All of the Words

As much as I am noticing articulation regression with Ruby, she is still expanding her vocabulary and working 'word bank'. She often gives us a gem of a complete sentence, totally independently and momentarily eases my worries that I still have to model "Can you please turn on music?" to her every single time we get in the car.

• A few weeks ago we were outside enjoying a nice breeze in the middle of the summer and I said, "It's beautiful outside today!" Without missing a beat, Ruby responded, "Yeah. God made it."
• "Absolutely" I love it when she pulls this one out, always in the most appropriate of context and usually pretty articulate.
• "Because" This is her most used word right now when she is talking totally unprompted. She loves to tell you the answer to your question, and then follows it up with "....because......beCAUSE..... because...." The other day I told her we were going to go to the store to get ingredients for dinner. She immediately told me, "OK, we need to get some pasta and sauce because it's my favorite. Then we'll get some hummus because that's for snack beCAUSE after school I'm hungry...
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movies

we own more movies than I can count. they almost never get touched. road trips are almost exclusively when our DVDs get used. I honestly forgot we had such a selection. but this week maddux and lehr are painting the closet where we store the mountains of movies, so they are temporarily housed in the front hall.

ruby loves this arrangement. she has been stacking and sorting and counting and thoroughly investigating them daily since the closet was emptied. she has not seen even half of these gems, so her interest has definitely been piqued.

it has been so fun to hear her reading the movie cases or rejoycing in finding one of her favorites or counting the latest stack she's made of movies she wants to "bring on the airplane for sleepover at grandpa's".

this girl. she is growing and learning and thriving in so many areas!

Therapy Update

It's been a while since I've posted an update on Ruby's therapies. Here we go!

Speech
Ruby is stringing together words more and more often now. Instead of saying, "Tall", she might sometimes ask, "how tall Eli?". And one of her favorites right now is "Stop mommy!" She will sometimes follow it up with something like "my turn" or "No sing".

The emerging sentence structure is a good thing, no doubt, but it is a reminder of just how delayed her motor planning is in regards to speech. That girl barely gets cut a break in our house with her speech. (i.e. When she say, "milk", we make her give us a sentence or request like, "More milk, please." or "Can I have milk, please." Repeat this with every aspect of her day, all day long!) Even though she is improving, it is a sloooow process.

Ruby is repeating everything, which is huge! I remember vividly when she was two, turning over photo cards with her and saying the words with the hopes she would make any kind of approximation. Now she will not only read words (or identify photos) spontaneously, but when she hears her siblings say things, or especially if she hears a new word or phrase, she will repeat it intelligibly.

Sight words are something we've been working on for a full year, in preparation for this kindergarten year, which is so focused on sight words. Ruby currently does 35 of 50, give or take a few, on the first try, without any prompting from me. She is starting to read more and more, but that's almost always directed by me; she has yet to discover that she can find those sight words in her books without me next to her.

OT
Ruby is buttoning and unbuttoning big buttons on sweaters and jackets! Unfortunately, most of her clothing is smaller buttons, but you have to start somewhere. Her OT at school has a few sweaters for Ruby to use as practice and her manipulation is coming along. At home we are starting to see her become more skilled in zipping up her jacket too. She has yet to be able to line up the zipper on her own, but once there, she usually holds the bottom and zips up herself.

Regarding scissors, she is getting much better at cutting shapes with scissors. Turning her paper to get the corners or curves is a challenge, but with minimal help, she is making it all of the way around shapes like circles and rectangles.

PT
We are not formally doing PT at this time, and we don't have swim or dance classes. BUT we are always looking for physical therapy opportunities in our day, so it is still something I can measure growth in. Ruby now often alternates feet when walking on stairs - up is easier than down, but if she's holding my hand, she'll do it on the way down.

Ruby's jumping stamina is still increasing. Just a year ago we finished Aquatic Therapy because she was finally able to jump enough to clear the height of a pool noodle. Now she jumps on and off curbs, over small sticks, and in place just for the fun of it!

Another big thing Ruby is doing, something she's always done, is mimicking and imitating other's actions. If she sees someone doing something of interest, she intently watches and then repeats it. This is a HUGE part of why we push for inclusion at school for Ruby, and it is helping with PT things as well, like balancing, running, riding a bike, bouncing a ball, etc. One fun way it came into play last week was during Maddux's basketball game. The players and coaches circled up for prayer before the game, and Ruby grabbed an older friend's hand, and Daddy's hand, and led them to circle up as well.

Ruby Updates

We are still on an upswing of skills, especially in the speech area!

Speech
We just keep enjoying the flow of words coming out of Ruby. She adds new words weekly, and constantly becomes more and more intelligible to people outside of our house. Her latest words/phrases are:

• Whaaat?!? - This one is hilarious because, while it is not a new word for her, she will respond with this when someone says something she didn't expect. (As in, she uses it very appropriately! Last week I told her, "Ruby, we are going to pick up Maddux and Davis, and he's going to hang out at our house until soccer practice." She responded with "WHAAAT?" And the best, 'what' face ever!) I need to capture it on video, but she pulls it out at the best, most unexpected times and cracks us all up in the process.
• Counting to 10 - she will do it all of the time, on her own, in the backseat, when playing with toys...rarely does she make a mistake anymore.
• A - Apple - Ruby LOVES to find letters and then tell me what word they go with. Or tell me what letter a word starts with. A few weeks ago we were playing with legos and she put one skinny one perpendicular on top of another and said, "Look, Mommy. 'T' Ty-ler." And yesterday while we were discussing Eli's school opportunity to dress up as something relating to the first letter of his name, Maddux asked Ruby what she would dress up as. She promptly responded, "Ra-beet". Dang, she is a smart cookie!

Physical Therapy
Ruby is playing soccer on Sundays this spring to keep her gross motor skills in check. Her balance continues to improve, and she loves loves loves to run! We are also doing swim lessons once a week. Ruby loves the water and after a minimally rough start, she loves getting in the pool and working with "Miss Kelly". We will not be ready for swim team this year, but our hope is that she will join Eli and Maddux next summer.

Ruby is climbing everything she can when outside, especially on the playground. A few weeks ago I took her to a playground with a taller rock wall (straight up) to a flat surface. I stood below her, nervous how I would be able to catch her if/when she fell from so high, but she scaled that thing without so much as a hiccup. And last weekend I took her to a birthday party at a 'bouncy house' place. She worked so hard to get through the long, inflated obstacle courses. One almost took her out, requiring her to climb up a wall that was pretty high, on small little blow-up foot supports. But she never gave up and finally made it out. (And then asked to go back and repeat it a dozen more times before we left.)

Occupational Therapy
At home we practice tracing letters a lot. Ruby's grip on pencils and crayons is improving, and sometimes she can write a few of her name letters without the guidance of tracing. Her coloring is becoming a little more refined also; she still can't stay in the lines, but now she attempts to stay closer to the part of the picture she is coloring. Her cutting is improving as well; at school she consistently cuts out shapes, even turning the corners by herself sometimes.

Talking Talking Talking

This girl just keeps going with her conversational speech! Over the holiday break she picked up a few new phrases:

• "Oh WOW!"
• "Oh my gosh!"
• "Santa Clause. My HOME!"
• "I missed you!" (my favorite)
• "Oh, dangit"
• "Oh, Yes, PLEASE!"
• "Tag in back" (when referencing how to put on pants)
• "I can do it!"

I couldn't love all of these new phrases more, especially because they were not intentionally taught; she just picked them up in her daily conversations with other people.

When returning to school this week, she hugged each of her classmates and told them, by name, "I missed you!". She also told her teachers that she was 'so happy' to be back at school.

Today is one year from the first day she walked into that classroom. I can't believe how far she's come in a year, and I couldn't be happier about all of the continued new
speech!

Update

Ruby's speech has come oh-so far in the last six months. Even the last three months. That girl is talking SO much and saying up to 4 words in a 'sentence', spontaneously (as in, not repeating after me) very consistently at home. As with any language explosion, her articulation has suffered because she is in such a rush to say all of the new things she can say that her mouth can't quite catch up. Especially because she has to work so hard to correctly make those sounds anyway.

One of the areas Ruby has always excelled with speech has been her receptive language. Basically that means what she's able to understand as it is spoken to her. Now that she's giving us so much more in the expressive speech world (what she actually says), we can see all that she's been learning and holding on to.

Prime example: she knows her name and how to spell it and loves to tell you. This is something she's been doing for a little while, but this video from the other night just brings it home. Check out this chatterbox! (Gobble, Gobble)

So many times we see our kids work really hard on something they are struggling with. With my typical kids, I have definitely seen them struggle and sometimes not succeed, whether it's with a sport or an academic milestone. But most of the time, they got to their goal or the goal was not one that was required for every day life (like a new sport). With Ruby and her peers, we see our kids work hard - SO hard - day in and day out. On everything. Not many things arise in their day that they don't have to work on, from social skills to physically maneuvering their world to speaking. And what I didn't realize before I had Ruby was that many times this hard work goes 'unrewarded'. That is, they don't always see the fruits of their labor. So many times Ruby will work on a skill for months on end before mastering it. Or, we will work on it for a solid year and still not have mastered it. This video has been a good reminder to me to reward the hard work even when the result is not video-worthy.

Therapy Update

I have been bad, bad, bad about blogging since the beginning of school. What can I say...busy times!

Speech
This girl.

She is such a chatter box! Ruby's speech continues to grow, with her spontaneous speech improving daily. We are in a season where I get comments from friends like "I can't believe how much she's talking!" or "She's talking so much." And these are people who see her a few times a month at least! I recently started going back through a large stack of sight word flash cards with Ruby. While in the hospital, we would go through them daily. My focus then was not for her to read them as much as mimic me saying them. At best, there were 10-12 that she could say (repeating after me) with enough intelligibility for someone else to know what she was saying. When we picked those cards up last week, I realized that she repeats every one after me, and only a few are hard to recognize. (This stack is at least 50-cards deep.)

This made me realize how far we've come in the last two years. Not only is she speaking more, but she is doing so spontaneously (without being directly by me, or without repeating after me) and she is able to repeat anything I give her. When you are in the early stages of speech therapy, you are often measuring success by how many words your child has. For a long time that was a single digit number: the total words Ruby could say, repeated or spontaneous. If I think about it now, Ruby's word measure is infinite. If I pull out 100 cards and say the word first, she will repeat 100 of those words back to me.

This. Is. Amazing. And oh-so encouraging.

PT/Aquatic Therapy

Still Ruby's favorite hour of the week! We missed Aquatic Therapy for a month recently due to school breaks and scheduling issues, but when we returned, Ruby's therapist was excited and surprised to see how much stronger she had gotten in that month (instead of losing skills/muscle). This speaks loudly to the benefits of being in a school environment that allows for free-time on the playground for recess. My girl runs (and runs and runs) and climbs the whole time she is outside, and it is really paying off!  

Ruby can now jump with two feet, getting actual air under her feet. And she likes to jump all of the time. She has jumped in succession (two or more times in a row), but that skill is still emerging. She has jumped over obstacles (pool noodle height or smaller), but that still is still emerging too.

OT
Just this week I am starting to see some improvements in this area. Hallelujah!! Ruby just started to show interest/ability in coloring inside of the lines and is working on that skill. FINALLY this week she started tracing some lines/shapes/letters for me with success. She has been able to trace a line going straight down for a while, and I know she gives them a little more accuracy at school, but at home we have been struggling with this one. (One afternoon she even traced an "R" with crazy accuracy!) And yesterday when we were coloring in the afternoon, she kept readjusting her crayon to hold it correctly (unprompted). This is crazy cool.

And her scissor skills are improving too. Straight lines through the entire paper? Yes, please!

Therapy Update

Speech

Ruby is rocking and rolling. I keep saying it, but she adds so many new words and blends all of the time. This means articulation suffers as she tries to keep up with her expanding vocabulary, but that's why we do so many hours of speech each week (to correct). She still does speech 2x/week at school as part of her day, and then she does speech once or twice a week with private therapists that focus on different parts of her articulation and blending. Ruby is stringing together thoughts to make toddler-esque sentences now; it is so cool!

PT/Aquatic Therapy

This is Ruby's favorite type of therapy. She LOVES the pool, she LOVES Miss Beth, and that means she LOVES Aquatic Therapy! Ruby is jumping all of the place now, which was our main goal when we started. She can jump from standing still, she can jump forward, she can jump off a curb, she can jump twice in a row (sometimes). For an hour each week Ruby and Miss Beth motor around the pool, sometimes with ankle weights, kicking (on her stomach, on her back, seated, on a kick board), maneuvering pool stairs, jumping up and down in different depths and on dry land, doing sit ups, balancing on one leg, balancing in the water on a noodle or Miss Beth's knee....it's an exhausting hour!

OT

This is Ruby's biggest struggle right now. We still haven't acquired private Occupational Therapy. She receives it 2x/week at school, and when she stays for the full day at school, the afternoon focuses on handwriting, which hits this area. That being said, when I work with her at home, my assessment is that her skills are still very lacking. Her control of crayons, pencils, etc. is not great at all, and even tracing straight lines is difficult, so the only letters she can at all form on her own are "O" and "X". And those are not on a specific writing line, but wherever on the paper she lands. We are tackling that harder than ever at home right now. We do a lot of thera-putty, cutting, using utensils to pick up objects...that girl works hard!

End of Year IEP Meeting

We had another IEP this afternoon. I called this one. We are not 'due' for another IEP until December (the goals should last a year and we had one to challenge Ruby's initial denial into the program last December), but with the school year ending, prep for another begins. I wanted to establish if Ruby would be returning to special needs pre-K, and in what capactiy, along with goal updates.

Prior to these meetings, there is always a lot of prep for Lehr and I. Re-reading her current assessments and reports, reading up on kids similar to Ruby in different settings, discussing what is working and what isn't, talking with other families to see how they are navigating these waters, praying, praying, praying... But even with all of that prep, this time we did not go in with a clear plan.

 Honestly, I felt very conflicted about what I hoped the outcome would be. We have pushed for as much inclusion as possible all along which would mean us requesting Ruby attend the typical preschool (Mt. Zion) 3 days/week, with a facilitator a few hours each week in addition to attending the special needs pre-K (Sope Creek) the other two days. However, she has done so well at Sope Creek in just four months. She is potty trained and has been with rare accidents since the first month, she has made friends that she has conversations with every day, and she is talking talking talking so much! Those great things (which didn't happen in the typical preschool) are so great that they make it hard to consider taking even a little bit of it away. She may still thrive that way with only 2 days/week next year, but what if she doesn't? And what if her typical environment is one that causes frustration again?

So with these questions (and many more) on our minds, we went into the IEP with a very open mind, ready to have a conversation with her teachers and therapists. We all agreed that Ruby has made a lot of progress in a short time, in all areas. (The teachers are so proud of how well Ruby navigates the classroom and fulfills her responsibilities with no prompting.) And we all agreed that next year she should continue that progress at Sope Creek. She will be eligible for the afternoon (full day) program as well. That program allows for smaller numbers (more one-on-one), and more intensive work to prepare her for kindergarten (handwriting, number work, etc.). However, if she stays until 2PM each day, it will mean her 2-4 therapies outside of school will have to take place after the big kids get home, making our afternoons even crazier than they already are. So Ruby will attend full day, but only on days she doesn't have therapy. (These last few months, it's worked very well for me to pick her up before noon and get her therapies done before returning home to receive Maddux from the bus.)

So that's the plan for next year and we are happy with it. Ruby's summer birthday means she could start kindergarten after next year, or after an additional year (starting right after her 5th or 6th birthday). Should we wait until the second year, her final year of pre-K might be a typical/special needs pre-K mix.

Here's what made me smile at the meeting. The team, Ruby's team, a speech therapist, an occupational therapist and her main teacher, gave lots of feedback with lots of genuine smiles. They told little stories and gave examples of her in the classroom or therapy that obviously brought them joy. They love my girl. They see my girl. They are proud of my girl. They get how much she loves to learn. They see how much she wants to learn and work.

Therapy Updates

It's been a while...my blogging takes a hit when we get busy. And, as humans, we get busy.

Ruby is still rocking and rolling at the local public school special needs pre-K. She loves her school, but she has become a little too comfortable as certain less-than-desirable behaviors are often present. Mostly it is not sitting/staying put during story time and not maintaining her personal space. We are working on it. (Story of our life!)

Aquatic Therapy
Ruby loves it. We started this a few months ago, but had some hiccups with Medicaid and insurance. We are back now though, and Ruby couldn't be happier. For those that don't know (I didn't), Aquatic Therapy can be used for PT, OT, speech...you name it. For Ruby, it's mostly PT, but also a little OT. She and her therapist move around the pool, using platforms and ankle weights and a variety of squeeze toys to engage core muscles and use the water for resistance and also balance support. After just one session I noticed some improvement in Ruby stepping over structures/thresholds. And just this week she jumped with two feet simultaneously (while waist-high in the water, on the platform) for the first time EVER. I have spent countless hours working with her on this skill on trampolines and curbs and all raised structures...who knew water was the answer!

Speech
Rock-n-roll. Ruby's speech is not clear, but her vocabulary is growing daily. And she strings words together so much now! Her latest and my favorites are:

• "Got it" (Ruby says this when she is working on something and you try to help her..."I got it".)
• "faster" (Ruby says this when you push or pull her down the hill in a wheeled mode of transportation.)
• "Caffee" (This is what she calls my mom. The big kids call her 'Grandma Cathie', but Ruby obviously feels that is a big formal because while she can say a version of 'grandma', she intentionally drops it for my mom.)
• "Baby. Want read? Ok."(This is an example of the conversations she has with her baby dolls and stuffed animals around the house while I'm making dinner.)

OT
At school Ruby works with an Occupational Therapist twice a week on specific tasks related to fine motor skills. She is getting so much better at controlling a writing instrument (usually a big crayon) to loosely trace lines and make round shapes. She is also stacking blocks and stringing beads with much more control and skill.

Ruby Updates

So much talking with this girl! As I've mentioned before, when we see growth in the area of speech, we usually see decreased articulation (more to say means rushing through previously mastered sounds), but that is a price we are willing to pay. So many of our friends, Ruby's therapists, and people in our community are able to understand her and carry on (small) conversations with her right now. Love it!

Ruby will tell you what song she wants to sing ("Go" for "Let It Go", "bus" for "Wheels on the Bus", "Bad Blood", or "Pi-der" for "Itsy Bitsy Spider"), she will tell you what she wants to eat or drink (usually "Muk" to drink these days), and she will tell you to "go way" when she wants you out of her space. The list of words this includes now is too long to list; she really gives me new words pertaining to her surroundings on an hourly basis. It's a very cool time for Ruby!

A few of my favorites from her:

• "Bless You, Mommy" - anytime she hears me sneeze (just in time for spring pollen!)
• "Thank you, Mommy" - She says this ALL of the time, and unprompted mostly. If you put on her shoe, or give her a cup of water, she will look at you and say this so sweetly!
• "Sing" - She will usually say this to me or Maddux, as in "sing for me!"
• "Bye-bye, Daddy. I love you." - Yes. All of that without any prompts. Perfection.

We are still not receiving PT services, but last week Ruby did start Aquatic Therapy. Once a week she will be able to jump in the pool with a therapist and work on some PT skills in the water (core strengthening, jumping, etc.) and hopefully pick up some swimming along the way.

Keep On Trucking

We are still happy with the immediate outcomes of Ruby's new school situation. This girl is making HUGE strides in potty training - only two accidents total last week! Her verbal skills are improving daily, and she is happy, happy, happy.

It must be noted that Ruby is still a toddler, so she still has the occasional push or hit at school, and if someone is across the room building a block tower, she must run over and knock it down, very joyfully. But overall, she is adjusting well. She loves the kids in her class, she loves her teachers, and she leaves with a smile on her face every day.

However, the new school schedule means Ruby needs to be awake by 6:30am to arrive on time. This is about an hour earlier than she would wake naturally. While she doesn't seem to mind getting up earlier, it does mean that her body has already become accustomed to early rising, so our weekends are now 6AM wake-ups as well. Boo.

Fitting all of Ruby's therapies into her now more-full schedule has been challenging. We had to drop gymnastics, and fitting in both of her private speech therapists is a constant calendar game, but we are starting a literacy tutor at Gigi's Playhouse this week, and we are looking into private PT and/or hydrotherapy.

IEP

We had Ruby's IEP redetermination today. It was a long meeting, first reviewing the findings of all of the tests and evaluations, then determining eligibility, finally setting IEP goals for what Ruby qualified for.

Lehr and I attended, along with Ruby's speech therapist through the school, the Occupational Therapist that evaluated her, the school psychologist that evaluated and observed her, the Special Needs Pre-K teacher, and the community based facilitator. Ruby was along for the ride, eating a snack and playing in the Pre-K room the whole time. (I was surprised with how well she sat for most of the meeting!)

There were no surprises in the findings for us; they agreed that Ruby qualified for Special Needs Pre-K and speech and OT. When it came time to set the goals, things turned slightly. Not from what we expected as much as what we agreed to. For most of the time leading up to the meeting, we have been so solid on maintaining what we've set up for Ruby in the way of inclusion in the typical (private) preschool. That is and always has been our goal. But I felt a very clear vision was cast in that room that demanded a different path to that goal. The team wanted several goals for Ruby, which lined up very well with the ones I had prepared in the past few months. In order to reach those goals, they asked for Ruby to receive speech one hour/week and OT 30 minutes/week. The OT stated that Ruby's scores did not qualify her for that much speech, but she wanted her to receive that support to boost her abilities in the classroom without support. When it came to determining how Ruby's Special Needs Pre-K schedule would look, they suggested 5 days/week.

Yup. Big change.

That is not at all what I ever said I would do. It's not what I planned on. But this team set goals that I think will help Ruby get to full inclusion. Four of the members of this team have met with me and talked to me about my vision for Ruby. Four of the members of this team have observed and/or worked with Ruby already and know her strengths and weaknesses. One of the members knows the private school she's attending, and has worked with her teachers specifically. They are not basing their suggested plan on results from a one-day evaluation.

We want Ruby to be in the 3-year old class at Mt. Zion next year. In order for that to happen, she needs to be potty trained. It is embarrassing for me to admit that I have not been able to succeed in that venture, despite working since this summer. I am aware that Ruby's current schedule of Mt. Zion and speech and gymnastics and more speech does not allow for much consistency in the way of training, so this 5 days/week in an environment that supports that goal will help. Also, for Ruby to be successful in a typical preschool with other verbal kids, she needs to have more practice with attending to tasks and sit-down time for longer periods of time. She needs more practice with using her words to get her needs met. She needs more practice with fine motor skills regarding writing and scissors in a classroom setting (not just at home). The realization I came to in that meeting is that we can either address those goals for the rest of this year, or struggle through this same process next year.

I know there are no guarantees. And I know that some (maybe all) of these things are possible struggles for Ruby next year and years to come. But we've been working on them with our current strategy since June with progress, but not success. I think we owe it to Ruby to try a new strategy for this semester to see if it speeds the progress. It is not our intention to hold her back in anyway with this new plan; we see it as equipping her with an extra boost to return to Mt. Zion next year, better than ever.

The Build-Up

I have not been blogging as much the last few months. Life is busy, as it is for everyone. In addition to our regular 'busy', my downtime has been a bit consumed in praying, researching, planning, preparing, reading...all things associated with Ruby and what her schooling and therapy should look like right now. Specifically, when it comes to public services.

So we've been weighing the pros and cons of her speech therapy, of her extracurricular (gymnastics, soccer, etc.), of her private 'typical' preschool class, of her other speech therapist (who has also been acting as a facilitator on occasion in her typical class), so on and so on. When we started the process of Ruby's public school experience, she was not found to qualify for anything more than one hour of group speech therapy each week. We didn't agree with that (as we knew the reasons why Ruby scored so high were not a realistic picture of what her school experience would be), but recognized that the team that would ultimately work with Ruby, the team that was making these decisions, had never met Ruby - they had only seen the evaluation results from another team. So we agreed to give them some time (six weeks) once Ruby started services (speech) in the fall to collect the data they needed and then we would call for another IEP.

This process has taken a long time. That's a painfully long time for those of us that are impatient, especially when it feels like we've been waiting since May. In reality, we called for the IEP redetermination at the beginning of October, over two months ago. We met a few weeks later to discuss the path to get there, had a few new evaluations of Ruby (psychological and OT, and a new speech, based on her current level), had 2 or 3 observations taken of her in her private Preschool class, filled out more paperwork and online questionnaires about Ruby's levels, abilities, etc., had her teachers fill out more paperwork. All of that will culminate in a meeting for IEP qualification and redetermination this week.

It feels like we've been studying for finals all semester, but without a real clear picture of what subjects will be covered. Even though we received some of the reports from the evaluations, the interpretation of them from the team may differ significantly from ours. It did last May; Lehr and I did not expect to be denied services at that time, even based on her star-student evaluation. I don't feel this is an act of deception by the team, it's just the reality that Lehr and I are inexperienced in these types of meetings, so we don't know what to expect. Friends that have gone before us have mixed results, causing some cause for cynicism, but we are hopeful.

At this time, we are praying for a clear answer of what will best benefit Ruby. We think that is her private Pre-K with a facilitator 3 hours/week, in addition to speech once/week and OT once/week. Whether or not she attends special needs Pre-K also is something we go back and forth on; we are open to hearing the team's thoughts on how that works into our plan for Ruby's full inclusion for Kindergarten in a few years.

All It Takes

These days my overall outlook, and mood, sways abruptly and severely from one side to the other. Optimism to pessimism. Encouraging to bleak. Joyful to depressed. When you invest so much time in 'training' someone, it's hard to separate yourself from the performance. As parents, we all experience this at various stages. I find it's exponentially more with Ruby than with my other two. The hours researching and implementing therapy strategies, the nights spent praying that tomorrow is 'the day' some skill emerges, the dollars spent on therapy sessions and materials...it all consumes so much of my time that when the wind slightly blows us off-course, I tend to crash. These are not good days, as Lehr would tell you. On these days, all it takes is one more instance of Ruby mis-articulating a word we've worked on forever, or acting out in a typical 3-year-old way for me to feel utter defeat. The metaphorical straw that broke the camel's back. It absolutely amazes me at how fragile I feel some days.

Thank God for the flip side. So many times I will be over the moon ecstatic because of something Ruby did, and when I tell someone about it, I will hear myself and think "this is so silly because it's so small". But I know it's not small - it's that word we've been working on forever, it's that skill that seems to always trip her up, it's that behavior that we have been trying to modify for as long as we can remember. When we have a breakthrough, nothing can tether me to the ground: I'm on top of the world.

Yesterday was one of those days. All it took was one of Ruby's therapists sitting in during her preschool class for one hour. All it took was her letting me know that Ruby talked a lot. All it took was her giving me the awesome news that Ruby was playing with friends - and they were playing back - on the playground. All it took was Ruby being her usual talkative self during Spanish to remind me that she can do it at school...just has to be where she chooses. All it took was Ruby using her mouth as best she can to form approximations of almost all of her classmates when we drilled their names before school. Yesterday was an amazing day.

That's all. It's the little things.

Speech Update

So many good things happening with Ruby most days. She is talking so much and we are understanding more and more of it all of the time. The sound her myofunctional therapist has been working on for over a month is "s". Ruby has been saying "s" for a long long time, but the primary focus of the myofunctional therapist is correct placement: lips, tongue, teeth. So while Ruby makes it sound fine when she says "s" with her tongue peeking through her teeth, that will relax into a lazy "s" before we know it, so we tirelessly work on getting her tongue up and correctly placed. Ruby does give us many opportunities to do that as she loves to identify letters when she sees them (in books, on clothing, on signs), and "s" is one of her favorites!

Ruby is also 'singing' like it's her job. If she hears one of her songs (she attaches to random songs on the radio), or if I start to sing a song she knows from preschool or therapy, she locks in and owns it. Sometimes she holds her imaginary microphone too. I love that for so many of these songs, especially the preschool or therapy ones, I can leave out words and pause and she'll fill in the blank for me.

Finally, new words are popping out all of the time. I dropped her off at preschool this morning and she hugged me at the door and said, "Bye, mom", totally unprompted and before I said "Bye" to her. She also picked up a more successfully "shoe(s)" this week; she often goes into the mudroom and empties the shelves as she matches and puts on all of our shoes. This week she's been naming them: "E-i. shooo. Addy. shoo. Mum. shoo. Ax. shoo." And her approximation on a few names from her class are starting to happen as well.

Different Sides of Ruby

With the introduction of a schedule for Ruby where she is away from me, but in an reoccurring environment that includes social and academic components, comes stress. But then, what doesn't stress me out these days, right? My stress is in the not knowing. In order for this to be the type of success I'd like it to be, it's necessary for me to not be present in that classroom. This is Ruby's chance to work on her own, with people other than me or Lehr. Even more than with Eli and Maddux, this is so important to start the expectation of Ruby being able to find success through her own means.

So far, school has been great. Ruby loves it and her teachers report she is doing well. Last week one of her speech therapists asked if she could go to the school for Ruby's session (instead of meeting with Ruby and me at the house). It was one of those moments where I chastised myself: why didn't I think of that? OF COURSE this would be a good idea. Not only could this therapist give me a clearer picture of what Ruby is doing/not doing (because she knows Ruby outside of that classroom, which the teachers don't), but she can also help Ruby find a few strategies in the moment, and she can give the teachers insight into how to best help Ruby and the class be successful.

The report was generally good, but nothing on this road comes without bumps. Ruby is not using her words in the classroom. At all. That is frustrating to me because she is such a chatterbox at home. And because Ruby does not show me any signs of shyness, I just assumed she was talking (in her own way) to the other kids and in general. It makes me sad that they haven't been able to see that very curious, very social, VERY talkative side of Ruby. Another thing our therapist addressed is Ruby not initiating play with others on the playground...in fact, it sounds like she just plays by herself most of the time. That is a really tough one for me, since Ruby is so social anytime I see her with other kids (not at school). The good news is our therapist helped facilitate some interactions on the playground that went very well and hopefully helped Ruby realize she has to talk to the other kids (like she does to me and her siblings when she's playing with us at home).

The different sides of Ruby...I had no idea she had this one that is showing up at school! It's so crazy to me to think of this playground side of Ruby, especially when a day doesn't go by that Ruby isn't continually tugging at my hand to 'ccccc-ooommmm' with her to play with the doll house or her kitchen (initiating play). A day doesn't go by that she doesn't play with me or Maddux using as many conversational imitations as possible (the 'talk' is incessant). We are very hopeful that a few more facilitated playground visits will find Ruby and her classmates initiating play together during these times, so that they can see the Ruby that we see.

ABC's

Speech updates to follow, but here is an example of one of the ways Ruby and I work on speech each day. Today we used plastic letters to practice our alphabet recognition, but sometimes we use flashcards of animals or objects, sometimes we use small plastic animals....whatever works! This day also found her not in a chair, hence the very busy back and forth. So many times when I work with her we are in a chair to keep her focus, but sometimes we incorporate moving across the room to put things in another area (couch, bucket, etc.) to incorporate following directions AND movement (which is her favorite part).

LONG video...no edits.

Therapy Update

As I've said before, gymnastics is our only official PT these days. Ruby still loves it. Stays with class and gets help from the teacher when needed (but does lots on her own too). We use the short balance beam in the backyard to help Ruby with her balance and core strength often, and she loves to climb on all kinds of playground equipment. She's running...yes, running...all of the time. Still not jumping with two feet, but we'll get there!

Speech! Ruby currently has three speech therapists. The school system every Tuesday, and Thursday is alternating with myofunctional (more correct lip/tongue placement for sounds) and regular speech. She is stringing more words together, "Thank you, mom", "More water, please" and the likes. She will also put two of those together: when she sees one of the kids or Lehr walking towards the garage she will say, "Bye, Eli. I love you." She is also commenting on her environment more and more daily. Ruby will see something or point to something, look at me and tell me what it is. Her favorites are umbrellas, airplanes, and babies.

Therapy Wrap-Up

What a week! We just finished school last week, followed by an extended weekend at the beach less than 24 hours later, only to return to a half week full of more than a regular week should hold!

This week was Ruby's last visits through Babies Can't Wait. As she ages out of that system next week, we had our final sessions with her speech therapist and physical therapist. Without intention, those sessions were back-to-back on the same day. This was bittersweet for us as Ruby has been with Sherri (her physical therapist) since the very beginning. Her first session took place when she was 5 weeks old! Sherri taught me so much throughout the last three years...the way she attacked PT with Ruby helped me shape how I handle all of her therapy, and I will forever be grateful to her for that. No breaks for our girl as she doesn't need them, and she's capable of so much if you just push her. Sherri taught me how to view every activity in Ruby's day as an opportunity for PT, and to this day Ruby is complimented on her form.

Paula came along later in the game, but she definitely gave us some great speech time. The main thing both Ruby and I took away from her is slowing everything down (Ruby tends to get very excited and amped up when playing new games in therapy). We will miss these women!

The day after we said good-bye to BCW, we had an appointment with one of the private therapists we love, Vivian. We are hoping to move to a more consistent, more often schedule with her, as she holds Ruby to her potential. She does for Ruby's speech what Sherri did for her PT skills. Our sessions with her are always full full full, and we are left with plenty of good stuff to work on. This visit found her happy with what she was hearing from Ruby. That doesn't mean she let her off the hook or that Ruby didn't have anything she needed to work on, but it is becoming obvious to everyone that Ruby's words are coming!