A Great Speech Session

Today we had our first one-on-one ABA session with Cari. I was pretty optimistic that we'd have a good day since Raquel was pretty rested over the weekend. Gabby managed to set her off right when Cari arrived, but once we bounced her on the fitness ball for a couple of ABC song repetitions, she was all smiles.

She did really well throughout the entire session. She was frustrated at times, but stayed pretty focused for the most part. And not one tantrum. Yes! Cari commented on how great she is doing and at the end of the session reviewed some of the data charts with me so I could see how much she has progressed in just a few sessions.

Raquel was very happy to see Mary this afternoon. Mary brought her usual 3 bags of goods, and Raquel was all over them. I think she was happy to see a familiar face. Mary commented on how vocal she was and has noticed a big change in her since she saw her a week ago.

One thing that did stand out to me in the speech session was how much more Raquel "works" for Mary than her other new ABA therapists. Mary had her doing a lot of immitations. At one point, they were playing with these push cars and Mary would say, "Ready! Set!" and then Raquel would say, "Go!" and she'd release the car. During the ABA sessions, they say "go" in order to encourage Raquel to say it. Raquel was also repeating back many words and sounds to Mary and wasn't nearly as cooperative in that regard this morning with Cari. Raquel was choosing from a field of three with Mary, and only a field of two with Cari. I mentioned all of this to Mary and she said that it was very typical, that she has seen Raquel every week since mid-February and that Raquel just knows her better. She did note that Raquel is very stubborn and wants to do things when she feels like it, so that could be part of it as well. :-)

First Week Over

Well, the first week in our new program has come to an end. I have to say that it is a lot different than what we've been used to and watching your child get pushed out of their comfort zone again and again definitely takes some getting used to. But I truly feel that Elizabeth has prepared me for it. It doesn't bother me nearly as much as it used to.

Today was bad timing - again. The 11:30am - 1:30pm sessions are going to be difficult at first because it interferes with her regular lunch and nap time routines. And Raquel is all about routine. She'll soon be adjusting to a new ABA routine.

Raquel was all smiles when Janine arrived with Cari. Although noticably tired, she did really well. At one point, she had a brief tantrum and I had to leave the room, but other than that, she was pretty easy to redirect. Next week they will be implementing a play area (most likely her table & chairs we have in the living room), that she will need to sit down and do her "work" at. Today, because she was so tired, they even did some of the session in her bedroom. Ten minutes before the session ended, she fell fast asleep. Fortunately, Janine let her stay that way. :-)

Some of Raquel's accomplishments this week that are standing out to me right now:

• Imitations! Imitations! Imitations!
• Increased Speech
• Use of PECS - she'll now choose either the stroller or the car picture to indicate a morning & afternoon walk or ride
• Seeks Attention - taps me on the leg (often) when wanting something instead of whining and crying
• Is learning that if she is having an attention seeking tantrum, I will not participate in it
• Familiar People - she chooses my picture in a field of three. Gabby will be her target next week.
• Receptive Commands - such as "put in". She also now says that.

It really is an intense program and I will definitely be experiencing some challenging times. But overall, I'm very happy. Happy that Raquel is getting the help she needs, and encouraged by what I've seen her accomplish in one week alone.

My Little Rock Star

This morning, Raquel was playing in her room when Janine, Jennifer & Cari arrived. Surprisingly, she greeted them all smiles. Janine was shocked and can't believe how quickly she is picking up on things and adjusting to the program. Towards the end of the session, Cari mentioned to Janine that today seemed like a regular session. I asked her what she meant by that, and she said that it was like they were doing it with a child already in the program. Janine then got out her data sheets (where they record all activities, behaviors, etc.) and showed me how much she has improved from day one. It really was impressive. Today they put a lot of demands on her. She was minimally frustrated, and didn't have one tantrum. She's also talking a lot more. This morning she was saying, "no way", "put in", "come on", etc. It was really nice to hear.

Elizabeth called Janine this morning to see how things were going and is very pleased. She is the one that pushed this program the most, and I'm really grateful for that because I am noticing wonderful things already. Janine is right - Raquel IS a little "rock star".

Day 2 - Much Better

Raquel had a really good day yesterday. She slept really well the night before, had a great morning, had her OT session, lunch and then an early nap. I was paranoid that she would not have a nap and be overly tired when Janine and Jennifer showed up at 2pm. Instead, because she was rested, I was excited to see how she'd do in her second ABA session.

I was playing on the floor with her when they arrived. As soon as they stepped foot into the living room, Raquel immediately started a tantrum. They hadn't even put their stuff down yet. Janine then asked me to go in the other room while they dealt with it. This lasted 10 minutes, and then I was asked to come back in the room. Janine was very excited that Raquel was upset when she first saw them. She said that this means Raquel already understands their roles, something that usually takes a couple weeks.

A little while later, when I was answering questions and not giving her all of my attention, another tantrum started and I had to go in the other room again. This one lasted 8 minutes. And a little while after that, another one started but as soon as I got up to go in the other room, she stopped. They are very happy that she is catching on to that as well. All 3 tantrums happened within the first 45 minutes. After that, she was very cooperative and able to participate in the session.

Again, they are extremely excited about her being in the program, commenting on how well she is able to do things already and that they see nothing but great things for her. We'll see how today goes. This is Janine's last day overlapping for training and the one-on-one therapy will start tomorrow.

Intense? Just A Little

Today Raquel had her first "real" ABA session. The ones we've had before were pretty much play therapy and getting her used to the new therapists, although they would place some demands on her throughout the session. I was a bit concerned at first because it was taking place from 11:30am - 1:30pm and would be throwing off her lunch and walk/car ride routine. I fed her an early lunch and thought she would be okay, especially at first.

Janine came with my other new therapist named Jennifer. Jennifer seems really nice and I'm convinced that I've been blessed with some truly amazing people who are going to do great things with Raquel.

Just a few minutes into it - I don't think they even had all of their paperwork out yet - a tantrum started. Again, nothing I could do would redirect her, except for, of course, THE ROCKING CHAIR. I rocked her, she fell asleep, and then I had Janine looking at me from across the room the same way Elizabeth used to, giving me the "you-totally-just-reinforced-the-behavior" look. Janine said she would give her ten minutes to sleep, only ten minutes, and then it was time to work.

When I woke her up, she started the tantrum thing again but this time Janine told me to let it go and see how long it takes for her to calm down. She also noted certain things, such as Raquel wanting 100% of my attention at all times. If I was answering questions and not giving her my undivided attention, she got louder. Janine asked me to not acknowledge her by picking her up or making eye contact when she was carrying on. At one point, she asked me to leave the room entirely. I'm not able to do this when I'm home alone with her because of her self-injuring behaviors, but they followed her around with the pillows during this time. They asked me to come back in the room when she quieted down and to make a big celebration out of it. This is teaching her that I will only pick her up and give her the attention she is requesting when she is acting more appropriately. This went on for about 30 minutes.

Janine wants me to create an area at the end of our hallway to confine her to when she is throwing a fit, a place that is padded where she can't hurt herself and I can leave her there to cry it out and go in the other room. I'll need to work with Mike on creating this and completely agree that it needs to happen.

She also calmed down when we played the music. They did the majority of their session with music in the background but, again, Raquel needs to learn how to request it being turned on or off in an appropriate manner instead of just having a fit.

Janine implemented the PECS program today. She overlapped with Mary for speech therapy yesterday and both are in agreement as to the direction we are going. These are pictures she took, laminated, and affixed to our fridge door. They represent: cereal, applesauce, milk, juice, and yogurt, and the picture of Raquel in the high chair means "eat" in general if she wants something else.


We also have these pictures on our back door:


The stroller means she wants to go for a walk, our dog Annie is for indicating she wants to play in the backyard, and my car means going for a ride. We will be adding a few others over the next couple of days. How does this work? We were doing it today with the juice. I knew she was thirsty so Janine handed her the picture of the juice. I had her juice cup. I said, "Juice?" and they had Raquel physically hand me the picture and I then gave her the cup while praising her and repeating, "Juice!" We did this several times. Janine is also putting together a PECS book which will contain pictures of some of her favorite toys and things.

Why are we doing all of this, especially if she can already say "eat", "milk", etc? Because Raquel doesn't have consistant communication and is so easily aggitated. Janine noted today that Raquel can go from zero to one hundred in just a matter of seconds. That doesn't give me very much time to figure out what she wants. If she tells me "eat" and I grab a yogurt and she actually wanted some juice instead, there's a problem. By her being able to hand me a picture of what she wants is supposed to eliminate the behaviors, and that is truly the goal right now.

It's a lot to take in and is extremely overwhelming. Both Janine & Jennifer left today very pleased with how the session went. I was shocked. Janine calls Raquel her "rock star" and Jennifer said she is so excited to be a part of this. I'm curious to see what tomorrow brings.

Rice Noodles - It's A Good Thing

We walked to the grocery store this morning and I came across some gluten-free, casein-free rice spaghetti noodles. I made them for lunch and they only take 3 minutes to cook! If you can get past the fact that they are white instead of your typical pasta colors, they are really good. Raquel loved them and even had them after her nap for a late afternoon snack with just some non-butter spread to coat them. I'm discovering new things each day and her diet is really getting much easier. The main thing now is to make sure that I have things readily available to heat and serve. Raquel cannot always tell me when she's hungry until her hunger pains strike, and then I find myself scrambling in the fridge and pantry trying to throw something together - and fast.

Yesterday she had her first session in the new ABA program. That was different and will definitely take some getting used to. I guess that is why they are coming here every day.

To start, Raquel woke up at 5am crying, "Me mad! Me mad!" and was pretty much like that the entire day - unless she was in the car. Walks were out of the question in the afternoon because of the heat - it's been over the 100 degree range here - and she seemed to be having an off day for some particular reason. She must be teething again. Either that or the heat is making her irritable. I know it was making me easily annoyed. Fortunately, she went down for a nap before her 2pm session.

Janine & Cari came in the afternoon. Raquel was happy to see them both, but was, for the most part, very uncooperative. Janine does an immitation (such as putting her hands on her head) and then says, "You do!" and then Raquel is supposed to repeat it. Yesterday, she told her "No." Janine said, "No?" and Raquel said, "No." Janine said, "You don't want to do?" and she said, "No!" It was too cute, but very unproductive.

But this is how the ABA program differs from what I'm used to - they don't give her an inch. It was somewhat similar to what I've experienced only during Elizabeth's sessions (except they don't intentionally try to get behaviors out of her like she did), but it's still a little different. At one point, they had her sitting at her table and wanted her to do matching. After a few minutes, she started arching her back and trying her best to get away but they held her there and, hand-over-hand, forced her to do whatever they were asking - several times - before letting her get down and take a break. If she threw a toy, they forced her to pick it up and put it down nicely. If she played inappropriately with a toy, they forced her to play right. And if she hit or scratched them, they made her be gentle. If she hit or scratched me or Gabby, we were told to immediately get up and walk away from her instead of acknowledging it.

They also used bubbles as a reward. This is a new thing that Janine came up with last Wednesday when I was rocking Raquel in the chair when she was having a tantrum. She started blowing bubbles and Raquel immediately calmed down. So now, in a session, they wait until she gives them what they've asked of her before she can blow the bubbles.

Janine also took more pictures for the PECS program. It will definitely be implemented next week but I think she wants to wait until after she overlaps with Mary for speech therapy on Monday afternoon.

We've got a really busy schedule next week. It'll be interesting to see how the first week of daily therapy goes. I'm still remaining pretty optimistic.

ABA Program - Very Encouraging

Yesterday was Raquel's official start day in the new Applied Behavior Analysis Program. I didn't know what to make of it, and was very concerned about Janine showing up at 2pm and interfering in Raquel's ususal nap time.

I tried to get her to sleep before she got there, but was unsuccessful. She was very tired and cranky in the beginning, and when Janine brought out a green, hopping toy, Raquel freaked out and started a tantrum. We both tried to calm her but nothing would help, so I rocked her in the rocking chair and she fell asleep in my arms. Janine says we'll be working on that. :-)

While she was asleep, Janine spent time going over this thick 3-ring binder with divider tabs and charts and stuff. It basically details Raquel's program. Now I know what Elizabeth meant by intense.

When she woke up, Janine was able to do some therapy on her and Raquel did really well. Janine was very impressed with how much she is able to do already and took my 3-ring binder with her to make some program adjustments. Raquel was doing imitations and matching items. Janine commented that she will do great in this program and is very excited to be part of the therapy.

The program is also going to be a tremendous help to me. Yesterday, I was in the kitchen and Raquel started whining. She wanted a snack. Janine told me that Raquel needs to get my attention in more appropriate ways - tapping me on the leg, for instance - instead of the crying and whining. She also observed some of the hitting & scratching during her tantrum and told me that will be coming to an end very soon. What great news.

Janine will be implementing the Picture Exchange (PECS) program as well. She took a few pictures yesterday - of milk, juice, yogurt, applesauce, and some of Raquel's favorite things. We'll start that tomorrow. She is also overlapping with Mary in speech therapy on Monday to make sure everyone is on the same page.

Janine will be coming all next week with Raquel's two new therapists: Jennifer, who I have not met, and Cari, who was here on Monday and is Elizabeth's sister-in-law. Janine is going to be the "bad guy" at first and the one to put all the major demands on her. This will allow Raquel to bond with her two new therapists. After next week, Janine will only come once per week to check her progress. She told me to prepare for the worst but after working with Raquel yesterday, really doesn't think it will get too bad. One can only hope!

And More Good-Bye's

This morning Elizabeth came with Jane, Janine & Carrie. Raquel did pretty good on her assessment tests - much better than I thought she would - and everyone was very encouraged by that. She was stacking and coloring, of course, briefly, but was doing really well. Janine is the one that will be supervising her in the ABA program and pretty much observed and asked both me & Elizabeth questions, and sometimes made suggestions. I think she is going to be great - really great.

And then I found out that this was Elizabeth's last day. She wasn't given the 2 hours a month that she thought she would. This was really hard. I know I've said many times that Elizabeth rocks, because she does, but not having her now is so sad for me. No one but us (and Gabby) know how much we talk. She has helped me overcome some really difficult situations with Raquel, and she is the one person that was always there for me during the darkest times, when I was ready to give up. First Wendy, and now her. When you have someone in your home on a regular basis, especially working and bonding with your child, it's hard to adjust to new people and all the changes.

And then I went to physical therapy at the park. Trish was so happy to see so much progress in Raquel. But when we went to leave, we realized that today was her last day, not the 30th.

We did have a really great speech session today. Mary hasn't seen her for two weeks and noticed so much progress. That's wonderful.

Here are the good-bye pictures I took - on my cell phone. I'm not nearly as good as Mike on that thing but these are better than nothing!

Saying Good-Bye to Wendy

I knew the day would come when Wendy would have to leave us but never thought it would be this hard to say good-bye to her. All of Raquel's therapists are wonderful, it's just that Wendy & Raquel really have a special bond. Raquel is always happy to see her "friends", but her face truly lights up as soon as Wendy walks through the door. Most times, Raquel would be happy with sitting on her lap cuddling instead of playing.

Raquel worked really hard in OT with Karin today. She was wheelbarrel walking in five second intervals (that may not seem like a lot but you try it!), and Karin commented on how much she is changing. Her finger grasping, although stronger on her left hand, is improving. She no longer gets frustrated doing the puzzles because of this. And on other tasks, when frustrated, she now will take a quick break on her own and calm herself before coming back to finish. She also is smashing open the plastic egg shells. Karin said that she is much more "mentally organized" and is acting a lot like a toddler should be at her age. That was great to hear. I also noticed that the dialog changed today. Instead of "no mouth", it was "If you put this in your mouth again, we're all done." And Raquel listened. She also talked a lot more and Karin noticed that as well. She's very encouraged about her being on the GFCF Diet. So am I. It's getting easier each day.

A couple things that we're still working on: strengthening her "extensors", which I think are the muscles on the back of her arms & back. We do this by continuing to have her stretch and reach in different positions, usually on the exercise ball, or when she's doing the wheelbarrel walking. She also wants her balance to improve. She said today that she sometimes walks like she's in a pinball machine, especially when she's tired. She said that this will also improve when her core continues to strengthen. It also has something to do with the "vestibular inner ear", but I'm not even going to attempt to describe this one. I probably didn't even spell it right.

Right before she left, Raquel became really aggitated and started the hair pulling & scratching. Nothing would calm her but the good news is that as upset as she was, she only threw herself back once, which is huge. Once she left, I gave her some lunch but she still seemed tired from all of the OT. She really did work a lot today. I was proud of her.

Then Wendy came. She asked if I heard from anyone and I told her yes. She said, "So you know this is my last day?" and I said yes. She then just went to Raquel and hugged and hugged her. Therapy was different today because I knew she was leaving. Mike came home at lunch and all of us just pretty much talked while they played. Raquel was still pretty tired from OT and didn't want to play as much as usual, but for the most part was very cooperative.

Of course I was in tears when she left. What I couldn't say was: Thank you, Wendy, for taking such great care of my girl(s) and for giving me so much encouragement. You will be so very missed. Every time I do a "nose kiss" I'll think of you. I'm glad you'll be reading my blog.

Preparing For Changes

Elizabeth came yesterday but didn't bring her sister-in-law as we previously discussed. She also didn't do any ABA assessments. Next Monday, she'll be coming with her boss, Jane, and one of my new behavior therapists, Jeanine, who is going to be taking over Elizabeth's role as team supervisor. Jane is coming so she can answer all my questions - such as the exact start date, program details, when my new physical therapist will be starting once Trish leaves this month, etc. Jeanine will be here because she wants to observe how Raquel works with Elizabeth. She also wants to take part in the assessment tests.

Elizabeth spent a good portion of the session preparing me for the program. She thinks it will be implemented next week. Since the initial part of the program involves a parent training component, I mentioned to her that I planned on taking vacation during this time so I wouldn't be distracted by work. She said that in the beginning, it will be pretty much play therapy, where the new therapists are just getting used to Raquel and Raquel is getting used to them. They won't be implementing too many new things and will only be putting small demands on her. That gradually increases. She said that three to four weeks into it is when it gets really tough. This is when Raquel will start to resist the therapy and the behaviors will come out. This is when she recommended that I take some time off work. Even though she said it gets worse before it gets better, it does get better, and that my new therapy team will be constantly reminding me of this as well as pointing out Raquel's progress.

At one point during our session, she stopped and said that I seemed very overwhelmed. Elizabeth is the one that attempts to keep me grounded. She said that joining the TACA group (www.talkaboutcuringautism.org) will be really great for me and that I will meet so many wonderful people that are going through the same thing and are feeling the same way. My first meeting is on the 26th. I figure it can't hurt to at least try it out.

She also prepared me for the assessment tests - prepared me for Raquel scoring low and not to freak out about it, that they are tests they are required to do before she starts in order to accurately track her progress. She really thinks that she will do extremely well in this program. Elizabeth was able to keep two therapy hours per month so she'll be able to come once per month to check on our progress. I'm thinking next Monday is going to be her last day for awhile.

ABA Program - Confirmed

Elizabeth just called and told me that Raquel will be switching to the Applied Behavior Analysis Program - probably on the 23rd. Tomorrow, Elizabeth will be "shadowed" (observed) by her sister-in-law, who will be one of Raquel's new behavior therapists. Elizabeth is doing her ABA assessments tomorrow - a couple of tests done at the start of the program so they can track progress. It sounds like she will have a team of three, one coming two hours five days a week, in addition to her regular speech, occupational and physical therapy schedules. Thursday will be Wendy's last session. It will be really hard to say good-bye to her and I am so sad we have to.

I am feeling extremely overwhelmed right now, but happy for Raquel at the same time. I just want her to get better.

Wanna Go For A Swim?

I know I'm partial because she's mine, but isn't this really one of the cutest pictures you've ever seen??!!! There is no question that Gabby is the big ham in the family but I'm beginning to wonder if Raquel is following in her sister's footsteps. Again, taken from Mike's cell phone. He takes some really great ones on that thing!

I walk the girls every morning - actually 2-3 times per day - but this morning Mike joined us and we walked to the grocery store about 1.5 miles away from our house. We have this sit-n-stand stroller now and if Gabby's in it, I'm pushing 70 pounds between the two of them. Talk about getting in some cardio on the hills! My hamstrings were on fire! I know my friend Alice is pleased about that. :-)

I finally got the report from Regional regarding Raquel's evaluation. Last Monday when I called my service coordinator, he asked if I wanted a copy of the report. DUH! Of course I did. It wasn't very enlightening - basically just stated everything I mentioned when she had the evaluation: she didn't want to play with their toys (because they were gross), she didn't like being confined in the room (I didn't either), she interacted much better with Elizabeth than the psychologist (that's a given), etc. etc.

This is the psychologists' summary and recommendations:

"Direct observation and parent report have identified some symptoms of an Autism Spectrum Disorder in most relevant areas. Intensive in-home early intervention services are recommended. Re-evaluation following a stable period of participation will be important to monitor Raquel's progress and clarify diagnostic issues. "

I interpret this as her recommending the Applied Behavior Analysis program (because she stated "intensive" and that is how everyone seems to describe ABA.) Hopefully this week I'll at least know what direction we are going in. I know it may take a few weeks to line up new therapists and all, which is why I'll keep calling Regional to make sure the paper flow is still moving. Her evaluation was taken on May 16th and 3 weeks later, I still have no answers. It can be very frustrating. At least we continue to see progress with her and that helps. It's just the not knowing part that drives me crazy.

Just the Cutest Thing

Even though she is really difficult at times, Raquel still is one of the cutest things I've ever seen in my life. Mike took these pictures from his cell phone tonight at the dog park. They were too cute not to post!

Today Karin came for occupational therapy. OT is a lot of work - for both Raquel and myself. I always feel I have the most "homework" from Karin compared to all the other therapists. She is also very technical and uses terminology that I don't understand and usually cannot translate it well enough to be able to google it later, which I'm getting pretty good at these days! Elizabeth says that most OT's talk this way and that I just need to keep asking for clarification. Karin still talks about how her "wirery movements" continue to improve. I have no idea what she is talking about - and she doesn't refer to them as that - but I'm just happy she's seeing improvements. She was also very pleased with the fact the Raquel now bounces herself on the exercise ball and requires little support while doing so. This means her core is getting stronger, which has been a goal for not only OT but PT.

Raquel worked very hard today with Karin. She had her doing many exercises to strengthen her arms and shoulders, by stretching and reaching in awkward positions on both the exercise ball and bean bag. She wasn't very cooperative with the wheelbarrel walking, but Karin wouldn't let her give up and kept going. She was visibly frustrated but easily redirected and I can only recall one time that Karin took her to the ball to blow some energy to prevent a tantrum from occuring. This is good news. She also had her sitting on a pillow during floor exercises. This forces her to sit up straight and, again, works on strengthening her core muscles.

I also spoke with Karin regarding the gluten-free, casein-free diet. She said that she has several autistic kids that have implemented this diet and she has seen huge improvements in them. Karin says that one child in particular seemed to be released from a "food coma" after starting the diet. Karin has bad allergies and is also on this diet herself. She encouraged me to keep doing it and says it gets much easier. When she was leaving today, I started boiling Raquel some Quinoa for lunch (corn pasta noodles) and she was giving me some pointers on how to cook it. I'm going to look for a cookbook and start meal planning. It appears that the whole family will need to go on this diet for it to be 100% effective. It's too hard having the things Raquel can't have in the house. And if she sees Gabby eating a graham cracker, let's just say it's not pretty!

Wendy didn't come today, which I think was a good thing because Raquel was very tired after the OT session. She plans on coming for a longer session next week.

The GFCF Diet - Not So Easy

I started Raquel on the gluten-free, casein-free diet on Saturday, after Mike and I went to Henry's Marketplace to stock up on food. Let's just say, it's not as easy as it sounds. I picked up some animal crackers labelled "gluten-free", for $6.99 mind you, and it turns out that they are in fact, made with wheat. So, I'm learning that just because it may be labelled gluten-free, that's not necessarily the case. And, just because something is gluten-free doesn't mean it is casein-free. It is also extremely important to plan meals. It's not that easy to grab something out of the pantry anymore.

Why the diet? The theory is that most autistic kids have weaker immune systems and digestive problems. This allows food proteins to pass through the bloodstream partially digested, particularly gluten (wheat) and casein (milk & dairy products). These then form peptides which have an opiate-like affect, causing harmful affects on the brain. Opiates can either cause or magnify autistic symptoms. You can learn more at http://www.gfcfdiet.com/. According to many, simply eliminating these two things can reduce symptoms, sometimes entirely.

I spoke with Elizabeth about it yesterday during our session. She has seen big changes in one of her "kids" after going on this diet. She will be going to the next meeting of the organization I just joined called Talk About Curing Autism. She said I'll meet many parents who are doing the diet. She told me that this particular mother orders a lot of the food on-line because it's cheaper and easier to find. Reading labels at the natural grocery store is very time consuming and was nearly impossible with Raquel with us on Saturday. I've also read that it's easier to start the diet in stages, removing casein first then gluten a couple weeks later. That is supposed to help reduce withdrawal type symptoms.

Therapy went well yesterday. Raquel was happy to see Elizabeth, but again, wasn't too interested in the toys she brought. We did some deep joint compressions which Raquel loved, and she was pretty happy the entire session. Elizabeth asked if I had heard from Regional, which, of course, I haven't, so I called my service coordinator while she was here. He said that the report from the screening has been received at the main office but that's about it. He said he'd send me a copy of the report as well as forward one to Elizabeth's boss. I still don't know if she's been approved for the new ABA program or if she's been given additional therapy hours. Hopefully over the next week I'll have some answers. I don't want to waste valuable time.

We did physical therapy at the park again, which went great. Trish was extremely pleased with her progress and told us to keep up the good work. She did tell me that she has given notice and will no longer be her therapist after the end of the month. She is moving back to Northern California to be near family and has accepted a wonderful position up there. I'm happy for her and am hopeful that we'll be able to have her replacement lined up before July starts.

Speech therapy went as expected. Raquel was very happy to see Mary but after about 45 minutes, she started getting bored and going to her room. She seemed very tired - I think the park wore her out a bit. Mary and I continued playing in an attempt to get her back in the living room, but she wanted no part of it. She eventually came out and Mary was able to complete her session. She wants us to continue with the nursery rhyme animations and keep repeating words we think she is saying. Mary is off next week so we won't have another speech therapy for two weeks. She would like Elizabeth to overlap on that session if possible, so I'll talk to her about it next week.