of the times he has had success with doing wees and poos in the past. But sometimes we've noticed that when he won't, he won't naturally mand for it until we tell him it's time to go, then he will cooperate with us and he, he goes, you know, happily to do it. But recently I've noticed that he prefers being in the nappy, he prefers doing his poos and wees in the nappy he won't request to go to the toilet at all. But if we notice he's doing a poo in his nappy, then I will take him to the toilet and then he just freezes up. He doesn't want to do it. But then when we put the nappy back on him 5 minutes later, maybe an hour or two later, he might do his poo then, but it's in the nappy. So we've noticed that happening every now and then. He is able to do the poo still in the potty, but it's not it's not super consistent. So we're just trying to figure out what's going on behind.
Mary: Is he going every day? Is the bowel movement mushy? Is it solid? Is it hard?
Vikram: Yeah, it is solid. But the kids have been sick the last three weeks. They've had some diarrhea.
Mary: Yes. So, I mean, I've done a podcast interview with Dr. Stephen Hodges. I would look at that. You know, it's basically it's really hard to toilet train kids, especially if they're constipated and especially if they're delayed. A lot of my work, the chapter on potty and my book and my bonus videos within the courses, really, we work on pee first. We work on a schedule. You know, we put kids in underwear at least for like a solid period, like a morning where you're actually working on potty training. So, you know, it's, you know, one could say he might be constipated, he might need a lot more reinforcement for going on the toilet. He might need no nappies in between periods where you have him have an accident, which, you know, I don't like that, and you also like protect your furniture and, you know, it's a mess. I you know, I don't know that potty training should be a huge priority at the moment. Like for me, I would work on hand-washing and things that you can prompt and reinforce. Like you can prompt you to work on handwashing ten times a day. Mm hmm. Can't work on having a bowel movement, and you can't do anything with it because he's got control. And it depends on diarrhea and constipation. It depends on so many factors that you're like, fingers crossed. Like, I would gain echoic control, I would get hand washing under control. I would get I would control the things you can control and then still continue to parent and up the reinforcement majorly for going on the toilet. Um.
Vikram: Yeah. Yeah, that's really helpful. Yeah. Yeah. Um.
Mary: Okay. Let's move on to language because we did cover quite a bit of language with the language sample. So I think we can just kind of fly through the middle column of language because like I said, we covered a lot of that. So the number one, number two word list, the watching, the Barb Esch Twinkle, twinkle, little star he can do, which is an intraverbal fill in. There is a blog on intraverbals there's a bonus video on into verbals. You do want to look at that? Like I said, ready, set, go is an intraverbal. He may have other intraverbals like 1, 2, 3 or other songs that you haven't discovered for Lucas. He he could do that when he was to. We just I just had no idea what that was or how to do it. So we, we do cover that. And then so I think for expressive language, I think we've given you enough to tackle. But receptive language he can touch body parts which is excellent. This probably do to the work maybe with Potato Head if you have that. Yeah, that's a great tool. Potato Head video modeling we talk about in the book, in the course, in a blog. So I feel like the language is coming, imitation is coming, visual matching, puzzles is coming. And that's all the early learning materials, all the the things that you're doing. And you're doing that every day, right? You're doing table time.
Vikram: We can't do it every single day just because one day of the week is at kinder, another day of the week we're at church. Okay? So we tried to it as much as we can, but it's hard yeah.
Mary: Okay. And you and your wife are both independently able to do table time.
Vikram: My wife has not gone through the training yet on table time, but I've still got to train her on how to do it. But she's catching on to it and she's sitting in on the table time with me to watch and observe and she's getting the hang of it. So that's great. One thing that we did by accident, which I thought had positives and negatives to it, was that we tried to get both our kids into table time just because my wife was not available to look after one of the kids. And it was helpful because my daughter, for example, she's able to sign for help so she couldn't get the puzzle into the place where it belongs the piece of the puzzle, I said, Do you need help? And she would say, Help. And then she would ask her brother to put the piece in for her and he's really quick with that. So I found like that dynamic was really helpful. But on the other hand, because my son's a bit older, he gets a bit distracted in a way. Like if he finds like she's a bit slow, he'll kind of like wander off because he's a lot faster with these things now. So I found like this positives and negatives. But I'm wondering, is there any case studies with both kids doing table time at the same time, or is it preferable not to do that?
Mary: It's a great question. And we have like we have some people currently with twins or two kids that they're trying to navigate that I think it's really important to have assessments and plans for each child. And I do think it's important for 15 minutes of table time not to start, but to work up to that per child individually and then also work with them together is fine. That's fine. One word of caution. I saw that on your first assessment and now you're saying help but like more, please help. Those are generalized signs. So we really want to if we're going to do sign, which I'm a big proponent of, although in the toddler course, I really don't talk about sign language or teaching sign language because I feel like if we do that without pairing, mama, mama, mama, you know, kids parents only have so much time in the day. So, you know, the language can get a little distorted if you focus on the wrong signs in the beginning. So even help is a generalized sign. And I would do language samples for each of them individually every week, you know, try to get your daughter babbling and having word approximations. And so that's a little aside. But yeah, I think it is better if we can get kids at the table by themselves to have one on one instruction. And then so also, I mean, you have two kids, you're going to have them together doing a lot as well.
Vikram: Yeah. Okay, great. That's good to know.
Mary: Okay. Let us move on to problem behaviors. So your son is having problem behaviors, including pushing his sister a few times a day, crying, stomping, especially when hungry a few times a day and putting objects in his mouth. So the mouthing of objects like is he swallowing things? Like is it more of like a pica thing? Is it more about mouthing or chewing on things?
Vikram: Yeah, it's more like mouthing chewing. He's not is not swallowing in the past and he doesn't seem to do that anymore thankfully. But where we live, there's areas for him to run around. He used to put soil in his mouth and I don't know if he was swallowing it to eat it. I don't think so. It's more about the texture. So the occupational therapist was suggesting eating like crunchy kind of cereal. Maybe it's the texture he's wanting. So we tried that. It sort of helps sort of, you know, wasn't super helpful. He still continued to do it. But now I've noticed he's not really doing it anymore, thankfully.
Mary: Yeah. So there's a condition called pica where you actually ingest not edible food that's very dangerous, soil in your mouth is very dangerous even if you're not swallowing it, e coli and all kinds of stuff. So we want to make sure, like if you're visiting playgrounds or whatever and they are, you know, the child is sticking something like you can't go there until you get it under control. You know, safety first. I will put a blog I wrote I did on Pica also. I have two, one on mouthing, one on chewing. I think we can put those in the show notes as well. It could be. Something simple, like a zinc deficiency that is causing a lot of mouthing and chewing on shirts and chewing on markers. You know, like Lucas used to chew on markers. He used to scribble with markers. You know, we got to keep the markers away sanitized all the time. Like, you know, it's hard. You've got two kids, you know, and just trying to catch all that up. So, you know, him pushing and and having tantrums. I do think that we covered a little bit about the chewing and you can learn more the crying when hungry. Let's feed him six times a day, visit a nutritionist, talk about like more sustainable protein shake or something for snacks, maybe crunchy foods. You know, like bury the texture, like don't be feeding him, spoonfuls of mush because that's not really going to help really look at straws that are helpful. If he does drink protein shakes like the talk tools this system, you start out with drinking water and juice like very liquidy stuff, but really to get their oral motor really improved, you want to do thinner straws with thicker stuff like protein shakes, like milkshakes. So that would really help his sucking, which would help his chewing and his feeding and talking potentially and articulation potentially. So you could be working on a number of things during these snacks or open cup drinking because that's like different oral motor skills, right? So solving your feeding and drinking issues and his problem behaviors related to hunger could you know and that's where I like to like come full circle, get the most bang for your buck as you're thinking about these things. So pushing his sister and he I read somewhere that he's like laughing when he does stuff, throwing stuff and laughing and dumping. We are going to talk about that actually next week with Rachel, who's our program director. And Rachel's helpful on the getting unstuck calls. And Rachel has a typically developing three year old who came to my house a couple of times and had some throwing problems and some hitting problems, and we were able to get that completely under control with just an email or two and some effort on her part. And so we're going to we're going to actually do a reverse hotseat with Rachel all about pushing and stuff next week. But in the meantime, I think, you know, we're going late, so I'm not going to continue on. We can include your plan and the assessment basically down the left hand column, on to the plan. You know, your son has some nice skills. We want to highlight those skills. We want to highlight the needs and we want to just keep putting one foot in front of the other to make progress on which you've done now from February to June. You know, by the time this airs and sometime in July, you're going to make more progress. By the time he gets his evaluation in September, he's going to make more progress. And it doesn't matter if he gets a diagnosis or not. You know, I feel like, like you said, he has eight out of the ten deficits, at least, you know, when you read my book. But, you know, in Michelle C's case, she was able to turn things completely around. And so, you know, there's no limit. There's no you can't do things. And a lot depends on you, you know, the neurology, the circumstance. But I think you have shown us that, like between you and your wife finding information. You know, becoming a captain of the ship and moving forward is. I mean, what else are you going to do right now that, you know, you can't unsee it? You can't go back to just waiting and seeing. Right.
Vikram: No, definitely not. So, I mean, these are very good tools in our hands right now to help him along the journey he's on. But yeah, if it wasn't you on the side sort of thing kind of educating and coaching us through this course. Yeah, we would have really, really been stuck and, you know, been at the mercy of just an SLP or an O.T. just once a week. But it just wasn't sufficient. As we discovered through going through your program, we needed to be hands on with him every single day, giving him that opportunity to really fulfill his potential. So we're very, very thankful for everything.
Mary: Wow. Well, I really enjoyed it. Before I let you go, part of my podcast goals are not just to help the kids, but help the parents and the professionals listening to be less stressed and lead better lives. So do you have any self-care or stress reduction tips that you want to tell our listeners?
Vikram: For myself? Um.
Vikram’s Advice for Autism Parents and Professionals
Vikram: Well, definitely. I think, you know, it's. It's hard, and I feel guilty to hang out with friends because some people said, oh, you just need to get away from your family. You know, like once every now and then hang up with some guys. And I tried doing that once, but I was constantly thinking about my kids, wondering if my wife's going to be okay. And so I'd have to tell those guys within an hour. I said, I think I need to go. So it wasn't wasn't that helpful? Because I find my passion is with my family. I really enjoy being around them and helping my kids a lot. But yeah, for stress stress management tips, I don't know if I can say this, but I there's a couple of things I do every single morning. I spend time in the Bible, spend time speaking with God, which I find is very helpful for me to navigate through my day, giving me the ability to manage my stress. But another thing I do is I keep a gratitude journal as well. And so every morning I'll reflect back on the previous day. And you know, it's funny because there's many things I do for my work. I'm driven, I love to set goals for myself, but all those things I thought would bring me happiness is nothing in comparison with every day I'm writing about my son at table time. And you know, this is how you responded during table time. Like during my gratitude journal. I feel like this is my whole life, you know, like I don't really care about what's happening, but I'm passionate about what I do. I'm very passionate about it. It's not a thing I write about every single day. I'm just writing about my kids table time experience, which is very funny and strange. But yeah, so those two things for me, spending time in a religious activity and then also with my gratitude journal. It helps to balance my life at the start of every morning. I also go to sleep very early every night, wake up very early to get all my work done. And so being on top of everything, you know, achieving my goals in life personally, also for my family, it makes sure I'm on track, I'm navigating my life well. So managing my time is really, really vital and I try to be a disciplined as I can with that so I can give my kids and my work my best.
Mary: Yeah, I love that. Well, it has been an absolute pleasure to interview you. I've been to Melbourne, Australia twice in my life. If I ever get back I definitely want to meet up and until then we'll just continue to see you within the community and just keep going and tell your wife thank you too for allowing us to, you know, use your son's journey and your materials to help others. And that's what it's all about. So thank you so much.
Vikram: Yeah, thank you, Dr. Mary. I really appreciate everything you're doing. And, you know, I would really I really encourage everyone because I was in a position where I was wondering if I should do your online course. And I heard a few different podcasts, which kind of flipped me over to say, okay, I'm going to go ahead and do this. There's a lot of fear, a lot of negative thoughts in our minds sometimes that prevent us from doing a course like this. But I just encourage anyone who's listening to just, just dive in and you'll be blessed you know, your kids will be blessed in return. So. Yeah. Just want to encourage people who are listening today.
Mary: Thank you so much. Have a great one.
Vikram: Thank you. Thanks. Dr. Mary.
Mary: If you're a parent or an autism professional and enjoy listening to this podcast, you have to come check out my online course and community where we take all of this material and we apply it. You'll learn life changing strategies to get your child or clients to reach their fullest potential. Join me for a free online workshop at MaryBarbera.com/workshop where you can learn how to avoid common mistakes. You can see videos of me working with kids with and without autism, and you can learn more about joining my online course and community at a very special discount. Once again, go to MaryBarbera.com/workshop for all the details. I hope to see you there.
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