Final Week- Entry 1

Tuesday 11th of November 2008

Liam**

Thoughts and feelings in the presenting situation…

Liam is four in December and has autism spectrum disorder as well as global developmental delay. I have seen Liam on a few occasions. Liam is reluctant to be compliant in therapy lately and is asserting his independence. He is not doing the tasks we want him to do. He replies with ‘no’ or ‘mum’ and has a tantrum and falls to the ground. Liam is hypermobile and has low muscle tone. He was fine today in the beginning on the tramp and climbing up the ladder, but as soon as I asked him to perform other activities he would fall in a heap and throw a tantrum.

How I managed the patient…

I had to be firm with Liam at times and direct him to activities and tasks. On a few occasions I had to remove him from the ball pit, which he did not like at all. He can’t just lay in the ball pit in therapy. We are trying to help him do it is for his best interest. Half way through he was not doing anything. We asked him what wrong? He just cried, so we said ok are you finished? Put your shoes on and find mum. He cried even more and refused to put his shoes on. I put his shoes on for him. It was extremely difficult today, this day the worst of them all.

What I did well…

I could only do what I could do. I wasn’t going to make him get distressed by forcing him to do a task. I could only try and explain to him what we were doing. I was firm with him and didn’t let him have his way and stay in the ball pit. I also stopped him when he ran away.

What I could have done better…

I could have said in a firm voice. ‘Liam you need to do some work before leaving’ or sat him down and asked him more than once, what is the matter. Etc. I couldn’t really do much. I could have maybe gotten his mum to come in and speak to him, but this may have made matters worse.

Forward plan…

Introduce Liam to some new equipment so he doesn’t refuse all therapy. He seems to enjoy new activities but not activities he used to enjoy.

Changes for next time…

Next time I think we need to be a little bit more firm. Get his mum to sit in, she left when he started throwing tantrums, and I don’t know whether that made him do less work.

Overall thoughts and feelings of how today has gone…

Once again today was another busy day. I was very disappointed in Liam today and his non-compliance. I believe he can do tasks but his struggle for independence is limiting him from showing this to us.

Strategies to improve my performance…

Know that you cannot introduce children to new activities every week. This is not helping them as they are not becoming confident in a task through practice. They will eventually just forget the skill if not repeated and taught to them with the correct technique.

Questions…

I wanted to have a chat about Liam. He will be joining a group environment in the New Year. This may allow him to model off other children and get more out of therapy.

** Name changed