Believing in Girls with Rett Syndrome

When we first got a diagnosis of Rett Syndrome for Becca we did a lot of Internet searches trying to figure out what we were up against. Paula found a blog called Spirit Dances about a woman with Rett Syndrome named Karly. The blog is authored by Karly as her mother held her hand and helped her type on a keyboard. The posts are complete sentences, complete paragraphs, with a very large and diverse vocabulary.

When I saw the blog I discounted it right away. I'd read about how debilitating Rett Syndrome is, and there was no way this disabled person was writing all that. Maybe she was picking the first letter and her and her mom was filling in the rest -- maybe not even intentionally or anything, but there's lots of research examples of facilitators who in trying to help end up saying things from their own head rather than the individual's. I didn't say any of this in a comment on the blog or anything, I kept it to myself, but I definitely thought it.

I didn't know Karly (she has since passed away) so I'm really in no place to make a judgment call either way, but I've since learned why my attitude is wrong-headed -- mostly by being on the receiving end of some healthy skepticism about Becca's abilities.

Becca is reading words. She only knows 14 letters, but that's enough that she's independently read the words "bat", "bag", "fat", "leg" and "hen". Last week we were trying to come up with Christmas words for all of the letters she knows, and she thought all on her own of "elf" for "e". The next day she asked me how to spell "lion". She out of nowhere last month told us that she hates her car seat, and she told me a few weeks ago that I make her shower water too hot, then helped me find a better temperature. She can count to five and she has just started saying her own prayers at night when she goes to bed.

Hunting for a Christmas tree we all could agree on

If you've seen Becca in real life then those events will probably sound next to impossible. Becca can't talk or sit up or walk, she shakes constantly, she struggles to move her arms intentionally anywhere other than to her mouth and struggles to keep eye contact focused on much of anything. Most people would look at someone in her condition and declare those skills as far out of reach. And if we told you how we know she can do all of those things (because she told us she can) then you'd probably put us squarely in the same bucket I put Karly and her parents in before. I can't really judge you for thinking that way since I sometimes still do myself, but I can try to help you see why you (and I) should rethink assumptions.

I'm going to introduce two probably-new-to-you concepts. The first is called "the least dangerous assumption" and the second is called "presumed competence". They both have to do with the benefit of the doubt, and hopefully will help you see why it's so important for individuals with disabilities.

The least dangerous assumption is a perspective re-think. It's essentially the request to take your assumptions about a person's capabilities and think beyond to the end result of those assumptions. Let's say for example that twenty years from now someone comes up with a drug that completely cures all symptoms of Rett Syndrome. Which would be worse, hearing Becca say "I laid on the floor for twenty years watching baby cartoons. I tried to learn to read but nobody would hold the books still enough" or hearing her say "I know you tried to help me, and I did get a little out of it, but most of the time it was too hard to focus and I didn't learn much"? Henry Frost is a young man with autism who fought this battle, using typing to convince the school that he was capable of learning. The least dangerous assumption is the assumption about an individual's abilities that will cause the least amount of damage if in the end you find out you were wrong.

Presumed competence is related. It's the idea that an individual shouldn't need to earn the right to be taught, respected or spoken to. You should assume that an individual understands what you're teaching them or saying to them or about them, whether they can respond or not. Don't skip explaining things to Becca just because she looks like she's not listening. Don't skip her in activity time with the kids because she's disabled. When Becca responds with what seems like only half or a quarter of what you were told is her typical response, you should take it and believe that it was intentional. Take it the rest of the way. Call it a victory, rather than thinking "that could have been an accident". Presume competence. Don't ask her to prove to you that she has a brain in her head, that's not how you treat "normal" people. If a "normal" kid says "appow" instead of "apple" you don't say "well *that* kid can't talk." I won't lie to you, presuming competence takes a lot more work than you probably think. It involves getting over your own insecurities in addition to the child's, and re-assessing yourself again and again.

Honestly presuming competence has made all the difference in the world with Becca. Once we started introducing concepts and ideas to Becca that were beyond where everyone (including us) assumed she was, she took off. Her yes/no eye gaze didn't get really solid until she started picking from six choices of places to go (backyard, front yard, downstairs, etc.) -- and I'm betting that at least the first few times she didn't completely understand what she was picking. But we took it and ran with it and then went a few steps farther. We didn't know for sure if she'd keep up but she has, again and again. I love the phrase I found a few weeks ago, "we teach intentionality by assuming intentionality." Just as often we we find we're not teaching intentionality so much as finally trusting her enough that she feels she can rely on us for communication. Whenever we feel like she's getting stuck it's usually not because of her understanding, it's because we got sucked back into "you need to prove you know this before we move on" again, and once we fix our side she picks right back up. Will that last forever? We have no idea. But we've heard too many horror stories of girls with Rett in high school who are still working on identifying colors, and we just have to think there's something more stimulating for them than that.

Check me out, I can rock the wink like no other.

Becca's mutation (K135E) is not a common Rett mutation, so I don't know that we can really speak for a majority of girls with Rett Syndrome, but from those we've seen Becca is not on the "light" end of the Rett spectrum, and she is still so very much "in there". We have to believe that most girls with Rett are as much "in there" as Becca. I still wonder about Karly's typing skills (my bad, I know. Why do I worry so much about being "taken in" by an online exaggeration?), but I now believe she was capable of writing a blog, that she could read and understand and benefited from her method of communication. I think it's crucial that we surround our girls with people who believe in them, because I've seen how much of a difference it can make.

If you don't believe Becca can do the things we claim she can do, we understand exactly where you're coming from but please give our daughter the benefit of the doubt. If you want a girl with Rett Syndrome to see you as part of her life then get excited for her, believe that she did it even when there's not the evidence most people would expect. Someday in the future you will see how she has changed you as much as you have changed her, and that making the least dangerous assumption has brought you into a circle of trust that will change your life in significant ways -- regardless of whether anyone else in the world believes you or not.

Rett Syndrome, Long-Term Memory and Neuren Pharmaceuticals' NNZ-2566

Over the last couple months I keep getting sucked back into the question of how Rett affects long-term memory. First I saw this write-up talking about how adult women with Rett seem to have better memory for events and objects from their early childhood. Then a few weeks later I was looking up long-term memory for an unrelated project and came across mentions of our good friend BDNF. I dug in a little then, but it's coming up again now as I'm working with Becca on learning her letters, and I wanted to better understand her learning process.

BDNF

So! Here's the somewhat limited (but still long) results of my foray into the relationship between Rett Syndrome and long-term memory.

Quick refresher from my previous post on BDNF, brain-derived neurotrophic factor is a protein and gene that have various effects, mostly on the brain. I believe it is also the first identified protein that is "downstream" of MECP2 (Rett). When you compensate for a BDNF deficiency in a mouse with Rett, their heart begins to function properly, their energy and strength improve -- many of the main symptoms of Rett are lessened significantly.

Then what about BDNF and long-term memory? Long-term memory is (I believe) defined as anything that's remembered for more than around eight hours. That includes childhood memories, lessons from school last year, and what you learned yesterday in class. The process of long-term-memorization seems to be getting something into short-term memory, then transitioning it to long-term memory and strengthening its placement in long-term memory over time. BDNF does a lot for the brain and is deficient in Rett Syndrome, so that's a great starting point for research.

 The first article I found was a winner, "BDNF is essential to promote persistence of long-term memory storage". The study shows two things, 1: BDNF is necessary for long-term memory persistence as part of a process that happens at some point after the original learning experience, and 2: even when other components of the long-term persistence process are missing ("hippocampal protein synthesis" is apparently the other part of the process), BDNF alone is enough to persist the long-term memory -- "in an ERK-dependent manner".

Cue the vocab lesson :-). Gathering these terms was no small feat, the neuroscientists of the world do not like to share their language with us peons.

Protein synthesis - the creation of proteins by cells. Hippocampal protein synthesis is the creation of proteins by brain cells, and is necessary for the brain to create connections. Apparently even if you suppress protein synthesis in the brain, a sufficient supply of BDNF is enough to allow for long-term memory. BDNF pretty much rocks.

Kinase - a kinase is an enzyme that allows for energy transfer. If I understand this correctly, a kinase is essentially a pathway through which actions can occur.

ERK - extra signal-related kinase. This is a specific kinase that is "activated" or used by, among other things, BDNF and growth factors (IGF-1, anyone?). This study was focused on spine growth, but showed that BDNF most definitely leverages the ERK "path" for its purposes.

CREB - CREB is a transcription factor (a protein) that helps regulate the transcription of certain DNA pieces. In other words, when a cell uses its DNA to send a message via RNA to create certain proteins,  needs transcription factors like CREB in order to send the correct message and have the protein created correctly. CREB regulates the transcription of a number of genes including BDNF.

Thanks for sticking with me, here's a picture.
CREB != crab.

PKMζ - PKMζ is another kinase. It appears that this kinase is necessary for the maintenance of long-term memory. Without it existing long-term memories seem to break down.

Akt/mTOR - Akt and mTOR are two kinases that I see lumped together a lot in the papers I'm looking at. The Neuren study implies they are a joint pathway that is inhibited by Rett Syndrome (more on that in a minute). 

IL-6 - this is a protein that is somewhat similar to BDNF and IGF-1. It does a bunch of cool stuff. I honestly haven't dug into it much, but the Neuren study suggests that their new drug may help via the IL-6 route in addition to the IGF-1 route. The only other paper I could find mentioning Rett and IL-6 wasn't directly related (but is wicked interesting and I'm going to dig into it later for sure).

Sorry, that was rough, but hopefully it'll help if you decide to dig in to any of the linked papers. I can proudly say I understand at least 30% of the Neuren presentation now :-). Anyway, back to our research. 

BDNF can facilitate long-term memory via ERK. In fact, another study said BDNF is a requirement for ERK activation (and also that CREB is necessary for correct ERK activation). There also appears to be a time element involved. In yet another study Alonso and company found that injecting rats with BDNF blockers prevented learned fear reactions -- but only some of the time. When BDNF was blocked 15 minutes before, or 1 or 4 hours after the training then the rats didn't developer the learned reaction, but when blocked at training time or 6 hours after, it had no effect. There were a few other studies that talked about time-critical moments in the long-term memory process. If there were a way to temporarily increase BDNF it seems like it could be done at a strategic time in order to improve retention when teaching new topics.

So is there anything to be done? Not sure. The whole "BDNF is necessary and also sufficient" thing is kind of a downer. I found some articles on how dopamine (2) and PKMζ increases can enhance long-term memory, but if BDNF is a must-have then I don't see how useful that is for Becca. Maybe it would help some even if it doesn't remove the main barrier, I don't know. I did also find some articles on memory strategies, the most promising of which is to try to encourage connections between existing long-term memories when introducing a new idea ("B" is for "bus", you ride the school bus every day to school), which can essentially make it more likely the idea will be pulled along into long-term memory (though somewhat paradoxically, novelty encourages attentiveness which improves retention as well). I'm trying to offer more variety while I teach Becca, pulling in both familiar and novel concepts, to hopefully do what I can to help her with retention.

Obviously long-term memory isn't completely nonexistent since Becca recognizes people from the past, she remembers things she doesn't like (her car seat) and things she does like (Wall-E, chocolate). She seems to recognize places she's been before. But when I work with her on school topics, it feels like she has a harder time making things stick between sessions. That's what this study says, too, that LTP exists in a weakened way in individuals with Rett Syndrome.

Oh right, LTP is another vocab word. Long-term potentiation is the biological process that most likely equates to long-term memory. They strongly correlate, anyway. As I look at my old notes, I remembered there were Rett studies mentioning plasticity, so I did a quick check on the relationship between plasticity and LTP. Apparently LTP is one type of plasticity, so if your plasticity is messed up then your long-term memory is probably messed up too. Like with Rett Syndrome.

Ok, so we're basically hosed when it comes to long-term memory, we do what we can but it's a very uphill battle. Lots of studies showing poor plasticity caused by Rett Syndrome. But remember, the IGF-1-as-a-replacement-for-low-BDNF studies on mice with Rett showed significantly improved plasticity (which should also mean improved long-term memory).

In fact, that's one of the main areas of study for Neuren Pharmaceutical's research drug, NNZ-2566. NNZ-2566, they claim, is an "analogue" of IGF-1 that can be taken orally but can still cross the blood-brain barrier, which is what needs to happen if it's going to have a positive impact on brain function.

Neuren has performed studies on mice where they "knocked out" or disabled FMR1, which is the equivalent of giving someone Fragile X. Fragile X is obviously not the same thing as Rett Syndrome (they may even be on opposite ends of the spectrum), but there are both genetic disorders with neurologic impact and do have some similar characteristics. Not sure I'm reading things right, but it seems like Fragile X *might* have the same problem of too little BDNF in the brain... The relationship between Fragile X and BDNF (search results) doesn't seem as cut-and-dry to me as with Rett, but I'm having a harder time understanding those results so don't read too much into that.

As far as the Neuren study goes, the Fragile X mice showed poor long- and short-term memory in different mazes when compared to wild-type mice. When placed in a simple maze 10 minutes and 24 hours after an initial exposure, the Fragile X mice were exploring the maze anew while the wild-type mice more quickly re-settled into their environment. In a different maze with essentially tall cliffs, the wild-type mice spent significantly less time on the anxiety-inducing cliffs than did the Fragile X mice. When given NNZ-2566 the Fragile X mice performed basically the same as the wild-type mice in both mazes.

Only one of these things has a head
full of fluff.  Also, stripes are cuter
than polka-dots.

So that's potentially very promising. It says to me that NNZ-2566 as an IGF-1 alternative may be a sufficient supplement for a BDNF deficiency as far as memory is concerned. We know from the other study I linked to before that IGF-1 positively affects brain weight and plasticity of Rett mice, so maybe that's enough of a correlation to be hopeful for Rett in addition to Fragile X. 

At any rate Neuren is working on Phase II of a clinical trial for NNZ-2566 as a treatment for Rett Syndrome. They are looking for adolescent and adult subjects (if I remember correctly, they're targeting older subjects because IGF-1 is a *growth* hormone and they don't want any confounding factors from younger subjects who are still growing), though if the drug is effective they will obviously work for approval for younger cases as well. They claim that in pre-clinical models of TBI, Fragile X and Rett there was a "normalization of Akt and ERK activation profiles" (you know what that means now, sort of!). Hopefully the clinical trials will back up their previous research.

What do the rest of us do in the mean time? Be patient is all I can suggest :-). It's been a tricky balance as I've been working with Becca on "school time" because she seems to remember enough to get annoyed if I'm too repetitive or spend too many days on the same subject, but it's also clear there are holes in her understanding that I need to fill before I can go too much farther. It does help to know there's the potential for learning, and that I'm not crazy in thinking she's getting it albeit sometimes at a slower pace. Even with all of her constraints she still surprises us quite often with what she knows or remembers, we just have to believe in her and keep remembering to ask.

School Time Update (Becca read a word!) - 11/20

Whew, it's been another month already. Lots of after-school adventures to recap. I was out a couple weeks for some work trips and things so it wasn't quite every day.

We've mostly been working on letters for the last month. Some of the non-letters work we've done was on matching baby animals to grown-up animals. Becca thought that was fun. ...actually that's the only non-letters thing I can remember doing. I need to be better about getting more non-letters things mixed in, it's just that letters is taking a lot of time and review.

Basically we introduce a new letter every couple days. I hold up a uppercase and lowercase version of the letter and we talk about it, draw the shapes, make the letter sound, and think of words that start with that sound. I always have at least one picture that starts with the letter, where it's the picture and also the word typed out with the first letter highlighted. We're trying to work on reading with her inner voice, so I prompt Becca a lot to say the letters in her head or make the sounds in her head.

When we review old letters she seems to do a pretty good job of saying whether she recognizes the letters. That is, she says she knows B and A and their sounds really well, but she struggles remembering D, and the fact that C makes a "kuh" sound is hard for her to remember too. The newer letters are still pretty hard to recognize. We've played a sound matching game a couple times, where we stick pictures on her board and then I ask her to find the picture that starts with the letter I hold up. A couple times on B and S she's done it without any additional prompting, but usually she needs to hear the sound the letter makes, and then she can find a picture that starts with the sound.

She pretty consistently (eighty percent? I haven't been counting) can find a correct picture (sometimes there would be more than one) by looking at the picture and then back at me. She does tend to look around at all the pictures, and sometimes she gets caught on one even if it's not the right sound, but with some additional prompting she'll usually keep looking. When she wouldn't engage well I would then scan through the pictures with her, saying the picture out loud and then asking if it had the right sound. There were only a few times we had to get to that point, but then we ended up at the right answer. Probably twice she selected the wrong picture before scanning, and she either changed her mind when I tried to confirm, or when she confirmed the wrong pictured and I said that didn't match she laughed. I'm pretty sure at this point she likes to tease.

We've also been starting to spell out words. I cut out each of our letters we've been working on with a thick edge at the bottom so I can hold the letters together more easily. Then I hold them up for Becca and we try to figure out the word. First we go through each letter and say what the letter is and what sound it makes. Then we make each sound one by one, faster and faster until we get the word. It's really cute to see her "get" the words, it's a very clear reaction where her eyes get a little wider and she looks up at me (when she's well-engaged). Sometimes it's not until I've fully combined the letters, but sometimes it's sooner than that. Once we figure out the word we celebrate.

A couple times when she reacted before the word was fully combined I'd ask if she thought she knew the word already. If she said yes then I'd say let's try and find the picture. I'd hold up different pictures and ask if they matched the word. The three times we did this she correctly picked the right picture.

One time was particularly awesome, I held up b-a-t and she reacted before I'd pointed out any of the letters or anything. I asked if she thought she knew the word and she said yes. I held up a cat and asked if that was the word, and she didn't say yes. Then I held up a sun and again she didn't say yes. I held up a picture of a bat and asked and she said yes. We celebrated a lot on that one :-). Becca read a word!

So far we've worked on the following letters: B, A, S, T, C, D, E, N, U and G.

School Time Update - 10/24

I think you all get the idea now on what we're doing with Becca, and I have the evidence I wanted in case I need it for school, so I'll chill out again now. Over the past two weeks we've done a bunch of different things with Becca. We worked on matching animal babies with their parents, picking items from a list, some more letter work, and pushing vs. pulling. Each time she answered our questions correctly at least 75% of the time.

A highlight for me was when we put 12 pictures on a board and had Becca select pictures from the grid using partner-assisted scanning. Paula worked with her on it first, just asking simple questions and finding Becca's answer. It was more freeform than we've been able to be with her before because there were so many different choices (some food, some equipment, some TV shows, some locations). The second day was right after a trip to grandma's with lots of driving.

I asked Becca to tell me what she wanted to talk about. She picked her carseat. I asked if she liked her carseat. Immediate no. I asked if she wanted a different carseat. Immediate no. I asked if she wanted something else instead of a carseat, I joked about putting a bed in the car. Immediate yes. She looked at me like, "that's an option?!" I think she has so much she's going to start saying as soon as she has a better opportunity to.

On the letters I noticed Becca has a hard time engaging for a long time, probably because it feels so repetitive. I ask her a lot to say words or sounds in her head (a la the nonverbal reading approach) and it's not exactly fast-paced. I try to explain to her why we're working on it, and that does help some. Also I've noticed when I get Becca's sister involved and have her practice, Becca does better as well. For example, we worked on matching pictures to the words describing those pictures (candy vs. sit vs. books, working on starting sounds). Becca made it through and matched each picture to the word based on the starting sounds with only one mistake that she corrected on her own, but the last one was hard, we had to play a hand game first to help her re-engage. Then when I asked Becca's sister to go through the same matching exercise I noticed Becca would look very attentively at the right answers, even though it wasn't her turn. I need to remember this trick. I know I wouldn't like being put on the spot all the time, in school I definitely preferred answering on my own with some other kid in the hot seat.

Anyway, lots more to learn, but that's the latest update.

School Time 10/11 - Describing Family

Yes to school time. I told Becca I wanted to use the same family pictures but use them to describe our family members, and then we would talk a little about some animals and describe how they look too. She said yes, that sounded good. Becca had a hard time with the session today, she was very tired and had lots of coughing, both of which made it hard for her to engage and for me to be sure I was seeing her eye choices correctly.

I got out the board with our pictures still on the left side (her left). Then I pulled out four pictures: a boy, a girl, a big person and a little person. Each time I would hold them up and describe them to Becca. Then I attached them to the right side of the board and said I wanted us to try describing the people in our family.

I went first and pointed to myself. I said daddy (I pointed to my picture) is a boy (I pointed to the boy) and is big (I pointed to the big picture). I went over what the pictures on the right stood for one more time, then I let Becca have a turn.

She looked at Becca first, and I said great, let's do Becca. What can you tell me about Becca? She kept looking at the people side, but not long enough to say any of them were choices.  Then she had a coughing fit so we had to wait. After that I asked if Becca was a boy or a girl. She looked around, but on the second prompt she picked girl. Then without prompting she picked big, not little. I said that was right, Becca was a very big girl.

Next we let Becca's sister go. She picked herself, and said she was a big girl, touching each picture as she went. I repeated that a couple times.

Next I held it up for Becca to go again. She picked her brother this time. I asked if he was big or little, and she said big after a short delay. I asked if he was a boy or a girl and she was slow to answer. Actually I think she was slow to answer that question every time. She wasn't super engaged and she might have been a little annoyed and thought it was obvious question, not sure. She did eventually pick boy.

I tried to model again how we can use picking different pictures to make a sentence. I did Becca's brother again, showing that we could say he was a big boy by selecting those pictures one by one.

I held the board up again for Becca and asked if she wanted to talk about anyone else. She picked mommy this time. I asked if she wanted to say anything about mommy and she quickly chose big. I asked if she wanted to say anything else about mommy. She had another coughing fit, and after getting re-settled again she picked boy. I laughed and said that was silly, mommy is a girl, not a boy. I asked if she was trying to trick me. She looked away, not sure what that meant. I modeled saying mommy is a big girl again.

I asked if Becca wanted to talk about anyone else, but she wouldn't look at the board anymore. After that we looked at a couple pictures of animals but only because I'd promised to. I told Becca we'd work more on the animals next time, but that she seemed very tired and we should probably be done for now.

School Time 10/10 - Becca Says

School time was a go. I told Becca we were going to play a game called Becca says, where she gets to pick a person in our family and have them perform an activity. I showed Becca a picture of each member of our family, then attached all five to the left (her left) side of the plastic communication board. I let her look over them and she looked around at all the pictures in a circle a couple times, then back at me. Then I showed her three pictures, one of a person dancing, one of a person singing, and one of a person jumping. She would look at the picture and then look at me, and I'd say what each of those pictures meant. Then I attached all three actions to the right side of the board.

Then I explained again that we were going to take turns picking a person, and then picking an action for them to do. I asked her to first pick a person and she looked quickly and for a long time at mommy. Then I suggested she pick an activity for mom to do. Her eyes would dart quickly back and forth between the people and the activities, and I wouldn't count it unless she sustained gaze, but she darted back and forth quickly a lot for this activity ("Mommy jump daddy sing brother sing sister dance" in like three seconds). After some prompting she looked long at the "jump" picture so I called out to mommy and asked if she would come jump for us. She came over and jumped up and down. Becca got a big smile on her face.

We took turns letting Becca and her sister pick (and her brother occasionally when he was interested). Becca chose difference people and different actions clearly. She would spend extra time looking at the people side, and sometimes it seemed like she wanted to change her person choice, but I wouldn't let her, I'd tell her that we'd already chosen a person and now we needed to pick an activity. After some more prompting she would pick an activity.

After the first time Becca chose to have her brother sing a song (which he did, with a lot of help), daddy dance, Becca sing a song (we sang one together), mommy jump again, brother dance, mommy sing a song, and maybe a couple other choices. Becca's sister would also choose some, though the only one I need to bring up is when she had daddy jump. Becca got a really big smile on her face and the next time it was her turn she had daddy jump again. One time in there I also picked and had Becca dance, and we danced together. She liked that, but she didn't like "jumping" in her chair when her sister picked that, it stressed her out a little bit.

School Time 10/9 - Plus One Again

I told Becca I wanted to work on plus one again, she said yes to school time working on plus one. Huzzah!

We got out the plastic board and did the same approach as last time, "__+1=___" on the bottom, with three options on the top. I first went through 1-4 in order. I'd fill in the first number ("1+1=___") and then ask Becca what came next ("one plus one equals... what?"). I'd read off her three options at the top, mixed up each time. If she didn't answer right away then I would talk about how plus-one is like counting, we try to figure out what number comes next. Then I'd count up to the number and stop right before saying the next number (i.e. "four plus one, that's one, two, three, four...").

For 1+1 she immediately looked at 2 (even before me pointing out the choices) and back at me. I moved 2 to the right spot on the board and we celebrated (I would wobble the plastic board so it made a funny noise and sort of fanned her face, and I'd sing the number to the tune of the Braves' war chant, "twoo-ooooo... twooo-ooooo"). This made Becca smile every time.

For 2+1 after I paused, she didn't pick. I then showed her the choices, and asked again. She started right at 3 for a long time. I said that was right, moved 3 to the answer spot, and we celebrated.

Becca's sister was a little jealous

For 3+1 after I paused she didn't pick. I showed her the choices and asked again. Still no choice. Then I did the counting thing. After that she looked at 4 and back at me.

For 4+1 she immediately picked 5 after I showed her the choices.

Next I said I wanted to review some of them and asked if that was ok. She said yes. We started with 2+1 again. She wouldn't pick, even after me showing her options and counting up to 2. She kept looking away instead of at the numbers. It could have been because her little brother started saying "tree" after my "one, two..." every time. Or it could have been she was annoyed that I'd already asked. Either way, I eventually said it was three and we drew a 3 in the air with her hand. I asked if she could find the 3 and she looked at it and back at me. Celebration song again.

After that I asked Becca if she understood why I was asking some of the same questions again. She wouldn't say yes, so I explained that for math we have to answer the same questions more than once so we can learn to answer it very quickly. After we practice enough then it gets easier to answer questions fast, and then we can use that to answer even harder questions. (Side note: I have no idea how to teach someone with no motor control how to add two-digit numbers. How do you teach something like carrying? Just tell them to keep it all in their head? Something like 4+5 is going to be hard enough..)

She's going to be so bored in school..

Next I did 1+1 again, and she rocked it with a smile on her face, no prompting other than to ask "what is 1+1". Next I said I had a hard one, 4+1. Again she picked the correct answer without needing them to be listed. Celebration again. I told Becca she was really smart and I was impressed she was getting better at her plus ones.

School Time 10/8 - Numbers

I got a little behind, so this will be more of a summary. Becca said yes to school time. I told her I wanted to practice our numbers one through five some more and make sure she can find them. She said yes she'd like to do that.

I got out the plastic board and taped the numbers 1 through 5 on it (same papers that we drew last week). I held up the board for a minute so Becca could look at all the numbers. I believe we also went over them before starting, me pointing to each number and asking Becca what it was, then saying the number when she looked at me.

Next I asked Becca if she could find the "1". She immediately looked at the 1 and then back at me. We celebrated by clapping 1 time. Then I suggested we should ask mommy to make one silly noise. Becca said yes, that sounded like a good idea. After Becca looked at Paula from across the room she made on silly noise. Same with 2, she found it right away, looked at the number and then back at me. We clapped twice, then asked Becca's sister to make 2 silly noises by looking at her. For 3 she looked immediately at 3, but then she wouldn't look back at me. I pointed to the one I thought she was picking and asked if she thought that was the 3, and she said yes. We celebrated. I asked if she wanted me to make 3 silly noises. When she said yes then I did. I asked if she liked the silly noises and she said no. I asked if I should try another silly noise and she said yes, so I tried another one. She smiled really big and I asked if that silly noise was better and she said yes.

For 4 Becca wouldn't pick the 4. She would look around and ended up sticking on the 2 a lot, but not looking back at me. I told her that was a 2, not a 4. I drew a 4 with her in the air with her hand and asked if she could find that number. She eventually did look for a long time and the 4 and we went with that, asking mommy again to make 4 silly noises. 5 was similarly slow, but she did eventually pick it. She looked at 2 a lot again, and Becca's sister pointed out that a 2 is like an upside-down 5. Becca's sister did 5 silly noises in celebration after our five claps.

Also after school time I told Becca I was impressed with how smart she was. I asked if she thought she was smart, and she said no (looking at me momentarily and then looking away). I told her of course she was smart. I started listing all of the things she had learned both at school and home since the school year started, and how those were amazing things to learn. She got a smile on her face as I started listing them (it took a little while to list them all). I asked again if she thought she was smart and this time she said yes with a smile.

School Time 10/4 - Plus One and Numbers

I asked Becca if she wanted to do school time and she wouldn't say yes. I explained that we weren't going to work on drawing today, we could work on numbers instead. I wanted to practice doing "plus one" with her, and looking at our numbers. I asked if she wanted to do that for school time and after a few seconds she said yes.

We got all seated at the table, and went to get started. We had some sibling tantrums we had to work through so it was quiet enough to focus, but then I said I wanted start by writing down what each of the numbers looked like, then we'd practice some plus one's, then we would work on the numbers a little bit more.

I said the first number was one. I asked Becca if she remembered what a one looked like. She wouldn't say yes. I asked if she wanted to draw it with me and she said yes. I held her hand and we drew a one on a sheet of paper. Then I asked if she knew what number came after one. She said yes. I said yep, two comes after one. I held up one crayon and said "when we have one crayon and add one more, we get two" and added another crayon. I did this for every other number as well.

We repeated the same process, she remembered what two looked like and was willing to draw it with me. She also remembered what came after two, and she remembered what a three looked like, and she wanted to draw it with me. She wouldn't say that she remembered what came after three, so I told her it was "one, two, three..." I waited until she looked at me, then I said "four". She didn't remember what a four looked like, and she didn't want to draw it with me, so I drew it for her and showed her the four. She said she remembered that five came next, but she didn't remember what a five looked like, but she did want to draw it with me.

Next I drew a couple more things for our activity. I put "__+1=__" on the bottom part of her plastic board. Then I would attach three numbers up above and put a number in the first blank. I talked about how "plus one" was trying to figure out what number came next, and how it was like when we measured things and sometimes our number wasn't quite enough, we had to "add one" more to get it high enough. I asked if she wanted to try doing some plus one's. She said yes.

I put "1+1=" and stuck on the numbers 2, 4, and 3 as options. I showed Becca the board and said we needed to try to figure out what was one plus one. She immediately looked at the 2. I talked a little bit more about how that means we need to figure out what number comes after 1, and how if we have one (held up one finger) and add another one (held up another finger), then how many does that make? How much is one plus one? Again Becca looked at the 2 and then back at me. I said that was right and we celebrated.

Next I put "3+1=" and stuck on numbers 2, 4, and 5. We did the same thing. Becca wouldn't pick one of the numbers. She looked at all of them but wouldn't pick. We worked through the same hints, but she wouldn't pick. Then we counted from one up to 3, and I paused and waited. When she looked at me I said, "4". I asked if she could find the 4 and she picked the 2. I said that was a 2. I showed her which one was the 4 and we practiced tracing the 4 a few times.

After that I put "2+1=" and stuck on numbers 2, 3 and 5. Same review. Becca looked at all the numbers and after a delay she looked for a long time at the 3. I asked if she was picking the 3 and she looked at me. I said that was right and we practiced drawing the 3.

Next was "4+1=" with the numbers 2, 3 and 5. Again she had a hard time picking. Eventually we counted up and Becca looked at me and I said 5. I showed her where the 5 was and we practiced drawing it. I said it seemed like she remembered 1, 2 and 3 pretty well, but 4 and 5 were harder for her. We did "2+1=" one more time and very quickly she picked 3.

Then I took off all the signs and put 1-5 randomly on the board. I showed Becca the board and told her I wanted to play a finding game, and see if she could find the numbers. We went over them together one time, tracing them and counting up from 1 to 5. Then I asked if she knew where the 3 was. She looked around and after a moment she stared for a long time at 3. I asked if that was 3 and she said yes. I said that was right and we cheered. Then we did 1 and she found it right away and looked back at me. Next we did 4. She looked at 2 and back at me. I said that was a 2 and we traced the 2 again. She looked at 3 and almost back at me but then away. I said yeah, that's 3 not 4. Then she looked at the 4 and back at me. I said yes, that's the 4 and we celebrated. 2 was next, and she got that one very quickly. For 5 we had some coughing interruptions and ended up doing a hand game before trying again. After we came back to it she looked at all the numbers and eventually looked at 5 and then back at me quickly. I said yes and we celebrated again.

School Time 10/3 - No School Time

First time I asked Becca said yes to school time. Then when I got her seated and ready I told her I wanted to work on drawing pictures, I asked if she wanted to do that and she wouldn't say yes. I asked if she wanted to work on pictures and she clearly said no.

Hm.

I tried explaining to her that I wanted to talk about how different ways of drawing and bright/dark colors can tell people about how we're feeling when we draw the pictures. Did she want to learn about that? Another clear no. I told her it was ok that she couldn't draw all by herself, I was going to try some different drawing tricks with her to see what we could draw together. Can we just try drawing one page? Another clear no.

Well, stubborn me, I said sometimes we have to learn things even if they don't sound fun, so let's just do one page and then be done. I didn't ask that time. I drew a couple pictures with different colors and showed her and talked about how the dark ones seemed more sad and the bright ones seemed more happy, how the colored-in ones seemed a little more realistic, etc. She kept coughing and looking away.

Then we did a quick hand game, which she thought was fun and funny. She re-engaged for a minute, until I started talking about drawing again.

Once we finished one page I asked if she wanted to be done and she wouldn't say yes. I asked if she still wanted to do school time and she said yes. I ran through some other ideas of things we could do for school time, working on numbers, letters... she wouldn't say yes to anything. I said that was fine, we could just be done then.

Well, she definitely has an opinion :-). I guess she either wasn't in the mood for drawing, or doesn't really like drawing all that much. Incidentally, Paula said this was a lot like what she was like the first time Paula tried to do school time with her. Good to know I'm not the only one who's run into Badditude Becca.

School Time 10/1 - Behavior, Becca Style

I asked Becca if she wanted school time today and she said no. I asked if she thought yesterday was boring and she said yes. I apologized and explained I wanted to try again today only talk more about things she could do rather than things other kids would do. I asked if she wanted to do school time today like that and she said yes.

This time I had pictures of things Becca could do (holding hands, giving a hug, looking at someone with a smile, crying, pouting, not holding her head up, not making eye contact). I would hold up the picture and ask Becca if she could see it. She would usually look for a couple seconds and then look away. I would ask Becca's sister what it was a picture of, and she would say. I would ask Becca if she ever did that thing or felt like doing that thing. Then I would hold up the picture between the happy and sad child and ask Becca if when she did that thing it made people feel happy or sad.

Becca would still look at the happy child a lot, and whenever I wasn't talking she would go back to staring at the child. I had to start holding the board down next to Becca so she would focus on other things, and even then sometimes she would look back down at the board after a little while like she wanted to see the happy child some more. Maybe this is why people use picture symbols instead of pictures..

I asked Becca how it made her feel when people gave her a hug. She was looking at "sad" when I asked, and she looked up and around the board over the happy, then at me. I pointed out that it looked like she didn't want to confuse me by looking at sad and then at me, and that made it more clear she was picking happy, so thank you.

Next was the picture of a child looking at their mother smiling. Becca looked quickly at this picture. I held it between the two options and she looked all around, at all three pictures. After a little while she looked at "happy" and back at me. I confirmed, and she said yes again. I said definitely. I said it always made me happy when Becca looked in my eyes and smiled. I asked if she knew who else it made feel happy. I asked if she thought it made her sister happy, and she said yes. I pulled her sister over and she nodded and smiled. I asked if she thought it made mommy happy, and she looked over at mommy in the kitchen and smiled at her. I told her it also made her brother happy, and her grandparents, and pretty much everyone who saw her. When people at church came to talk to her, they know she can't talk, they're not hoping she will talk to them, they just hope she will look at them and smile because it will make them feel sooo happy.

Last we looked again at all the pictures of things that make people happy and talked about how we can always try to help other people feel happy. It's ok to feel sad sometimes, but when we are happy to people then they feel happy and then they do things that make us feel happy when we're sad, and that's how we become friends.

School Time 9/30 - Behavior

Yes for school time. I held up the plastic board with two pictures, a happy child and a sad child. Pretty quickly I realized we had a problem because Becca was very fascinated by the picture of the happy child, she wouldn't stop looking at it and it was making it hard for her to answer questions. First we talked a little bit about how some of the things we do make people happy and some make them sad.

Then I would hold up a picture of a child doing something, and ask if when a person does that thing it makes others feel happy or sad. The pictures were of things like a child sharing ice cream, a child falling asleep in class, a child yelling at their mother, a child running in front of a car. etc.

This was probably Becca's least-successful communication session, she wouldn't pick hardly any of the time whether the reaction was happy or sad. Either she would look back and forth between the two pictures over and over, or she would stare at the happy child and then look away. She was also pretty unhappy.

I realized after a little while that none of the pictures really applied to Becca in that they were things Becca could do. We stopped at that point and I explained it was important for her to understand that kids do good things and bad things, and that can make people happy or sad. Sometimes people do mean things or nice things to Becca and that makes her feel happy or sad. She still wasn't very attentive.

Then I started talking about things Becca could do that would make people happy or sad. Right away she perked up and smiled and paid better attention. I talked about how she can reach out and put her arm on people or hold their hand, and how that makes them feel so happy. Or that she can look in their eyes when the come visit and that makes them feel special. She looked much more attentive for that part, and stopped looking away as much. I still used the board to point out things she does that make people feel happy or sad, just pointing to them, but I didn't ask anymore questions because I thought she was probably done with questions for the day.

School Time 9/27 - How We Use Rocks

I asked Becca if she wanted to do school time today, she said yes. I told her today we were going to go outside for school time and learn about how we use rocks to make things. I asked if that sounded interesting to her and she said yes. We got everyone outside and walked down the street to a house that had big rocks in front for decoration. We looked at them. Then we walked up to the actual house and looked at the bricks the house was made of. I asked Becca if she knew what they were and she said yes. I said they were bricks. I asked if she knew what bricks were made of and she didn't say yes. I told her they were made out of rocks, kind of like how we made mud yesterday when we mixed dirt and water together. Then we walked back down to the sidewalk, and I asked Becca to look down. She did and we saw that there were rocks in the asphalt, and that the road and also the sidewalk were made out of rocks. We walked around the neighborhood and saw that all the houses were made out of rocks. We also looked for things that weren't made of rocks, like trees and fences.

I asked Becca if she was tired because she wasn't opening her eyes very wide, and she said yes. I asked if she wanted to go home and she said no. So we walked around a little longer, while her siblings ran around and played and we looked at flowers and yards (also not made out of rocks).

When we finally got home I asked Becca if she wanted to be done with school time, and she wouldn't say yes. I figured we'd review what we learned another day, but when I asked if she wanted to play a review activity she said yes. So we printed out a bunch of pictures and had two big squares on her plastic board, rocks and not rocks. I told Becca that mommy wanted to work with her this time and was that ok, and she said yes.

Paula held up a picture of a brick wall between the "rocks" and "not rocks" pictures and asked Becca if bricks were made out of rocks or not rocks. Becca looked back and forth at both pictures. Paula prompted again, and Becca looked at "rocks" and then back at Paula very quickly. It was so quick Paula wasn't sure if it was a choice, so she asked for confirmation and Becca said yes, she thought bricks were made out of rocks. Paula said yes, they were, and we all cheered.

Next Paula did a tree, and Becca chose "not rocks" after looking back and forth a few times. Again Paula wasn't sure if that was actually her choice, so she confirmed again and Becca said yes to her choice. We cheered and said that was right, and attached the picture to the "not rocks" section. Next Paula held up a picture of Becca as a baby. Becca wouldn't pick "rocks" or "not rocks" at all, even after lots of prompting. I chimed in and said we hadn't talked about whether people were made of rocks, but she could just guess if she wanted to. She still wouldn't pick one. Eventually Paula set that one aside. Next she did a picture of sidewalk, and Becca chose "rocks" very quickly. Next was a window, and Becca chose "not rocks" very quickly. It seems like when Becca has a choice board where the options aren't moving (i.e. two new options every time) she doesn't need to look back and forth much before picking. On asphalt Becca wouldn't pick without a lot of prompting. Eventually she chose "rocks". 

Next was a picture of dirt. Becca looked at the picture of dirt for a little while, then might have picked "not rocks". Paula reminded Becca about what we talked about yesterday, that dirt is made up of little tiny rocks. Then Becca chose "rocks" on her own. Next was a picture of a car, Becca chose "not rocks" very quickly. Paula said that was right, and talked about how it would be silly if cars were made out of rocks because they'd be so heavy and they'd fall apart into dirt. After that was a picture of a cow, which Becca quickly chose as "not rocks".

Last, Paula held up the picture of Becca as a baby again. Becca wouldn't pick right away, but after some prompting it looked like she chose "not rocks". Paula wasn't sure so she confirmed, and Becca said yes. 

School Time 9/26 - Rocks & Experiments

Today was a yes for school time. I got Becca situated in her chair and she was couching a little bit to start. I told her no worries, today we're just going to learn about rocks and dirt and soil, no tests or anything.

First I asked Becca and her sister if they knew where rocks came from. Neither one would say yes. I talked about mountains and how in the rain and earthquakes and things the mountains start to break of really big pieces of rock, and those break smaller and smaller until they become rocks like I'd gathered from the yard onto a plate. I held it up and Becca looked at it. I took a rock out and put it in her hand so she could feel it. I talked a little about how some rocks are hard and some are smooth, usually because they got rolled around in the water until all the hard parts got chipped offed. We felt both a hard rock and a soft rock.

Then I got another paper plate with small rocks on it and talked about how those came from bigger rocks that broke into smaller pieces, and we felt those rocks as well. Becca looked attentively down at the plates both times. Then I got a plate with dirt on it and talked about how dirt is really just really small, teeny tiny rocks that had been broken up. I put a little bit of dirt in my hand and held it up to Becca's sister and asked what it looked like. She said, "rocks". Then I held some up and Becca looked intently at it as well. I asked if she wanted to feel it, and when she said yes I helped her feel it.

After that I talked about how when dirt mixes with dead plants and animals and pieces of wood and animal poop then it looks a little different, and I held up some soil from our garden on another plate. We looked at how it was different than the dirt, and had tiny pieces of wood in it too. Then I got a plate with grass clippings on it and talked about how grass and other plants grow in soil, because all of those things mixed together make "vitamins" for the plants that make them healthy so they can grow. I helped Becca feel the grass as well.

Then I held up the soil plate and the small rocks plate and asked Becca which she thought would be better for growing plants. She looked back and forth at the two plates a lot of times, but wouldn't pick one. She looked noticeably more at the soil plate, but she wouldn't look back up at me after looking at it, like her cue is normally.  After a little while she looked like she picked the soil one, and when I asked to confirm she wouldn't say yes. I asked if she was choosing the other one, then, and she wouldn't say yes. I said, "you need to pick one, are you trying to trick me?" and she laughed and looked at me. Then when I asked about the rocks one again she didn't say yes, but when I asked about the soil one she said yes. I said that's right and we talked again about the "vitamins" in soil that would help it grow, and how rocks aren't good for plants to grow in.

Next I asked Becca's sister a question, I can't remember which. After that I held up the grass and the dirt, and asked Becca which came from the mountain rocks. Which one did the big mountain rocks become after they fell down and broke apart, the dirt or the grass? She looked at both again but then looked away. I realized she was staring at the plate of small rocks to the side. I said yes, mountain rocks do become those size of rocks eventually. I moved them away and asked about the dirt and grass again. She wouldn't pick, so I started asking one, then the other. She still wouldn't confirm. I reminded her it wasn't a big deal, and she could pick one if she wanted. Eventually I started pausing longer after asking, and she said yes when I asked her about the dirt. I said yes, the dirt was just little tiny rocks after all.

After this I proposed we do some experiments and see what happens when we mix things with water. I had a clear plastic container. First I put in some rocks and asked Becca and her sister if they thought the rocks would change when we added water. Becca's sister said she thought they wouldn't change. I asked Becca if she thought they would change, and she didn't say yes. I asked if she thought they would stay the same and she didn't say yes. I said, it's got to be one or the other, silly girl! The next time she said yes, she thought they would stay the same. We poured water on them and, sure enough, they stayed the same.

Next we did the same with dirt. This time Becca answered first, and she said yes she thought the dirt would change, first time. Becca's sister thought the same. We poured water on, and it turned to mud! That was definitely a change. We felt the mud and Becca got a big smile, I think partly because I forgot to get a towel so I just had to hold her hand while Paula got a towel for us.

After that we did grass. Becca's sister thought the grass would change. Becca had a coughing fit in the middle of me asking, but after her cough was over she said yes to the grass staying the same. Sure enough, the grass stayed the same. We did flour next. Becca picked first and thought it would change. Becca's sister thought it would change too. It did, and we felt the paste that it made, and Becca smiled again at that. Next we did oil. Becca thought it would not change and her sister thought it would change. We poured water in and looked at it (Becca would look attentively at the container after each time I poured water in and mixed it around) and noticed bubbles in the water where the oil was coming through. I said that's because the oil and water don't mix together, the oil doesn't change when you add water. Last we did some juice. Becca's sister and then Becca both thought the water would mix with the juice, not stay separate like the oil. Sure enough, that's what happened. I told them that oil is one of the few things that doesn't mix with water, but other things like milk and chocolate syrup and juice and soda pop all mix with water. I talked a little bit about what an experiment was, trying something new to see what would happen, and how even things like trying new food can be an experiment. Then we called it good.

I asked Becca if she had fun with the activity and she wouldn't say yes. I said I thought she was tricking me again because she was smiling when we were feeling all the goopy things mixed with water. I asked her again and this time she said a definite yes, that she had fun with school time today.

Side note: I was really surprised that Becca got all the experiments "right". With something like experiments I didn't feel like there was pressure to pick a "right" answer, we were just guessing and then discovering, so I was less worried about me introducing my own bias because it didn't matter to me which answer she picked, I was kind of hoping she wouldn't get so many right actually.

School Time 9/25 - Measuring Round 2

School time got a yes response. When I sat down on the couch by Becca she was just staring at me expectantly, like, "are you going to ask me or what?" I wasn't planning on doing it today, but I couldn't say no to that look.

I told Becca we would work on measuring again today, and asked if that was all right. She said yes. Becca had more congestion than she has in a little while so we had to stop a number of times to take a break. She also seemed less motivated in general.

This time we just did the "think of a number in your head" guessing over and over. I would hold something in front of Becca and we'd talk about what it was. Then I said, let's all think in our heads how many blocks tall we think the object is. I told Becca to let me know when she had picked a number. On the first object, a wood square that was 2 blocks tall, Becca wouldn't say she was ready and when I asked her numbers she wouldn't pick one. I assured her we were just guessing and it didn't matter if we got it right or not. We were just trying to learn how tall things are. After that I started asking if she thought the wood was 1 block tall, 2 blocks tall -- she thought it was two blocks tall. I told her I thought it was 2 blocks tall too, and that's what Becca's sister chose as well. We measured and got to 2 blocks when we reached the top of the toy. We cheered for all of us since we all guessed the right number.

Next we did a box of crackers from yesterday. I asked Becca to let me know when she had chosen a number and after a second she looked at me. I asked Becca if it was 3 blocks tall, 4 blocks tall - she thought it was 4 blocks tall. Her sister thought it was 5 blocks tall. I said I thought it was 4 blocks tall. We measured up to 4 blocks and I pointed out that it wasn't tall enough. It was 5 blocks tall! We cheered for Becca's sister for getting it right.

Next we had 2 objects that were both about 2.5 blocks tall that Becca's sister had picked. The first one Becca's sister guessed first and said it was 2 blocks tall. I waited for Becca to tell me she'd picked a number. I asked if it was 1 block tall, 2 blocks tall -- she said it was 2 blocks tall. I chose 2 blocks tall as my guess. We measured to 2 and I pointed out that it wasn't high enough. Then we measured to 3 and it was too high. I said, oh no! It's in between 2 and 3. That's a tricky one. We were all as close as we could get so we cheered for everyone.

The same thing happened with the other object, except Becca's sister chose 3 blocks after Becca chose 2 blocks. I chose 2 blocks. We measured again and it was another tricky one, in between 2 and 3, so we cheered for everyone.

Next we measured a water bottle that was 4 blocks tall. I talked about how we had some reference points with a 5-block-tall box, a 3-block-tall cat, a 1-block-tall tomato, and that might help us. If something was the same as the box it must be 5 blocks tall, etc. I waited for Becca to tell me she had her number. She decided very quickly after looking at the bottle. I asked her if it was 1 block tall, 2 blocks tall - she chose 2 blocks tall. Becca's sister chose 4 blocks tall, and I chose 3 blocks tall. We measured up to 4 blocks tall. We cheered for Becca's sister for getting it right.

We then did 2 other objects that were 2 blocks tall, one from yesterday. At this point Becca slowed down in her selections. On the first object I think she might have picked 5 blocks tall, but I wasn't sure. I talked about the height relative to other objects again, and how that might help us know how tall it was. I went through all the numbers again and then once more very slowly. That time she picked 2 blocks tall. The second object was similar, we had to go through the numbers twice and wait on a coughing fit before she picked 2 blocks tall. I try not to over-emphasize the "right" answer with Becca, especially on something like that where it doesn't really matter, but the second time through I leaned in while asking and she engaged on that option. She didn't do that before when I leaned in on a different number, but I'm still not sure I wasn't affecting things.

Next we did a sandal. Becca indicated right away that she had picked a number. She smiled big when I asked her if it was 1 block tall and she looked right at me to confirm. I thought it was 1 block tall, but Becca's sister thought it would be 2 blocks tall. We measured and it was 1 block tall, and Becca laughed. We cheered for getting it right.

We did one other object, I can't remember what it was or the height, but Becca had a hard time picking. I had to go through the numbers three times before she would pick one. I think it was 3 blocks tall and I wasn't sure if she picked 5 when I got to it, but then we talked about 

At this point Becca had a coughing fit and we had a wait a few minutes. I asked if she wanted to do one more and she wouldn't say yes. Then I asked if she wanted to be done and she wouldn't say yes. I asked again if she wanted to one more and she eventually said yes.

We looked at a 4-block-tall glass. I acted out what we do with a glass. About five seconds after the prompt Becca said she was ready with a number. I asked through all the numbers up to five and she wouldn't look at me for any. I went through comparing to other shapes and then I went through the numbers again, this time with very long pauses. 1 block, 2 blocks, 3 blocks, 4 blocks -- she might have said 4 blocks. I asked for confirmation and she looked at me quickly and then started coughing. I should point out that there were a lot of times today when she would say "no", as opposed to not saying yes. She would look at me for a split second and then look away, and I would tell her I understood that to mean "no". If she sustained eye contact then I would interpret that as "yes". This time it was a short "yes" interrupted by a cough, but I took it since she'd already had a couple coughing fits on this object. We measured up to 4, which we all got right. We cheered and celebrated and called it done.

After that I asked Becca if she had fun and she might have said yes, I was unsure. I asked again and this time she sustained eye contact to say yes.

School Time 9/24 - Measuring

School time was a go. I told Becca I wanted to practice measuring things today. I asked her if she knew what measuring meant and she said no. I said we wanted to take a bunch of things and see how tall they are. We wanted to see how many blocks tall they were. I asked if she wanted to do that with me and she said yes.

First we took six blocks and stacked them, counting as we went. Then we took some household items like a box of crackers, a tomato, and a puzzle and measured how many blocks tall they were. We would take the object and then stack blocks next to it until it reached the height of the object. We had things that were one, three and five blocks tall. After the first few I started asking Becca to guess in her head how tall she thought each object was. I asked her to let me know when she'd picked a number. She would look at me and I'd ask if she had a number. When she said yes again then we would measure just like before.

The first time it was five blocks high I asked if five was the number she picked in her head. She wouldn't say yes. Then I asked if she picked a different number than five in her head. She wouldn't say yes again. I said, "you forgot to pick a number!" The second time it was three blocks high and I asked if three was the number she picked, she said yes. The third time was similar.

Then I took an object that was three blocks tall, a can of formula, and put it in front of Becca. I held up her plastic board with a 1, 3, and 5 on it. I asked her if the formula can was one block tall, three blocks tall or five blocks tall. She looked at all the numbers and then up at three and back at me with a big smile on her face. I asked if three was her choice and she said yes. We measured and it was three blocks tall! We cheered and did a celebration dance and she laughed a lot.

Next I grabbed a tower of Duplo blocks. I asked her how tall the tower was, 1 or 3 or 5 blocks tall (it was 5 blocks tall). She looked at all the numbers and wouldn't pick. It looked like she picked three and when I asked she wouldn't say yes. Then she looked at five and back at me, and when I asked if that was her choice she wouldn't say yes. She looked around at all the numbers a couple more times and then wouldn't pick. I realized I didn't explain that these objects were definitely 1, 3 or 5. Not sure if that was the problem, she was thinking of a different number. I then asked if it was one block tall like the tomato, three blocks tall like the bubble toy, or five blocks tall like the crackers (I used this comparison on all following questions when she struggled, too). She still took a while, but eventually she picked three again and said yes when I confirmed. We measured and when we got to three I pointed out that it wasn't enough blocks, so we kept going. We got to five blocks. We celebrated getting to the right number.

Next we measured a stuffed animal (5 blocks tall, trying to avoid process of elimination). I asked how tall it was and Becca wouldn't pick again. I assured her we were just guessing and it didn't matter if we got it right or wrong. It was really hard to tell if she was picking, and it looked like she picked 3, then 5, then 1, but each time she wouldn't confirm. Eventually she picked 5 and might have confirmed, or it might have been me putting words in her mouth, not sure on that one. I said I thought it was only three blocks tall. We measured and when we got to three it wasn't tall enough. It was 5 blocks tall. Hooray!

After that we grabbed and Eeyore toy (1 block tall). Becca got a big smile on her face. When I held up the numbers and asked she quickly picked one block tall and confirmed when I asked her again. We measured and sure enough, it was 1 block tall. Hooray!

Next we measured a bar of deodorant (3 blocks tall). Becca wouldn't pick again, and it felt like she wasn't liking the quizzing version of the game so I made a mental note to just go back to just measuring after this one. She picked 3 but wouldn't confirm, 1 but wouldn't confirm. Once I compared the numbers to things we'd already measured again then she picked 3 and definitely confirmed. Becca's sister said she thought it was one block tall. We measured and when we got to three I pointed out that it one black wasn't enough. We kept going and sure enough, it was 3 blocks tall. Celebration time!

After that we went back to holding up an item, guessing in our head how tall it was, and then measuring. We had a wood plaque that was 2 blocks tall. I asked Becca if 2 was the number she picked and she said yes with a smile. Then we measured a toothbrush. Becca's sister thought it was four blocks tall. I asked Becca if she though it was four blocks tall but she wouldn't say yes. I asked if she thought it was three blocks tall and she said yes. I said I thought it was three blocks tall too. We measured and when we got to three it wasn't enough, so we kept going and it was four blocks tall! We cheered for Becca's sister.

We measured a few more things without the plastic communication board. Becca confirmed 3 blocks for the 3-block-tall toy and 1 block for her shoe. She picked 4 for the 4-block-tall toothbrush before her sister also picked 4, 4 for the 3-block-tall deodorant after her sister also picked 4, 3 for the 3-block-tall shower scrubber before her sister also picked 3, and 3 for the 2-block-tall popsicle holder after her sister picked 3.

Afterwards I asked if she had fun and she said yes. I asked if she wanted to be done and she said yes.

School Time 9/19 - How Cities Change

Today Becca said yes to school time again. I told her we were going to learn about Utah today and how Utah grew over time, but first we needed to go over jobs again. We reviewed jobs and where people work. I would show her a picture and ask if she knew what it was. When she said yes I would say "yes, that's the post office" or "school" or whatever. Then I said, "can you think of somebody that works there?" and when she looked at me (usually after a second or two or three) then I'd say "a doctor works a the hospital" or whatever. After we did all four workplaces then I asked her where she goes every day, to school or to the farm. She wouldn't pick for a little while, and I asked her if she'd ever been to a farm. She wouldn't say yes. After that she looked at the school and back at me. I told her she had been to her grandpa's farm before and seen a horse and a pig, but it was a long time ago. Then I asked her which she thought would be more fun to visit, the farm or the post office. She looked at both pictures a couple times, then at the farm and back at me. I said I'd rather see the farm too, with all the animals and plants it would be so fun. Then I asked Becca if she were a grownup, where would she rather work, the hospital or the post office. She looked back and forth a couple times, then I think she looked at the post office and back at me. I held the post office closer and asked, did you pick the post office? She said yes, so we talked about why the post office is fun. I asked Becca's sister which she would rather work at and she picked the hospital, she said she wanted to be a doctor because she could help people feel better.

After that I said I wanted to talk about how Utah has changed over time. I talked about how Becca's grandma grew up in Utah and her mom and dad and their mom and dad grew up in Utah, but that lots of people didn't used to live there. Some people came to live here and they built some small houses out of wood, and I showed a picture. Then I showed a picture of when people started to build things out of brick and the city got a little bigger. We talked about how people would have kids and their kids would want their own houses because they didn't all fit in the houses anymore, and so they kept building more houses and bigger buildings. Then I showed another picture of when there was a downtown and some large building. Last I showed a picture of Salt Lake City today and showed how very big the buildings are now.

Next we had a quick hand game.

After that I showed the old Utah picture again and talked about what classrooms used to be like back then, one-room classrooms. Then I showed Becca a picture of her school and asked her if she knew what it was a picture of. She wouldn't say yes, so I asked Paula and she said it looked like Becca's school. Then I showed Becca another picture, this one of the pool at her school. I asked if it looked familiar and she looked over at Paula again. Paula said it looked like her pool. I talked about how now there are lots more people at the school and lots of different classrooms and fancy things they didn't used to have. 

After that I asked Becca if she knew what a neighborhood was. She wouldn't say yes. I explained that a neighborhood is a bunch of houses all close together. I talked about basically if we have to drive to someone's house then they're not in our neighborhood. I said grandma isn't in our neighborhood, but Samuel (a friend from her church class, but I didn't point that out) was in our neighborhood. I quizzed Becca and her sister on various people and if they're in our neighborhood. I asked Becca if her Olivia from her church class was in our neighborhood, and she said yes. I asked her if her cousin James lives in our neighborhood and she said no (she looked far away, not just not looking at me if that makes sense). I asked Becca if Berkeley (our next-door neighbor) lives in our neighborhood and she said yes.

After that we did another hand game.

Then I somehow tied neighborhoods back into school and asked Becca which school she'd rather go to, her school or the old school where everyone was in the same classroom. She looked back and forth a couple times and then looked at her school and back at me. I said her school does have a lot of fancy stuff in it, and it was a fun school.

Next I asked Becca which came first in Utah, the old wooden houses or the fancy buildings. She looked at booth and then looked at the old picture and back at me. Next I said I was going to do a hard one, and I showed her the two pictures of Utah that were somewhat similar, but one was a little newer. I said one had some wood and some brick buildings and the other had brick buildings that were a little taller. She had a little coughing fit and wouldn't engage, so we wiggled her arms just a little bit and then I switched the pictures (I realized I'd been putting the right answer on hear leaning side more than half the time) and asked her again. She looked quickly at the older picture and back at me, so we put that one next. Then I asked her which picture came last, which was newest, the picture with tall brick buildings or the picture with fancy metal and glass buildings. She looked back and forth for a little while and I had to prompt her a couple more times, but then she picked the newest picture.

After that we did a three-way clap because I was so impressed with how well she answered questions today. We cheered and cheered and sang a silly song.

School Time 9/18 - James and the Giant Peach

Paula tried again today. I went over and talked to Becca when she first started and explained that me and mommy needed to take turns, and that she needed to be a good sport with both me and mommy doing school time with her. I asked if she would be willing to let us take turns and she said yes.

They started with James and the Giant Peach again. Paula asked which character had more feet, the grasshopper or the centipede. Becca looked for a little while, then picked the centipede after a couple additional prompts. Then Paula asked which character couldn't see, the ladybug or the worm. After a couple additional prompts Becca chose the ladybug. Paula had her look at the worm and see he was wearing dark glasses because he couldn't see. Then Paula asked which character was a bug, James or the Spider. Becca chose the spider. In general she was answering questions but not very quickly and she didn't seem super engaged.

Next they worked on letters, D, H and F. Paula would show each letter to Becca and talk about some words that started with the letter. They went over the sounds. She attached all three to her clear plastic board and then asked Becca which letter matched the starting sound of different words (i.e. which letter does h-h-horse start with?). Becca chose H for horse and hat (together), D for dog, F for fish. She picked H and D very quickly, but F which was on the far side from where she was leaning her head. We gave her some additional sounds (family, food) and then she picked F.

After that Becca's sister wanted to show us her puppet show of the Three Little Pigs, so we watched that. Then we did a quick hand game and Becca perked up a lot.

After that I quizzed her on letter sounds one more time. I asked her what letter h-h-house (like the houses the wolf blew over) started with and she looked very quickly at H and back at me. Then I asked what letter d-d-down (like the houses fell down) and she looked very quickly at D and back at me. Then I asked what letter h-h-hippo started with and she looked at all the letters but wouldn't pick one. I prompted her a couple times before she looked at H and back at me. Then I asked her what letter f-f-fall (like the houses falling down) started with. After a delay she looked at F and back at me.

Then we called it good and ended school time for dinner.

School Time 9/17 - Review and Letters

Paula worked with Becca today, and I wasn't around, so this will be just a summary. She asked if Becca wanted to do school time her and she said yes. First they worked on where people worked, and Becca correctly categorized the workers. After that she wouldn't answer questions very well, she kept looking away. Paula tried asking her about characters printed off and cut out from the book she's reading with her, James and the Giant Peach, but she didn't do well with those. She also tried to do three new letters, D, H and F, but Becca wouldn't answer questions about those either. Specifically she tried asking Becca which was the letter D or H or F based on drawing them on a sheet of paper or also on a magna-doodle.

School Time 9/16 - Jobs and Workplaces

School time was a go, good, direct eye confirmation when I asked if she was interested. I told Becca I wanted to go over some stuff from before, so we reviewed seasons. I would talk about each season again. She looked at them all and payed attention, but wasn't much in the mood to answer questions. First I asked her which season we season we went back to school, Spring or Fall. She picked Fall. Then I asked her which season we make snowmen in, Winter or Summer. She picked Summer. I said that would be silly, the sun would melt the snowmen. She kind of smiled and then looked at Winter. Last I asked her which season the leaves changed, Fall or Spring. She wouldn't pick on, she kept looking away. I said I guess that was an easy one since it had a picture on the card, I held up Fall. I asked if she wanted to learn about something else and she said yes.

Next I said I wanted to talk about jobs that different people have, and I asked if she wanted to learn about that. She said yes. I said first we needed to learn about the places people worked. I talked about how people all have different jobs so they can take care of their families. I listed lots of different things that people do, and I talked about my job and how mommy's job is to stay home and take care of the kids (and that if she didn't then it would be someone else's job to be a babysitter for the kids). t showed her, one by one, pictures of a School, a Farm, a Post Office and a Hospital. I talked about each one, the people that worked there, what kind of things happened there, etc. She would look at each picture for a minute and then look away. I attached each picture to her clear communication board. By the time I finished she was started to have some coughs and be less engaged, so we played a hand motion game to try to get her back in focus.

Then I asked if she wanted to play a matching game. She said yes. I reminded her what each of the four job locations were, and then I held up a doctor and asked if she knew what that was a picture of. She looked at me to say yes. I said yep, it's a doctor. I asked her where the doctor works. She immediately looked at the hospital and then back at me. I said yes, the doctor works at the hospital, and attached it to the hospital picture. Then I held up a mailman but she wouldn't look at the mailman, she kept looking at all the job locations. So I pulled those out of the way until she looked at the mailman (I did this with all of the pictures after this, too). I said that was a picture of a mailman, and asked where the mailman worked, and she immediately looked up at the post office and then back at me. Then I held up a farmer and asked where the farmer worked. She immediately looked down at the farm and then back at me. Then I held up a teacher and asked if she knew what it was a picture of. She said yes. I said yep, it's a teacher. I asked if she knew where the teacher worked, and she immediately looked at the school and then back at me. Then I held up a bus and asked if she knew what that was a picture of. She said yes, and I said yep, it's a bus. I asked her if she knew where the bus driver worked, and she immediately looked at the school and back at me. I commented on how impressed I was with how quickly she was answering these questions, she was really nailing it. After this it was more like usual, a little bit of delay or sometimes a longer delay before answering.

I said next I wanted to do a hard one. I held up a stethoscope picture and asked if she knew what it was. She didn't say yes. I told her it was medical equipment, something doctors use. I asked her where she might find a stethoscope. She wouldn't look at any option, and she had a bit of coughing. I eventually said I guess I gave it away by saying it was a doctor's tool, and then she looked over at the hospital. We did another hand game to try to help her focus. She liked the hand games a lot today.

Then I held up a girl farmer (the other one was a boy) and asked if she knew where this person worked. She looked at all the options and then looked a long time at the farm, but not back at me, then up at the post office. I said I wasn't sure what she picked because she didn't look up at me. After a little bit she looked at the farm and then at me. I said that was right, and attached the other farmer. I said I had another hard one, and held up a picture of a mailbox. I asked Becca if she knew what it was, and she kept looking at the picture. I said it was a mailbox, with a letter sticking out of it. I asked her if she knew which place our letters got taken to. After a minute she looked up at the post office and then back at me. I said that was right, and we attached the picture to the post office.

I held up a pig and asked Becca if she knew what it was. She said yes. I said yep, it's a pig. I asked her if she knew where a pig might go. She looked quickly at the farm and back at me. I said that was right and attached the pig to the farm.

We kept going with additional roles and items. For janitor she looked at the hospital and then at the school. For librarian she looked all around but wouldn't pick anywhere. I told her the librarian works at the school. Then I talked about the library and how that's another place people work, even though it wasn't one of our pictures, and maybe that's what Becca was looking for.

I held up a couple more pictures, of a classroom aide, a principal, and a lunchroom worker and talked about how they all work at the school too.

Side note: I can't remember the question, but I asked Becca something that she wanted to say no to. She looked right at me for a split second and then away, very intentionally. I was impressed with that response and told her so.