(Note: I found this in a tucked away journal. It was almost written two years ago when I was doing some of my clinical experience for my master’s degree.)
Hugo doesn’t speak. When I first saw him he had a lot of physical ticks and throat clearing. He loves the iPad. My strategy was to gently move into his space physically and match his energy. He is quiet and there is a sweetness about him. For the first few sessions I sat next to him on the couch. My supervisor, had been working with him and would say “my turn”, take the iPad and model a sound. When he made a sound (any sound), he got the iPad back. So I started there. Hugo likes to play animal games, especially animal puzzles. I would consistently say the name of the animal as it was on the screen. With time, Hugo would look up each time for eye contact and a smile. I started signing the animal name along with saying it. Hugo started imitating the signs.
This became our routine. Hugo was starting to make a few different sounds but still routinely says “t”. One day, after 35 minutes of our 45 minute session, he turned off the iPad and started to leave. I followed his lead, figuring he either needed to go to the bathroom or go swing in the jungle room(he had OT after our session). He started to run, but I held his hand and gently said “no running, let’s walk, hold hand”. He lead me to the swing. He was swinging for a while, looking at the colorful animals painted on the walls. I followed his eye gaze and signed the names of the animals. When he finished swinging, he stood up and hugged me. That was a first. He had held my hand before but never initiated a hug! I think it was a sign of affection and thankfulness.
One month later…
We were having our usual session of Hugo looking at the iPad and making animal puzzles. After 35 minutes he closed it and was ready to go. I said 5 more minutes but he wasn’t interested. Again, I followed his lead because I had a hunch that he wanted to go back to the jungle room. He wanted to run again (we didn’t). When we got there, he pointed to the large elephant and said “t-t” and looked at me. I signed it for him and he had a big smile. He did that with each animal (pointing and smiling, not just looking). I really got the feeling that he was making the connection for the first time between the animals in the iPad puzzles and the animals on the wall! Generalizing is so hard for children with Autism. It was so exciting to be able to witness that realization on his face. For a second, I felt like Anne Sullivan.
The following month:
Hugo was consistently imitating signs for animals!
Sometimes, we have to let go of our treatment plans. We have to remember that children with autism process and absorb information at a different pace than we do. If you can be patient and gently join them at that pace, they may surprise you.