This was Josh's status as of his entry into The Hughes Center in April, 2010. It is no longer applicable.
Josh's primary need is to be in a group home.
Some additional needs, which could be addressed properly in such an environment, are:
We often get the impression that Josh's acting out is due to physical pain, possibly just a headache or possibly dental. We have absolutely no way of determining this. I used to give him neck-massages which seemed to calm him down, but this could have been purely because it feels nice to have a neck-massage whether or not you have a headache. We also can't see any visible indication of tooth problems, but it is very hard to get him to open his mouth; even brushing his teeth regularly is a battle.
Obviously it would help if he could communicate when something was hurting, but I don't know if he can be trained to do this at this point. I've heard that there are "tricks" one can do to get medical clues from a non-communicative person; Josh really needs to be regularly looked at by someone familiar with that sort of thing.
The most important life-skill Josh could use at this point would be some way to indicate what he wants. His current methods of indicating that he wants something include:
- "hovering" around the office (to get our attention)
- whacking one or both of his brothers (so someone will get up and notice that his juice is empty, or other things; sometimes we can't figure it out)
- random vocalizations (we encourage this one over the others, as it is more communicative in nature)
There are a variety of methods Josh could use to indicate what he needs without having to use verbalizations (e.g. pointing, or taking someone by the shoulder and leading them); he seems unable to do any of them, though perhaps training could help with this. At school and other places, he often is given picture-cards as a way of informing him of the day's schedule; I don't know if anyone has made a serious effort to get Josh to indicate choices using similar cards. (2006-06-25 Update: Yes. Read this.)
Completing his toilet-training would also be helpful. He seems to have grasped the concept of wiping, but he still expects others to do it for him if they are around (and when they are not around, he tends to use the entire roll of toilet paper and all the moist-wipes).
Josh sometimes displays surprising skills and awareness. Just now (2008-01-20) he accidentally knocked over a box of (plastic) Christmas ornaments – and then spontaneously started picking them up and putting them back in the box. He did it very efficiently and thoroughly, even spotting an extra hook on the ground. After that, he apparently started pulling ornaments off the tree and putting them away too, so we had to hide the box... but now we know that he'd probably enjoy helping with that task when we're ready for it.
Later that day, after we made him come in from a walk (in the freezing cold) that wasn't as long as he wanted, he attacked the kids and me -- punching me in the shoulder and slapping me in the face.
Recent behaviors that have become a problem: leaving fridge door open, crying in middle of night when he loses member of either of his current Groups.