BEHAVIOR THERAPY. Remember, I was given the most hours for this in the beginning because Raquel was so challenging. Here's Elizabeth's notes after our first meeting: "Discussed her behaviors at length, including pulling out her hair and eating it; aggression (hit, scratch, throw objects at, pull hair) toward mother; sleeping issues (refusal). Discussed replacement behaviors and the need for consistency across all settings."
Six months later, here's the latest comments from Cari: "What a great day! She did 1-2-3-Go 100% Independent! She also scored 100% on drawing, body parts, manding attention, non-verbal immitations, pointing, receptive commands, and sitting. Great day. Tomorrow she'll move on in prompt levels for many programs."
Side Note: I also want to add that her trichotillomania (hair pulling/eating) is 100% GONE. After the koosh ball didn't deter her from doing it, Elizabeth suggested that I cut off her curly locks, which I sadly did. She did look really cute with short hair, though.
As her hair has grown back in - and, again, curly - she doesn't do it anymore. The habit has been completely broken. If anyone reading my blog is going through this or knows of anyone who is, please contact me! You are not alone and things will get better.
SPEECH: We've had Mary the longest. Here is her take on day one: "Raquel used good eye contact and showed interest in the toys introduced, although she primarily threw any toys that were small enough to manipulate in her hand. Raquel was friendly and did not show a fear of interacting with me. She showed anger when her sister put away toys that she wanted and laughed when interacting with Mom during play. Raquel used quite a bit of jargen and produced a few true word approximations. Mom and sister were shown some beginning signs to try and help alleviate communicative frustrations (e.g. "mine", "all done", "milk", "more", "eat") also emphasizing a head shake for no."
And now: "Raquel had an awesome session today. Words that she used were: baby, look, cup, nook, put in, hey, moo, buk (for the chicken), come, no, nope, ball, play, boat, plane, me, and bye. These were through imitation or delayed imitation. Raquel exhibited some great things in her play today. She reached inside a mystery box to take things out, which she did one thing at a time. When she pulled a little train out, she carried it to the kitchen and pushed it on the floor. She also pushed the big train as she crawled behind it."
Side Note #2: I failed to mention last week that Gabby looked out her window anxiously awaiting Mary's arrival to tell her the good news (Raquel saying "Gabby"). I have never seen Gabby run so fast to greet anyone before. I don't even think Mary was able to get out of her car! Needless to say, she was very pleased.
OCCUPATIONAL: Becky wrote on her first session: "Raquel was able to sit and play for several minutes. She tolerated hand-over-hand to place toys in and for musical instruments. She placed one object in independently and placed her hand in container while still holding the toy several times. Showed Mom how to do core strengthening on her lap over her legs. Also demonstrated pulling her on a towel while she's sitting to work on balance and core stability."
Now: Well, I can't understand Karin's notes. :-) But I do know this - Raquel is not only independently putting items in and out of containers at her request, but also doing puzzles and doing them correctly - putting the circle where it goes, etc. Puzzles are still very frustrating for her because her fine motor still needs a lot of work, but she is showing great progress.
PHYSICAL: From one of Trish's first visits: "Raquel displayed extreme behavior, as she cried and screamed unconsolably. Attempted to do the following exercises to not much success: squat to stand exercises, walking across couch and mattress, which she needed contact guard assist/minimal assist for. She is also now able to climb on to the couch when she steps off a 4" step."
Trish's last session: "Raquel did great today. She did not have any upset moments. She participated in all activities and never complained. She was happy to play and walk around the park. She has markedly improved her ability to walk on grass. On inclined grass, she is now able to walk up without hand held assist. She is also making huge gains in her ability to walk up stairs with only one hand held assist. She walked up and down a curb by herself without holding on."
Hope this gives you a little insight. I'm very excited to see how much she improves over the next six months.
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