Sad and Happy Faces

Two weeks ago, Miggy drew this. Tell me something about your drawing, I said.
Miggy: "This is Miggy's sad face and this is Miggy's happy face."

*Note that the paper is crumpled. He used it to cover one of his books.

"The man is dead."

February 9, 2009:
Miggy was waiting his turn for a haircut at SM Baguio's Barbero. He saw a man, eyes closed, lying comfortably in a chair, with shaving lotion all over his face.
Pointing to the man, Miggy exclaimed: "Look, the man is dead!"

"Miggy is sick"

Oct. 21, 2009 :
Miggy: "Mommy, drink medicine."
mom: Why? Who is sick?
Miggy: "Miggy is sick."
mom: What hurts?
Miggy. "My neck hurts. It's hot."
I touched his neck and it was flaming hot. And later I found out that his front tooth had just erupted from his pink swollen gums, which caused his temperature to rise.
Notice his red cheeks in the photo.

- Since birth, Miggy had sensory problems. When he was little, he would hit his head on walls, slap his face, hit his chest, scratch little bumps on his skin (vaccine marks, insect bites, old wounds) until he bled without so much as an "ouch" and not even a single tear. He did not register pain the way typical children do. Why did he not experience the appropriate reaction of pain after injury? Because the beta-endorphins released in the brain can produce an anesthetic effect, which would account for his indifference to pain.
- Through sensory integration techniques (deep pressure, massage, pancake and vestibular ball rocking) integrated in his regular occupational therapies, his sensory problems had lessened. Now, he is able to feel pain and even verbalize his pain and discomfort, unlike before when we would always have to guess what was wrong with him.

His First Candy

October 16, 2009: Miggy at 7yrs/2months, ate his very first candy. Oops, wrong word, more so, tasted his first candy.
It was his classmate's birthday and he received a loot bag containing sweets and some goodies. He knew candies are a no-no. It will trigger his hyperactivity. Perhaps curious, he opened his candy and licked it. Because he wasn't used to too much sugar, he handed it to me and said: "Mommy, eat it. Candy is not for Miggy."

Asleep

Sept. 30, 2009: Bedtime
It was 10pm and way past Miggy's bedtime.
I checked. Miggy was breathing deeply and evenly and not moving.
I tested, whispered: Is Miggy asleep?
"Yes", he whispered too.

Calendar Lessons

November 2008 (Calendar lessons with stamping as reinforcement):
mom (Showing Miggy the angel rubber stamp as a come-on): Miggy, do you want a stamp?
Miggy: "Yes."
mom: Okay, get the calendar. (he complied)
What month is this?
Miggy: "January" (I rewarded him with a stamp on his arm)
mom: Can you point to January? (he did) (another stamp)
What month is this?
Miggy: " August" (stamp)
mom: When is your birthday? (he pointed)
Miggy: "August 4. It's a Monday." (another stamp)
mom: Can you look for December? (he turned the calendar pages to December).
When is Christmas day?
Miggy: "December 25" (he pointed)
"Mommy, Miggy open the presents?" "Yes????"
mom: No!

*Every year, before it turns November, we already have the Christmas tree with presents under it (to test if he can be trusted not to open them and wait until Christmas. Every morning, he just leafs through the presents, reading the names on each tag, "Look, mommy, this is for Miggy", "This for Clarisse". "Do not open" (he mimics me).

Comment from Miggy's Speech Therapist

Dear Mrs. Cuevas,

What Miggy is today is a testament to you and your family's struggles, sacrifices and most of all achievements. You've come a long way, and you should be proud. Miggy is continually progressing at a steady rate, thanks to you. He is one of the few so greatly blessed with a family who loves him dearly and gives their utmost effort to help him cope with the demands of daily life. With all our combined effort, we will reach our goals. =)

Teacher Justine

Intervention at 2yrs/9mos to 3yrs/4mos

Profile:

Alphonse Miguel Mabilangan Cuevas

Date of Birth: August 4, 2002

Age: 2years/9months

Diagnosis: Autism Spectrum Disorder

Developmental Pediatrician: Jocelyn Eusebio, M.D., Saint Luke’s Medical Center

Date of Diagnosis: May 13, 2005

Exactly 6 days after the diagnosis, Miggy started the intervention program.

May 2005 to December 2005

Occupational Therapy, one-on-one, 1hour, 2x a wk at Child’s Dream Foundation

- started May 19, 2005

Activities:

Sensory integration ( deep pressure, brushing, massage, pancake); Spooling – for concentration, attention span, color identification; Coin translation; Waiting skills; Pack away; Colored thumbnail; Ball rocking; Colored pop-locks; Coloring Activity using templates; Obstacle Course - jumping on trampoline & crawling w/ color identification; Puzzles – animals, numbers, alphabets; Alphabet flashcards; Number clock; Alphabet board; Drawing, tracing & shading of different geometric shapes using templates; Writing activities; Brushing of teeth simulation; Body parts identification; Letter sounds; Color sorting; Shape sorting; Speech & language stimulation; Number identification & Counting; Beads activity & spooling – for color ID, counting & concentration; ADL activities - Lacing; Alphabet identification; Feeding simulation; Shape identification; Animal sounds; Sounds of things; Pre-speech and Pre-writing activities.

(In some activities, HOHA – hand-over-hand-assistance was given.)

Mom Sessions:
Activities: 24/7 redirecting, modeling, prompting & copying what the occupational therapist did.
Watching videos with Miggy (pausing the video every few minutes for step-by-step teaching) – ABCs, 123s, body parts, animals, colors, shapes.
Flashcards of alphabets, numbers, body parts, animals, shapes & colors, food. Swinging in a hammock for 30mins -1hr per day for SI sensory integration (while Miggy listened to Mommy counting aloud or teaching alphabets: A is for apple, B is for ball, …. Z is for zebra (always stressing on the first beginning letter of the word).
Deep pressure, massage for sensory integration, at least 30mins., 2x a day.
Establishing eye-contact : peek-a-boo games; always talking to Miggy at eye level. Prompting Miggy to talk: not giving him what he wanted unless he said the word.
Spelling of words (animals, colors, familiar words);
Reading common words.
Puzzle completion (alphabets, numbers, 10 to 20-pc puzzles).
Pointing – Point to ___.
Pack away toys.
Animal sounds; Vehicle sounds.
Creative play – Lego building; building roads, railways, bridges.
Pretend play – tea party, feeding stuff toy animals, actions like swimming, flying, driving, sleeping, eating, etc.
Taking turns (but always unsuccessful).
Potty training (Unsuccessful: still diaper-clad at night and at poop-time; He probably did not like the feel of the cold seat on his bottom) (not diaper-clad during the day: he expresses his need to urinate by pulling down his shorts).

Family sessions: Regularly going to church (He remained seated inside the church for 5mins only, the rest of the time spent on just walking around the church or staying in the car); Bedtime prayers.

No diet - except for a little limitation on sugar intake, especially from 4pm onwards, as this will cause hyperactivity.

Intervention at 3yrs/5mos to 4yrs/4mos

January 2006 to December 2006

Occupational Therapy, one-on-one, 1hour, 2x a wk at Child’s Dream Foundation

Activities:

Sensory integration ( deep pressure, brushing, massage, ball rocking); Writing activities - straight, diagonal & horizontal dotted lines; Tracing / Drawing of geometric shapes with templates; Spelling activities; Picture dictionary; Learning opposites; Color combination; Spelling blocks & Spelling puzzle; Identification of common objects; Group activities; Alphabet sequencing; Problem solving skills training; Interpreting pictures; Fine motor activity - using clothespins & small pegs; Coloring within borders; Tracing / Writing letters; Puzzle completion; Obstacle Course - get a little___, go under table, put in correct slot; Pegboard & color sorting; Waiting skills; Following instructions; Answering questions; Color identification; Alphabet identification; Coloring / Tracing; Tracing letters of name; Number identification; Alphabet sounds; Speech & language stimulation - speaking in simple sentences & short phrases; Listening / Following instructions; Following more complex verbal instructions and responding to questions appropriately; Using complete simple sentences; Using longer phrases; Action songs; Coloring within small regular & irregular boundaries; Tracing numbers; Matching; Fill in the blanks; Connect-the-dots; Writing numbers; Functional counting; Writing name; Action words; Reading / Word recognition; Answering "how many?"; Missing letters of common words.

Regular preschool (July 17–Aug 17, 2006), 45mins, 3x a week, at Step Tutorial Center:

For social interaction with regular kids; Academics : alphabets, numbers, colors and shapes; coloring.

* (It lasted only for a month because Miggy and four other special children were

rejected by the center and some parents.)

Mom Sessions: 24/7 redirecting, modeling, prompting & copying what the occupational therapist did.

Watching videos with Miggy (pausing the video every few minutes for step-by-step teaching) –

Special Kids Video Collection: Alphabets, Numbers & Quantities, Colors & Shapes, Spelling, All about Jesus, Animals, Birds & fish, Body Parts & Grooming;

Bumble Bee Vocabulary Builders (Volumes 1-5) and Action Words (Vols. 1-3)

Swinging in a hammock for 30mins -1hr per day for SI sensory integration (Miggy listened while Mommy counted 1 – 50, pausing to see if he would say the next number, which he did.) (Teaching alphabets; Mommy prompted: A is for____. Miggy answered “airplane” , B is for ____. “balloon”,…... Z is for _____. “zipper”.) Flashcards - alphabets, numbers, body parts, shapes, colors, fruits & vegetables,

vehicles, action words.

Sensory integration – deep pressure, massage, 15 - 30mins, at least once a day. Maintaining eye contact - always talking to Miggy at eye level; always prompting him to look at me.

Following simple instructions – Miggy, get the___. Open the door. Wipe your mouth. Throw in the garbage can. Pack away your toys.

Vehicle sounds; Animal sounds.

Self-help skills – washing hands, eating cereals by himself using spoon, eating cake using fork, combing hair, taking a bath, getting dressed.

Requesting/ Naming the title of the cd he wants to watch.

Reading / Spelling of common words (colors, shapes, animals, body parts)

Creative play –Basic toy manipulation: Lego building; building roads, railways, bridges and houses.

Pretend/imaginative play – acting out action words (Mommy acts, Miggy imitates) and puppet play.

More complex puzzle completion (up to 120 puzzle pieces).

Taking turns (still unsuccessful; very impatient at waiting turns).

Potty training -(still unsuccessful): diaper-clad at bedtime. He wouldn’t go back to sleep if I wake him up to urinate; diaper-clad at poop-time. He probably did not like the feel of the cold seat on his bottom.

Family Sessions: Regularly going to church (now able to remain seated for 20-30mins,

still fidgety);

Praying at bedtime (Miggy listened only while Mommy prayed: Dear Jesus, bless Mommy, bless Daddy, bless Ate, bless Miggy.)

Still no diet, except for a little limitation on sugar intake, especially from 4pm onwards, as this will cause hyperactivity.

Intervention at 4yrs/5mos to 5yrs/5mos

January 2007 to January 2008

Socialization : play dates with typical peers (1-2hrs, 2x a week) at SM Kid Around

Occupational Therapy one-on-one, 1 hour, 2x a week at Child’s Dream Foundation and

then at Systems Therapeutic Activity Center 1 hour, 2x a week

(Occupational therapies up to September 2007)

Activities:

Sensory integration ( deep pressure, massage, jumping on trampoline); Writing activities – letters, numbers; Pegboard & color sorting; Listening; Following simple verbal instructions; Answering simple what questions – what is this?, what color is the ____?; Using phrases; Describing pictures; Using simple sentences; Reading/Word recognition; Counting & answering how many?; Filling in blanks – what’s the missing letter?; Waiting skills;

ADL Board (buttons, snaps, strip with buckle, Velcro & zipper); Structured & Free hand name writing; Structured & Free hand beading and stacking; Shape progressions (progressive use of shapes that involves patterning from easy to difficult); Copying skills; Flashcards – words, colors, shapes, numbers, body parts, fruits and vegetables; Behavior modification techniques; Sentence strips for social graces; Iconographic representation of facial expressions; Socialization – introduction of other kids in the midst of activities; Free play; Sensory integration – trampoline and therapeutic/Swiss ball; Complex puzzles, like Philippine map).

Speech Therapy, one-on-one, 1 hour, 2x a week at Child’s Dream Foundation

-started January 19, 2007

Activities:

Answering simple what questions (about colors) - ex. What color is____?

Identification of objects by function - given choice of two pictures. Example: What do you use to call someone? (phone or chair), What do you use for brushing teeth?, to tell time?, when it’s raining?;

Increasing length of utterances (subject + verb + direct object. Ex: boy reading book);

Naming common objects; Identification of body parts; Behavior modification techniques;

Pretend play – Lego building (What are you doing?, what are you building?); Regulating – “give me + object + please”; “help me, teacher”, ”excuse me”, “bye + name”, “thank you”.;

Identification/naming of less familiar objects;

Attribution in 2 words – ex: blue boots, sitting doll, yellow t-shirt, green pail, red heart, orange skirt…

Yes and No – Is this a dog? (shown a picture of a horse) “No, it’s a horse.”, Is this a cow? (shown a picture of a cow), “Yes, it’s a cow.”

Answering “What’s that?” with familiar and less familiar objects;

Answering simple what questions: Animal sounds & vehicle sounds, ex. What does a dog say? Arf arf; What’s the sound of a train? choo choo;

Answering in complete sentences; Attribution in 2 words for familiar & less familiar objects;

Regulating – request for help, ex: Teacher Justine, give me ____./ Help me ____.

Describing actions in complete sentence using visual cues : subject + linking verb + verb + object, ex: The boy is pulling the rope.;

Increasing length of utterances – ex: Teacher asks: What color do you want? Miggy answers: Teacher Justine, I want yellow coin.;

Identification of objects by function – ex: What do you wear on your feet? Shoes.;

What questions – What can you eat? What can you drive? What can you drink?,

What do you use for coloring? What do you use to clean teeth? What do you wear when you’re cold?

Horseback riding therapy for 1 month 2x a week (June 2007) (speech lessons)

Big and small, long & short, tall & short;

“Over there” plus pointing to the object; Attribution in 2 words: color + object, number + object.

Attribution in 3 words: color + color + object, use of and, ex: black and white stripes;

Describing pictures; Part/Whole relationships;

Possessives - ex: Whose shirt is this? mine/teacher’s/yours

“I want ____.”, “Give me ____.”;

Yes and No: ex: Did Mommy drive the car?, Did you drink milk for breakfast?, Does an elephant say meow?, Can you eat a train?

Counting & counting slowly (one to one correspondence);

Pronouns (he/she); Negation – given 2-3 choices (Which is not a ____?);

Plurals – ex: flower/flowers; Using pronouns in sentences – ex: He is swimming in the water.

Regulating - given cues to request in complete sentences; Asking "What's this?";

Yes / No questions - ex. Is this a ___? "Yes, it's a ___." or "No, it's a ____."

Tutorials, one-on-one, 1 hour, 2x a week, February & March 2006 (2mos.) at University of Baguio,

given by U.B. student volunteers

Special Education, one-on-one, 2hrs, 3x a week, at Easter College Sped,

(started August 6, 2007):

Activities:

Colors, Pre-writing and writing skills, reading, letter name and

sounds, blending vowel and consonant sounds, matching words with their beginning/ending sounds, understanding comparisons (fat & thin, long & short, big & small, thick & thin), classification (same and different, What doesn’t belong?), fruits and vegetables parts of the body, nursery rhymes, art, praying.

Mom Sessions: 24/7 redirecting, modeling, prompting & copying what the occupational and speech therapists did;

Sensory Integration – occasional massage and deep pressure when fidgety and hyperactive.

Watching videos with Miggy (pausing the video every few minutes for step-by-step teaching) – alphabets, numbers, body parts, animals, colors, shapes, spelling, getting dressed, opposites, music, all about Jesus, places to go to ( school, church, restaurant, theater, barber shop, grocery store, library), grooming, getting ready, telling the time, counting, action words, food, simple math.

Flashcards – alphabets, numbers, animals, vehicles, body parts, shapes, colors, action words, fruits and vegetables, things found in the house.

Self-help skills – getting dressed, self-feeding, grooming, toileting (indicating need to urinate or defecate), buttoning/buckling/snapping/zipping/velcro.

Maintaining eye contact – always prompting Miggy to look at me.

Teaching Yes and No.

Hi, Hello, Thank you, I’m sorry. Goodbye.

Teaching facial expressions – happy, sad, angry, surprised, scared.

Connecting paper clips or clothespins – to increase concentration and attention span.

Always prompting Miggy to talk; Express wants – “Miggy wants___.”

Following simple instructions.

Creative play – drawing, painting, basic toy manipulation.

Pretend play – acting out scenes, like going to the grocery store, cooking, eating in a restaurant, going to the theater, riding a train.

Setting the table; Folding clothes; Clean up.

Taking turns (still unsuccessful; very impatient at waiting turns)

Potty training (still unsuccessful): diaper-clad at bedtime. He wouldn’t go back to sleep if I wake him up to urinate; diaper-clad at poop-time. He probably did not like the feel of the cold seat on his bottom. “Mommy, diaper on. Miggy u-u.”

Computer lessons (given by older sister) at least once a week (started April 2007)

Keyboard functions, using the mouse, Typing in Microsoft Word, Playing simple games (following instructions): ex: Click only the diamonds, Click on the green dots, Put yellow crayons in yellow pail, What’s missing?, Which way to the ____?

Family Sessions: Regularly going to church (Shortly before his 5^th birthday, he was

successfully able to complete the whole 1hour mass; patiently waited for the mass to end to be able to kiss the priest’s hand);

Praying at bedtime – Miggy’s prayer: “Dear Jesus, bless Mommy, bless Daddy, bless Ate, bless Miggy.”

Still no diet, except for a little limitation on sugar intake, especially from 4pm onwards, as this will cause hyperactivity.

Intervention at 5yrs/6mos to 6yrs/4mos

February 2008 to December 2008

Occupational therapy one-on-one, 1 hour once a month at Child’s Dream Foundation

Monthly evaluation: assessment of behavior; abstract skills; basic cause and effect; functioning skills; senses; comprehension; gross and fine motor skills.

Speech Therapy one-on-one, 1 hour, 2 x a week at Child’s Dream Foundation

Activities: Possessives – my, mine, yours, ___’s); Yes and No; Negation; Plurals;

Pronouns – ex: What is he/she doing? “She is running.”, “He is swimming.”;

What questions – common knowledge: ex: What do you put on a toothbrush?, What does green mean?, What does red mean?, What is the color of an apple?, What do you use for writing, What do you use when it’s raining?, What do you use to slice food?, What do you use to cut paper?.....;

Where questions with visual cues – rooms in the house, ex: Where do you find the tv?, Where do you sleep?, Where do you take a bath?, Where do you find the refrigerator?...;

Identification of objects when described – given choices, ex: This is a fruit that is color red and crunchy when you eat it. What is eat? :“apple”

Following commands – ex: Touch your nose and jump., Clap your hands and say your name. Touch your knees and kick your foot 2 times.

Wet and dry;

Completing analogies – purely auditory, ex: An elephant is big, a mouse is little.,

Apple is a fruit, carrot is a vegetable. Airplane is to air as boat is to water.

Where questions without visual cues (purely auditory) ( grocery store, school, library, bus station, barber shop, zoo, park, beach, house, farm, playground)– ex. Where does the cow live?, Where do you go to buy toys?, Where do you find animals?, Where do you find trains?

Naming objects (purely auditory) – ex. This is something you wear on your wrist to tell the time. “watch”;

Negation – ex: Which is not a ____?;

Use words that describe physical state (sleepy, hungry, thirsty, cold, hot, happy, sad, scared, angry) – ex. What do you feel when you want to eat? “hungry”, What do you feel when you want to drink? “thirsty”, What do you fell if you want to wear a jacket? “cold”…;

Completing analogies – seat on chair, eat on table; cow gives milk, chicken gives eggs; apple is red, banana is yellow.

Defining words – ex. What is an apple? “something you eat”;

Identifying objects that don’t belong – Which one is different?;

Following 2 step-related commands – ex. Get blue and color rabbit’s shoes.;

Describing pictures/scenes; Object descriptions (auditory input);

Categories (animals, toys, food, clothing, vehicles);

Who questions – ex. Hannah is drinking milk. Who is drinking milk?, “Hannah”;

Describing items using long and short in phrases/sentences;

Object/place/animal description – ex. This is something that you use for writing, it has an eraser on top. What is it? “It’s a pencil.”;

Grocery shopping and Movie watching with Teacher Justine and Teacher Lua at SM (Wall-E);

Why questions – ex. Why should you not play with fire? “because you will get burned”, Why should you wash your hands? “because it’s dirty”, Why do you exercise? “to stay healthy”, Why should someone watch you when you swim? “because you might drown”, Why should you not get wet in the rain? “because you will get sick”.

Name categories- (animals, toys, food, vehicles, music, clothes); Half and whole; Drawing and describing; Naming objects/places when described; Ordering items from smallest to biggest/biggest to smallest;

Listening comprehension – (simple story)/ answering who/what/where questions;

Naming items when described – food and body parts; Reading comprehension;

Describing/Formulating sentences.

Special Education , 2hrs, 3x a week at Easter College Sped

Activities: Writing, spelling, reading, coloring, math, nursery rhymes, art, self-help skills, exercises (dancing, morning exercises), social skills.

Tutorial classes, 1hour, 2x a week (2 months) (February and March 2008)

at Tot's Thoughts Tutorial and Resource Center:

Touch Math (addition of one to three digits) and self-help skills (washing hands and face, eating snack, grooming and getting dressed).

Tutorial classes, 1 hour 2x a week (started November 2008) at Tot’s Thoughts Tutorial And Resource Center:

Activities:

Puzzle; Coloring; Story-telling; Reading; Phonetic reading-strategy (Letter & sound, syllable, cvc/short vowel sound, long vowel sound); Tracing broken lines (letters, words and sentences); Blends; Writing (blue to blue & red to blue).

Mom Sessions : 24/7 redirecting, modeling, prompting & copying what the occupational and speech therapists did;

Sensory integration when needed(massage/deep pressure).

Watching videos with Miggy (pausing the video every few minutes for step-by-step teaching) –Telling the time; Spelling; Opposites; Places to go to ( school, church, restaurant, theater, barber shop, grocery store, library); Reading; Math; Educational videos – Hi-5, Dora the Explorer, Blues Clues, Sesame Street, Barney, and some children’s movies.

Self-help skills – self-feeding, taking a bath, getting dressed.

Teaching parts of the house and things found in every room. Teaching emotions – happy, sad, surprised, angry, scared.

Always prompting Miggy to talk; Expressing needs/wants.

Bedtime stories.

Look-and-find books – for concentration and attention span.

Puzzles; Workbooks; Telling the time; Making the bed.

Creative Play – building Lego house; Arranging furnitures in playhouse.

Potty training - (still unsuccessful): diaper-clad at bedtime. He wouldn’t go back to sleep if I wake him up to urinate; still diaper-clad at poop-time. He probably did not like the feel of the cold seat on his bottom. “Mommy, put diaper on. Miggy wants to u-u.”

Computer Sessions, 1-2hrs at least once a week:

Typing in Microsoft Word the following: his name, name of favorite cartoon characters, alphabets, numbers 1-50, different colors with matching font color.

Playing educational games, like Caillou Colors and Shapes, Lion King Activity Center, Blue’s Clues Preschool, Disney coloring, What’s Different?, Arranging furnitures in different parts of the house, What’s missing?.

Family Sessions : Regularly going to church - able to complete the whole 1hour mass; patiently waited for the mass to end to be able to kiss the priest’s hand.

Playing simple and non-violent play station games with older sister – for cause and effect.

Bedtime prayers: Prayer to my Guardian Angel (with pauses to allow

Miggy to participate, then the “Dear Jesus, bless Lolo, bless Lola, bless Mommy, bless Daddy, bless Ate, bless Miggy”, then he would add on his own: “Bless Teacher Justine, bless Teacher Thelma, bless Teacher Joan….bless trees, flowers, butterflies, cars, Superman, Spiderman, Mickey Mouse, Minnie Mouse, Donald Duck, Daisy Duck, Sponge Bob, Dumbo, Jolibee, The Incredibles, Pooh and Piglet" "Amen.” (And later I discovered he was looking at his stickers on the cabinets and walls).

Still no diet, except for a little limitation on sugar intake, especially from 4pm onwards, as this will cause hyperactivity.