The kind of program that we set up for Susanna could be applied to a forty-two year old, a sixty year old, or even an eighty year old. The key is discovering each person's interests and passions and then using them as motivation to carry out the steps in a way that is enjoyable for her.
Motor Planning. To work on what she called her "clumsiness," we wanted to start with the Evolution Game - slithering first, then crawling, walking in a more coordinated way, then hopping, skipping, jumping, and doing some trampoline work. Susanna made these exercises into a workout routine with music. She had already been doing activities to music to keep fit and was following an exercise show on TV. She had some of the audio recordings from that show, which she used to get herself going in the mornings, so she could easily incorporate her new exercises, setting the Evolution Game to music, into her routine. She found this amusing and fun, and it helped get her started every day.
Gradually, we added more complex left-right movements and sequencing. Susanna was never a good dancer, but she loved to dance. So she tried to master new dance routines using DVDs that had both visual and auditory instruction on how to do the latest dances. That helped her learn to sequence - she could see it, and she could hear it. To further her sequencing abilities, she set up some simple obstacles and combined them with the Evolution Game. She had to crawl through hula hoops and furniture and climb over different barriers, all of which helped her coordinate her body. Behavior Plan For Students
When it came to balancing activities, Susanna liked the idea of standing on balance boards and moving to music. She then combined tossing a ball up in the air with standing on a balance board and doing it rhythmically with music. We worked that into her basic routine.
To help further with balance, Susanna also did some yoga work. She had tried yoga once or twice before but found it quite hard to do because the different postures required muscle tone that she really didn't have. Now she approached yoga with a renewed vigor, feeling that it was going to help her pay attention. She attended yoga classes and did routines at home along with her dancing. Susanna attended some dance classes, too, once she felt she wouldn't be "embarrassed" and had gotten to a certain level of competency. All these activities together improved her motor functioning.
Sensory Modulation. Susanna recognized that she was very overreactive to sounds and had a hard time staying focused and attentive in noisy environments. It was easy for her to become overwhelmed and overloaded. So she identified, with my help, the different frequencies of sound that bothered her - low-pitched sounds like grumbling, sounds of a heating system going on, and motorized sounds were the most distracting for her.
High-pitched noises weren't pleasant to her either, but they weren't as distracting. Gradually, Susanna exposed herself to these distracting sounds as part of activities that were very calming and regulating, like listening to music and rhythmic activities. Susanna liked soft country-and-western music with a slow pace. She could expose herself to different sounds as part of this music or while doing yoga movements that relaxed her. This helped her get habituated to them. Gradually, while these sounds still bothered her, they bothered her less, and over time she was less distracted by them.
Visual-Spatial Thinking. As I mentioned before, it was hard for Susanna to picture her house from different angles or picture things she had read. She couldn't turn stories into visual images. When I asked Susanna to picture her boyfriend and her best friends in a certain place as though she had just taken a picture of them, she couldn't do it. Susanna read a descriptive paragraph, and I asked her to picture what she had just read. She would always say she saw a blur.
Working on this visual-spatial area was more difficult for Susanna. We worked with blocks and different block designs. We worked with quantity concepts (because she always had a hard time with math, even picturing "big" and "little" was not easy for her). We did exercises with water in different-shaped glasses, the same basic conservation tasks that kids do in school but that she had never quite fully mastered. We helped her make more and more sense of what she was seeing and develop a sense of quantity by doing these exercises. Finally, she "got it," as she put it. This was basically hard work on her part, and we couldn't figure out an appropriate activity, that would make it fun for her. However, she enjoyed where the journey was leading her.
To further strengthen her visual-spatial ability, Susanna started doing two things. When she wrote short stories or poems, she treated them like screenplays or stage plays and tried to picture how each scenario was hid out. Starting out with one or two characters and very simple dramas, over a period of six to eight months she built up to the point where she could actually picture things that she had written. From there, she became able to picture things that she was reading.
To apply all this to the tasks of her life, each morning Susanna would draw on a chart what the sequence of her day was going to be. Using little stick figures, she mapped out her activities or plans in terms of things she had to accomplish at work, things she was going to do for leisure activities, things she was going to do with her boyfriend or girlfriends, and so on. Rather than write them out as she had always done (she had pen marks all over her hands because she wrote things down to remember them), we had her draw her tasks using simple stick figures. This way she had a visual road map and timeline of what she needed to accomplish in a given day. She would keep checking this road map throughout the day, every half hour or so. Behavior Plan For Students
She could see where she was in the timeline and where she had gotten off course. From that, the goal was to help her internalize the timeline, to create an internal road map with activities so that she could picture her progress and mentally check off tasks or activities as she completed them. Over a period of about four months, she was gradually able to do this. She kept working back and forth between the things she would say to herself and the things she would picture. The picturing was the hard part, but it provided a more cohesive guide for her. Although she was very motivated to do all of this, she also required a fair amount of encouragement. Sometimes she slipped and went backward and gave up on it, but then came back and persevered.
As Susanna improved the visual-spatial part of her thinking, she found that she was a better abstract thinker in general. She always saw herself as a person who had an eye for detail. She retained this ability, but she also became a better big-picture thinker.
As I met with her, I encouraged Susanna always to ask the question, "How does this all fit together? How do you put all of this into one big picture?" Whether it was a policy paper or a speech she was working on, what was the overall goal? What were the subgoals? Even though she was always a good creative writer, she often had trouble keeping the overall goal in mind. Now, when Susanna had to do a paper, she actually created a visual design with boxes and arrows going from the main point to the supporting points and realized how important it was to see things, not just to have the words in mind.
Over about a year, Susanna gradually improved her ability to stay on task, to follow through, to solve problems, to be less distracted and more focused. Her overall thinking abilities and the quality of her relationships and her life also improved because she was less frazzled, less harried, less fragmented. Her emotions were less chaotic, too, because she could understand her own feelings better and not feel pulled "all over the place." Feeling more calm and engaged, she could now gain some perspective when she was upset with her boyfriend or her parents or with something at work. She could see how the different feelings she was having might be related to larger issues.
Susanna made a lot of progress and really mastered the problems that she came in with a year earlier. She is a very good example of how adults with attentional difficulties can adapt the approach that we take for children and make it work for them. To learn more, you can check out Behavior Plan For Students.
