M

om: I’m not sending Sara to therapy so that she’ll become exactly like me. She doesn’t have to run a business. But she does have to be able to run her own life.

Teacher: Sara still needs help but now that she pays attention to what’s going on around her it’s easier to help her.

Sara: I used to feel disoriented all the time. But now I get what’s happening.

Sara seems wary at our first session but her eyes light up when I hand her a digital camera. “Let’s go take some pictures.” I lead her to the reception area. “Mrs. Schiff?” I call out. The secretary has a phone to her ear hands on a keyboard and pen between her teeth. “Smile!”

Back in my office I load the pictures onto the screen. “Great photography” I tell Sara. She smiles. I click randomly on one spot on the picture and zoom in 800 percent. A close-up of the secretary’s pen fills the screen. I turn to Sara. “What’s going on in this picture?”

Sara needs to acquire situational awareness: the ability to look around and be able to answer the question “What is going on here?”

Sara looks confused. “It’s a pen?” she says uncertainly.

I click on another part of the picture. Now a grotesquely magnified fingertip is displayed. “Can you tell what’s going on now?”

Sara shakes her head.

I zoom out so the entire photo is visible. “Now can you tell me what’s going on in the picture?”

Promptly Sara replies “The secretary is working.”

“Perfect!”

I print out a copy and hand it to Sara. “Now you get the whole picture” I emphasize. And our work begins.

Fixating on one detail will not give Sara the information she needs to function appropriately in the situation.

Using a method developed by Kristen Jacobsen MS CCC/SLP and Sarah Ward MS CCC/SLP I teach Sara to STOP and evaluate her surroundings:

Space — what’s taking place around you?

Time — what time of the day/season/activity is it?

Object — what are the important things here?

People — who are the important people here?

In order for Sara to know what to do in a given situation she needs to be able to interpret what’s going on around her. Referring to the picture Sara identifies the space as the office the time as work hours the important object as the computer and phones and the important person as the secretary.

By “reading the room” it’s easy to figure out what’s going on and what’s expected of her.

We practice these skills for several sessions and Mrs. Gelbwirth does homework with Sara too. When Sara masters the ability to “read the room” we tackle the concept of time. Sara’s sense of time is poor: She doesn’t feel time passing and can’t estimate how long a task will take.

I place a large analog clock on the desk. Below a protective glass cover the hands tick merrily. “This” I tell Sara “is an hour.” I hand Sara a hat scarf gloves backpack and boots. “Let’s see how long it takes you to get ready for the bus.” We time her: five minutes. Using a dry-erase marker on the glass Sara colors a five-minute “slice” of time over the face of the clock.

We repeat this exercise with different activities. It’s fun and Sara laughs a lot. We learn that it takes five minutes to eat a piece of pizza two minutes to brush your teeth and fifteen minutes to do a math worksheet. Sara colors in a slice of time for each activity.

As our sessions progress Sara learns to better estimate the time she’ll need for a task and her awareness of the passage of time improves. Her mother is cautiously optimistic as we get ready to put all the pieces together.