Emotional engagement

Earlier, I have posted few posts from the Facebook page Autism Discussion Page" and I found that every parent / caregiver / therapist or any autism professional must read this page. I know, dealing with autistic people (kids and adults) is very tough task, but with a good understanding and strategy we can reach to their hearts. 

Emotional engagement with severely impaired adults!

I have the privilege of consulting with many individuals that have severe impairments and multiple behavior challenges. They are often either living in institutions or community group homes. I used the exact same principles to teach "safety" in my presence, and trust in my interaction. I start where they are at, identify their interests and comfort zones, and take what little leverage they give me to teach social engagement.

One individual, I had the pleasure of meeting, was very aggressive and required one on one staffing to be within six feet of him at all times, to protect himself and others from being hurt. His name was Eric. Most interactions between staff and Eric were instrumental in nature (directions, prompts to do things, or not to do something). Eric did not feel connected with staff, so obviously did not feel safe and accepted by them. He had to control all interaction and activity around him to feel safe and predictable. Eric would typically refuse to engage with staff or comply with daily activities. He wanted to be left alone to engage in self stimulation most of the day.

When I first met Eric, I ask staff what he initiated on his own that he enjoyed doing. The only thing that staff could come up with was "ripping magazines." He enjoyed ripping pieces of pages in magazines and then dropping them in a pile on the floor. When I asked staff if he does this a lot, they reported “no”, because they keep magazines away from him. Since this behavior of ripping was not the “norm”, they defined it as being destructive, and found it to be problematic. Unfortunately, staff did not see this as a strong interest that they could use to establish an emotional bond with Eric. This behavior gave me a self-directed interest for this young man, that I could use to create engagement (we-do activity) around.

I sat down next to Eric, introduced myself, and put my hand out to shake hands. He refused. I shared that I had heard that he was good at ripping magazines and that I would like to see him do it. I gave him a magazine and allowed him to start ripping, perfectly straight, narrow pieces off the pages. I marveled and commented on how well he could do that, and expressed interest in doing it myself. I started slowly ripping paper right in front of him, face to face, within easy vision for him to reference me. As he ripped, I imitated him, animating how I was trying to do it as well as him. I would drop my pieces on the same pile as his. I commented on how well it felt to rip the pages, and he would look up at me like I was weird! Periodically I would reach out my hand in gesture of acceptance and he would gradually reach out and lightly touch mine. I continued to follow his lead, imitate what he was doing, and celebrate with words of acceptance and frequent give "five." 

After several minutes of this, he seemed to feel comfortable with this level of engagement, so I decided to throw in a variation, to stretch his comfort zone. I put my magazine down and asked him if we could rip together. I slowly reached over and started a small rip at the top of the page, and motioned for him to finish ripping it. He looked a little anxious, but followed my lead. We proceeded to tear and rip together, me starting the tear, and him finishing it, then dropping into our pile. Now we had back and forth interaction, with both of us playing an active role in ripping. I would invite him to celebrate after every three or four rips by putting out my hand for him to reach out and give me five. I continued to give animated emotional expressions that I enjoyed sharing this experience with him. A couple of times he smiled. We were using an activity that he felt comfortable with and enjoyed doing, to build reciprocal engagement around. 

Next I wanted to see if I could expand on this activity. I wanted to get him up to a table to rip there, but felt he might be hesitant to move to the table. I had staff place out two glasses of pop (which is his favorite drink). We went to the table and shared drinking pop together as I commented on how much fun I was having ripping magazines with him. I decided to try expanding it to making a collage of the bits of paper that he ripped from the magazine. As he ripped a piece of the magazine I would paste it onto poster board to make the collage. He seemed to find that interesting that we could use the pieces of page for something after he ripped it. He ripped, and I pasted, sharing the experience, and frequently celebrating with "give fives" and emotion sharing. Next, he would rip, I would put glue on the piece, and give it back to him to paste on the board. We filled up the paper and hung the collage on the wall, commenting on how nice it looked, and celebrating as usual. 

In a matter of about 40 minutes, we had established a social connection together, around an interest that people were typically defining as bad and limiting his opportunities for ripping. I had started where he was at, engaged myself into an activity of interest for him, let him initially lead, while I imitated his action, and frequently celebrated with "give fives" and emotion sharing. Once he felt comfortable with that I expanded on the activity by adding variations to it. This resulted in co-regulating back and forth interaction, where we helped each other in completing the collage together. This was a real eye opener for staff to see that the avenue to socially connect with him was validating and engaging in the sensory preference (ripping) that he found rewarding. From there the staff were given directions to bring in all the old magazines they could find and do this activity at least twice a day to build a social connection with him. Over time both this young man and staff started to feel more comfortable and connected with each other, and eventually expanded the "we-do" activities into a number of reciprocal, interactive activities together.