Bobby is 3 years old, diagnosed with autism.  He only eats a small group of foods and when new food is offered he pushes it away, shows no interest, or protests if it’s forced.  His mom wanted to expand his foods so she brought a box of cereal Bobby won’t eat.  It seems at times that even if this were the last food on earth, Bobby would stand strong against it.

Bobby loves the alphabet.  When he comes to my office he asks for each letter, one by one, placing each one lovingly on the ground.  We have our little routine.  He says “up” for me to pick him up.  I excitedly take him to the shelf and model the word “letter” as we get closer and closer to the letter.  I have found that the more I give and model, the more he spontaneously speaks and interacts.  He shuts down when I start making requests.  I’ve learned to make more indirect requests like pausing after modeling a word.  Sometimes he approximates the word and I quickly get him the next letter. Other times he giggles and waits in anticipation for me to get the letter for him.  Once he gets the letter he makes a few laps around the playroom, he looks at it out of the corner of his eye, and he sets it on the ground.  He’ll run up to me with a big smile and we start the process over again, working through the whole alphabet.  

This time I added a step to our routine.  I wanted to get him used to being around the food, without putting any pressure on him to eat the food.  I placed a bowl of cereal on the floor across the room.  After he placed his beloved letter on the ground, I placed one piece of my beloved cereal on the puzzle.  Bobby quickly came over and moved the piece of cereal back to the bowl.  

The two things children tend to be most controlling about is food and potty.  This is because it is really the only thing they have complete control over.  You can’t make them eat and you can’t make them use the bathroom. Therefore we want to look for opportunities to help our kids feel more in control, especially in these two areas.  

I cheered Bobby for putting the food away.  I said “You are right!  That food doesn’t belong on the puzzle.  Thanks for cleaning up!”  I went back to our regular routine for the next couple letters.  When we got to “D” I nonchalantly pointed to the dog in the puzzle and said “I bet he’s hungry.  Here you go doggy,” as I placed the cereal on the puzzle piece.  Bobby comes over, picks up the cereal and puts it back in the bowl.  Again, I supported Bobby by saying “Awe, thanks!  He wasn’t very hungry.  I’m glad you cleaned up Bobby!”  I took the cereal bowl and moved it all the way across the room as I explained that we weren’t going to have any food right now.

I’d give control, then every few letters I’d try again in various ways.  When Bobby came to me to get the next letter, I picked him up and put a piece of cereal on the previous letter.  Then I went to the shelf to get him the next letter.  Eventually we had pieces of cereal on the next several letters.  At that point Bobby got one of the cereal pieces and brought it to me to eat.  I happily ate each piece he gave me, thanking him and letting him know how great it was.  

Next, he started putting the alphabet puzzle pieces into a toy mailbox.  I joined him by putting cereal into the mail box.  He’s take it out and feed me each time.  When he wanted the next letter I started making small requests for Bobby to feed me to give me more energy to run to the shelf to get the letters.  He did it the first few times and then he became completely disengaged.  It was clear to see he had reached him limit.  Typically he stays with the game until we get all the letters.  Bobby stopped asking for the letters and played by himself.  I took the bowl of cereal, explained that we were all done with it, and put it away on the shelf.  Bobby slowly came back to finish the game, without the food.  

I saw this as a great learning.  I got to see how far I could stretch him before he shuts down.  I also really got to show him he is in complete control.  I never once asked him to eat the cereal and I supported him every time he pushed it away.  

Our session ended and I walked them out to their car.  Bobby didn’t want to leave the office.  Since we both had a flexible schedule that afternoon we decided we’d use this as an opportunity to show Bobby he has control in multiple ways.  We explained he could stay in the playroom as long as he wanted to.  His mom and I stepped out onto the sidewalk, where we could see him through the glass door.  He watched us talk for a minute and then he walked toward the glass door.  He was too little to open it so I walked toward the door to open it for him.  As I walked toward him he walked away.  This happened several times over the next couple minutes.  It was as if he was testing how much control he had.  I decided the prop the door ajar so he could come out on his own, without my assistance.  He stayed in the playroom several more minutes.  At this point I told mom to get in her car which was a few yards down the road.  I stayed back, out of view, waiting for Bobby.  Within a few seconds Bobby walked out on his own accord.  I guided him to the car and he got in his car seat.  

Bobby was seeming hungry.  His mom casually offered him a couple pieces of cereal, thinking this was a great time to show him he can have control when he says no.  Bobby takes the cereal, looks at it for a few seconds and puts it in his mouth!  He proceeded to eat about 10 small handfuls on the way home.

I know we can’t always give our kids control.  But we can look at the times in which we can let them feel more in charge.  We spent the two hours in the playroom showing him he was in control.  And instead of picking him up and making him leave, we let him decide when he was ready.  When working toward helping our kids be more flexible, it is important to highlight the control they do have.  We have to be the change we wish to see.  By being more flexible ourselves, it gives us more credibility when we ask them to be flexible. 

Matthew was so much fun.  He loves to look at people with a smile on his face.  In our time together we bonded in several ways.  I enjoyed exploring his world by mirroring his stims.  When he rolled his fingers along the wall, I did the same.  After several swipes, he turned around, looked at me and smiled big while letting out a little giggle.  Once he made that connection with me, I modeled the word "swipe" as I moved my hands toward him down the wall, ending in a "Got you!" as I lightly tickled his belly.  Our first session was more focused on creating a connection and lengthening his attention span while modeling lots of language. 

     What worked well for Matthew?
-He seemed to open up more when he had control in the playroom. 
     For example, in the beginning when I was speaking to his father, he was putting his fingers in the crack of the door and disappearing out of sight.  I tried closing the door once he came in and he seemed to tense up a little.  I explained we can leave the door open and I let him explore while making sure he was safe.  It was more important for him to feel safe than it was to focus on having a conversation in that moment.
     When it was time for our play time and Mom and Dad were going to be watching from the observation room, I explained exactly what everyone was going to be doing and why.  I also moved very slowly, not trying to trick him to stay in the room.  I wanted it to be his decision.  He did very well, staying in the playroom and working thorugh the transition.  

-Following his lead.
     Matthew is easily distracted by the new environment.  There were lots of fun things to explore.  I had the majority of toys up on the shelf.  There was a therapy ball, a few plastic animals, and a plastic bucket on the floor.  When he went to the ball, I offerd to help him roll.  When he clapped his hands, I clapped mine.  When he slid his hands on the wall, I did the same.  Each time, with complete excitement which really seemed to catch his attention.  Each time he needed a break (e.g. flushing the toilet, walking in circles, staring off for a bit) I let him recharge his batteries by taking that break with him.

     What will I do differently next time?
-Upon reflection, next time I would model a more useful word, such as "move".  In the moment, the word that came to mind was "swipe" but if he learned the word "move" I imagine he would get a much more powerful response as it is a clearer word for people to understand and it is an easier word to physically say.  Next time, I'll model the more useful word. 

-I will lock the bathroom door before he gets here next time as he is not potty trained yet and it was a distraction that I can control.  If the door is locked before he gets here, it keeps me being the good guy.  I purposely did not lock the door when he was here as a way to prioritize building our rapport.  I wanted him to know he is in control and I am here to help him. 

     Summary:
-The most important goal I had today was building a relationship with Matthew.