Might be time for a new pediatrician

When we moved here from Virginia Garrett was three months old. I looked up pediatricians in the phone book and took the next available appointment with the next available ped when it came time for his 4-month check up. We've stayed with the same ped even though there are times she has really annoyed the fire out of me.

Now, fast-forward three years and I'm taking my 4-month old daughter to the same ped. It was deja vu all over again and I realized again why I was thinking about switching three years ago and just too lazy to do it.

Pediatrician: "How is she sleeping?"
Me: "Great! She only wakes up once or so to nurse and then she goes right back to sleep." I specifically through in "She easily sleeps five to six hours straight," because as a pediatrician she should know that "clinically" 5-6 hours of uninterrupted sleep is one of the three criteria considered "sleeping through the night." 
Pediatrician: "I think you need to wean her from that. She doesn't need to nurse during the night and she's essentially using you as a pacifier and relying on you to put her back to sleep. You need to wean her from the night nursing."

I've mastered the art of smiling and nodding while standing up and screaming, "NO!" inside. If Olivia is healthy and growing well and we are happy, well-rested and enjoying the arrangement why should we have to change it? I greatly enjoy nursing her and being close to her at night, especially on the nights I have to go to class and I see no reason why I should change that. From a medical stand point there is no medical reason to change our arrangement either. 

We moved on to food.

Ped: "How is she eating? Is she eating any baby food?"
Me (rather proudly, I might say): "She is still exclusively breastfed."
Ped: "I recommend starting some solids at four months. She doesn't need them but at four months she's lost the tongue-thrust reflex and can start eating solids. You can mix some rice cereal with breast milk if you'd like and feed that to her. It will also help her learn to accept a spoon."

This was the same speech she gave me when my son went in for his four-month check up.

My facade must have cracked and I think even she could see my disdain through my tense smile and nod.


Now, I'm no doctor but I am a mother and I like to think of myself as educated and versed on the needs of my growing children. I am a fanatic when it comes to breastfeeding, having breastfed my son for one year, eleven months when he weaned himself. I did not start my son on solids until he was eight months old when he got his first teeth and started showing genuine interest in other food. I also have a fantastic and healthy breastfeeding relationship with my daughter despite being back at school. She is growing beautifully and is perfectly healthy!

I know the American Academy of Pediatricians (AAP) recommends exclusive breastfeeding for the first six month with supplementing with breast milk up to a year. According to the CDC the risks of childhood obesity decrease the longer you breastfeed, specifically if you exclusively breastfeed to at least six months. For every month you breastfeed, according to the CDC, your child's risk of obesity is decreased by 4%. There may even be health benefits to delaying solids and new research presented in the breatfeeding and baby food classes I took in 2008 suggests one sign a baby's intestines are ready for solids is the introduction of the baby's first teeth.

Either way, my 4-month old shows NO signs she is ready to start solid food. She cannot sit up on her own. She does not reach for food or bring things to her mouth on her own. She also has no pincher grasp.

I've also read many articles that suggest a child eating solids too early can mess with sleep patterns and entice him or her to start nursing more during the night.

I remembered the battles I had with her when at Garrett's 6-month check up he was still exclusively breastfed and how she warned how he would have a problem using a spoon. We battled it out again at his 9-month appointment when he was only beginning a few solids and feeding himself, not being "fed" by me with utensils.

Well, when you are using the baby led weaning method, why does it matter if he (or she, in this case) can tolerate a spoon or not?

Then she got a crooked smile on her face and said, "Are we doing any vaccines today?"

She knows my answer to that question. She's been my son's pediatrician for three years and we have yet to give him a single vaccine. Before I get crucified on the cross of pro-vaccination I must say that I am not anti vaccines. I am anti so many vaccines at such young ages when there is low or no risk of the disease being contracted. I have told many people, many times, that if the diseases we commonly vaccinate against were to start coming back due to individuals not vaccinating against them I would be the first in line to get my children vaccinated. If polio started a come back you'd better believe I'd get my kids a polio vaccine. Yes, there has been a slight come back in some diseases such as pertussis and even measles but the risks in our family are exceptionally low. They do not go to day care, they stay at home with me in a closed environment. All in all we really don't have much to worry about.

I shook my head. "No," I said.

"You'll have to sign the vaccine refusal form."

They must have a dozen of those refusal forms from me.

I'm not trying to be difficult and I'm sure that she had 3-dozen patients who have gone through her model of growth that are alive and well to tell the tale about it. I have my own style and opinions and research to back up my parenting decisions regarding my child's sleeping, eating and vaccinations. I have not felt disrespected for my decisions, but I have felt that condescending disapproval that says, "I'm the doctor, I know best."

I don't want to have to be geared up for battle every time I go to the pediatrician's office. It might be time to make a switch. But, to who?

Spiders and School and Squirrels, Oh My

Garrett has had two more appointments with his speech pathologist since my last blog (or has it been three). Since that time I have also gone back to school to become an EMT. This has set our little world on its head and effectively sent it spinning.

There are rarely spare moments (like the one I stole to write this blog). I'm constantly trying to find time to study and when I'm not studying I'm thinking I should be studying playing with the kids or feeling guilty I'm not playing with the kids studying.

I'd be lying if I said I have been perfect about keeping up with what I'm supposed to be doing with Garrett for his therapy.

Because of that, or maybe not, Garrett has kind of hit a wall. His understanding and speech have really not gone anywhere in the last 3-4 weeks. He continues to be able to give two or three word commands for things he needs or wants but he still cannot tell stories or put things into sequences through verbal communication.

The pathologist has been trying very hard to get him to tell simple stories such as what he did on a particular day or what is going on in a book. If he talks at all it's a bunch of jumbled gobbly gook with a few words thrown in that mean nothing when taken out of context. 

The two events that have encouraged me have been the dead squirrel and spiders.

Tonight, while coming home from the grocery store, Garrett saw a dead squirrel lying in the road.

He correctly identified it as a squirrel and then noted that, "Squirrel fell down."

I confirmed for him that the squirrel had, indeed, fallen down.

Garrett continued with, "Bump his cheek. Boo boo."

I confirmed that I was certain the squirrel did, in fact, have a severe boo boo.

When we got home he continued to talk about the squirrel.

"Squirrel fall down. Bump on the cheek. Hurt. Boo boo. That's naughty."

I corrected him that neither getting a boo boo nor falling down was naughty and that sometimes it just happens and it's okay to get hurt.

He said, "Oh. Okay."

It's really been the first time he has attempted to tell a story that ended up having any kind of sense and flow to it. He's tried to tell many stories before with unsatisfactory results.. i.e. we couldn't understand anything he was trying to tell us. So to have a story, even if it's just three broken sentences, is a huge thing for him.

He's also fascinated by spiders. He hasn't been able to tell me any stories about them but he has been able to alert me with, "Mommy, come here!" and point out spiders wherever he sees them. He's also very good about saying, "Bye bye, spider!" as I flush it down the toilet.


Another part of his therapy I finally got around to doing was making picture prompt cards for him. Previously, whenever John would come home from work and ask Garrett what he did during the day the onslaught of unintelligible blabbering would start. Thrown in would be those few words that meant nothing to me but obviously were sources of great passion for Garrett.

The pathologist then suggested that I make picture cards of places we commonly go and things we commonly do and as he does the activity or goes to the place, upon returning home I was to put the picture card on display so that when John got home he could take Garrett to his activity board and run him through the prompts to get him to tell the story of his day.

I started out taking pictures of these places but decided to get crafty and ended up making construction paper pieces instead....

I think they turned out pretty good. If I may say so myself.

I will admit that I am extremely jealous of parents who can talk and dialog with their young kids. In our play group there are several 2-4 year olds who have regular dialogs with their parents. They tell stories, communicate wants and desires, give their opinions. I ache to do that with my son. Then I feel like crap because I realize there are parents out there with children with much greater disabilities who will never be able to dialog with their children even to the extent that I can with my son.

I am trying to be content with what I have while also trying to press for betterment and the best for my son... all while trying to be a mom to my daughter, a wife to my husband, a student, a housekeeper, an accountant, an instructor, a friend, a sister, a daughter and whatever other role I'm forgetting I need to play at this particular moment.

Right now, however, I think I need to play the "sleeping person" role. 

Understanding Correction

When the Speech pathologist showed me that Garrett's echolalia was a sign he didn't understand what was going on I felt particularly bad because there had been many time I have disciplined or corrected Garrett thinking his echolalia was evidence that he was understanding.

"That was naughty."

"Naughty."

"Do you understand?"

"Understand."

"Say you're sorry."

"Sorry."

I'm happy to say that in the last three weeks, through being more interactive with him and with some more tools to better understand him I have not had to correct him for anything. He's been pretty obedient and good.

That changed last night when I saw the cat go galloping out of the bathroom with Garrett following close behind with his bathroom cup held over his head. Before I could even process the scene, Garrett threw the cup at the cat who barely escaped behind the basement door.

"GARRETT!" I yelled. "That was naughty."

Instead of echoing back to me he just looked at me.

"Come here. You are going into time out."

"Time out."

"Yes, time out."

I put him in his time out chair and it did not seem to register to him that he was in trouble. He sat there smiling and seemingly waiting for an explanation for why he was sitting there.

After a minute or two he tried to climb down.

"No. You stay there. You are in time out."

He finally got it. His little face scrunched up in sadness and he whined, "Time out?"

"Yes. Time out. You threw your cup at the kitty. That was naughty. You need to be nice to the kitties."

He just looked at me.

"Mommy, time out!" he said.

"No. Mommy doesn't go into time out. I didn't do anything naughty. Do you know what you did that was naughty?"

"Naughty?" he asked.

"Yes. Naughty. What did you do to get a time out?"

"Throw at the kitty."

"Yes. You threw your cup at the kitty."

"Sorry," He said without my prompting.

"You need to say you're sorry to the kitty."

"Sorry, kitty," he responded.

After that we hugged and he promised to be nice. We practiced being nice by petting the kitties and that was it.

This is rather paramount to us and him as this is the first time he's ever been corrected where I know for sure he understood what he did wrong and why he was being corrected.

Again, this morning, at play group he tested the waters by pushing another little boy who was trying to play with the same toy Garrett was playing with and we went through the time out process again. This time when I asked him what he did wrong he said, "Push the boy."

After he apologized we practiced sharing and being nice by helping the boy build a fort out of giant legos. He didn't push anyone else for the rest of the play group (which in itself is a bit paramount as pushing has become his go-to method of communicating disapproval).

It's such a relief to know that he's understanding correction and discipline and even responding to it.

It certainly beats sentence after sentence of echolalia.

Sequencing... and It's Not Autism

This morning was Garrett's second appointment with the speech pathologist. I was so excited to tell her about Garrett's progress: his new understanding of books, increased vocabulary, better understanding and follow-through of two-part commands, better following of direction and increased use of words in sentences.

I was feeling pretty optimistic about today's appointment.

We spent the first few minutes of the appointment talking about his progress and while the pathologist was impressed with his progress she didn't waste a lot of time praising us. Instead, she jumped right in to the next phase of his evaluation.

She sat down with him and a whole bag filled with laminated pictures of things. My kid ROCKS the nouns. Even things she would preface by saying, "Not many kids get this one," or "This one's a hard one," he'd name it with hardly a pause.

With that test Ace'd she moved on to sequencing.

And he failed miserably.

She put down four cards with pictures put in line to tell a store. In the first picture a little girl put on her boots. In the second picture she put on a coat. In the third she added a hat and in the last picture she walked out into the rain.

Despite going over the pictures with Garrett many times, when asked what the little girl was doing in each picture he would resort to simply naming items in the picture to include naming the pictures on the wall behind the little girl and the color of her boots and hat.

We took a step back from sequencing and tried instead to get him to name actions in pictures.

The pathologist brought out a couple dozen pictures of children performing different actions such as talking on the telephone, reading a book, drinking juice, etc.

Again, instead of naming the action Garrett plowed ahead with naming the things in the picture. "Juice!.. Milk!.. Chair!.. Baby!"

She went over every single picture with him and he was able to echo back the actions such as, "washing his face... drinking the juice... eating the sandwich," and when she tried again with the same pictures he responded perfectly with the correct answer. But when she added new pictures with the same actions he was stumped again.

When she tried to get him to work on one more set of pictures he wanted nothing to do with it and resorted to dumping her bag, knocking over chairs and tipping the play refrigerator in the room over all while screaming, "NO!" at the top of his lungs.

I was mortified by my child's destruction but she just smiled and said, "This is so typical of a child who's just come to the end of his understanding. He doesn't get it and so he's giving up."

We talked a little about preschool and she warned me that he is not ready for preschool at all at this point. She was afraid he would spend most of his time in correction because he wouldn't understand and would start acting out like he was with her and neither he nor the teacher or his classmates would benefit at all.

After a few moments of thinking she said, "I'm still not going to give you a diagnosis of what I think is going on here. There are some things I'm pretty sure it's not but there are a few things he's showing signs of that I want to see if we can work on and maybe narrow it down further or eliminate them altogether."

I asked her if she could be a little more specific and she said, "Well, not right now, but one of them does have to do with how he cannot identify the same action in different pictures."

She went on to explain that kids normally see a behavior, the behavior is named and when they see that behavior being done in another scenario they can correctly identify it as the same behavior. For instance: Johnny is brushing his teeth and later, when the child see Susy brushing her teeth the child can identify that the act of brushing teeth is not unique to Johnny. Susy is doing it, too. The child can figure that out on their own without being told.

Apparently some children need a little help expanding those connections of actions across several scenarios and it can effect understanding which then effects language.

She said he has a fantastic basis of knowledge with which to work with as evidenced by how many objects he could name. So now we can start to back off on working on naming objects and work more on naming actions and sequences such as, "I am brushing my teeth. First, I get out my toothbrush. Then, I get my toothbrush wet with water. Then, I get out the toothpaste. I put the toothpaste on the brush...." and so on. We're also supposed to point out those same actions in others and try to make the connection for him ("Daddy is brushing his teeth. Remember when I was brushing my teeth?") to try to help him make the connection to actions and just not things.


She sat him down with a puzzle and while he worked the puzzle we talked a little more about the next steps.

Finally, I asked her point blank, "Are you thinking autism?"

She said, "At first I was, yes. I won't lie. Part of my job is to work with kids with autism spectrum disorder and when I first met Garrett I was seeing some definite, isolated signs that I couldn't ignore. But the more I interact with him and the more I see him and how he relates to me and you and with the progress he's made I am no longer thinking that's what we're dealing with. He's so interactive and social. He shows a few isolated signs here and there but nothing close to the full criteria we would expect for someone who was truly autistic."

She added, "There are a couple of disabilities I have in mind but I don't want to get fixated on them without more time to work on a few things and see if it's not something else altogether or be able to better narrow it down. These things take time and I don't want to rush it and risk putting a label on him without knowing for sure what is going on or whether or not there really is a problem."

I was satisfied with that. I've been very glad to be working with someone who doesn't want to just put him in a box with a specific label on it and write him off as a disability or disorder.

I'm thrilled to have her working with me and giving me tips and guidelines and ways to help communicate with him.

One thing I must stop doing is asking him whether or not he "can" do something when I'm trying to give him a direction. When I say things like, "Can you get off the table?" I'm giving him the option of saying, "No." Instead, I'm supposed to make it the command it's meant to be, "Get off the table."

It was also nice to have her tell me to stop feeling guilty.

I mentioned how bad I felt that here we were, two adults just going about our merry way and not really noticing any problems, talking over him and just expecting him to catch up and she cut me off by saying, "Hey, that's how most children learn language. This was nothing you did or didn't do so stop thinking that right now. You are doing a great job with him."

We have two more weeks with these new guidelines. Here's hoping we can blow her away with his new mad skills!

Train Book Breakthrough

Garrett's favorite book is The Train by David McPhail. We bought it for $.10 at a Library book sale.

We've read it to him every night for months. It's the book that I was so discouraged about after reading it to him the first night after his evaluation.

John and I vary who puts Garrett to bed and who reads to him so that he gets time with both of us. Friday night, after another full day of modeling pronouns, interactive play and going out to the store to buy him some fake food for him to play with and a Buzz Lightyear to encourage him to talk for his toys, it was time for bed. John took him upstairs and Garrett started asking for "Train Book" which means he wants to be read The Train.

John had gone through one of the Read Together, Talk Together books about fire engines on Wednesday night and I went through the Read Together, Talk Together guidelines while reading The Train on Thursday night. It took 45 frustrating minutes of interactive questions, explanations and work that I wasn't even sure was getting through. But I used the guidelines given to me by the pathologist and tried my best to shed new understanding on the story.

When John picked up the book and started reading it to Garrett I was happy to hear John immediately start in on the Read Together, Talk Together interactions and even more amazed to find that Garrett seemed much more in tune to the story.

The Train is a very small book about a little boy named Matthew who loves trains. Matthew lets his baby brother operate his toy train and his baby brother runs it too fast. It falls off the tracks and breaks. Matthew wants to fix the train but his father tells him it's time for bed and he'll have to fix it in the morning. They go to sleep and that night Matthew dreams about fixing and running a real train.

John had not been there when I went through the reading guidelines with Garrett while reading The Train so he wouldn't know what questions I asked or prompts I'd given. This was a perfect way to see what genuine information Garrett had gleaned from our going through it with the new guidelines in place.

Immediately we saw amazing results! I was so amazed I had to stand back with my mouth open in astonishment as I saw John and Garrett interacted while reading the book.

"Who is that?" John asked.

"Matthew!" said Garrett.

"What is Matthew doing?"

"On the bed!"

"Right! Matthew's sitting on the bed. What is he doing?"

"What he doing?"

Knowing echolalia means Garrett doesn't understand, John took another approach. "Is Matthew reading?"

"Yes!"

John read a few pages of the book where it talks about Matthew and his love for trains and letting his baby brother run his train and breaking it.

"Crash!" Garrett said.

"Yes!" Replied John, "Crash. His baby brother broke the train. What did Matthew say?"

"I can fix it!"

My mouth fell open. "That right," said John. "Matthew said, 'I can fix it!'"

He turned the page to where Matthew's father comes in and tells Matthew the repairs will have to wait until morning. Matthew asks if they can read a book before bed and Matthew's father agrees to read one book.

"What was the book about?" John asks.

"Trains!" says Garrett.

I am in complete astonishment at this point. This is the most interactive I have seen my son regarding a book, EVER!

John turned the page and asked Garrett what was happening.

"Mommy turn on light."

Garrett gets his off and on mixed up but it was still pretty darned amazing as this was the part in the story where Matthew's mother says goodnight and turns off the light.

When Matthew's dream about fixing the train begins it's a picture of Matthew working on a wheel with a wrench. When asked what was going on Garrett said Matthew was working on the wheel. Matthew then cleans a headlight and when asked what Matthew was cleaning Garrett again answered correctly with, "Light!"

Garrett went on to tell us that Matthew helped load the baggage car, passed out pillows and punched tickets. He identified the water tower in the picture where the train takes on water and talked about Matthew helping to drive the train. By the time it got to the end of the story and Garrett said, "Good night!" I was nearly in tears.

Later, after John went back downstairs and Garrett was asleep, I crept into his room, knelt beside his bed and I did cry. I thanked God for such a precious little boy. I thanked Him for giving him to us. I thanked Him for the progress Garrett's made and asked for help for Garrett and for myself and for John. I asked for patience and for wisdom and grace. I watched Garrett sleep, combing his hair with my finger and just wept in gratitude and love.

All my frustrations and guilt for the day were gone and I was so happy and thankful to have see him understanding and enjoying his favorite book with his Daddy.

Personality?

People who meet Garrett for the first time often ask the question, "What's he like?" meaning, what's his personality like.

I'm often stumped by this question because I feel, sometimes, like his personality is locked behind this communication barrier. I know he loves trains and cartoons. He's pretty easy going except when he's tired but he has not yet started to show truly distinct personality traits, especially around other kids.

He is a personality copycat right now. He mimics children around him. If one kid is screaming, he will scream. If one kid starts throwing a ball, he will throw a ball. If one kid hits, he will hit. If the other children are laughing, he will laugh. And if you look at his face it is as though he is confused but eager to follow and keep up with the other children. He performs all actions with a look of, "I don't know why I'm doing this, but everyone else is doing it so I will, too."

When children take things from him (except for trains) instead of looking hurt or angry he looks confused and then resigned almost like, "Oh, I guess I wasn't supposed to have that." He doesn't fight or argue and when the other child is corrected and told to give the toy back or to apologize it is almost always Garrett who is saying, "Sorry" and receiving the toy back with a look like, "Oh, I guess it's my turn again."

I've even seen him get bitten so hard he was nearly bleeding and just look at the little girl like, "What sort of game is this?" When the little girl (who is almost a year younger than Garrett) was told to apologize to Garrett she refused. Her mother, mortified by what happened said, "You say your sorry and give him a hug." Her daughter said, "NO!" while Garrett leaned over, gave her a hug and said, "Sorry." Later that day he started biting himself and coming to show me the bite marks. Thankfully that didn't last long.

This is not to say he doesn't have fun because often, once one child he's been mimicking has stopped a particular style of play he will continue it on his own and continue laughing in seemingly genuine enjoyment at having learned something new and fun. Unfortunately, the same thing goes for "unwanted" behavior that he learns from playmates as well.

Watching him play with other children is a little like watching perpetual deja vu. Unless, of course, there is a train around, then he's perfectly content to sit by himself and play with said train and ignore anyone and anything else.

Perhaps it's all been part of his echolalia. He doesn't understand what's going on so in order to feel like he is participating and interacting he just echos the actions of other children like he echos the words of adults when he doesn't understand.

Other than with toy trains he has expressed no real interest in branching out to new toys and forms of play. I have been trying to introduce him to new toys and games through puzzles, match games, drawing and other pretend play. Lately, I've actually been trying to keep him away from his trains just a bit to help him branch out and discover what else he might like.

That being said, I've been waiting for his personality to develop and to see him have some original ideas, feelings and expressions.

He goes to two play groups and a children's library group every week and lately I have been seeing him getting a little more belligerent with other kids. This encourages me because it means he's starting to form differing opinions about what they are doing.

While he has yet to hit or push or bite out of anger (as opposed to out of simply copying what he's seen) I'm finding he has a very strong, "STOP!" and the cutest little scrunched up angry face.

I never thought I'd be happy to see my kid finally screaming "STOP!" at other kids and I'm trying to somehow express to him that letting his opinion be known is perfectly acceptable but perhaps not at that volume. Right now I'm a little inclined just to let him keep it up.

Speech 101: The First 24 Hours

Life is communication.

The better one can communicate the easier life will be. Of course, the opposite is true and the more difficult it is for someone to communicate the harder life will be.

I failed to realize just how hard life is for Garrett right now and to be honest (and to put more miles on my guilt trip) we have failed him in our communication with him. We've come to a place that is "comfortable" for all of us and it has left Garrett at a stalemate.

We did everything that we thought good parents do (played, interacted, played games, didn't let him watch too much TV, read him books, gave him snuggles) but until yesterday we didn't have much in the way of ideas on how to work with him and figure out whether or not he was understanding our communication with him. In honesty, our "play" with Garrett was more of us sitting on the floor and watching him play or running our trains behind his trains or tickle fights or simple interactions that don't require much language.

Armed with some new information from the pathologist John and I wasted no time diving in with our interactive play with Garrett centering more on language.

Right away when we got home I started modeling pronouns. I listened closely for his echolalia and tried to figure out new ways to phrase questions so that he understood. I also spent most of the day figuring out ways to take all of the negative commands I've given him over time into positives. Since he's also potty training, a lot of our time was spent in the bathroom communicating with words like "pee," "potty," and "YEAH!!"

When John got home we jumped right into working on his two-step commands. We got out some toys for Garrett and took turns telling him to take one or two of those toys to Mommy or Daddy. We then went on to interactive pretend play by breaking out pots and pans and setting up a makeshift kitchen in the living room.

It was then we really started to grasp how little he really is listening to us.

We brought out a cup full of colored marbles that he was "cooking" for us and I asked him to give me all of the red marbles. He didn't even register that I was talking to him. John tried to tell him to give me the red marbles and we might as well have been talking to the wall. I started to take all of the red marbles while saying, "I am taking all of the red marbles," and he finally realized that this was something that required both listening and a response and through a series of fights over whether or not I was stealing his marbles he finally started to give me marbles of specific colors or put marbles of specific colors into certain dishes or cups.

That small battle over with we did our homework by watching the "Read Together, Talk Together" video about dialogic reading and asking and responding to questions that expand language.

It was about bed time so John took the first Read Together, Talk Together book upstairs and read him his book and put him to bed.

The next morning started a new wave of challenges for me.

I'm very used to making him breakfast and letting him play on his own while I clean the kitchen and other household chores.

I started collecting laundry after the morning potty rituals and stopped in his room for some interactive play.

The pathologist said it was important for him to incorporate play that includes him having to "talk" for a toy like a doll or animal. She said not to press the issue with him but to model that kind of play for him and see what happens. So, here I am, a woman who has not "talked" for a toy in probably twenty years, on the floor in his bedroom with Woody the cowboy and a stuffed kitty trying to model both sides of a conversation. It was very awkward at first. I'll admit.

Garrett thought this was hilarious and laughed at me and threw blankets at me but I wasn't deterred. After a while I was throwing the kitty into "jail" in the laundry basket and asking Thomas the train to take Woody to the Sheriff's office. When I put the toys down to pick up my screaming 2 month-old I was so happy to see Garrett pick up where I left off and at least try to mimic my play and talk with his kitty, Woody, monkey and goofy bird.

Soon Olivia forced us downstairs for some diaper and potty time and then we were right back to pretend kitchen play in the living room. Garrett expressed to me that he wanted to cook me eggs and that they were hot!

Instead of leaving Garrett upstairs play on his own while I did laundry I let him come downstairs and help with feeding the cats while I did laundry.

Upstairs I modeled pronouns and actions by explaining and trying to get Garrett to help me fold towels.

"I am folding the towel. I fold it in half. Then I fold it in half again."

One of his issues is that it seems like he's listening but he's really only listening for key words that indicate what is going on and skipping over the rest. For instance, when I say, "I am folding the laundry," he knows this means I fold clothes up and put them in piles so if I ask him to help he just wads up clothing and puts it in piles but does not listen or understand the language behind actually folding or putting clothes in specific places.

I worked with him through those steps and then we went upstairs and I had him help me put clothes away.

"I am putting my clothes away. Garrett, where does Daddy's pants go? Daddy's pants go in the dresser. Daddy's pants go in the dresser drawer. Can you open the dresser drawer? Can you put Daddy's pants in the dresser drawer? Can you put Mommy's socks away? Where do Mommy's socks go?"

It was a long but fruitful process.

Then came lunch and the whole process started over again for cleaning the kitchen and doing dishes.

Garrett expressed to me that he wanted to help and instead of telling him no and that this was Mommy's job I figured this could be another opportunity to communicate with him.

He climbed up on a chair next to me and started going nuts. He was throwing dishes here and there and for a moment I didn't think this was a good idea.

I told him to stop and to listen and to put dishes in the water one at a time.

The pronoun modeling started and it was, "I am washing the plate. I am washing the bowl. I am washing the spoon. I am putting the plate on the drying rack. Do you want to help Mommy dry?"

Garrett said, "Yes," so I gave him a plate and he promptly threw it right back in the dish water.

"No, Garrett. That is washing the plate. What do we need to dry a plate?"

Out came his echolalia, "Dry a plate?"

"We need a towel to dry a plate."

"Towel to dry plate."

I took out a towel and started to dry.

"I am drying the plate. I am drying the plate with a towel. We need a towel to dry a plate."

I gave the plate and towel to Garrett and he did well. And step by step I directed him in putting it away.

Then he climbed back on his chair and I gave him the next plate. He promptly threw it into the dish water.

We started the whole process over again.

After about the third or forth try he was starting to realize that drying was not the same as washing and that dishes to be dried did not go in the water. I was even more encouraged when I started to ask him, "What do we need to dry the plate?" he started looking around and thinking about it and finally said, "Towel!"

And it wasn't echolalia. He understood. It was like music to my ears!

We even got to the point where he was following two-step commands like "Give me the towel and put that plate away."

The rest of the day was like this, even down to bath time where I sat there with three trains trying to come up with conversation for the three trains as I mimicked them talking to one another in the bath.

After a few minutes playing trains it was time for bed and it was sweet to have him climb up in my arms and not want to let go, asking to "Snuggle Mommy." 

For bed time I read one of the Read Together, Talk Together books and then he wanted to read his train book.

Now, we've read this book to him almost every night for probably a whole year. You would think he would know what was going on in the story. But using the Read Together, Talk Together guidelines for interaction and the pathologists guidelines for ques as to whether or not he was understanding I got a big slap in the face to how little of the book he actually understands. To him, the book is about trains and that's all that matters.

Almost every question I asked him about what was going on was answered with echolalia. It made me feel like I was being kicked in the gut. Months of reading to him and it seems as though absolutely nothing was getting through. I went through the Read Together, Talk Together guidelines through the book as though we were reading it for the first time. A book that typically took us three minutes to read took almost forty-five minutes.

To sum up my feelings of the day: I am exhausted.

I am encouraged. I am humbled. I am chastised. I am frustrated. I am hopeful. I am mad. I am unsure. I am determined. I feel bad that Olivia is kind of getting a back seat to Garrett as other than feeding and changing her I've been propping her up on pillows and putting her in the swing or just sitting her in my lap to play and interact with Garrett. I feel torn about my responsibilities to him, my daughter and my home. I'm feeling a bit overwhelmed and it's just the first day.

 And now it's off to bed to rest up for day two.