Wednesday, February 28, 2007

Random Stuff...

So tonight, I was in CVS picking up a few things and this mother walked in with her daughter that appeared to be about Katherine's age (7, maybe even a bit younger). I was browsing through the Easter section (killing time before my 7:00 meeting) and the mother walked in, left her kid in the aisle, and went all the way over to the other side of the store to drop off a prescription. The line over at the drop off counter must have been long because she was gone for a good 5 minutes. Just long enough for some psycho to take her kid and run. I was kind of horrified actually, and even gave the woman a dirty look when she came back (just because I felt like being catty and all that) but I was thinking to myself (and I don't know maybe I am over protective) that I wouldn't even leave my 10 year old daughter alone in a store for that long. What was even more annoying was that she was busy gabbing away on her cell phone asking if so and so had just sent her an obscene text message. I'm like, "Dude, you have a kid! And you are in public talking about obscene text messages while you leave your daughter alone in the store? What the hell kind of a parent are you?" To each his own I guess but really, am I crazy? Or is she?

Anyway, as I was going up to the counter to pay for my things I noticed one of those turn style rack thingies that had gift cards to about a million different stores (Home Depot, Old Navy, Blockbuster etc). I started thinking about how convenient that was (not actually having to go to the store itself to get the giftcard) but it strikes me as kind of counterproductive too. If I go to CVS to get my Dad a Home Depot gift card that means I haven't actually entered Home Depot. I'm thinking if I was a marketing person, I would want people to come to my store to get the gift card, see the product we have to offer, and perhaps, purchase some additional items as well. Make sense?

Tuesday, February 27, 2007

Heroes...

...was intense last night, huh? Wow. That show rates right up there with LOST in my book. I am obsessed.

Monday, February 26, 2007

Julia: Early Literacy Skills Emerge

I have been meaning to update you all on Julia's "academic" progress and how impressed I am with how well she is doing in this area.

She has recognized all of her colors (red orange yellow green blue purple black brown and pink) for quite sometime. I bought multi colored blocks not too long ago, as well as color cards and had her sort by color (which at first she just did by recognizing that two blue blocks were the same, not neccesarily that they were blue) and labeled each block or color card as we went ("Julia, pass me the blue block"). She eventuallly just caught on and started naming the colors herself. She even uses colors on a regular basis now, when describing something to me(For example outside in the snow today she said, "Mom, I got the purple bucket").

The color cards that I bought were also sahpe cards. After reviewing and mastering her colors, I decided to start working on shapre recognition. She now recognizes squares, rectangles, circles, triangles, diamonds and, occasionally octagons. At first, she would only recognize the shapes on the cards and not other objects out in the "real world." Now though, like with the colors, she uses shapes in her everyday descriptions of things("Look at the circle, Mama" when pointing to the hoola hoop).

Perhaps the most impressive of all? She recognizes all of her letters. Not only can she label a letter (by asking her "What's letter is this Julia?") but she can find them mixed into words in books or in the form of her puzzle pieces spread out about the room ("Julia, where is the "A"?). I will probably start working on letter sounds with her soon.

She is also beginning to recognize different sensations and labeling them correctly ("This is cold", "This is yucky" This is wet" "This is warm"). I have some ideas of different things that I can do to encourage her in this regard which I will probably start working on with her sometime soon.

She has been making huge strides with her language development too. She has been able to make choices correctly which, although still needs a little improving is drastically improved from when she didn't even understand what the concept of a choice was. Last time at playgroup, when it came time to choose a song card, she jumped right up willingly and actually verbalized her choice of the bug song. She has also (though not consistently been able to choose between foods and toys. Her overall communication skills improve on a daily basis. For example, yesterday while out in the snow,after being warned that we would be going in the house soon, she said, "I don't want to. I want to play with my snow." Her 4-6 word sentences are the norm for her now, and, as the above example illustrates, has been using two sentences strung together on many occasions.

Julia in the Snow

We have about 4 inches of snow on the ground so I decided to take Julia out to play. Last year, she HATED the snow and was done after about 2 minutes. At the time, she had just learned to walk, which meant she was unsteady anyway, and walking in "fuill snow gear" is a difficult task in and of itself. What a difference this year. This time, she cried when I told her it was time to go in! She was still very cautious walking but, she managed to go up and down the small hill in the backyard, which is something that in the past, she has had difficulty doing, even without the snow as an added obstacle. She played standing up only and wouldn't even sit in the sled with me (or by herself) which I think may have been a sensory thing (perhaps she thought she would get wet or cold if she sat, depsite being covered head to toe in water/cold proof gear). Either way though, she had a blast and, I somehow managed to get an adorable closeup picture of her!

Sunday, February 25, 2007

Weekend

It's not over yet but I figured what the heck? I know what we are doing later so I am just going to do the review now.

The rally for lia sophia in CT was amazing! It was really inspiring to hear the stories of success! I have so much information that I feel I can incorporate in to my own business and a new found confidnece level that, admittedly, just wasn't there before. Aside from the awesome ideas I left with for boosting my own business, I had such a good time with my "lia ladies" that it would have been worth going just for that! We really do have such a nice mix of personalities.

After we got back to Middleboro last night (about 9:00 or so) I scooted over to Plymouth for a 30th birthday party. I had originally thought I would just head home but Ryun had called , saying everyone was asking for me so of course, I had to make an appearance. I am glad I did. Missing a party with my friends from the "hood" would just be a tragedy. Seriously, they are such a fun, amazing group.

We are heading over to the 'rents house tonight for dinner. Mom is cooking a boiled smoked shoulder dinner...yummy!

The Amazing race All Stars and the Oscar's are on tonight so I will probably plan on parking in front of the tv for the night!

Friday, February 23, 2007

Gone...

...for the night, all day tomorrow and tomorrow night. Back sometime Sunday!

On My Mind...

...Emily's Special Education Meeting, scheduled for March 1st. For some reason, as schooled as I feel on the whole situation I am starting to feel really nervous about this. What do you do when you suddenly feel uninformed and fearful of sounding like an idiot? Why you read and research the hell out of special education meetings and what they entail, hoping that it will help.

...lia sophia and self doubt regarding why I ever decided to do it in the first place. I love the jewelry and I love the money but who was I kidding? Scheduling shows is HARD and not having any puts a huge damper on the confidence. I am attending a day long training event tomorrow in Connecticut. I am hoping I find some inspiration...or something.

...Mardi Gras. Not the "real" one...the one the PTA sponsors every year. I have a lot to do and a relatively short amount of time to do it. Ugh...

...That's it. I think. There's probably more but yeah, for now, that's it.

Thursday, February 22, 2007

Tonight is...

...the series finale of The O.C. I actually find myself to be grieving the show's end more so than I ever thought I would. I really had no idea how much I liked it until I was faced with it's end. Yahoo has a nice photo retrospective highlighting some of the things that will be most missed. I have to say, I agree with the selections.

Wednesday, February 21, 2007

Update on Julia, Today's Plans

After day 5 of a fever, I took Julia to the doctor late yesterday afternoon. Turns out the poor doll has a double ear infection. This was last on my list of concerns as she was generally sleeping through the night and didn't seem to be in pain otherwise. Apparently, both she and Emily have a high tolerance for ear pain (when Emily was first diagnosed with Epilepsy 2 years ago she had the worst ear infection the doctor in the ER had ever seen and she hadn't complained once about her ear hurting). Anyway, after just one dose of the amoxycillin, she seems better already.

Emily and I are going to start her book report today. She had to pick a President or a First Lady to write about so, she picked Bess Truman. Emily has to write a report, make a 3-d model of somethign related to Bess Truman (we are making a tennis racket out of pipe cleaners as Bess Truman was an avid tennis player) and dress up like Bess. I still have no idea what we are going to do for the "dress up" part but I thought I might look on Ebay for vintage children's clothing from the 40's. I could probably find a thrift shop that might have some older pieces but I will have to see.

I need to run out to the bank today too. I haven't had a coffee since Monday either so that will be a must (one day without Dunky's is like...ah, nevermind).

On the agenda for tonight: AI and , of course, LOST.

Tuesday, February 20, 2007

Blue Maturity

Your Brain is Blue

Of all the brain types, yours is the most mellow.
You tend to be in a meditative state most of the time. You don't try to think away your troubles.
Your thoughts are realistic, fresh, and honest. You truly see things as how they are.

You tend to spend a lot of time thinking about your friends, your surroundings, and your life.


You Are 90% Grown Up, 10% Kid

Your emotional maturity is fully developed, and you have an excellent grasp on your emotions.
In fact, you are so emotionally mature - you should consider being a therapist!
How Emotionally Mature Are You?

Via Jay.

How Vacation With The Kids Has Gone So Far

While getting the orange juice out of the fridge, Emily knocked a full double size pitcher of ice tea out, knocking the cover loose, and spilling it all over the floor. Apparently, our floor is not level as what started as a puddle in front of the refrigerator quickly spread (quickly as in within the few seconds it took for Emily to go grab towels to clean it with) from the refridgerator across the kitchen floor, and all the way to the cabinets on the other side.

Julia still has a fever this morning so a trip to the doctors is in order.

Katherine sounds like she is getting a cold.

Please, don't let this be any indication of how the rest of the week is going to go.

Ugh.

Monday, February 19, 2007

Weekend

Julia has a horrendous cold type thing which has been going on now for 4 plus days with no sign of relief in the future. What started out as just a continuously runny nose has turned into a somewhat runny nose, a wet, phlegmy cough and slight wheezing when she breathes. She's had a fever for 4 days now, so if it has not disappeared tomorrow without the aid of Motrin, I will probably bring her to the doctor's office. Her symptoms are beginning to look and sound suspiciously pneumonia-like which is of course, not good.

Julia was supposed to be spending the weekend with Aunty Heather but due to her illness she spent the weekend at home with us. Wayne spent the weekend here with his kids which was nice. Emily and Katherine were happy to see their cousins (even if it was just for one night...they left on Saturday to spend a glamorous weekend with Aunty which included such things as haircuts, finger nail painting, ice skating, swimming and pizza).

Today was our planned trip to Disney on Ice: Princess Wishes. Again, Julia missed out due to her not feeling well. Emily and Katherine really enjoyed the show, and so did I. The show featured very cool special effects and fireworks and was different from shows we have seen in the past.

Anyway, there you have it...the weekend summed up in a few paragraphs. Now, if you don't mind, I am going to go and get some much needed rest!

Ice Skating

My sister took Emily and Katherine ice skating yesterday. They have never been before (which, I know is weird, given the region of the country we live in). Ryun doesn't skate, and I haven't in years, so we just never thought of going with the girls.

It's in situations such as this, that I realize how much Katherine is like me, and how much Emily is not.

Katherine never left the wall of the rink. She hated it, was afraid, and didn't ever want to do it again. Much of Katherine's fear comes from lack of confidence in her own abilities, which was a huge thing for me when I was younger, and still is today. Admittedly, age has brought a little more confidence my way, still, I'm afraid faith in myself is something that I don't have much of. It's kind of hard, as a parent, to watch your child go through the same thing. I am sure it was difficult for my own parents to watch me. The thing is, I wish she had more confidence, but at the same time, I know pushing her to won't help. So, I will give her a little encouragement here and there, and hopefully, she will find it in her own time.


Emily laced up her skates, stepped on to the ice and skated around like she'd been doing it all her life. This doesn't really surprise me, but at the same time, I still can't believe she did it. Her confidence in awe-inspiring. It's really an amazing thing to watch. In some respects, I am jealous. Mostly though, I am just thankful that she has it. Based on her confidence level alone, it is really hard to imagine Emily failing at anything she tries.

(Video coming soon!)

UPDATE: See Below!

Friday, February 16, 2007

Julia's Report

Julia had an appointment with her developmental pediatrician last week. Another thing that I love about her doctor? She send a complete, detailed report of the visit to me and to Julia's regular pediatrician.

Some people may wonder why I choose to post such personal, detailed things here. Mainly, it's for me own purposes. If I didn't keep track of my day to day life via this blog and the others I have had in the past, I would forget it. Seriously, time passes too fast and i don't want to forget a single significant moment.

Anyway...the report.

Julia is a 30 1/2 month old girl with a history of developmental delay, hypotonia, and relative macrocephaly (aka a relatively big head for her weight and height).


Julia was last evaluated in June, at which time she had shown improvement in her developmental skills. She was observed to be an independent ambulator and was saying many single words and some phrases. Julia had an EEG which was read as abnormal and was going to be scheduled for an overnight EEG.

Julia continues to receive her primary medical care from Dr. B. Julia has been healthy without any significant illnesses. Past laboratory testing has included high resolution banding chromosome studies, specific testing for Tuberous Sclerosis, thyroid function tests, CPK, and a cranial MRI, all of which were negative.

Julia was admitted to Children's hospital for overnight EEG monitoring. The results showed " no electrographic change suggestive of seizure activity."

Julia continues to make developmental gains but continues to have developmental challenges. She is not yet able to climb up and down steps age appropriately. She has difficulty rising up and sitting down in chairs. Her muscle tone continues to be low and she does not show any resistance when her extremities are moved passively. Julia has difficulty turning knobs or handles that require pressure.

Julia continues to have some language delays. She has many words and sentences but frequently does not answer questions appropriately; she can not answer questions where a choice is given. For example if she is asked, "Do you want to play with your piano or blocks?" she will either say "yes" or "blocks or piano".

Julia has some sensory issues. She becomes upset when her hands or face are dirty. She is very finicky about the types of food she will eat; she will only eat certain foods and textures and generally resists trying new foods. She is fearful of going up or down stairs or walking on uneven surfaces. Occasional "hand flapping" has been observed. Julia can be overwhelmed in certain situations and can be excessively shy or timid.

Physical Examination: Julia's weight was 26 pounds, 8 ounces which was in the 30% for her age. Her height was 86.9 centimeters which was in the 15 % for her age. Her head circumference was 51.5 centimeters which is greater than the 97 % for her age. Palpebral fissures were slightly downslanting. Mild epicanthal folds were present. Extremities so increased range of motion with overall hypotonia. Gait was significant for some immaturity and mild unsteadiness. Julia required some assistance to rise up from a chair consistent with her history.

In summary Julia is a 30 1/2 month old girl with a history of relative macrocephaly, hypotonia and delays in some of her motor and language skills. Julia continues to present with delays in her motor skills ans well as sensory integration issues and language challenges. Julia appears to have more difficulty with abstract receptive language. She is able to follow a command but unable to respond to questions when choices are included.

It is recommended that Julia continues to receive EI services. Sensory Integration Therapy would be helpful.

It is strongly recommended that Julia transition in to an integrated preschool program when she turns three years of age. Julia should qualify for this program based on her speech-language, motor and sensory challenges.

A referral a genetics consultation will be made. Further diagnostic testing may be carried out at the discretion of the consulting geneticist.

Julia's progress will be followed over time and she will be scheduled for a follow up this summer.

Wednesday, February 14, 2007

Camping In NH

I had mentioned the other day looking for sugestions as to where to camp in the White Mountains. I think I found the place. It looks fantastic, scenic, close to the "hot spots", and right smack in the middle of the picturesque White Mountains. Now, I just need to figure out when exactly we are going.

I can not put in to words what a beautiful area that is. I wonder, if I lived there if I would appreciate it is as much? I suspect not.


Anyway, I can't wait!

Happy Valentine's Day

While this holiday doesn't hold much esteem for me, I do find it to be a great reminder of how much I love my family ( not that I need reminding...they show me every day how lucky I am). We make it special for the kids (well, we really translates in to me because lets face it, the sappy, sentimental one in this relationship is me not Ryun) but other than that, it's just another day really.

I am planning on doing the usual "fun" dinner set up with Valentine plates and cups, candy hearts scattered about as decoration for the table and a special dinner (which tonight will actually be pizza from The Cabin...yummy). I have a Tastefully Simple Apple Cake Mix that I might make for dessert, and for the first time in I don't know how long, I think I am going to skip my PTA meeting and chill with the family instead.

So anyway, Happy Valentine's Day, hope it's fantastic!

Why I Love Katherine

Last night, on the way to Reading Night at school, she said, "Mom, do you think sometime you could take me to see Barry Manilow?"

Seriously, she is so my kid.

Then, this morning at 4 AM no less, she got up, made 4 Valentine's cards and gave everyone in the family a present from her personal toy collection. For Ryun, it was a pencil pouch type thing for him to hold all of his "special work stuff" in. For me it was a bookmark and a homemade macaroni necklace. For Emily it was a book. For Julia it was three toy horses. The cutest thing in the world (although Emily may not think so) ? She woke Emily up to ask her how to spell "fantastic."

Two reasons, among many of course, that I love Katherine.

Monday, February 12, 2007

Blah...

I 've been busy. Really busy, slightly overwhelmed, and a little stressed to boot.

The past few days have been kind of hectic. My grandmother is back in the hospital, this time after a slight heart attack and resulting congestive heart failure. She seems to be doing ok now but shewent in to the hospital just a day before my parents were supposed to leave for Anguilla. They still went, but not after my mother went to the hospital Friday morning instead of work, to check in on Nana, and assure herself that it was still okay to go. We have phone numbers etc. to contact her should anything drastic happen but for now, it seems like she will be ok.

I am feeling slightly overwhelmed by the neuro-psych report we got back on Emily. In all honesty, it wasn't some big surprise or anything...I knew what was going on. Still, having a proffesional confirm what I already knew sort of adds a new level of "reality" to the whole thing. The same goes for Katherine and her Title 1 help, and pending speech and Special Education Evaluations. I knew there were concerns, having them confirmed just makes it seem that much more real.

I have about a million other things going on, including a few major events coming up with the PTA and Girl Scouts that will all require a good amount of work on my part. I enjoy most of it, but sometimes, it gets to me. Sometimes being, like, right now.

Anyway, that's all. I do have a few things I want to post about (including how Julia did at playgroup today, how sometimes I wish I didn't have to ask for things, that they would just happen, and how I need your best suggestions for camping locations in the White Mountains region) but, that will have to wait. Perhaps later.

Sunday, February 11, 2007

Emily: Part 3

Recommendations:

I strongly recommend that Emily be provided services through an Individualized Education Plan on the basis of her diagnosis of ADHD, and a learning disability characterized by weak executive functioning and poor written expression, which are undermining her academic skill development and functioning. The accommodations she is currently receiving on her 504 plan are not sufficient, as they do not address her significant difficulties in the area of cognitive organization and written expression.

With regard to her organizational weaknesses, Emily needs help breaking down long term projects in to manageable pieces. She also needs support in the areas of time management and remaining on task. In addition, Emily should be taught how to create a check list and encouraged to use it consistently. I recommend that she receive pull-out support (2-3 times per week, 45 minutes each session) with a special education teacher to provide her with support in the areas of time management and the organization of her materials.

Further, Emily's written expression vulnerabilities warrant the provision of individual or small group tutoring, in the area of written expression. This tutoring should involve direct teaching organizational skills through the use of graphic organizers that are applied to Emily's existing written assignments. It should employ a systematic, curriculum-based approach and be implemented by a qualified individual( special education instructor, speech/language pathologist) who is trained in such an approach. This pull-out service should be provided 3 times a week, for 45 minutes per session.

Based on Emily's attentional variability, due to her diagnosis of ADHD and executive functioning vulnerabilities, she should be provided with additional time (i.e. time and a half) to complete quizzes, tests, and standardized exams. To be clear, Emily may not use all of the time allowed; however, she needs to be instructed to check through her work more carefully due to her tendency to rush and make careless errors.

Due to Emily's level of distractibility, she should be provided with preferential seating (e.g., away from window views or busy hallways) to allow her to attend to what is being taught in class. In addition, her teachers should cue her for attention and refocusing. This cuing could be done with a subtle signal that does not single Emily out from the rest of the class.

Further, given Emily's weak organizational skills, she would be expected to have some difficulty discriminating the most salient aspects of new material presented in class. As such, she would benefit from the provision of an outline of information to be covered in class. Similarly, she would benefit from the provision of study guides for upcoming tests and quizzes.

Additionally, at the end of each school day, Emily should check in with a pre-designated faculty member familiar with her classes, to make sure she has the correct assignments and and all material needed to complete her homework.

Due to Emily's difficulty keeping track of her belongings, a vulnerability common among students with a diagnosis of ADHD, she should be provided with an extra set of books to keep at home to be sure she has access to the texts needed to complete homework.

Emily would also benefit from visual cuing strategies. For example, she could be provided with supports such as lists that offer individual cues to help her structure ans manage tasks more independently (e.g., morning routine, rechecking schoolwork for name, date, completeness).

Emily's relatively weak ability to learn de-contextualized information likely interferes with her ability to recall specific facts, dates, names etc. She would benefit from using memory strategies such as mnemonics (e.g., ROY G BIV to remember the order of colors in the prism), over-learning information through frequent rehearsal, as well as tape recording information herself and them replaying it.

I recommend that Mr. and Mrs. E (aka Ryun and I) continue to work with Emily's neurologist to address Emily's complicated profile and suggest that they share this neuropsychological report. Clearly Emily's neurological (i.e. seizure) issues need to be considered when determining appropriate medications to help address ADHD symptoms.

Individuals with ADHD have more difficulty than others regulating mood and behavior. Research indicates that exercise can regulate mood, while sufficient sleep and a consistent sleep schedule have been connected to improved attention. Thus, Emily should be encouraged to maintain a healthy diet including breakfast, a regular exercise regimen, and a consistent sleep schedule.

Finally, I recommend that Emily undergo neuropsychological re-evaluation in two years' time, in order to monitor her progress with the interventions listed above and to obtain updated information to facilitate further academic planning.

Friday, February 9, 2007

Emily Part 2

Impressions:

Emily presented as a very friendly and engaging girl who was extremely cooperative and invested in her performance throughout the testing. She appeared at ease during the assessment, her mood was generally cheerful, and she displayed a good sense of humor. Emily's receptive language skills were intact and she exhibited well developed linguistic pragmatic skills (the ability to use language for social purposes). Expressively, she was easily able to initiate conversation and respond to questions from the examiner , although she was observed to have some word finding difficulties and would frequently use "filler" phrases such as "that's cool." In addition, consistent with her ADHD diagnosis, Emily's arousal and attention levels were variable and she exhibited some impulsive behavior, such as interrupting with tangential comments. Nevertheless, given Emily's level of motivation and hard work, the results of this evaluation are considered valid indicators of her present levels of functioning.

Results of intellectual assessment reveal that Emily is performing at or above age expectations. Her overall verbal reasoning skills measured in the High Average range, while her visual - spatial reasoning and perceptual reasoning skills measured solidly in the Average range. Emily's working memory was also assessed in the Average range, although her performance was noted to be inconsistent on these task due to variations in her level of attention. On contrast, Emily performed relatively lower on tests of processing speed, scoring at the low end of the Average range in this regard. Specifically, Emily displayed difficulties on tests of "mechanical skills" such as speed of visual scanning and graphomotor output. Due to the discrepancy among Emily's index scores, a General Ability Index was calculated to provide comparable approximation of her overall intellectual functioning. results of this find Emily to measure in the High Average range.


on standardized tests to assess Emily's academic skills, Emily generally performed at or above grade level expectations. For example, Emily's math calculation skills measured solidly in the Average range. In addition, on tests of reading comprehension, Emily performed above grade level, although on a timed single word decoding and phonemic awareness test, Emily performed relatively lower ( but within grade level expectations). With regard to writing, Emily exhibited Superior Range single word spelling skills. However, despite Emily's strong single word spelling skills, when asked to write a story, her writing contained multiple spelling, punctuation and capitalization errors. In addition, although Emily experienced Superior range vocabulary, her story contained simplistic vocabulary and awkward sentence structure.

From a diagnostic standpoint, the results of the present evaluation highlight the continued presence of ADHD, a neurologically based disorder involving difficulties with he regulation of mood, attention, behavior and energy level. In addition, current neuropshychological assessment was notable for a learning disability characterized by significant difficulties in executive functioning including the areas of organization and processing speed, and for weakness in graphomotor control. Notably, many children with Epilepsy have significant problems with attention, arousal and executive functioning. Further, based on the discrepancy between Emily's intellect and diminished written expression skills, she meets the criteria for a specific learning disability in written expression.

During the testing Emily's behavior was notable for decreased behavioral control, impulsivity, and trouble organizing information. In addition, compared to her strong verbal cognitive abilities, Emily's processing speed is relatively weak. This profile is very common among individuals diagnosed with ADHD. Further, qualification of a standardized questionnaire, found Emily's parents to indicate symptoms of ADHD at a clinically significant level (99th percentile) while Emily's teacher noted that Emily often appears disorganized in class. the discrepancy between the home and school attentional issues is likely related to the structure inherently provided during the school day, one that is not always feasible in the home.

Results of current neuropsychological testing were also notable for executive functioning vulnerabilities including reduced behavioral regulation and difficulty inhibiting responses, both aspects of executive control.

Executive functioning also encompasses problems with cognitive organization. On several tasks, Emily displayed difficulty organizing large amounts of both complex visual and verbal information. For example, Emily's approach to copying a complex design was less organized then expected for a student of her age. While Emily was able to appreciate the overall "gestalt" of the design, she had difficulty recognizing the organizational components of the design and integrating the details. Similarly, while Emily could readily organize some verbally presented information, such as repeating orally present complex stories, when presented with a long list of unrelated words, Emily was relatively unsuccessful at independently generating an organizational strategy, therefore displaying difficulty initially learning and then retaining the information over time.

Difficulties with cognitive organization frequently lead to problems with efficient information retrieval. On a task of naming picture, Emily often required cueing of the first word sound in order to retrieve the vocabulary that she knew. One way that this weakness in cognitive organization manifests in school is that students will know information and understand concepts, but struggle to retrieve what they know under the pressure of a class discussion or in testing situations.

Emily also presented with significant fine motor difficulties. her handwriting was extremely messy, her graphomotor speed on a timed task measured in the Low Average range, and her ability to manipulate pegs in a pegboard measured below age expectations for both hands.

Fortunately, Emily presents with many strengths in her profile. Nevertheless, despite her many strengths, Emily presents with a neurologically based attention disorder. In addition, she displays executive functioning vulnerabilities that are significantly undermining her development of written expression. With this profile, I view Emily as a student who is at risk for being undermined academically by increasing writing and organizational demands. As such, she will need support in order to help her capitalize on her strengths and compensate for the areas in which she performs less efficiently.

Emily (not part two just a funny story)

The other night, Emily and I stopped at Subway on the way home from Girl Scouts. On the way, I explained to her that there were 6 inch and 12 inch subs, and that she was getting a 6 inch one. The 12 inch one would be too big and she would never finish it.

So, we get in to Subway and the girl behind the counter asks Emily what she wants.

Emily says, " I'd like a half of a ruler size chicken sub."

She's one funny kid, that Emily.

Thursday, February 8, 2007

Emily: Part One

Below find Part 1 of the report I received in the mail the other day from the neuropsychologist who tested Emily in the beginning of the month. The report was quite long so I am breaking it up in to two entries. Behavioral Observations

Emily is an outgoing, delightful, and well-mannered girl. Throughout the evaluation she was friendly and hard working. Emily presents as an engaging and interesting child. Emily expressed feeling very tired and was noted to yawn and stretch many times. With regard to attention, Emily was easily distracted. In addition, toward the end of each testing session, she displayed increased fidgeting, interrupting and impulsive responses. Emily was generally able to understand test directions and orally presented items. Emily's expressive communications were notable for word finding difficulties. Within the structured one to one context of the assessment Emily was able to initiate and shift within and between various tasks. In contrast, Emily displayed some difficulty regulating her behavior during the evaluation. She was often fidgety , doing such things as looking around the room and fidgeting in the chair. Emily was also observed to interrupt the examiner and respond impulsively to test questions, without always seeming to have fully thought them through.

Test Results:

Verbal Comprehension: High Average Range
Perceptual Reasoning: Average
Working Memory: Average
Processing Speed: Low End Of The Average Range
General Ability Index: High Average Range
Abstract Verbal Reasoning: High Average
Expressive Vocabulary: Superior Range
Comprehension: High Average
Digit Span: Emily's ability to repeat orally presented strings of digits in reverse and forward sequesce measured in the High Average Range.
Letter and Number Sequencing: Average Range
Block Design: Visual Construction Skills Average Range
Picture Concepts: Conceptual reasoning based on visual information measured at the high end of the average range.
Matrix Reasoning: visual-spatial reasoning: average range
Coding: Emily's graphometer speed measures in the low end of the average range.
Symbol Search: Average range
Numerical Operations: Average range
Spelling: Superior range
Contextual Conventions: Emily's overall ability to use appropriate capitalization, spelling, and punctuation when writing a measured below grade expectations.
Contextual Language: Emily's vocabulary tended to be ordinary and while she expressed some interesting ideas, she had difficulty organizing her story.
Story Construction: Average Range
Silent Reading Test: High Average range
Sight Word Reading: Average efficiency
Phonemic Decoding: Average ranged efficiency of sounding out nonsense words.
Automatized Series: Within age expectations on tests of reciting basic verbal series (e.g., alphabet, months of year).
Sentence memory: Superior range ability to repeat orally presented sentences verbatim.
Story Memory-immediate recall: Very Superior range ability to repeat orally presented stories.
Story Memory-delayed recall: Very Superior range ability to repeat orally presented stories after a 20 minute delay.
Story Memory-Delayed Recognition: Superior range recognition of story details following a delay.
Verbal Learning-immediate recall: High end of the average range
Verbal Learning-delayed recall: average range
Verbal Learning: Delayed recognition: average range
Visual Spacial Processing and Visual Memory: Emily's accuracy on a design copy task assessing visual-motor integration measured slightly below age expectations. Many of her errors appeared to be due to her tendency to rush on this task.
Copy: Below average: Emily took a disorganized approach to to copying a complex geometric design, resulting in a final product that was distorted.
Immediate recall: Below average: Immediately after copying the design, Emily was asked to draw it from memory. Emily was able top recreate a distorted outline but lost most of the details.
Delayed recall: Below Average: further distortion.
Grooved pegboard: Dominant hand (right) On a test of fine motor speed Emily measured below age expectations. Non-dominant hand (left) : On a test of fine motor speed, Emily measured significantly below age expectations.
Emotional Control: 96th percentile: clinically significant
Behavior Rating Inventory: 90th percentile: borderline clinically significant
Organization of Materials: 88th percentile: clinically significant
Executive Control: 90th percentile: clinically significant
Letter Sequencing: Significantly below average speed of alphabetic sequencing
Letter Fluency: Average range verbal fluency in response to letter cues.
Verbal Fluency: Superior range (When contrasted with Letter Fluency, Emily's higher score suggests that she benefits from external organization of materials.
Sort Recognition: Significantly below average ability to recognize organizational frameworks used by examiner to sort cards.
Color naming: significantly below average speed of naming colors from a limited repertoire.
Cognitive Problems/inattention: 73rd percentile: clinically significant

I Finally Got My Fix

*WARNING* IF YOU WATCH LOST, BUT HAVEN'T WATCHED LAST NIGHT'S EPISODE, YOU MAY NOT WANT TO READ THIS.*

I am seriously torn between Jack and Sawyer and who belongs with Kate. Mostly, I think Kate and Sawyer but last night I was feeling the Jack and Kate connection.
Could Jack have been any hotter at the end of the episode when he said to Kate? "Don't ever come back for me." God, I think I might have just about died.

On to more pressing matters though...what the heck was that whole thing that Alex's friend Carl was in? Some kind of funky mind washing thing? Some kind of weird hypnosis station? That was really odd. I was trying so hard to commit to memory all of the messages that were flashing and the various pictures that were blinking by because with LOST even those seemingly insignificant things could mean a change in the whole way you view the show. This morning of course, I can barely remember a single thing but I do plan on looking at the fan sites to see what I can find there.

I really wish they would do a back story on Ben. I am sure they will at some point. I want to find out what kind of power he holds over the island, as it appears that he is the person that can actually allow people to leave the island with out being trapped by some kind of magnetic force field type thing or whatever it is that keeps them all there.

I thought it was interesting last night to see Juliet's back story. It was kind of cool to see how they actually "recruited" her to be a part of the "island team" back when it was a government site with all kinds of funky stations, including the zoological research station that they were holding Sawyer and Kate in. I didn't really get the whole sister story. I mean I understand that the drugs Juliet were giving her were supposed to make it so she could have a baby when she couldn't but miracles like that happen all of the time in "real life" so what was so special about that? Impregnating male mice with her "drug" was of course a medical miracle so that made sense.

Anyway, I can not wait to see where this season will go. LOST rocks people, and if you are not watching it, you should go rent the DVD"s and catch up. Yeah, yeah I know, I'm pushing LOST again. I can't help myself...it's that good.

Tuesday, February 6, 2007

Julia's Appointment

One thing I love about Julia's Developmental Pediatrician? She understands. She just does. She always confirms too that my concerns in regard to Julia are valid, and not just some product of my imagination or me over analyzing. Validation is a nice thing, even when you wish in some small way, that it was all in your head.

Anyway, I had emailed her my concerns and the first thing she said was that while she had some symptoms of PDD-NOS, Autism, or Aspergers, she definitely would not diagnose her with any of those disorders. She is too "connected" is what she said exactly. Even though I had already ruled these out myself, it was nice to hear regardless.

She had Julia try and do a few gross motor type things including getting in and out of a chair, walking, running and jumping in place. She commented on her "gait" and how it was still sort of waddle-like, similar to when they first learn to walk. I had noitced this too and had just forgotten to mention it on my list of concerns I had emailed. She felt her legs and arms and said, "Oh yeah, she definitely has the low tone"(which of course she already knew but was just commenting on out loud).

She is in agreement with my diagnosis: Sensory Integretation Disorder. She is going to send me some SI activities to practice with at home and give to her PT from EI to incorporate in to our bi-weekly meetings. She is also going to make a recommendation that Julia attedn the integrated preschool (aka public preschool). She would go 3-4 times per week, for a couple of hours each day. She said that she thinks I will notice a huge difference once Julia is in preschool and is consistently exposed to other kids, and more Physical and Sensory Integration Therapy on more regular basis.

The last thing she recommended was that Julia have genetic counseling. She plans on making a referral for that. Basically, a geneticist would look at Julia's medical history, and decide whether or not her "symptoms" are indicative of any specific disoders, and the genetic test would be conducted for that specific condition. So, I figured you know, what the heck? What the heck and of course the whole, "If I don't do it I will probably regret it" thing coming in to play.

Assault Via The Postal Service

In the mail over the weekend...

...A request from the Middleboro Public Schools to evaluate Katherine for Special Education Sevices (in addition to her already planned speech evaluation). I didn't even know that this was going to happen and to tell you the truth, I am a little upst by it...not with the actual test itself or the possiblity that she may qualify, but with the fact that this is how I find out the teacher thinks there's a need for this. I feel like I should have known this long before now (that there was a concern). The only thing I can think of is that maybe when there is a possibility of a speech and language delay, they automatically do an educational evaluation too?

...A bill from Health South, for Julia's Physical Therapy Services that ended in August, saying that we owe $200 for a service that was supposed to be covered at 100%. Turns out we were lucky they paid any of it, as the rep that answered told me that PT services are not covered for a child under the age of 3 because they need to be getting it via Early Intervention. I promptly shut my mouth and hung up the phone. Still, the $200 pissed me off, and the incompetent rep who answered the phone when I called way back when she started services that told me it was covered at 100 % annoys me. Good customer service means knowing your "stuff."

And here, folks, is the kicker.

...A bill, from the Children's Evaluation Center saying that the insurance company rejected the claim and that the balance, in full was now due...all $2900 of it. After my heart momentarily stopped, I called and figured out that because of the diagnosis (EFD and ADHD) the claim should have been submitted to Value Options, the company that handles the "mental health" portion of our insurance. Fine and dandy but the CEC only bills Blue Cross, so now I have to print out some form and send the bill directly to VO, which they will pay at 75%. When this was all started, I thought we would be paying $580 (because BCBS pays 80%) but now it will be $725. That's not a big difference but annoying just the same. Inncidently, I also have a gripe with the fact that, particularly in Emily's case, where she has a known abnormality in the frontal lobes of her brain, the area in which EFD and ADHD tasks are organized and executed, where she has an actual medical condition causing these concerns, EFD and ADHD are considered "mental health" issues. This is really another post entirely, one that I may tackle at some point when I have my thoughts on the matter organized.

Anyway, the moral of the story?

Sometimes, it's better to not bother getting the mail.

Monday, February 5, 2007

"Welcome to Hollywood, Dawg"

What's More Stressful...

...then finding out your children have Epilepsy, Tuberous Sclerosis, ADHD, Executive Function Disorder, Speech and Language Delays, Gross Motor Delays, Sensory Integretion Disorder, Ashtma, Allgeries, and Hypoglycemia?

Dealing with the bleepin' insurance company and trying to get them to pay for all of the tests needed to diagnose.

BCBS? You can kiss my butt.

Sunday, February 4, 2007

Classic Emily

I was in the kitchen with various ingredients spread out across the counter, making dinner. Ryun was standing on a chair behind me, replacing a light bulb in one of the kitchen lights.

Emily, who was sitting at the kitchen table behind both of us said, "This looks like the average American family, with the Mom cooking dinner and the Dad fixing something."

Friday, February 2, 2007

Julia...

...has an appointment with her developmental pediatrician next week (Tuesday to be exact). I have emailed her the list of concerns I expressed here a few weeks ago so that we can discuss things at her appoitnment. I have decided though, to narrow it down to my top five concerns...the things that occur most frequently and the things that seem to worry me the most.

1. Sometimes, in certain situations she seems overwhelmed. This seems to happen in larger crowds but it has happened on occasion with a one on one situation. She is so overwhelmed that she is reduced to tears and it's the "oh my god I don't know what to do with myself, I can't handle this cry." It's different from her, "I am in pain cry" and it is different from her "I just feel like crying because I am two years old and dammit I'll cry if I want to cry cry. " Another way in which this seems to manifest itself is in her repetitive "Hi Mama" exclamations when new people walk in to the room. It's like this even among people she sees on a fairly regular basis (friends). It's almost like she is confirming that I am there, and that she is safe.

2. Her eating concerns. The past couple of days have been ok, with her eating the broccoli and corn, but overall, there is still something going on there. I am sure that it involves the texture of foods and the feeling of moving the food around in her mouth but either way, it's a concern.

3. The way she doesn't "stand up for herself" or even share toys with other kids. She backs off and just lets the other kid use her toy. Two year olds don't do that. They fight, or say "mine" or in the best case scenario they decide to play with the toy together.

4. The fact that she has no idea how to make a choice. It's hard to explain this but it's not like she doesn't want make a choice or doesn't prefer one thing over another. She doesn't appear to understand the concept, at all. When presented a chouce visually (2 different toys say) and you ask her, "Do you want to play with the red ball or the yellow car?" while holding the objects in front of her she either stares blankly, repeats the phrase you have just said ("red ball or yellow car") or just says, "Yeah." The same situation occurs when the choice needs to be made without a visual aid ("Do you want juice or milk?"). She in no way indicates what she wants by verbalizing her choice, or in the case of something she can see, pointing to it. Some people are going to say to expose her to more opportunities to make a choice and she will catch on. I can't even tell you how many opportunities I have presented to her and continue to present to her and, while it's true that she will more than likely "get it" eventually, it would be good to know if there was some reason for her inability to do it, or if there is anything else I could be doing to help her.

5. The whole sensory thing and how this could all be related to everything else that is going on. The symptoms she has, the ones that are questionable and everything in between.

I plan to focus the discussion on these specific concerns, as well as obvioulsy any the doctor may have. I am also hoping to get a letter or recommendation from the doctor regarding Julia's admittance in to the public pre school (even if I can't believe that my baby will be three in July and ready to go to school...even if I am freaking out thinking about how hard it will be to leave her even if sher doesn't cry when I do, even though I think she will...even if...well, you get the picture)!

Sisterly Bonding At Its Best

Julia was tired yesterday afternoon (not that this is different from any other afternoon as I am pretty sure she has officially given up her nap). I found her and Emily all cozy and cute on the couch together and, of course, I grabbed the camera!


Recipe: Mini Meatloaves

I found this in one of my favorite magazines, Kraft Food and Family. If you like to cook, or have to cook, or even just like looking at what you wish you could cook, I highly reccomend you subscribe. The best part? The magazine is free!

Anyway, the recipe...

1lb extra lean ground beef
1 16 oz pkg of Stovetop Stuffing Mix (I got the Savory Herbs flavor but I am sure any would work)
1 cup of water

Mix with any of the following

Italian Style:
seasoning: 1 tsp italian seasoning
sdd-in: 3/4 c spaghetti sauce
cheese: 3/4 shredded mozarella cheese

Fiesta Style:
seasoning: 2 tsp chili powder
Add-in: 3/4 taco bell home originals Thick N Chunky Salsa
Cheese: 3/4 c shredded mexican style cheese

Mediterranean Style:
seasoning:1 tsp dried oregano leaves
add-in: 3/4 c chopped roasted red peppers
cheese: 3/4 c Athenos Traditional Crumbled Feta Cheese

BBQ Style
seasoning: 1 tsp garlic powder
add-in: 3/4 Kraft Barbecue Sauce
cheese: 3/4 c shredded cheddar cheese

1. Preheat the oven to 375 degrees. Mix meat, stuffing and water and the seasoning until well blended. Press evenly in to medium muffin cups sprayed with cooking spray; make an indentation in the center fo each with the back of a spoon.

2. Spoon add ins in to indentations.

3. Bake 30 minutes or until cooked through. Top with cheese, bake for 5 minutes. Let stand for 10 minutes.


I bought the ingredients to make the italian style. Depending on what my plans are with my sister, I might make them for dinner tonight but if not, on Sunday.

They sound yummy though, huh?

Snow

Today, for the first time this season, we had "shovelable" snow. Ironically, this occured on Groudnhog Day. For the first time since 1999, Phil did not see his shadow, indicating an earlier spring (well if you believe in folklore such as that). Today's weather looked like nothing even remotely close to spring, with big flakes of white precipitation falling from the heavens and blanketing the land in white. The kids, of course, were beside themselves with excitement over the whole event and, when I casually mentioned that after they got on the bus I was going to shovel, Emily said, "Only shovel the driveway please, not the backyard." This was funny becasue, well, have you seen the size of my backyard? That and who the heck would ever shovel their yard? I did manage to get out and shovel the deck, stairway and the entire driveway and thankfully, it was the light fluffy kind of snow that's easy to just push out of the way (as opposed to the heavy, "wet" snow that sometimes actually hurts to shovel).

Anyway, it had been so long since we had seen snow (or any real good amount of it anyway) I just had to take pictures.



Demonstrating that there was enough show to shovel...barely, but enough.


I love when you can actually see the snowflakes in the picture. They were the big fluffy, white kind that just make everything look beautiful.


"Untouched" snow in the driveway., with a falling flake just to make it even more picturesque.


Wouldn't this be the best Christmas tree? As Emily put it, "This one belongs in Rockerfeller Center."

Thursday, February 1, 2007

Katherine: Speech and Title I

I had mentioned here a while back that I was concerned because I had not heard from Katherine's teacher regarding whether or not Katherine was going to be needing speech or Title I services. Her teacher and I had talked, at the Parent Teacher Conference about the fact that the teacher thought she would be a good candidate for extra support and I had some concerns about her speech. I hadn't heard anything on either count yet, but Katherine had told me a couple of times that she had been taken from the classroom for testing (although she referred to it as " reading stories and talking"). Yesterday, I decided that I would send a note in with Katherine to see what was going on. Her teacher sent a note back saying that a speech screening was done and that based on that, they would be doing a full speech evaluation. I don't really know what the difference between the two is, but I am assuming the evaluation is a longer process. As far as Title I goes, her teacher feels that Katherine would be a good candidate but doesn' t know yet what the results of the "official" screening were. Hopefully, she will find out soon.