Friday, June 7, 2024

Gestalt method of speech therapy in autism: how to teach langauge to autism kids

Teach with meaning, not with grammer.
Teach will words and sentences not with letters and phonics 
Teach with linked sentences and not broken words .
Teach with contextual references and not just monotonus.
Teach without asking questions, a good teaching ahs teachers asking questions.
Teach in a flow, understanding and not grammer is the key 
Teach without perfection at each step 
Teach without repititions,, dynamic diverse different and difficult learning is key for better cognition.
Teach face to face looking into eyes without touching.
Use many sentences to describe one meaning.

Just keep adding affirmative narrations, events actions conversations, mythology stories, panchtantra stories with moral lessons, Akbar birbal wisdom stories.   Before thevkis ready for schooling.

Friday, May 10, 2024

basic advice to parents of autism kids about how learning is to be initiated and in what direction

When we need to do correct, we need to stop doing wrong.
When going ahead is our goal. Let’s not go behind.
Whatever child used to do in past and has regresses, lets keep that as a goal to get back in 6 months and move ahead.
Our kid has learning deficit. It’s not delay. Delays get catch up, deficits need double speed to overcome to an extent.
In autism the social and cognitive development is slowed down to say 0.0005 x zoom.
All developmental soft milestones which appear normally at an age and maturity wil seem to appear slowly, slower, later and develop over months than just 2 weeks in normal kids.
Development Of social and cognitive milestones is important for learning.
Our kid has learning deficit. Kid couldn’t learn like normal kids bcos child is not receptive for learning.
Whatever child has learnt, had learnt in extremely slow speed with heavily repeated conditioning.
Our aim is to help the kid learn on his own from environment.
So, when learning is our motive, and we have serious learning deficit, we need to be very serious about this goal and work towards it.
So when learning is our motive, at least for 2 months let’s give 200% percent to it and strictly stay away from entertainment
If maximum time of the day is not spent on learning it means that maximum time of the day is just time passed or spent on entertainment. And if so, means we are not serious about learning.
What child has to learn is being human to become a member of the family.
Being a member of family. One who can become a member of family then only one can become member of society.
To become a member of family, the kid has to learn to connect with family members.
Only when u connect with someone we communicate with them.
Without connection and communication  there is no onversation.
What one has to learn is to
 1. Be with humans 
2. Look at humans 
3. Listen to humans 
4. Follow humans 
5. Feel humans 
6. Develop a relationship with humans 
7. Listen to humans
 8. Copy the feelings, looks, communication and conversations 9. Copy the language and intellect and behaviour . 

To develop awareness of human word  it’s important that child should develop awareness of environment. Initially (basic non living and ) most importantly basic living environment.
Awareness of environment is developed only when child gives attention to the environment.
To notice any thing or any one or feel any thing or any one , one needs to notice the environment 
To notice the environment,  one needs to develop posture of attention.
Posture of attention is like being receptive. 
Without receptiveness, there is no learning 
So let’s make the kid receptive. Only when we can make the kid receptive, we can expect a response. Initially without understanding  and later with minimal understanding, which will grow as per inputs.
Posture of attention means steadyness of body and mind. It’s like fixing the dish antenna to receive signals. Only when body receives signals, in time and adequate, the signals are noted and processed.
Autism kids are not receptive as per age. Mainly bcos their mind or body is not in a state of receptiveness.
For example, 
1. One may need to call by name or action many times to get attention
2. One may fail to get child’s attention to the learning objects or people
It means eyes are there to notice and ears are there to listen, the kid is not blind or deaf, but cannot see or hear promptly to a signal.

One most common reason why someone cannot pay attention despite repeated attempts being..
1. The child is not steady by body or child’s body hands or feet or eyes are in continuous state of movement. When one is in movement, attention takes backfoot 
2. The child is not steady by mind or child’s thought behaviors action feeling or sensing the environment are not steady. Unless the body is steady, mind cannot  be steady
3. Only when body  and mind is steady , eyes can focus.
4. To learn something , eyes and ears attention needs to be given to the person who is teaching throught eyes and sound /language.
5. Unless u look at a person or human, u cannot connect with them.
6. Listening by ears , need a sustained focus with eyes.
7. Humans are best connected by eye to eye connection.. longer and sustained
8. Only when u develop a good eye to eye connection , u can initiate listening.
9. Ears are there to listen.
10. To become aware of environment, we need to appreciate, understand and learn signals given to eyes and eats
11. 99% of our knowledge and learning comes through listening or verbal learning.
12. Verbal or listened learning has language, vocabulary, imagination, past tense and future tense 
13. Visual learning lacks all this and surely touch based learning doesn’t  help u understand language communication and no 12 above.
14. To conclude, one has initiate sustained sitting, sustained looking and sustained listening in preferablybverbal form to develop awareness of surroundings.
15. Learning by eyes and ears through verbal form is 1000 times superior to nonverbal learning through skin and toys.
Dr Santosh Kondekar

what therapist to choose? choose the one that is closest and works as per your needs and guidance of your developmental pediatrician - Dr kondekar

Psychologsts versus therapists .. 

The issue is settled with pure understanding that autism being a primary neurodevelopmental disorder with require a neuro developmental or SI OR OT therapists and it is not a primary psychological or behavioural or psychiatric disorder to require psychiatrists  or behavioural psychologist to manage the same.


We even see arguments in psychiatrists  versus psychologists ..
It's because a decade ago autism was thought to be a behaviours disorder and 2 decades ago it was thought to be a psychaitric disorder and 3 decades ago it was called childhood psychoses or schizophrenia.

 I see maddening run for CBT , ABA,RDI, other branded therapies in autism. Please understand that your OT ST and neuro pediatrician is enough to manage holistically and help you decide when to go for it and whether it is really needed. 
Please save time and resources for early intervention, whatever u can do is best but always be least for your kids.
Some brands u will find only in cities and very far from your location, and it's not worth wasting that much time if u have a therapist locally who can learn those tricks and help u modify holistic care.
If available across the door go for both,. See what suits and stick to it. Autism is not a single set of symptoms presenting same way to be managed by short term courses (that cost a huge bomb.,)
What is most important is something should be started and u should switch to other if u feel it doesn't work in 100 days.  Go for one who puts their heart into therapy .
N SIMPLE WORDS... OT /ST is generic... And others are branded... But the key differences being the branded methodists are not trained in basic human neurosciences and diseases the way the Therapist education goes.  Branded therapies seem to be a shortcut but can't be holistic.

ABA is a principle of life , every human and every therapist has to incorporate in their interventions. All ABA do use concepts of therapy for development of necessary socialisation.

 ABA can only be top up and not replacement for basic OT. AbA are not always trained in OT but it's easy for an OT to undertsand all ABA and practice. Don't spoil peace of Ur mind and waste money just bcos one doesn't have a brand ABA person within 20 km of ur stay. It's not possibly practical. Fees of specialists go on rising more the shortage is created with more special names and not dependent on quality care.
When we say we all need rice and Dal to eat, each hotel comes up with their own dishes to say theirs is the best and most effective nutrition.  Now every one knows we all have home made daal rice is the best . But we do need some tips to make the home made daal rice a little more tastier and nutritive.
Same is aba on top up of OT. What ABA imhas created a brand name for different techniques... Is actually practised by many therapists world wide and ABA want to call it's separate name.. and in that brand it's forgetting the holistic and basic OT which is required for the child.

All are parts of therapies just a section taken out and branded as name to market ... Only for a section of improvement. Don't fall for it. Sit with the therapist you have available and close, discuss with them and chalk downs plan.. don't run here n there...  Plan your goals . And u will start seeing improvements. If u find no change with an intensive program of therapy over 3 months . .. re-wise.   ***Discuss with neuropediatrician, ask for second opinion let there be healthy communication-between tow therapists.. and continue with closest and comfortable places. 
Otherwise we had seen people running for camels milk too spending all the resources and time which they would have used for the child at that moment.
it's just a marketting strategy and many OT and ST practice same techniques world wide. It's a brand name that they had developed... And sell at high rates. Don't fall for it. More so ABA ARE NOT TRAINED IN BASIC HUMAN SCIENCES LIKE OT ARE. So they don't understand exact developmental disorders.. and hence they are ineffective in managing kids who have abnormal behaviour  due to brain issues. There is a specific role for ABA in learning. 
OT with SI is the best form of therapy for autism .please discuss with your neurodevelopmental pediatrician how they can guide in achieving what therapist is best at what level of the issue and how to chalk out a collective plan if needed and also about medications to make child therapy ready and improve the speed of interventions.

Tuesday, April 30, 2024

cry in autism kids, meltdown or temper tantrums or pain?

A good number of time children with autism are seen cranky, crying or irritated, restless and not receptive or cooperative.
There are few reasons which can help us settle the issue.
1. Tantrums: These also called temper tantrums, often have a reason or need not being met. The reason can be as stupid or simple but may not be often obvious. The cry is mainly because the demand is denied. So when a child showing tantrums, he may giving a good eye contact and some response to communication or bargain or deal. Often it's close to stubbornness. 
Tantrums is best tackled not by meeting the demand but by ignoring it.
2. Stubbornness: is often associated cry as there is obvious resistance from both sides. The resistance can be for any specific pattern of behaviour action communication or need of some object. When a child starts developing his social communication, his ego starts developing. With his ego, he tries to get his demands and needs met by controlling others. If there is any resistance or denial or neglect by others, child gets agitated , the ego being hurt and it results in hurting or cry or pinching or biting or pulling hair or throwing in Autism kid. The best way to treat this is by ignoring, going out of scene, going away from eyes of child, running out of room for at least 3 minutes.  Even standing like a statue facing wall with eyes closed also helps. But dealing, bargaining, trying to explain or counsel the kid or falling from demands or even looking into kids eye will worsen the situation. 
3.meltdowns: often when an autism kid has a meltdown, the reason cannot be judged or found. The child keeps crying relentlessly. There will be no eye contact, no demand. Child any roll on floor or keep walking while crying. Often this is result of child's inability to cope up with nature, situation or frustration. Often this is cry of frustration and depression.
4. More commoner causes of crying in autism kids:
Constipation/ indigestion
Colic or cramps
Nose block or runny nose
Pain due to any trauma or injury
So often doctor or therapist dealing with autism has to keep these reasons mind.
When a child is in crying phase, often the therapy session goes waste.
A developmental pediatrician helps sort out understanding and treating such issues with appropriate medications when needed.
Counselling and behaviour therapy works better only when the child is in a state of LISTENING. 
It's the neuro pediatrician doctors job to make a kid more receptive, responsive and responsible.
DR Kondekar

Do ask about Block Hypothesis 

levels of speech development in children

Saturday, March 16, 2024

autism reversal principles and some basic advice PARENTS ARE KEY

if you feel you have learnt all tricks of OT etc , and you can teach OT to any kid with autism or take care of your 
autism kid for years, *you are wrong*; it just means that you dont know the next step. Sometimes it's good to 
accept we are wrong, then only we can *see the ray of hope.*
When we work with medicines and therapy *we develop connections and cross connections to processing 
centers;* which shows extended level of communications in the form of development in various *domains of 
understanding* including knowledge, nonverbal communication, behavior, emotions, socialization, interactive 
games and talking and writing skills apart from physical things.
** *Leaving things half way will develop connections half way and loose connections always die.* ** Often with a 
*Development is decided by connections, speed is decided by myelination.* 
At least keep a *minimum goal of readiness for primary school* admission over 2 year phase. Then divide them 
into steps. 
*Later the age of intervention or medicines harder will be recovery or development of milestones.*
Work towards reducing severity of level, A child who can take main stream schooling for primary usually is 
*independent* and can be educated and trained to take care of family responsibly , when he or she grows up.
*Remember every one has limits.. even God too does.. we all are attempting to look beyond the perceived limit 
and find a higher achievable limit, in the best interest of the child, when we walk towards horizon attempting to 
touch the limit, the limit too moves ahead.*giving us hopes to improve further every month 
Dr Kondekar #MakingSense
I want all parents to understand when we are looking for improvements, what all changes we may look for. A keen 
parent would like to note down minor details about every change on weekly basis rather than saying sir no 
Other parents may have similar ideas but if u don't note down In details, it's not easy to compare the improvement 
across time line. See the monitoring chart. Given at website for getting a serious idea to see 
objective change.
The improvements can be minor when we expect changes every week , it's always better to note down.
*Try to list changes as per gains since last visit and goals till next visit*
Also you have headings
activities - living, household,, skills and gross /fine motor
Langauge concepts
Pre match concepts
Story concept
Math concept
Abstract concepts etc
Medicines :
As I told u most of them are raw material used for building block for forming bridges in brain. These combinations 
will reduce or change every month after every weekly titration across whatsapp. After first positive response we 
follow gradual reduction in nutrients...systematically.
Half hearted efforts will give incomplete response, more so in a situation where world say nothing can be done 
except exercises.
Exercises only effect the input but has no major role in processing connections in brain

key principles in autism reversal:
1.Dont be Special, turn into social
2.To make social, switch from object world based teaching to people and action based teaching
3.To develop communication; switch from screen based learning to body language based learning
4.To develop language, switch from seeing-doing activities to listening talking activities
5.Sitting tolerance increases by sitting activities with sensory breaks as per childs requirement.Making a child 
continuously jump and run will make him expert in jumping and running
6.Constant hugging kissing and carrying skin to skin, make the child get physically pampered and stubborn. keeping 
your child 2 feet away face to face helps develop eye contact and social communication
7. If you dont make rules for child behaviour, child will start ruling you and throw tantrums to change your 
8.Children copy what they see, hear and feel. Dont let them see ,hear and feel what u dont want them to learn, for 
example saying no or physically handling the child or shouting to grab attention.
9.Dont teach letters and alphabets,or what is this type of teaching; they are for picture recognitions. Teach in 
sentences, it means language. Dont ask questions, just go on narrating.
10.Music/rhymes is good only for momentary solo pleasure. Switch to lyrics and language if you wish the time to 
be utilized for learning and communication. 
Dr Kondekars ten commandments on Autism reversal
*Understanding-Goal Directed Approach :*
Dear Parents
Make a list of all things u feel will be impossible in your kid and work towards it.
if you believe nothing is impossible, list things or issues your kid has difficulty in and list what all you did for your 
kid for same issue for last 3 months. list what all you made possible.
if you can list all changes you brought in last 3 months, discuss with expert about next step and how rapidly it can 
be achieved.
if you are stuck at a step for more than 3 months, we are losing time and raise an alarm.
*Accept autism, don't accept disability, work towards enabling same*.
Understand and re understand the issue differently and work towards it.
Its true that you know best for your kid, but *its equally true that u don't know what is best for others kids* 
;Parenting an autism kid since ages, doesn't make you an expert for others kids unless you get through details of 
thousands of cases.
So unless you are expert *don't start teaching other parents,* you may be giving some information halfway which 
is true only for your kid. It's not a routine parenting issue in autism.
*Dont give up your desire to learn and do something new every day.*
its true that home therapy is needed, but *don't make your house a therapy center with various toys and 
Home therapy in true sense will mean practicing tricks with home based day to day objects and acts

Gestalt method of speech therapy in autism: how to teach langauge to autism kids

Teach with meaning, not with grammer. Teach will words and sentences not with letters and phonics  Teach with linked sentences and not broke...