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Ashton’s diary - August 2019

02/08/19








08/08/19

Session with Liz

A few months ago Ashton would not have been able to copy this so well and to spend ten minutes and see it to completion is wonderful.
















15/08/19

OCCUPATIONAL THERAPY SESSION SUMMARY

Name: Ashton Groves

Date of Session: 15/08/2019

People Present: Ashton, Viryan, Liz

Location: Home

Long Term Goals:

1. Ashton will be able to come up with ideas to initiate play with his sisters and peers, and have the confidence to interact and engage with others.

2. Ashton will achieve toileting independence. Currently he is developing the skill to identify that he needs to go to the toilet and needs adult assistance for toilet timing. His pull up has been dry for 3 weeks now.

3. Ashton will use strategies to regulate his emotions when engaging in challenging activities.

4. Ashton will develop his gross motor strength and coordination.

5. Ashton will be happy and comfortable in his home and preschool environment.

6. Ashton will develop his school readiness skills of tool use (drawing, scissors, glue etc) and following tasks on an adults agenda.

Session Goals:

- Facilitate engagement for whole session.

- Progress complexity of play sequences and themes.

- Extend participation in adult led table top tasks for visual motor / fine motor / early learning

Activities to Facilitate Goal Achievement:

• Predominately child led session with stations of activities set up in therapy space.

• Encouragement of FIRST painting THEN screw dinosaurs

• Painting - following line from left to right using squeeze paint. Ashton able to tell me he didn’t want to complete the activity. Encouraged to participate by using a FIRST and THEn approach. He was able to copy one line independently, and then used my finger to trace the next line in the wet paint. He was able to connect the lines very well and used careful motor control to do this.

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• Pretend play - I attempted to utilise Ashtons interest in the screw dinosaurs to create a ‘dinosaur part hunt’. Ashton was motivated to find the pieces, but we had limited shared interaction for this game & the ‘pretend’ challenge may have been too high.

• Dinosaur Putty. Ashton really enjoyed this activity and demonstrated some great unprompted requesting and social engagement. He used his pincer fingers well in both hands to complete the activity and added all dinosaur parts in the correct position.

• Scooter board, climbing rope and collecting bean bags. Ashton understood the concept of getting the bean bags, however it was difficult for him to organise his body to lie on the scooter board and pull himself up the rope. Eventually, he was able to do this & with practice should develop the skills to participate in this sort of activity well. He seemed to enjoy collecting the bean bags off the rope and eventually getting to the blow dinosaur. This activity works on his bilateral coordination, motor planning, upper limb strength, social skills, fine motor strength and midline crossing - so will be a great one to get into the repetoire of games!

• Dinosaur balloon. Again, great social interaction, requesting and sharing of play with this activity.

• DinoByte - chew toy. Ashton was interested in this tool, but more with regard to including it in pretend play than a sensory toy (which was lovely to see!).

• Ashton was calm and engaged for the whole session, even when he was not particularly motivated by a game.

Homework:

• Continue focus on pincer grip strengthening in play - pinching and poking with pointer finger where possible.

• Continue encouragement of supported turn taking at daycare and with siblings.

• Continue pretend play sessions, always challenging ideas and adding in themes where you can.

• Allow Ashton to wear the dinosaur necklace and direct him to try chewing on it when he he is biting on his hand.

Plan:

Next session 8am 22nd August - Temple.

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22/08/19

OCCUPATIONAL THERAPY SESSION SUMMARY

Name: Ashton Groves

Date of Session: 22/08/2019

People Present: Ashton, Chantelle, Liz

Location: Home

Long Term Goals:

1. Ashton will be able to come up with ideas to initiate play with his sisters and peers, and have the confidence to interact and engage with others.

2. Ashton will achieve toileting independence. Currently he is developing the skill to identify that he needs to go to the toilet and needs adult assistance for toilet timing. His pull up has been dry for 3 weeks now.

3. Ashton will use strategies to regulate his emotions when engaging in challenging activities.

4. Ashton will develop his gross motor strength and coordination.

5. Ashton will be happy and comfortable in his home and preschool environment.

6. Ashton will develop his school readiness skills of tool use (drawing, scissors, glue etc) and following tasks on an adults agenda.

Session Goals:

- Facilitate engagement for whole session.

- Progress complexity of play sequences and themes.

- Extend participation in adult led table top tasks for visual motor / fine motor / early learning

Activities to Facilitate Goal Achievement:

• Predominately child led session with stations of activities set up in therapy space. Ashton was organised in his play and moved through activities systematically.

• Encouragement of FIRST and THEN. Ashton attempted to move on from the fine motor activity at table top. He was able to easily redirect back to the activity with a FIRST we finish and pasting, THEN we play with the hungry t-rex; and another prompt to pack up the task.

• Cutting / pasting bugs onto dinosaur scene. Ashton engaged well in this activity. He was motivated to cut up pictures of bugs, when given the choice between dinosaurs and bugs.

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He required some prompting to position his right hand correctly when holding the scissors, but was able to make 2-3 snips between the bugs to accurately cut the paper before pasting with accuracy onto the prehistoric background. He was engaged in this activity and spoke about the different bugs, and what they were doing.

• Pretend play. Ashton is continuing to progress with his flexibility, creativity and complexity in pretend play. Today I introduced the idea of making ‘bugs’ by ripping coloured paper and pinching it into small balls. He followed this idea well, making ‘bugs’ to go in the bug stew mixed with real bugs. He helped the t-rex stir the stew by holding the spoon in his mouth; eat the stew by using a fork, and share the stew (with prompting) with his other dinosaur friends. He was able to respond to my statement ‘oh oh the stew is hot’ by blowing on it. He was able to transition themes by putting the dinosaurs, people and puppets on the bus together and taking them on a journey to the ‘zoo’. Well done Ashton, so wonderful to see you enjoying pretending in social play.

• Cutting plasticine with a knife. This was incorporated into the pretend play theme. Ashton is learning how to move a knife forwards and back with his right hand to ‘saw’ through the plasticine.

Homework:

• Continue focus on pincer grip strengthening in play - pinching and poking with pointer finger where possible.

• Continue encouragement of supported turn taking at daycare and with siblings.

• Continue pretend play sessions, always challenging ideas and adding in themes where you can. Start to expect a little more depth of play from Ashton, showing him how to add in details like ‘it is hot’, or ‘it needs some salt’ or challenging his theme (e.g. ‘My dinosaur would like some of that bug stew’; ‘my person would like to go on the bus’).

Plan:

Next session 8am 24th August - Temple.

Page !2 of 2

I was away for this session so no video.

24/08/19

Session with Liz o/t







Ashton is very good with his fine motor skills and glueing and pasting. His cognition is showing an awareness of where things go and what things are and he easily dies these activities but gets bored with them and runs off, he can be encouraged to come back. From comprehension point of view he understands what is required but from an interest point he is not connected. Only thing is to persist with this for concentration and completing a task he is not interested in.



29/08/2019

OCCUPATIONAL THERAPY SESSION SUMMARY

Name: Ashton Groves

Date of Session: 29/08/2019

People Present: Ashton, Viryan, Liz

Location: Home

Long Term Goals:

1. Ashton will be able to come up with ideas to initiate play with his sisters and peers, and have the confidence to interact and engage with others.

2. Ashton will achieve toileting independence. Currently he is developing the skill to identify that he needs to go to the toilet and needs adult assistance for toilet timing. His pull up has been dry for 3 weeks now.

3. Ashton will use strategies to regulate his emotions when engaging in challenging activities.

4. Ashton will develop his gross motor strength and coordination.

5. Ashton will be happy and comfortable in his home and preschool environment.

6. Ashton will develop his school readiness skills of tool use (drawing, scissors, glue etc) and following tasks on an adults agenda.

Session Goals:

- Facilitate engagement for whole session.

- Progress complexity of play sequences and themes.

- Extend participation in adult led table top tasks for visual motor / fine motor / early learning.

- Introduce emotions using face tokens.

Activities to Facilitate Goal Achievement:

• Predominately child led session with stations of activities set up in therapy space.

• Encouragement of FIRST and THEN

• Drawing - T-rex dot to dot. Ashton chose to complete this activity first and readily engaged in the task. He held a texta in a right handed tripod grasp without prompting. He was able to follow the dot to dot lines around the dinosaur, and whilst he didn’t have the motor control to connect each dot one by one, he was able to draw around the edge of the dinosaur in roughly the same shape as the outline before colouring it in. Well done Ashton!

• Money Box posting dinosaurs and emotion cards. Ashton was initially very interested in this activity until he realised that there was a combination of dinosaurs and emoji’s on the cards. He was very happy to engaged in the posting activity with dinosaurs, but demonstrated disengagement and slight distress when encouraged to look at, or post the emoji cards into the

pig. He was able to watch me post them from a distance, and needed lots of encouragement to even look at the cards.

• Spiderman duplo. Duplo was chosen over lego for this activity, as the goal was turn taking play towards building something together as opposed to challenge Ashtons motor / perceptual skills. Ashton was very motivated to engage with the Duplo and made several creative robots out of the bricks. Social engagement was limited with this activity and Ashton tended to retreat into his own play and ideas. He was able to pack up with some verbal prompts from his mum.

• Tweezers with bugs and dinosaurs. Ashton was initially motivated by this activity, but seemed to become bored with it when I challenged him to take turns and sort the animals. He was able to operate one set of tweezers easily, but found it challenging to operate the 2nd set which required more hand strength. Lovely to see Ashton introducing pretend play ideas with this activity, and referencing things he had seen on the TV in conversation. Whilst playing this game, Ashton demonstrated interest in the mini operation game. He responded well to a FIRST and THEN approach in sticking with the first activity.

• Mini Operation game. Ashton was initially interested in this game, however when I added some more structure he disengaged.

• Shaving Foam. Ashton was interested in exploring the shaving foam today. He communicated when he wanted more foam on the placemat and was happy to play alongside his sister for this game. He was happy to get messy - which is the first time I have seen him fully explore the foam. He may have continued with this messy play for longer however I increased the challenge to draw a volcano, which may have been too much given the sensory challenges that Ashton was overcoming! He was able to wash hands with minimal support. He was quite elevated in activity levels after this activity - possibly in response to his body processing the sensory exploration he had just achieved.

• Blow toys. Ashton demonstrated some lovely back forwards blowing with paddle steamer whistles. He makes such beautiful visual engagement during simple activities like this, and was able to engage in ‘turn taking’ blowing different rhythms.

• Pretend play. A short pretend play session today, that was more around putting the animals in a fence & exploring some new (to therapy!) toys, as opposed to creating a complex social play theme.

Homework:

• Continue focus on pincer grip strengthening in play - pinching and poking with pointer finger where possible.

• Continue encouragement of supported turn taking at daycare and with siblings.

• Continue pretend play sessions, always challenging ideas and adding in themes where you can.

Haircuts:

• You tube of children getting haircut.

• Video of sisters getting hair cut.

• Try with wet hair hair comes off in bigger chunks.

• Visuals to make each step concrete and finite - Liz can make if you want them. • Try a visual timer - start at a 30 second hair cut; gradually increase from there.

• Deep pressure to head whilst other person is cutting hair. • Introducing haircut play into pretend play.

Plan:

Next session 8am 5th September - Temple.















TOILET time for Ashton

Ashton is asking to go to the toilet ..

he is wearing undies all day and is dry the morning with his night pull up .. he asked me to go to the toilet . When asked he will now say” no the toilet” if he doesn’t want to go and he will say yes if he does..

he asked me to go to the toilet as he was sitting on the lounge

“ I need to go to the toilet” he said .

(Two weeks later 15/9/2019 and he has been dry at night with pull ups and he ask to go to the toilet. Not one wet pants.. )

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