A couple of weekends ago, on our last public therapy trip with Emily as Tony’s hab therapist, he laughed, smiled, and flapped as we walked towards the door of our local Fry’s. When we first started our public therapy programs, I never would have expected to see him looking happy in that context. The best I had been hoping for was to achieve sufficient tolerance for us to accomplish what was needed.

We had to put our son’s public therapy programs on pause for the first several months of the pandemic while we worked on building up his tolerance for wearing masks. Our little man has a history of pretty intense tactile defensiveness which we have been working to improve via therapy since before he turned 2. For the mask, we had to start with putting it on and letting him take it off in home, and then we increased by two second intervals until he could tolerate that for two days in a row with at least 80% of the attempts at wearing, and once we were over a minute I increased the number of seconds for each increase, and we just worked up from there. After about 10 months, we were able to achieve enough mask tolerance to resume short trips into public places.

Once we were back in the stores, we found that the break had allowed him to become less rigid about directional flexibility, but we have had to deliberately make sure we vary doors entered and routes walked for every location so that he doesn’t revert to directional rigidity in these environments. All work in any medical setting is limited to his own visits because of the pandemic, though we are hoping sometime in the next couple of months to be allowed to take him into the hallways of the local elementary school to practice safety skills there.

We still have many things we need to achieve when it comes to our son’s ability to function in public spaces (like not trying to grab other people’s drinks from them or avoiding micromanaging how they’ve set up their carts). But as his tolerance has grown, we’ve been able to start to fade the use of the metronome (an NMT technique to promote emotional regulation and help maintain a steady walking gate when his sensory system is overloaded). I haven’t seen fear based eloping unless we’re in a medical setting this past year, though he will sometimes run or walk off to try and start a game of chase. We’ve been able to advance his communication skills from not just talking about what he wants in the store to having him label items he sees. And more importantly, we’ve been able to increase the number of people he’s working with in these settings so that he can generalize his cooperation.

What follows is going to be as series of pictures of some of the things we’ve been working on the past few months. We do public therapy programs in both hab and ABA therapies. Most of our trips are just Tony, a therapist, and myself. One trip every month or two involves the oversight of the ABA clinical supervision team.