Natalie's Story: Using Structured Learning Principles in the Home of a Child with Special Needs

With permission from her parents, this week I am sharing the progress of Natalie, a wonderful little girl with Trisomy 4p.  Trisomy 4p is a rare chromosome disorder in which some of the material in one of the body’s 46 chromosomes is duplicated.  Like most other chromosome disorders, this is associated with birth defects, developmental delays and learning difficulties.

For Natalie, the disorder’s effects are significant.  In the early years of life, she struggled with illness and many health complications.  More recently, she has gotten to a place where she is healthy enough to come to school and explore her environment.  With that exploration, there have been a few growing pains. In the beginning, it was just exciting to watch her become mobile and explore her world regardless of what she was exploring...her brother's toys, the refrigerator, pots and pans, the washer and dryer, etc.  But then came the time when limits needed to be set. 

In early December her mom texted me, “Help! Natalie is into everything and even broke the Christmas tree!”  With that text I knew it was time for a house call which turned out to be an amazing opportunity for all of us.   I had never realized how much the structure of the classroom can be adapted to a home to create success until I start working more closely with Natalie’s family and care providers.    

As I reflect back I think when Natalie started school, she realized that there was more to life.  She enjoyed the structure and challenges that school provided. But the transitions from school day to home life presented two very different environments that brought out mischievous behavior at home.  At school, we structured growth opportunities.  At home, Natalie found them on her own like trying to figure out how to open the baby gate to the basement, prying a door knob open, or tearing her brother’s library books.  She was craving structure and challenge.  She actually started to like school so much that she cried when the bus dropped her off at home.

So how did we build structure into her home? Well, HUGE props to her mom, dad, and grandparents for doing just that!  I shared with them a few ideas for structuring her toys and play things.  For the most part, Natalie has never found interest in toys.  She would much rather dig in the kitchen cabinets or get into the refrigerator so we had to come up with a way to make toys interesting to her.  She loves to put in and take out. She has become very proficient at put in tasks.  So her dad simply repurposed the cube shelving that they had in the family room and her bedroom. 

NOTE: Her dad mounted the shelving units to the wall so if she pulls herself up with them they would not fall on her.  

They bought a few extra fabric boxes and then her mom went through the family toys and placed one toy or put in task in each box.  (Notice the new boxes they found at Home Depot.  They are in half sized sections. So exciting for us organization geeks!! :) I purchased some for our literacy center so we can double the amount of leveled boxes we have!)

Here's what the cube boxes look like in Natalie's bedroom.  

Her dad strategically mounted the shelving going out from the wall.  This helps care providers and parents keep her in the space they would like her to play in.  She is much like a toddler in that she likes to leave and explore different rooms.  This blocks her from seeing the door.  It is much like how our social center is set up in the classroom.  (I am hoping to share that center with you soon!)

The systems work like magic!  Her mom even said, “Wow, we should have done this with her brother when he was little.”  It is just good practice for all children.  By organizing their play things, it organizes their play.  For Natalie, it also provides boundaries. When her toys were stored in a large toy box, they were overwhelming to her.  It was much more structured and fun for her to go to the kitchen cabinets and pull out the pots and pans.  Now that her toys are organized, she is more interested in putting in and taking out her toys rather than pots and pans.  Next, we will work on her ability to play and engage with toys for a longer amounts of time.  

Of course, there is some training involved.  At first, Natalie was in the habit of going to things that were off limits. I told her parents and care providers to redirect her to her spaces in the home each time she would try to explore the kitchen or other off limit spaces.  The family also added a hook and eye to the top of the door to her brother’s room and the bathroom so those areas would be off limits unless accompanied by an adult. 

So what’s in the boxes?  Some of her favorites:

• Monkey in the Box  
• Sorting kitchen set
• Fisher Price Classic Television 
• Other cause & effect light and sound toys
• And various sorting and put in toys. 

The key to success is that the family switches the toys out every two or three weeks so she doesn’t get bored and start engaging in previous behaviors.  Fortunately for Natalie, her family has collected a lot of great toys over the years with the help of grandparents and garage sales.  We also supplement her toys by checking out some of our classroom toys and tasks to her and her family so she can generalize play skills and experience things in both settings. 

The family has become accustom to building put in tasks and other task boxes from things around the house with the help of my trusty resource, "How Do I Teach This Kid?" by Kimberly Henry and the great folks at Task Galore.  Natalie's favorites work on increasing her skill level.  Here are some examples.

Counting Bear Put In 

Notice that I hot glued craft foam on the top of the put in container so that students can’t put in and dump out.  They can only put in. 

Bell Put In

This task includes its own reinforcement as Natalie loves the bells making noise as she puts them in. 

Golf Tee Push In

This task has the added element of pushing in rather than just putting in. 

CD Put On 

This task is a step up from put in as it's put on instead. 

String Bead Take Off/Put In 

This task works on two-step directions:  1. Take off and 2. Put on.

Bead Put In   

The bead put in was something we added to desensitize Natalie to putting things on.  She resists putting on bracelets, necklaces and more importantly stocking caps and her prescription glasses.  By taking an activity she likes and is successful at (Put In) and using parts of beaded necklaces as the put in materials she has become less resistant to necklaces. Now, we can work toward her putting on other things.  She now wears beaded necklaces, bracelets and stocking caps for short periods and tolerates holding her glasses.  She used to scream and bang her head each time I presented her with her glasses.  It is all a work in progress, but wow, we are proud of her progress so far!!  

Other advances we are making with Natalie is in relation to direct instruction at home and school.  You can click here to see what direct instruction looks like at school. At home, her parents created a small work space near their dining room. Here is the table she works at. 

Typically, the chair in this work space is a Rifton chair.  This is not to hold her in or confine her but rather to help her sit up properly and become more attentive.

To the left side of her table, her parents have repurposed a wooden chest to hold all of Natalie’s tasks. 

Inside there are a variety of task boxes organized in plastic bins. Natalie’s mom shared that the only thing they purchased for this area was the plastic shoe box containers.  The rest of it is simply stuff they have saved and accumulated from their house and her grandparents’ houses.  And such a wonderful job they have done with it!!! Way to go!!! It looks awesome and really serves as a great learning space for Natalie. It helps fill her day with appropriate learning and exploring activities.

And with that, I must share the next step for Natalie.  In the video clip below, you will see Natalie using her teaching area to learn to communicate in an appropriate manner.  Since Natalie is nonverbal, one of her biggest struggles is finding ways communicate and express herself.  Two of the main ways she communicates is by banging her head and/or screaming and crying.  Both of which, we would like to shape into more effective communication techniques.  Over time she has learned if I bang my head someone will come and help me or redirect me.  The current forms of communication provide her with the attention she is seeking.  

So as a team we have come up with an alternate plan when she bangs her head.  We do not give her verbal attention or eye contact. We simply put our hand in the space she is banging so it is a softer surface but direct our attention to something else that is going on the room so she does not get attention for the head banging.  This was a technique I learned from the training I did regarding Applied Behavior Analysis with Jill Koertner and her K-Cart team. 

Like you all know, this technique alone will not curb the behavior. We have to teach a new skill.  The skill we are teaching is for Natalie to learn to communicate her need for attention and/or help by using a come here button.  

Here are the video clips showing Natalie’s speech therapist, Andrea Carmichael, and I during a home visit teaching the come here button to Natalie’s mom and home nurse.  Because they were recorded during a collaborative home visit you will hear Natalie’s team and I brainstorming how the button should work.  I am hoping the brainstorming you will here will be helpful as you watch it and not be a distraction to seeing what Natalie is learning and doing. 

It is definitely a work in progress at school and home. We have incorporated the big come here button as well as a device with four buttons that have come here, all done, and help on them.   

The fourth button is strategically left blank.  When Natalie pushes it, nothing happens helping her to realize that each button has meaning and the blank button doesn’t get her anything.  This is especially important in the teaching phase of the device so we can see if she is just pushing to push or if she is pushing for purposeful communication.

A big thank you to Natalie and her family for sharing Natalie’s progress with the Considerate Classroom Family.  As a special education teacher once shared with me, the journey is a marathon not a sprint.  As Natalie grows & matures, additions, adaptations and changes to her systems will be made to best meet her needs.  She is truly an amazing little girl. A miracle who has overcome so much!!! I see so much potential in Natalie especially with the love and dedication of her parents, brother and grandparents.  She is so blessed to have such wonderful family support and nursing care.   

And my blessing is to have the opportunity to work them.  I have learned so much from them and truly admire the love and dedication they have for each other.  Natalie has taught me so much.  Her family’s willingness to let me come into their home and strategize and plan with them has been an amazing opportunity.  I have learned to celebrate all gains...big or small.  There's no doubt that Natalie came into my life to remind me to appreciate each moment and all that I have. 

I have the utmost respect for all parents raising special needs children.  Parenting is such a hard job especially when the job is intensified by special needs.  In my experience, there are often so many questions for these parents: Where do I turn? What do I do? Who can help?. It changes your life in more ways than can be identified or counted.  My hope, as a special education teacher, is that I can be the support you need and share what I have been blessed to have learned from others.

Applying Structured Teaching Principles to Home Organization

After several hundred hours of picking up toys around our house, I have finally come up with several ways to encourage my boys to clean up after themselves.  It also helps me know where their toys are when they request them as that happens all the time! 

For their playroom, I purchased three large tubs for the barn & farm toys, fire trucks & emergency vehicles, and rockets & airplanes.  I simply labeled each tub with picture icons printed on self-adhesive shipping labels. 

The labels make it easy for the boys and their playmates to help in the clean-up process.   

After recognizing the success of these tubs, I went garage sale hunting and found a colorful drawer set that store our dress up clothes, shields and swords, and pretend construction tools.  

I also labeled other things in the playroom with self-adhesive shipping labels such as cardboard blocks, stuffed animals, and board games. 

By organizing the boys toys in this manner, I have found they are able to pick something to play with and stick with it longer.  Think about your desk at the office. How would you get anything done if you couldn’t find what you needed to work on?  Not only did the organization help improve the boy’s play skills but it also helped them practice a very important life skill of being organized and cleaning up after themselves.  Even our 2 1/2 year old has gotten the hang of ‘helping’ clean up.  

Instructor's Insight:  To help your child communicate what he/she would like to play, velcro a set of icons to the top of the shipping labels you attached to your toy tubs and bins.  Your child can then bring the icon to you when wanting to play with something specific.  This trick especially works well if the child can't open or reach the tubs or bins used to the store the toys. For more instructions on this and similar techniques, check out Teresa A. Cardon’s book entitled Initiations and Interactions: Early Intervention Techniques for Parentsof Children with Autism Spectrum Disorders.

Another solution may be to put an aided language board in the room at easy access so your child can make requests like asking for help, asking for more, asking to be all done, or make comments. 

It's similar to the of P.O.D.D (Pragmatic Organization Dynamic Display) philosophy.  For more information regarding P.O.D.D., check out the work of Gayle Porter, Linda Burkhart or my earlier post on aided language boards.  

In order to make life easier in the family room, I took the advice of my oldest son’s Parent Educator, Miss Pat. When he was 18 months, I cleaned out one of the cabinets in our kitchen island and designated it as the toy cabinet for all his upstairs toys.  It worked out so well that I cleaned out the other two cabinets in the island for me and my husband’s things. Then when Payton came along, I cleaned out my cabinet and donated it to him for all his baby toys and manipulatives.  Recently, I added names to the cabinets using scrapbook stickers.

For fear of scaring you, I did not take pictures of the cabinets' insides as the boys literally have them jam packed with toys. However, this has been the best method for holding all their toys.  Now when someone comes over we don’t have all their toys cluttering up the front room.  Best of all, when it is time for bed each night they are able to independently clean up after themselves.  This method also teaches the boys personal responsibility as the rule is the items in your cabinet are off limits to your brother.  If you choose to leave your items out, they are fair game for your brother to play with.

Moving on to some other home organization features, the boys’ bedrooms also have specific places and locations for toys.  Each of them has a nine square Closetmaid shelf that you can get at Home Depot or Target.  They truly are my favorite organization solution.  Payton’s has different colored fabric boxes in it. EJ’s has the same colored boxes with little writing labels. 

Again making the boys responsible for their belongings and making their rooms easy to manage.  

Note: One more rule in our house is that their rooms are picked up each night before they go to bed. Now, the playroom is a different story!  We don’t pick it up daily. But depending on the train wreck that is the playroom and who will be coming over to the house, it is either picked up weekly or even biweekly.  However, everything does have its space in there too. Making picking up easy and manageable when the time comes.  

Our home has really evolved as the boys grow and their interests change.  For example, in our office space right now we have a small child’s sized table with Legos beside it. It's been an extreme interest of our two year old.  This gives him a place to play while mommy or daddy are doing school work on the computer.  

The Lego box was a gift from Aunt Christie.  It is so clever. It stores Legos by size.    He is also interested in playdoh so I have several playdoh tools and kits stored behind the lounge chair in the office.  It's easy access for me and Doug to get out for him but not visually available to him.  

Our six year old is very into making projects right now with everything from duct tape, to Velcro, to markers, paints, and scissors. Therefore, in the office space I have also added a chest that stores all sorts of art supplies.  

And more recently we have added a space that holds his finished projects or projects he would like to continue working on.  My OCD would often kick in and I would throw his projects away or put them away before he was done so now I have cleaned out a drawer in our coffee table for him to store them. 

Before moving out of the office, I want to share with you a mommy space.  Under my computer desk, I have two fabric boxes one for future blog posts & presentation items and one for future classroom projects.  I also store my school bag under there so I have it at easy access when I get a chance to work.  

Now moving into the entertainment room where there are two more features to share. Under our wet bar, I have three cabinets.  One stores extra blankets and pillows while the other two hold puzzles and game boards.  Organized like a true teacher, one cabinet has lower level games like Candy Land and Memory and the other one has higher level games like Monopoly, Pay Day, and Yahtzee.   

Lastly, I would like to share an extreme interest for both boys.  They both love to watch cartoons and movies.  But they always do it in McDaniel boy fashion...they dress up like the characters they are watching whether it be Spiderman, Captain America or the bunny from HOP.  I store all their costumes in a large fabric Thomas Chest that my mom picked up at Toys R Us last year for Christmas.  

I used to have all their costumes in the playroom. But to save myself time, I put them in this tub by the TV so they can independently find what they want and clean up after themselves when they are finished.  They tend to want to dress up like the superhero or any other character they are watching on TV so this really helps!

Ohhh...I geek out when I think of all the amazing things you can do to structure your home!! Yes, I am a little anal but it saves me a lot of time and teaches the boys some great life skills along the way.  It all relates back to the theories of Structured Teaching...building independence and success for all.  

To learn more about this technique, check out the presentation I created for TASN regarding Structured Teaching in the home.  Unfortunately, I don’t have clearance to share the video footage but hopefully you will gather ideas from the text and pictures. 

Join me next week as I'll be sharing how we structured up the home of a little girl who has significant needs to make a world of difference for her, her family and her care providers.

A Tribute to the Best Teacher I Ever Had

Today is a very special day in my family.  It is my mom’s birthday.  In her honor, today I am sharing a small token of my gratitude for her as my mom and my kids’ grandma.  She contributes more than she will ever know to both my career and our family.  Many of you have asked where I find the time to not only develop my classroom ideas & strategies, but also share them with the Considerate Classroom community.  The short answer: MY MOM!

My mom regularly takes the boys for an evening or long weekend so I can get caught up on everything I have overcommitted to do including school work, blog stuff, and various presentations or projects.  I am incredibly thankful to my mom for these extra opportunities for adult time. These little evenings or weekends truly rejuvenate me and keep me sane.   

My mom has always been a sounding board, especially early on in my career.  On the bad days, she would hear my cries for help, whines of helplessness, and complaints of frustration.  And on the good days, she helped celebrate the small wins and momentary successes.  My mom has always been one of my biggest supporters, loudest cheerleaders, and strongest voice of reason.  

Unfortunately for me (and probably thankfully for her), the calls are a little less frequent now because I've gotten busier. However, I still know she is only a phone call away when I'm feeling like "Alexander and the Terrible, Horrible, No Good, Very Bad Day"!

My mom has always been able to provide a healthy dose of perspective especially B.C. (a.k.a. Before Children).  Before I had my own little humans running around, I am pretty sure my expectations for children and their parents were unrealistic at best.  For an example of my early impractical B.C. mentality, I once actually came up with a plan for preschool homework.  Yes, that's right, homework for preschoolers!!

Long before I was a teacher, my mom taught me how to care for children.  When I was a preschooler, my mom had her very own house full of daycare children who all cried "I stay here!" when their parents came for pick up.  Later I followed her example as I filled my parent's home with my own daycare kids each summer.  "Camp Lindy" was complete with crafts, plays, and all sorts of school projects and complete household destruction each day!  Looking back, I have no idea why she sponsored my teaching aspiration so early on. 

As the loving mother of four very independent and individually unique children, my mom has been teaching my siblings & me for thirty plus years!  As I reflect on every lesson we've learned, every tear she's dried, and every bit of wisdom she's bestowed, it's clear where my passion for children came from.  I owe her a huge debt of gratitude for shaping the teacher I am today. 

Often times, it's easier for me to show my love in a project rather than words. Therefore, I wanted to share my mom's birthday gift with you all.  It is a creation inspired by the crafty Miss Karlie, our newest para, and Pinterest.  For Christmas, Karlie made my family this absolutely gorgeous plague with a few 2x4s, a cricut machine, scrapbook paper, and mod podge.  

Her creation encouraged me to make my own. I had seen a quote on Pinterest that read “Great moms get promoted to grandmas!” I took it and ran with it.  I printed the quote on scrapbook paper and then had my husband cut a 2x4 to size.  I mod podged the quote to the 2x4 after staining it with a dark color.  

Then, my husband cut four 2x4 squares to go above the quote.  I stained and mod podged them with a matching scrapbook paper. Next, I mod podged the very first hospital photo of her holding the boys and my niece.  

I made an extra block for more grandbabies in the future.  (My siblings have that job! :))  

The final project turned out perfectly. 

Mom, you are the best!  I have no idea where I would be without you.  Love You Mom!  Happy Birthday!!