The last couple of days Josiah has seemed so much more like himself. He allows us to get close and pulls us in for hugs. He smiles sometimes. He even giggled a few times yesterday.  All of these are great indicators he may be closer to being discharged.

The primary goals are for him to be eating well, sleeping through the night and showing little to no signs of aggression before he can come home. He’s eating really well. We’ve been told he’s sleeping well, but just learned he’s recently starting his happy day at 2:30 or 3 am. Not good. There are still some signs of aggression but comparatively speaking they are mild.

Mostly it seems his aggression is from frustration. He pairs his ‘finished’ sign with a swift blow to his head. When he is not interested in something, he’ll quickly sign ‘finished’ and faster than we can block it, pop himself in the head.  ‘Finished’-bam, “finished’-bam. Over and over again, until he leaves a red mark on his forehead. I’m not sure why he decided his ‘finished’ sign wasn’t good enough to get his message across. How are we going to get away from him hurting himself every time he doesn’t want something?

It works best to use a prompting sequence with Josiah.  We give a verbal command, next we’ll add a gesture, then we’ll give a partial physical prompt (for example: take his arm and point it towards the object) and finally we’ll use a full physical prompt, which means we will hand-over-hand guide Josiah through the process of what we’ve requested.  It takes consistency and a boat load of patience to do this. Ultimately, it sends the message, we mean what we say; you don’t get to call the shots around here.

While Josiah is in the hospital, he’s calling the shots. He is the king of the castle.  He’s getting to do what he wants when he wants, which basically is to just eat, sleep and play with his beads. There are very few demands placed on him. He’s hitting himself in the head, so less and less is being required of him. Instead of being expected to comply, he’s teaching others to back off. And it’s working for him. No one wants to see a kid hurt himself repeatedly.

Last night, I expressed concern over Josiah’s unwillingness to participate in much of anything and the increasing hits to his head.  I explained the prompting sequence and suggested it’s important we all expect more from Josiah because he is capable of quite a bit more.  We can not have him getting away with this. We need to ensure he is not going to become increasingly self injurious and more aggressive once he’s home because of the additional expectations placed on him here. Everyone who works with him at the hospital needs to be on the same page and trained on how to ensure compliance.

Today I’m hanging a copy of the prompting sequence on the bulletin board in Josiah’s room. His calling the shots days are ‘finished’.

BAM!