Reply to WH from Denise

Dear WH and team,

Your update is very encouraging and positive.

By the sounds of it, Faith has reached very important cognitive milestones. I anticipate that you will start to see other more interesting learning and developmental behaviours from here on. For a start, you could test her on symbolic tasks; such as feeding a teddy-bear or putting a phone-receiver to her ear.

Keep me updated.

Best Regards
Denise

OT Dom's Email 30th Sept 2005

hi there,

How are things going? This past session with Faith, I had a look at how Faith eats and drinks. Looking more at detail at her oralmotor skills cos she's making more and different noises which is wonderful. But she can't blow or suck which is what we need to address as it shows that she has little awareness of her mouth and how to use it.

She had a piece and bread and had a drink from her little cup. It appears that Faith doesn't have a mature 3 d rotary chew and she seems to take a few bites, move the bread around and them swallows it.

With her drinking, her tongue is extended so that when she's drinking, you can actually see her tongue from underneath the edge of the cup. So she's uses a lot of suckling action to drink.


I think I wrote this in the last e mail but in addressing the oralmotor skills, it will also help her more with developing her verbal and articulation - speech. The mouth is also the start for all kids in the understanding their space.

- I've asked Faith's grandma to give her food that is not so soft or minced up. This will encourage her to chew more. Like, chicken or meat that is in bite size or cubes.

-Even fruit that is a little harder where she can chew on them. Preferably try to put them at her molars where she can bite down on them to begin with.

- If faith is on the bottle, she needs to stop that as it encourages the suckling action which she is using when she drinks from a cup.


As she is mouthing more, it could be likely that she is seeking more input to her mouth. Through touch and proprioception by biting down on it.

So just like how we'd excercise our bodies when we want to get fitter, for faith, we need to excercise the muscles in her mouth so that we can get her eating and drinking better and that would put her in a better position for speech developement.

I know it's hard so perhaps we can begin with just changing the texture of the food that is faith eats and get her to start chewing more which will build on the stability of her jaws first, get her tongue more of all before we move onto more complex things like blowing and drinking from a straw.

let me know what you think

dominique

ps i should be putting this on the website right?

OT Dom's Email 30th June 2005

Image is a shot of Faith enjoying a live music concert at the Esplanade. That story here.

This is an email from Faith's OT Dominque.

Thursday 30th June 2005 from OT Dominique

thanks for the mail.

it's not just that she knows how to get what she wants but her receptive language skills are improving a lot. that is the beginnings of speech. understanding before expressing.

The information about her oralmotor skills is helpful. As a result of her weak oralmotor skills, it's probably not helping to support her to produce speech.

Today, i noticed that Faith is babbling a lot more than usual. It was great to see her. She had the headphones on for about 10 min. She went to get a big air mattress which I have never taken out for her cos she has been afraid of movement.

Today, she went up to it, and tried to get it down. She was up there, standing, bouncing on it. Tumbling off onto the cushions and laughing. Just climbed back up again.

Posturally, she's much more organised. Able to use her body much better to help with her exploration. Hardly any drooling today but she was stimming at times and doing that thing with her tongue.

Faith has come a long way. She never used to be comfortable with movement and now she's doing headstands? I saw her do one this morning as well - she was on the air mattress. The movement sense is important for many things. The sense of gravity, detecting changes of head position, alertness level, muscle tone, postural control. it also influences the visual and auditory sense. That she is now going and seeking it, exploring her body in different ways is very helpful and 'nourishing' for her system. It's time for catch up basically. She's been deprived of movement for so long that you'll find her doing more crazy things.

How long is she listening to the cd for? The music has been specially recorded and Faith gets a lot of vestibular input from that as well via the auditory system. It also helps with attention and awareness and posture.


How to help her oralmotor skills along.

1. Stop the bottle. She can drink from a cup and she should. Drinking from the bottle does not help to facilitate proper speech patterns or dental health. She is old enough and really shouldn't still be drinking from the bottle. It may take some time to wean her off and it is a change in her routine. Does she drink from the bottle lying down before she goes to sleep at night?

2. Wonderful that she's getting more interested in other foods. Have to be careful about the sweet stuff. Do look at what she's eating to see if they can be used to encourage more chewing. Does she eat crunchy food? Can the meat she eats be cut in bite sized pieces and placed on the molars to encourage more chewing?

3. Blowing and sucking - Is there any sensitivity in her mouth? Does she tolerate brushing her teeth? Is that a problem? Might have to build first on her jaw stablity before working specifically on blowing.

to suck from a straw, how have you tried to teach her?

Many more questions.

Hope all is well.

Regards

Dominique

Email from OT Dom and my reply

This is an email from Faith's OT Dominque and my reply to her.

Thursday 16th June 2005 from OT Dominique

Hi,

I know I'm seeing Faith tomorrow but she's doing really well.

The last time I saw her, she listened to what I said, I told her to get a ball to jump on. She went round to roll a yellow therapy ball over and put it on the tyre.

She was so happy, listening out to the music still. Playing so well with me. Less drooling.

I meant to ask you, what does Faith eat. Does she still eat a lot of soft foods, is she still being bottle fed, can she chew her food or does it need to be mashed up? Can she blow?

Let me know and we can see perhaps what we might be able to do about her oral motor skills. We just went on a course
about oral motor skills. actually, there's a one day workshop being held on august 26th, friday but explorer learning. It's a good one to attend re feeding skills and speech. The speaker is very experienced and is an engaging in her delivery. Worth attending if you have the time.

Hope all is well.

And, is Faith still listening to the CD over the stereo with her teachers?

regards

DOminique





Wed 29th June 2005 from Kin Mun

Sorry for not getting back to you sooner, Dom.

Yes, she is still listening to the CD.

Good to know her progress. So she knows how to get the object she likes and push it to the right place. That's great.

Lately she has been very good with the joint attention. She grabs our finger to point at specific things in books (she has a few faves) to make us read it out. And she knows which pics she likes. She usually points at pictures of things she knows, like flowers, cars, characters like Lulu and the Wiggles characters. She is also very good at flipping to the page she likes.

She is also starting to do crazy things like handstands. She would also lie down on my lap, face up, and head sticking out over my knees. She looks at the world upside down for a bit, then she brings her legs over her head, to do a flip.

Faith is still drinking milk from a bottle, but she can drink water from a cup (but sometimes she spills).

She chews her food but likes to keep food in her mouth a little too long.

She still does not like hard foods to much. But she is being eased off the GFCF diet now, and she is getting mighty curious about other foods, especially sweet stuff.

She cannot blow or suck a straw.

Hope this helps.


Regards,
Kin Mun

Other Faith stories from my site

You may also be interested in reading about Faith learning something about medicine, from her brother: Link 1

And Faith scolding her brother for the first time: Link 2

And Faith behaving like a big sister for the first time: Link 3

Faith's favourite book and her new reading skills

Faith's favourite book
Originally uploaded by mr brown.

Faith has developed an interest in books, and is now able to flip to pages that she likes by herself.

She would pull my arm, to ask me to read something, and she flips the pages by herself, then if she finds the page she wants, she would direct my hand or finger to the item on the page, to make me read it out loud.

This is one of her favourites; a cloth book of farm animals, with lots of sensory stuff like wool, crinkly pages, and sound makers.

Faith likes the page with the sheep and duck, especially the duck that quakes when you squeeze its wing, and she also likes touching the furry sheep, and making me say the animal name and sound when she points my hand at it.

Faith also likes the page with the cow and horse. She would not just direct my fingers at the cow and horse, but also at the flowers in the cow page, to hear me say "flower".

It is a good sign, I think. Not only is she initiating communication, she is able to get the book she wants, flip to the page she wants, and then direct me to speak the items on the page.

This means she is probably able to do PECs or at least some basic level of picture exchange.

According to Wanhua, Faith has been displaying this behaviour with her for two weeks now. I just found out over the weekend.

It was a good step of progress to see.

On a side note, Isaac can go "baaa... baaa... baaa" when he sees the sheep page. It is very amusing to watch.

From Denise: on new reinforcers and Faith's changes

Hi Kin Mun, Ginny, Wan Hua and Wan Ying -

Thank you all for the recent updates about Faith's progress. It was very heartening to read. I was away this past week, so have only just found some time to reply/comment.

Could I suggest that a regular Reinforcer Assessment be conducted to keep track of changes in Faith's preferences here? This is particularly important if the school teachers are noticing that certain variables are losing their "pull" on her motivation(s) to sit, attend and work.

The changes that you are observing in her "profile" of learning and relating with the environment seem to tally also with the fact that she is able to withstand kinesthetic activities better. Perhaps you could re-look "sit-&-bounce" balls, balls with bumps and other textures, inflatables (from sports shops), and on a smaller scale, feathers, kiddy pipe-cleaners (with their ends shaved down), etc.

Kin Mun & Ginny ­ any chance that the four of you could spend a weekend at Sentosa or one of Singapore¹s coastlines together? There are lots of activities that the children might really enjoy doing: sitting in kiddy-chairs attached to bicycles that you can cycle up and down the beach, walking on sand/grass, playing in water with a variety of floaties (eg. long "noodles' or little water-beds), sitting in buses (including the open-air kind on the second deck), sitting in the beach train that goes "choo-choo" up and down the shore-line (Sentosa), traversing the suspension bridge (Palawan Beach, Sentosa), riding on a horse/carriage (Sentosa Ranch), playing in fountains... In fact, you should try and catch the upcoming long weekend to try and accomplish all of this!

Thank you all again. Keep up the great work!

Denise

AWWA teacher visit

Christina, Faith's teacher from AWWA, visited our home last night. We had a nice chat, and Faith was noticeably excited to see her.

It was obvious that Faith was happy to see Teacher, and she kept making eye contact with Teacher the whole evening. Faith is on one week school holidays, so she has not seen her Teachers for almost a week. She will be getting a new teacher who will replace Christina's partner, when term starts on Monday, so there will be some adjustments to be made. There may a permanent Teaching Assistant assigned to her class, because the children are currently a little rowdy and also because of the new teacher coming in.

Faith ran around the living room, playfully, and spun herself around and around. She never does this normally when we are home. This is obviously because Teacher is around.

Christina says that in school, Faith is ok at snack time and play time. She will sit patiently and wait for her snack. But when it comes to work time, she will try anything to avoid it, like run around, giggle excessively, and even give the teachers a kiss and a hug before work time starts, as if that will allow her to escape work. This is in contrast to her previous year under Teacher Ivy, who said she could sit down for work for long periods of time.

We also discussed Reinforcers because the school needed more. Teacher says the pigeon wipes packets are not really good for her to play with too much, because she tends to stim with those.

Other concerns we told her are the long holidays without school, her speech (the lack thereof) and her potty training.

Christina told us that potty training will take a long time, but they are already adding it to her structured schedule. At fixed times everyday. they will take out the card for "toilet" and take her to pee at the toilet. They try to encourage her to take her diapers and skirt off herself, and if she pees while on the bowl, they will make a big deal of it (cheering and clapping). She is also taught to reach for the flush (although Teacher helps her to press it down because it is a little hard for her). She is also taught to wash her hands after visiting the toilet.

Eventually, when she can pee on the bowl consistently under the structured approach, they will take away the diapers. If she wets herself without the diapers on, they immediately take out the card for "toilet", and take her to the toilet to reinforce the notion that peeing should be done in the loo.

The ultimate goal would be for her to indicate her need to pee, and to go to the toilet.

Faith is able to sit in a toy car (the Playskool type where you have to open the car door to get inside) and with encouragement, she can use her feet to move the car around. They have tried letting her "drive" her car in open spaces too, and she is fine with it.

She got frightened by a large cowboy hat though, that was introduced as part of a lesson. She freaked out when the big hat was pulled out of the bag as a surprise.

When it was time for Teacher to go, Faith could wave goodbye. And we even heard her verbalise the word "Bye". Her version was "Buh-eye, buh-eye". Although she only said it when she was not making eye contact with Christina.