Not Necessarily A Lefty

I've been convincing myself that Raquel is going to be left handed. She is consistently throwing with her left, her grasp is stronger with her left, and during the ABA sessions, when they do the put in trials and have the ball on her right side, she'll pick it up and put it in her left hand before putting the ball in the cup.

I mentioned this to Karin during our OT session and she said that Raquel still wasn't making a preference, which Karin prefers. It's something about both sides of the brain communicating. That's why Dr. David liked her crawling for so long - the brain thing. Karin said that it has to do with crossing midline, that if she had a left handed preference, she wouldn't pick the ball up with her right and transfer it to her left, she'd pick it up with her left hand at first. Again, the OT thing - very technical.

We had a good OT session this morning. Raquel has been difficult for the past few weeks during her OT sessions so I made sure we had a normal routine today. She was all smiles for Karin, and the happiest I've ever seen her throughout the session. Karin said that Raquel has had such a growth spurt, that she's not only much heavier but also taller. I've noticed the chub on her legs, too, and have had to get out bigger clothes. She thinks it is also related to her gfcf diet and said that she has seen a lot of changes in her since I put her on this. Very nice to hear. I see her 24/7 so I'm not always able to notice subtle changes.

During the wheelbarrel walking, Raquel is still walking with a closed hand. I asked Karin if I should be making her palms flat and she told me no, that it was all about just strengthening her arms. A little bit later, after observing Raquel taking a break, she picked her up and took her in our kitchen to try the wheelbarrel walking again. Raquel immediately put her hands flat on the kitchen floor. Turns out, it's a sensory thing with the carpet - she doesn't like the feel of it on her hands!

The sensory stuff is still fascinating but way complicated for me to completely understand, even though I have books about it. Karin said that there are three responses to sensory stimulation:

1. Tactile (sense of touch): The sensory system that receives sensations of pressure, vibration, movement, temperature, and pain - primarily through receptors in the skin and hair. Protective receptors respond to light or unexpected touch and help a person avoid bodily harm; discriminitive receptors provide information about the tactile qualities of the object or person being touched.


2. Vestibular (balance & movement): The sensory system that responds to the pull of gravity, providing information about the head's position in relation to the surface of the earth, and coordinating movements of the eyes, head, and body that affect equilibrium, muscle tone, vision, hearing, and emotional security. Receptors are in the inner ear.


3. Proprioceptive (position sense): The unconscious awareness on sensations coming from one's muscles and joints that provides information about when and how muscles contract or stretch; when and how joints bend, extend, or are pulled; and where each part of the body is and how it is moving.

Raquel has issues with all 3 sensory senses, which is why we do bouncing on the fitness ball, deep joint compressions & squashes, and the jumping. I don't know which one helps with what sense, but it seems to be working.

We had a much more cooperative session with Jennifer today. Meet our latest reinforcer:

A $3 Hannah Montana phone from Big Lots. It was actually too reinforcing - Raquel wanted to play with it constantly and was very distracted by it. That's what I get for trying to help! Jennifer said that the novelty will wear off over the next couple days. Raquel was, again, very vocal throughout the session and also doing some very functional playing on her own, which Jennifer really liked to see.

And we had big excitement during our session:

Gabby lost her first tooth! She says the Tooth Fairy will bring her $100. I told her I thought it was 100 pennies - but she keeps insisting it's $100...

More Vocals Today

Today started out with Raquel waking up at 5am. She was very happy, extremely affectionate, but then by around 7am was not enjoying herself. We played "I'm Yours", (yes, it can start this early), and then Mike took them out to run some errands, which was a really nice break for me. When he came back, she went to sleep and was still sleeping when Jennifer arrived at 11:30am.

She was talking up a storm during her session with Jennifer and doing a lot of functional play, but wasn't interested in participating. Because she was trying to escape during her trials, she was not able to move up as I was hoping. Now, since she scored low because of this, she will again have to score higher a few days in a row before they can attempt to move her on. This is the frustrating part for me because I know she can do the things they are asking. I watch her do them day after day. She just wants to do them when she feels like it.

Part of the problem is the toys. She's getting bored with them. After the session today, I went to Big Lots and bought a few things that will hopefully be a little more motivating to her. We'll find out tomorrow.

I also heard from Regional. It's time for Raquel's mid-year review. Ken will be coming next Monday to observe her speech session (Janine is overlapping with Mary so I wish he wasn't going to be here) and then after the session, me, Janine & Ken will have the review.

Start Of An Interesting Week

Little Miss Raquel can be quite puzzling to all of her therapists. She's just a difficult piece of work to read sometimes. Strong willed probably does not say enough.

Today, during Cari's ABA session, she started the "you do" in vocals. She's been saying "you" and "do" consistently over the last week and a lot over the weekend, so I knew it was just a matter of time. Now she can put them all together: "No way - you do." She is beyond stubborn. Again, very cute when she does this - especially when you factor in the smirk on her face or the twinkle in her eye - but at the same time, very unproductive therapy wise when she's being so non-compliant. Non-compliant. Now I'm starting to sound like a therapist. :-)

Besides her rebellion, she did pretty good with Cari and she actually wants to move her up on three programs: familiar people, non-verbal imitations, and receptive commands. Yes! I love when they move her on, even if only slightly. Hopefully Jennifer will agree with the change tomorrow. And hopefully Raquel will be cooperative so she can move on.

Raquel was very happy to see Mary for her speech session. I told Mary how stubborn she's been during the ABA sessions in regards to vocal imitations. Mary wants me to identify a couple of items that Raquel absolutely loves so they can use these to entice her. During ABA, we want Raquel to say "open" when they open the toy box. Even the sound "O" would work. Mary gave me suggestions last week of things I can do around the house to help with this, such as keeping her bedroom door closed and requiring her to say "open" when she wants to go play in her room - or at least make an attempt at it by saying "O". Mary was also telling me that when she has therapy in the classroom (she also works for the school district), she has several boxes for just "up & down" so she can rotate and keep the kids engaged. She said she knows it's hard to rotate like that but when you are dealing with a child like Raquel who gets easily bored and distracted, that's what you have to do sometimes.

During Mary's session today, she brought this little toy chest of drawers. Inside she had a few pieces of cereal so when we shook it, it would make noise and keep Raquel interested. Mary is always very animated and we were taking turns saying "open" while playing with the chest. Raquel said, "O" and Mary said to acknowledge that as her interpretation of "open". We opened the chest, she had a couple treats but was pretty much not interested in this particular play. I told Mary that I had just given her a snack before she got there - I like her to have sessions after she's eaten so the hunger factor is not an issue - so we moved on to other things. And she finally fed Mary's bunny puppet today while saying "put in"! She's usually not too interested in that thing.

Towards the end of the session, Raquel wasn't participating as much as usual. When this happens with Mary, we ignore Raquel and engage in some activity by ourselves. Raquel then will typically come back to us after a few minutes of watching us having fun. Today, instead, she decided to sneak a treat from the toy chest, since we weren't paying attention. She not only opened the drawer, but then closed it, too. If it wasn't for hearing her crunching, she probably wouldn't have been caught. But as soon as we heard her and looked in her direction, she was all smiles. Mary then went back to the toy chest and resumed the "open" imitations. Raquel was consistently repeating "O" and getting her treats, but then it started to change. She started saying, "Pen" after Mary would say, "O", like she was finishing the word. She did this several times. Mary wants me to monitor this as well as inform the ABA team. If this is the case, she says that Raquel has great phonic (or something) awareness.

A Fun Day

We packed the girls up this morning and headed to the Wild Animal Park. We had a great time - and what a beautiful day.

Raquel is starting to really enjoy the carousel rides.

And loved it when Gabby fed her some of her yummy fruit smoothie.

It was great for us to get out of the house and do something fun as a family. The girls had a wonderful time and Raquel laughed and laughed all the way home. Right now, it's really easy to get consumed by all of her therapy, especially for me. That's why it's so important for our sanity to make sure we take time for ourselves, like we did today.

A Three Day Break

Cari is on vacation tomorrow so we technically have a therapy 3-day weekend!

This week has been interesting. Monday, Raquel wasn't very vocal with Cari, and Cari even asked me to speak to Mary during speech about ways to increase her talking during the ABA sessions. Mary suggested rotating toys to keep things new. But that's a problem because there are a lot of toys already involved and a whole lot of trials, so it would probably take one person just to set up the whole toy rotation alone if we went that route. Mary also again noted that Raquel is very stubborn and wants to do things when she feels like it, and that the ABA program is about keeping a routine - something that will prepare Raquel for with school. She has to learn that things can't always be on her terms.

Tuesday, she had an awesome session with Jennifer. Again, the 11:30 - 1:30 time slot makes me nervous, but I have to tell you that after this week, I will no longer have anxiety about it. She was talking up a storm and very cooperative, even though very tired. Jennifer commented that this was the first session that SHE ended - usually Raquel will become aggitated and she'll have to stop. Very encouraging!

I went to the office on Wednesday morning for a production meeting and came home, an hour later, to pure madness. Karin was just trying to start her OT session. She was off last week so we aren't sure if Raquel was just thrown off by an ABA therapist not being there when there was a knock on the door or what, but it just wasn't pretty. I played "I'm Yours", got her to calm down, and then she actually was able to have an okay session with Karin.

Janine overlapped with Jennifer on Wednesday afternoon and we are now doing part of the session outside in Raquel's swing. She's able to get in some of her "ready, set, go's" as well as waving and pointing. It also helps with her sensory processing. Once we were done swinging, Raquel was much happier - and more vocal. Janine also brought new pictures for familiar people, and Raquel is doing much better at picking out Gabby in the rotation.

Janine filled in for Cari today. Raquel still gives her the "look" from time to time, but doesn't cry when she walks in the door anymore, and today was actually pretty cooperative with her. She scored really well on several trials and Janine is hoping that she will be moving up on some of them next week.

And one mystery is solved. Raquel has been saying "Amy" for the longest time. Mary has asked me who Amy is, a sister, aunt, friend, etc. We don't know any Amy's in our family. The other day, Mike had Raquel outside and our dog came up to Raquel. She patted her back while saying, "Amy Doog! Amy Doog!" The translation: Annie Dog - our beautiful, black lab. Now that we've acknowledged "Amy" as Annie, Raquel will say her name when she hears her barking or when she sees her. I now understand why Mary stressed the importance of confirming the speech. She wouldn't use it consistently until she knew we understood what she was saying.

Introducing ... Amy Doog! :-)

Music Therapy

Tonight, Jason Mraz is playing to a sold out crowd at Mile High stadium. When he performs "I'm Yours", I wish everyone could know how much this song has helped with Raquel's therapy!

One of the things I've never touched on in this blog is how much Raquel responds to music. Certain songs are calming to her. One of our goals is to have her be able to go to her little boom box and push play all on her own when she knows she needs to calm down. Needless to say, we are far from being at this stage so we have to do this for her.

Our neighbor, Toca Rivera, who is actually considered part of our family, travels the world with Jason. A couple months before the new album came out, he brought us the dvd of their first single, "I'm Yours." Gabby, being Toca's biggest fan, must have played that thing a million times and Raquel immediately took to it.

Gabby & Toca (ya think she kinda likes him?)

Raquel & Toca - she loves playing with his jewelry!


Even though the ABA sessions are going really well, there's usually a couple times during the session that she gets extremely frustrated and needs calming. Sometimes, moving on to a different task will distract her. Sometimes bouncing on the fitness ball will work. But when she is unconsolable, it's time to play "I'm Yours." She even has a PECS for the radio. As soon as she hears the start of the song, she immediately stops whining/crying. It's amazing. We take turns dancing with her and by the time the song has ended, she's ready to work again. The other day when Janine was overlapping with Jennifer, the cd was locked in Mike's car and Janine ran out to her car to get her copy - they are all buying the album! And yesterday, at the end of Cari's session, Raquel was able to complete her sitting program by me playing the song. It really is our secret weapon.

Thanks for writing such a great song, Jason! Enjoy listening everyone. The first is the video version and the second is a live show. And don't forget to go buy his latest album, "We Sing. We Dance. We Steal Things." It's a great, makes you feel good album. Just ask Raquel.

First ABA Team Meeting

Last night we had our first ABA Team Meeting. These are going to be held monthly from this point forward. I couldn't believe it was going to take 2 hours, but it actually went a little over that.

After her regular session ended and they recorded all of their data collections, Janine, Jennifer, Cari and myself basically sat on the floor and talked about everything going on and reviewed her progress. They got out Raquel's binder and reviewed it section by section, with Janine making adjustments as needed. It's important to have these meetings so all therapists are on the same page and are remaining consistent throughout each session. It also gives me a chance to ask questions as well as provide them with my feedback. Janine said that now that she is off and running in the program, the therapists will be leaving notes for each other, detailing specific methods that worked and didn't work as far as getting Raquel to perform her tasks. This continues to be an ongoing challenge. Raquel gets easily bored with specific items and if you don't have something else to interest her, she's very uncooperative. Janine says this is a good thing - they like seeing so much personality - they just need to figure out what works and what doesn't.

Raquel's ABA Session consists of the following:

• Body Parts - right now we're doing "tummy"
• Drawing
• Hi/Bye
• Intraverbals - the "ready, set, go" stuff
• Familiar People - she's doing Gabby in a field of 3 now
• Matching
• Manding for Reinforcers - indicating a choice of 2 items
• Manding for Attention- tap arm/tap leg
• Non-Verbal Immitations/Gross Motor - today we start with tapping table
• Non-Verbal Immitations/Objects - shaking maracas
• Oral Motor Immitations - open mouth
• Pointing
• PECS
• Receptive Commands - put in (such as ball in cup)
• Sitting - the goal is to eventually have her sitting at her table for the entire session
• Toy Play
• Verbal Immitations

Raquel is asked to do each program at least 5 times (more if possible). Once you factor in the time it takes to do this, not to mention all of her "no's", it can make for a pretty exhausting session. Intense is definitely a good way to describe the program.

Towards the end of our meeting, Mike was able to sit down with us and go over his concerns - the main one being that Raquel wants my constant attention and will literally follow me around the house, room by room, usually crying. Janine explained to him that properly asking for my attention is one of the things they are working on, and that we've already noticed big improvements with her not only tapping my leg, but also during the sessions. When we first started, I had to be next to her at all times. Now I can go in the other room briefly before she comes looking for me. She also said that a lot of what is going on with her is nothing more than separation anxiety, which will go away with time.

I know we have a long way to go, but am so fortunate to be involved in this program and surrounded by such truly amazing people.

Not So Vocal Today

Raquel was pretty quiet today. She's still cutting molars and has been pretty miserable because of that so maybe her discomfort was interfering with her talking.

She had a good session this morning with Cari. She is just so stubborn and does not like having to repeat the trials over and over again. But that is required of the ABA Program. The problem is that she scores lower than she should because we all know she can do something - and she'll do it 2 or 3 times in a row - and then the next time will reply with, "No way". Even though it's pretty cute when she does this, it's very frustrating. For instance, the interverbals. They now require Raquel to say "go" during the "ready, set, go" section. Before, they would acknowledge any sound Raquel would make. Now she has to say it first - and she won't sometimes, just like today. She would say, "no way", "come", "more", "come on", but not go. When Cari would move on to something else, then Raquel would start saying "go". It's like she's taunting us - and she probably is!

She was really happy to see Mary when she arrived this afternoon. But, again, not very talkative. Mary commented how she just wanted to do her own thing today. Then Mary got out the balls. Raquel absolutely loves playing ball and this is how Mary typically ends each session. At one point, Mary started immitating Raquel's actions and Raquel got irritated and said, "Go away!" It was so funny. And then she started talking more. Mary has a way of bringing out her communication, even if only briefly.

The hardest part with all of this is still trying to figure out what Raquel wants. Yesterday, Mike left at 5am to go fishing and just him not being here when Raquel woke up in the morning completely threw off her routine and made for a very intense day. The PECS Program is supposed to help with all of this but I have to say, I'm having issues with the PECS. I don't understand why she has PECS for words she is already saying. I asked Mary about that today and she said that she thinks they are trying to get her to be consistent with the PECS process - Raquel coming up to me and handing me a picture of what she is trying to communicate. Wednesday night we have our first ABA Team Meeting after Raquel's session. This is where Janine, Cari & Jennifer sit down with me and Mike for two hours and review her progress to date, and answer any questions/concerns we are having.

One great thing - Raquel is consistently coming up to me and tapping me on the leg when she wants or needs something, such as a diaper change or a cup of juice. The crying and whining are decreasing in this regard big time so that is very encouraging.

Therapy Week Off To A Great Start

Raquel had a pretty challenging weekend (was cutting molars), so I didn't really know how she would react to the start of her new week. I commented to Mike on Sunday night that I almost wished Janine wasn't coming for her first weekly session because I didn't want to start the week out all stressful, especially after the weekend she had. Sorry Janine!

Janine overlapped with Cari again. Raquel was happy to see them - well, Cari - but only wimpered a little when Janine walked in. Then she just gave her what Mike calls, "the stink eye" from across the room. It was very apparent that Raquel identifies Janine as the "bad guy", but eventually does warm up to her. Yesterday, it took about ten minutes and she was sitting next to her.

Raquel was in her throwing mood yesterday. Her throwing is different than what it was at the start of her original program when anything placed in front of her would be chucked in any given direction. Yesterday, it was kind of her way of saying she didn't feel like participating in that particular trial. But again, this is ABA, so everytime she did it, Cari would make her pick up the object and put it down properly.

Despite the throwing, she had another really great session. She continues to be more and more vocal, which is wonderful to hear. And she really seems to enjoy this program. She has her favorite demands and is very stubborn, but overall I think she likes the routine - so far.

We had the most AWESOME speech session yesterday afternoon!!! Besides TONS of talking and verbal immitations, Raquel was doing the most functional play!!! At one point, Mary brought out her "mystery box" and Raquel would peek inside to see what she wanted. She pulled out a little train, then got up, walked to the kitchen and began pushing it on the kitchen floor. I know that may sound pretty trivial, but it was actually HUGE! It didn't go in her mouth, it wasn't thrown, it was used the way it was intended to be used. Then Mary gave her a big train that had a spinning blocks on top, and Raquel started crawling on the floor pushing the train, and then putting the spinning blocks where they were supposed to go. She was stacking, putting things in, and just doing pretty much whatever Mary asked of her. And when Mary left, Raquel waved good-bye to her. Sorry ABA Team! I know you have a program for this...

Raquel woke up at 5am this morning and then fell asleep at 11:15am - 15 minutes before her session with Jennifer. Jennifer started filling out her paperwork , and then I had to wake her up after napping for about 20 minutes. Despite being tired, she did good. She wasn't as cooperative as the last time, but was still pretty vocal and was doing her tasks. One time, Jennifer was scoring her attempts (and giving Raquel a break) and Raquel went up to her and said, "Play." Jennifer said, "You want to play?" and Raquel said, "Put in." Jennifer immediately got the cups and balls and they started doing the put-in trials. It was really nice to see her effectively communicating.

Tomorrow she has occupational therapy in the morning and then Janine & Jennifer overlap for the 2pm - 4pm session.

More Progress

Raquel is really doing well in her new ABA program. I am truly amazed at the changes I am seeing in her. It is so encouraging.

She had an awesome session with Jennifer on Tuesday. Again, the 11:30am - 1:30pm time slot makes me a little nervous, but Jennifer knew exactly how to handle Raquel and it wasn't even an issue. She was doing tons of imitations and was extremely vocal throughout the entire session. Jennifer was very pleased.

Yesterday, she didn't have a very good OT session, which was kind of surprising to me. Karin noted that even though she was doing the demands placed on her, she just seemed overall pretty stressed out. I asked her if she thought she could be tired from all the therapy and Karin said that was a possibility but also said that it could be that she's just trying harder to attempt things and is getting more frustrated at failed attempts. Karin will be overlapping with the ABA session in another two weeks, and I'm looking forward to seeing how that works.

This morning, Janine came with Cari. Raquel was all smiles when Cari walked in but started crying immediately when she saw Janine. This became a full on tantrum, her first of the week, with Raquel actually biting me (this is the first time EVER - and I'm not 100% convinced it was intentional), and I ended up having to leave the room. The tantrum lasted 15 minutes. Janine noted that it was directly related at her and is happy about that (meaning she is more connected to Cari & Jennifer - which was the goal for the first week).

Besides the tantrum, she had a great session today. She'll now pick Gabby in a field of three, she's matching in a field of three, and she's picking specific items in a field of two. Her receptive commands (such as "put in") scored at a 66% independent level (meaning they didn't have to do it hand-over-hand), and her interverbals (ready, set, then saying "go"), scored at an 80% independent level. This is wonderful! I'm actually seeing my little angel break out of her shell. Janine said I should get Raquel a t-shirt that reads, "I love ABA!" Maybe I should get one, too.