Happy Birthday, Josh!

The day has finally arrived! Josh is three! For how much we've been through this year, I have had to take a step back several times and remind myself how young he is. He is still a baby. Since Emma was a baby, we have attended several birthday parties for her and her friends. I always thought a birthday party at The Little Gym was the perfect place for a three-year-old party, and pictured that was where we'd celebrate Josh's third birthday. Well, the Little Gym by us is closed now and my vision of a perfect birthday party for Josh was different than I had planned. However, my expectations were far exceeded. The months preceding Josh's birthday, I kind of dreaded him being three. I worried that the gaps between him and typical kids would be widened and more obvious. I worried that he wouldn't get the idea of a birthday party and I pictured him screaming when we sang Happy Birthday to him.

I worried a lot for nothing. Josh has progressed in so many ways and far exceeded my adjusted expectations for what he would likely accomplish by three. His party was at our house and we had my family and Danny's family over. After church, we stopped at the store and got balloons for him and told him we were having his birthday party. He said "party cake" and "tummy hurt." When we've gone to other birthday parties, I've given him his treats and told him that the birthday cake would make his tummy hurt. So, I explained that I would make him a special cake that wouldn't hurt his tummy. I bought the Thomas the Train decorating kit from the grocery store bakery and made his special cake. I had visions of it looking perfect, but the frosting barely held together and I had to forgo the double layer cake for a goopy single layer cake. It didn't matter. Josh was thrilled for his day. He loved his Thomas cake and squealed with delight as we sang to him. He opened his presents and was happy to play with is new toys.

Josh's birthday was perfect. He's worked so hard this year and I am so proud of every single accomplishment he's made. This year, he started to say "Mommy" again to now starting to initiate and engage in simple conversations. We've gone through so much together to accomplish these things and each are like little miracle gifts as our expectations changed. This year might not have been what I had envisioned it to be, but I now take greater joy in the things I previously took for granted or assumed would be. Seeing Josh so happy brought us much joy. We have grown in so many different ways thanks to Josh. He's a blessing to our family and we look forward to what the next year will bring for him and our family.

"This is my dearly loved Son, with whom I am well pleased." Matthew 3:17

October? What October?

I've had multiple people mention the last week that 9/25 was my last blog entry. Whoops! This blog break was brought to you by a weekend of rest at my parents' house, Danny travelling, Josh not sleeping at night anymore, several assessment appointments with the school district, and the flu running through the entire family! I still haven't gotten ahead on cooking and laundry since we all had the flu, but we're getting back on track again. At least we all weathered it well and are recovered.

I started off the month with a relaxing weekend with my parents. Danny took a Friday off of work. Kate and I headed to my parents' house on Thursday night and stayed there until late afternoon on Saturday. It was nice to have some time to relax, take a nap, and my parents took good care of me with good company and wonderful food. Much needed break!

Emma is doing well in first grade! Her reading has really taken off and impressed us. She's not just getting through the words now, but she reads as if she's telling a story and gets what is going on. She is wonderful with Josh. In August, we did a training session at Josh's ABA therapy center that included Emma so she could learn what to say to him and how to help teach him to take turns and to respect things that are hers. She is a great role model to Josh on how to play and to use his imagination. She's constantly modelling new words to him and includes him in her imaginary play so well. Last night, she built a "tent" between the couches with a blanket. She had Josh going in the tent with her and they went to sleep. He loves Emma so much and I couldn't ask for a better big sister. She's such a great help to me, just by being a helpful big sister, willing to help with Josh or Kate very often.

Kate has started to crawl! At first, she would make a scoot or two to get to a toy, but once it clicked, she's all over the place on a mission. She and Josh have had their first "fights" over toys. She'll take a toy from Josh, he'll scream and take it back, and she'll scream. What an attentive baby - her eyes are following everything that is going on and she is very intent on being involved. I am so thankful for Kate being such a good baby. I've been taking her to Josh's therapies and several assessments with the school district this month and I never have concerns about taking her with me. I call her my portable baby. =)

Josh is continuing to progress. I am getting compliments from all of his therapists. I filled out a follow up form for Thoughtful House this week and here are the areas I highlighted as progress:

• Increased expressive and receptive language
• Improvement in behavior problems and head-banging
• Improved eye-contact
• Improved sensory issues. We can drive over speed bumps without screaming or even a mention of it in the car! We can drive next to a semi. Sounds that used to send him overboard into head-banging bother him much less.
• Expressing needs better and physically coming to get us occasionally when he needs something
• Reduction in visual stimming (running next to a wall or surface and watching out of side of his eyes, or watching fans and objects that spin for prolonged periods of time)
• Playing with more toys appropriately
• Improvement with obsessions with fans, turning them on/off and things that spin. Also, improvements with needing to carry objects with him frequently and obsessing about what toy he goes to bed with.
• He has started to sing songs again and allowed us to finish reading an entire book to him.

We have attempted getting out more and facing situations we would have avoided in the past. We went to the big pumpkin patch that we have gone to since Emma was almost 2. It's very crowded and we didn't think Josh would handle it well at all. We were wrong and he had a great time, including going on a tractor hay ride where he sat with Emma with no issues with the sound of the tractor. He also went on a bounce house slide with Emma three times! Josh has never cared for bounce houses at all and we were floored he did it, especially in a crowded place. We couldn't exactly get his attention for pictures, but hey, I can't have it all, can I?

Because we started speech services through the state ECI program (Early Childhood Intervention) when Josh was 19 months old, they fed us to the school district for evaluation and to qualify for services when Josh turned three. So, this past month, Josh and I have had several meetings and evaluations with the school district. I did an intake form assessment with a diagnostician, the autism evaluation team performed the ADOS autism diagnostic test at the school, the autism evaluation team observed Josh at our house with a few friends over, the physical and occupational therapists evaluated Josh at the school, and the special education teacher spent some time with Josh to create goals for him. I also had a meeting with the autism evaluation team to go over their detailed report on Josh. They diagnosed him with PDD-NOS (Pervasive Development Disorder - Not Otherwise Specified) on the autism spectrum, which was the same diagnosis we received from the developmental pediatrician. They were very thorough and I was impressed with their observations of Josh as well as the details of their assessment. They really praised the path we were on and how much Josh has accomplished with early intervention. It was nice to hear such encouraging words and their positive outlook for Josh's future. I also met with an in-home trainer from the district and took a tour of the school they were recommending Josh attend PPCD class (Preschool Program for Children with Disabilities). We had our ARD meeting, where we agree on district services to be offered to Josh. Prior to going to the ARD, I learned of some insurance changes that will be in effect in January. The Mental Health Parity Act requires that insurance coverage for behavior health have comparable limits to that of medical health. ABA therapy is considered psychiatric therapy (I'll save my thoughts on that for some post that I'll probably never have time to write). Our insurance plan covers 30 behavior health visits/year, 60/year for treatments received more than once a week because they are considered "intensive." Anyway, I have confirmed with our insurance carrier as well as our benefits administrator at my husband's work that we will have NO limits next year!!! We have been planning to pay for the majority of next year and trying to figure out how, so this is a HUGE relief. ABA is the most expensive treatment. However, in conjunction with his medical treatments helping him feel better and able to learn, ABA has changed our lives. Anyway, all of that is to say that we are opting to keep Josh in the ABA center 5 days/week next year and will work with the school district for speech services. He starts speech two mornings a week after Thanksgiving. I am planning on continuing with his private speech therapist once a week until we see how the district therapist goes. As in all therapies, it depends mostly on how your child clicks with the therapist.

To end on another high note, Halloween was great! I didn't know how to best handle it. I can't break traditions Emma loves - she has already sacrificed a lot (diet changes alone are enough!!!). We tried getting Josh to pick out a costume, but he was more interested in the Halloween snow globes on display. So, I bought him a Superman costume and we tried to get him to wear it for Emma's school carnival. We put it on, he looked down at it and said, "off." I took it back and didn't know if he understood what we were talking about with Halloween. It's one of the communication challenges. Sometimes, we wonder if we're even close to being on the same page, and other times he floors me with his very clear understanding of what is happening around him. I thought the candy would be torture for Josh. We really have to watch sugar with him since it feeds yeast issues he has in his digestive system. Initially, we planned on having him help pass out candy and if it became too much for him, we'd put it on the porch and be done for the night. The more I thought about it, there was no way Emma's friends were going to come over and leave the house dressed up without him having issues. There is always a way to include him and my plan was for him to go on a wagon ride and bring his favorite snacks for the ride. So, an hour before her friends came over, I asked if he wanted to be Greg from the Wiggles (we had the shirt from when Emma insisted on being Greg when she was 3). Josh went straight to his room and worked as hard has he could to get his clothes off and find the Greg shirt. He rode in the wagon and a few houses in, got up to trick-or-treat. I took a breath preparing for the tantrum to eat the candy, but he put it in his pumpkin bucket and proceeded to pull the wagon himself. For a few blocks, he just pulled the wagon as if he were on a mission to make the wheels spin as fast as he could. Out of the blue, he dropped the handle, picked up his bucket and went up to a house. I prompted him what to say and after his "thank you" he marched back to the wagon, placed his bucket in it and pulled it until he reached the next house that looked right to him. When we got home, I have him one of his diet compliant cookies and all the candy disappeared to an Emma-disclosed location. I really enjoyed that night. I will look back on it often to remind myself not to underestimate what Josh understands and to motivate myself to give Josh more opportunities to surprise us. Even though Josh didn't "get" Halloween the same way other kids did, he had a good time and he felt a part of what all the other kids were doing. He was so proud and deliberate on his mission. I was proud, too.

Major milestones

Quick post to share exciting accomplishments from this week! Josh's language has been reaching a new level. He has started to tell us words about his day! He went to his therapy on Monday. In the evening, he said to me, "New friend. Eric." When we returned to therapy Wednesday morning, I asked his therapist if a new friend named Eric started this week and she confirmed it.

He had his speech therapy yesterday and she commented on how much he was talking. She said his other therapists stopped them in the hallway because they couldn't believe how much he was talking! She said he did so many new things in therapy yesterday that she couldn't write them all down. The rest of the day was horrible with raging fits and head banging like I haven't seen in months, but I'll let go of that with today's accomplishments.

Tonight was the first time Josh let me read an entire story to him!!! We "read" books every night, but usually Josh has complete control of the book and will point to a few pictures and sometimes name them. We were excited to get to that point. I often try to read to him (honestly, a little discouraged to try some days), but have never gotten past reading more than one page. We got through all of "How animal mommies love their babies" tonight.

After reading and saying prayers, we talked in bed. He said "soccer ball" and I told him that Emma has another soccer game tomorrow. He said, "Nana, Uppa." referring to Danny's parents going to her last game. I told him that Nana will be there and that Grandma and Grandpa were coming too. I said that tomorrow is Uncle Chris' birthday and he would come over to celebrate tomorrow as well. Josh said, "Cake. Candles. Hot. Sing."

I am just on cloud nine!!! So often Josh's speech seems so memorized and often jumbled. For example, I thought I taught him to answer what his name was and how old he is, but he often doesn't distinguish the two questions apart. He'll repeat phrases he knows, but they don't always match the situation. But this new speech where he is telling us about what he did, what his experiences are and what he likes, is so exciting.

I have often wondered what his third birthday will be like, if he would understand or care about the celebration, or get excited about opening presents. I have renewed hope that there is still more to come. And, we'll just have to wait and see what his 3rd birthday will be like.

Our long awaited visit to Thoughtful House

Last week, we made our long awaited trip to Austin to go to Thoughtful House. We saw Lucas Ramirez for two hours, then had an hour follow up with the nutritionist. We had been anticipating this visit for such a long time. My parents travelled down with us so they could help watch the girls while we had our appointments with Josh. We could not have done it without them and we feel blessed to have their support!

A few weeks ago, we had sent off a stool sample for analyis and got the results back a few days before our appointment. It showed a high level of bad bacteria as well as strep in his digestive system. The lab also tested for which antibiotics and natural remedies the strains of bacteria were sensitive and resistant to.

During our visit with Lucas, we went through Josh's medical history, all lab work as well as our current assessment of his behaviors. I had completed these assessments back in July as well when we started processing paperwork to go to Thoughtful House. It was nice to see how in just two months there were areas I had previously categorized Josh as moderate-to-severe that I now categorize as slight-to-moderate.

Our action plan is to treat the bacterial and strep infections in Josh's system, adjust his supplements we had started with the nutritionist here in Dallas, and follow up in a few months. One of the things that I loved about Lucas was that he offered us tips on handling behavioral issues with Josh. Since he has a son with autism, he had been through self-injury and severe tantrums. Josh threw a huge fit in his office and he was great in giving us suggestions on handling it, as we were emotionally attached to the situation, and he wasn't. I have often wondered how to tell the difference when Josh was hitting his head into the wall or floor because he was in pain vs. to get attention from me.

He was great to talk to and also corrected me in saying sorry to Josh when he didn't want the snack I had for him. He pointed out that I didn't do anything wrong and by apologizing to Josh, I was implying to him that I did something wrong. We ask him to say sorry for hitting his sister (doing something wrong), so when I say sorry, he'll take it that I did something wrong. Seems obvious, but following in generations of apologizers in my mother's family (sorry,mom!), "sorry" is a word that flows out of my mouth all too frequently. This makes perfect sense because Josh is extremely literal. In the car, I had to hit my brakes suddenly and the motion made Josh scream. I said, "Sorry, Josh." Quite often, when I hit the brakes suddenly, he'll scream, then say, "Sorry, Josh." That was what I taught him. So, it was good that things like this were pointed out to me. It makes sense.

As we started all our assessments and treatments earlier this year, I expressed a feeling that we were somewhere in the middle of the typical world and the autism world. Many ASD kids are far worse off than Josh. Often, in ABA therapy, I'm told by other parents how lucky we are that Josh is verbal. There is this feeling of guilt being around other parents who covet the simple words coming from Josh's mouth. My parents got to see that on our visit. While they were in the waiting room with the girls, they saw many kids coming and going and visited with some of the families. They had tears in their eyes as they told me about some of the kids they met with much more severe symptoms and understood what I meant.

I'm in a different place now emotionally. I think I've gone through my phases of grief, or at least the initial round. August was my month to be angry and depressed, but September has been my month of acceptance. I feel like we are coming around to seeing more of what Josh can do rather than what he cannot. We are learning to be patient and compassionate rather than selfish (never-ending work to do here). We are seeing the blessings that have come from this. While we are doing everything we reasonably can for Josh, I accept that there is no "cure" and he may never be typical. However, he has overcome so much already and I am choosing to move forward without an outside benchmark of his success. He has a great sense of humor, an incredible memory, a smile to die for, and is working so hard to do the right thing. At two, I think he's worked hard to overcome so much.

I have been reading Ten Things Every Child with Autism Wishes You Knew. It is written so well and really helps to bring out compassion for Josh rather than frustration. I really think this book has helped me come around more on focusing my efforts on just loving, supporting, and accepting Josh. I begin each day with a prayer for patience, strength and love. One day at a time.

So disappointed in NBC

I'm so disappointed in the Dateline special, and am almost sorry I asked friends and family to watch it. Over the last several months, we have been surprised that there seems to be a lack of media interest in autism treatments. Our ears perked up on a July morning when we heard a blurb on the Today show talking about a study on the link between GI issues and autism. We ran to the TV to hear Dr. Nancy Snyderman follow up saying there is no link and parents should stop wasting time and money with special diets and dietary supplements that do not work and will not help their children. My jaw dropped. Diet changes alone had been helping Josh dramatically. So, we looked up the study ourselves and read it. The commentary along with the study didn't close the door on the link and said the study showed there is more to study.

Here is a link to the interview where Dr. Snyderman puts her personal spin on the study it doesn't appear she read:
http://today.msnbc.msn.com/id/26184891/vp/32168581#32168581

Here is a link to details on the study performed:
http://www.webmd.com/brain/autism/news/20090727/gi-problems-and-autism-no-link-found

We were so excited to learn that Dr. Wakefield and Thoughtful House were going to be featured in a major media outlet after being so disheartened with the coverage in July. However, when I saw the 10 minute clip on Friday's Today show, it appeared they were going to turn the story into a debate about whether or not vaccines cause autism. So, rather than a light-hearted update on my family in today's blog entry, I feel the need to tackle my view on how the media is handling autism and the vaccine debate.

As a parent, I want to see the hope in treatments for autism and the show barely touched on the actual treatments for autism that Thoughtful House and other DAN (Defeat Autism Now!) doctors perform. They made it seem that parents were following Dr. Wakefield because he had a sympathetic ear on what caused their child's autism. I took offense to that. Yes, parents want to understand what happened to their child, but more importantly, we want every opportunity to TREAT our children. Parents are not stupid people! Mainstream medicine and the media tell parents that autism is a psychiatric disorder, for which there is no treatment. That is not the case as parents of autistic children and these doctors are taking the time to learn and explore treatment options that follow biomedical practices. If Thoughtful House has patients from 48 states and 48 countries, it is because they are helping autistic children! Why on earth would there be this large of a following for treatments not covered by insurance if there were not results? I might have been stupid enough to blindly listen to past pediatricians who vaccinated my child with 5 vaccines at the same time he prescribed prednisone, albuterol, polmicort and antibiotics, but those days are over for me and my family. I am choosing to be educated about our health and make my own decisions rather than blindly trusting what a medical association says is "safe."

As for my thoughts on the topic of vaccines, I think they are a piece of the puzzle, but not the sole cause. Josh had health problems almost since birth, and in our autism puzzle that was his predisposition. Once I figured out his food allergies by doing elimination diets while nursing him (eliminating all common allergens from my diet and testing his reaction by eating them), I got his wheezing and allergy issues under control. It was his second year when the ear infections started to kick in, along with more eczema, runny noses, viruses, herpes simplex and so much more. I have obtained copies of is medical records since birth and taken a look back and he had a rough second year and took more antibiotics than I had recalled. I think his turning point was around 18 months old. Our new pediatrician put him on a slower vaccine schedule and her policy was to give measles, mumps and rubella individually rather than all together since she had seen the MMR vaccine change kids in her practice. She also did not give more than two vaccines at one time. So, at 18 months, Josh received just the measles and IPV vaccines. About 6 weeks later, the viruses kicked in, followed by the herpes simplex virus and it went downhill from there. His speech and awareness regressed, head banging ensued. We called ECI for an evaluation when he was 21 months old and it's gone on from there. His speech, imitation, response to his name were gone. Over the months to follow, there was some regression and some progress and our concerns grew from there. He continued to get ear infections and we continued to give him antibiotics. He spent his 2nd birthday watching the helicopter blades spin on a ride at Chuck-E-Cheese for 45 minutes. I didn't think it was odd, I thought it made him happy. His obsession with fans and things that spinned grew exponentially. At his 2-year checkup, we had enough behavior concerns that his pediatrician talked more seriously with me about vaccines and we opted to not do any at that checkup. Christmas was an all-time low. He was on antibiotics and went absolutely crazy! He was either crying or banging his head for days. I stopped the medication and he improved, but the head banging and severe tantrums continued for months. We expressed our concerns to our pediatrician and she encouraged us to perform metabolic tests on Josh, as she had seen digestive and malabsorption issues cause behavioral issues in kids. We performed that lab in March, 2 weeks after Kate was born and several weeks before we read and suspected autism. So, we are truly blessed our pediatrician was more conservative on vaccines, gave alternatives to antibiotics when we started having issues with his behavior, and that she was familiar with biomedical and nutritional testing. We were already on the path for treatment before we knew of autism.

I like how our pediatrician puts it best. Everyone is born with a garbage can to collect the toxins they are exposed to. Some have large garbage cans and some have small ones. Our job is to make sure we account for those kids with the small garbage cans. Basically, when there are more toxins than a body can handle, they get stuck in the digestive system and can leak into the bloodstream and the brain. So, do I think vaccines cause autism? No, not in a healthy child with a healthy immune system. I do, however, believe that the medical community owes it to parents to research these theories further. With 1 in 150 children being diagnosed with autism and 1 in 94 boys, we owe it to our future generations to figure out why these numbers are so high. Something is going on, and rather than shutting the door on researchers who are trying to figure out why, doctors should be lining up to figure out what these doctors are doing to reverse the autism diagnosis in so many children! As an adult, you are told not to get a flu shot when you are sick. However, pediatricians continue to prescribe antiobitics and administer vaccines for children in the same visit. I can't tell you how many times Emma was diagnosed with an ear infection and prescribed antibiotics in the same visit she was administered four vaccines.

We need to be smarter people. We don't care about what we eat, what we clean with, or the chemicals on our carpet until they affect us. We trust that when a doctor says we need a medication or vaccine and that it is safe, that is true. They are smarter than we are, right? No. There are so many things that I wish I knew before having children, but I'm looking forward, not backward. But I do want others to think about their health and that of their children and know that you don't have to do everything a doctor tells you. Read about vaccines!!!! Read how they work to get your body to build antibodies to a given disease. Read about the diseases they are made to prevent and consider an alternative schedule. YOU get to choose the vaccination schedule for your child, not a doctor. If your child has an infection, a virus or their immune system is obviously busy fighting something, your can wait to vaccinate until the next appointment! I am hearing of more pediatricians doing this, most often after they have had a child close to them diagnosed with autism. Do our children need 36 vaccines by the age of three, more than any other country? Is chicken pox life threatening enough to warrant the vaccine ingredients to be injected in your 1-year-old? Read the ingredients on the vaccines.

I am SO thankful for the parents and doctors who have gone before us and pieced together the underlying health issues and how it can link to autism! I cannot imagine we would have made a fraction of the progress we have to date if there were not already proven paths for us to jump on. So, as I am disappointed in the reporting of NBC on this topic, it hasn't changed a thing except my skepticism of their objectivity. I cannot wait to make our first visit to Thoughtful House in just under two weeks! And, I look forward to the day when the news about biomedical autism treatments gets the front page treatment it deserves!

Here are links to responses to the Dateline episode from Thoughtful House and Dr. Wakefield:
http://www.thoughtfulhouse.org/newsletters/2009-08a.pdf
http://www.thoughtfulhouse.org/newsletters/2009-08b.pdf

Enough on this tangent. I felt like I needed to address this after being prematurely excited about the Dateline episode.

Coming up, Emma coverage! She started first grade and is such a big girl!

Thoughtful House to be on NBC Dateline this Sunday

Very exciting news, I hope! Thoughtful House, the autism treatment center we have started to work with for Josh and will be visiting in a few weeks, will be featured on NBC this coming weekend. This is a HUGE deal as the "alternative" and biomedical approaches to treating autism are rarely portrayed in a positive light in the media, mostly due to these approaches placing some blame on vaccines, I believe. So, for those of you who are interested, set your DVR and hope that this invaluable information can be presented in a fair manner so that autism treatment and prevention can be taken to the next level. With 1 in 150 kids and 1 and 95 boys being diagnosed with autism, we need to pay attention and get to the bottom of this epidemic.

Here are the times:
- 10 minute segment on Today show this Friday, 8/28
- 10 minute segment on NBC Nightly News on Saturday or Sunday, 8/29 or 8/30
- 60 minute Dateline special on Sunday, 8/30

Here is a link to a letter from Thoughtful House with their thoughts on this opportunity:
http://www.thoughtfulhouse.org/newsletters/2009-08.pdf

Didn't realize how long it has been

Wow, I didn't realize how many weeks I let go by without an update. I am not sure where August has gone. I finally spent a few weeks to deal with a lot of my feelings and grief that I hadn't dealt with yet. I put aside things around the house, which I am still paying for (and I am SO sorry if I am delinquent on a thank you note to you!) and took time for myself. I think I spent the first several months in action mode after we knew Josh's diagnosis and I needed to deal with all my feelings I brushed aside during that time. I've had my angry, sad, and just plain tired days. I needed that time, and I'm sure these times will come and go, but I'm getting back into being a bit more productive again.

We have been seeing marked improvements in Josh, as have his therapists. Josh's speech is improving in clarity and he's picking up more and more phrases. He is doing a great job with puzzles now as well as picking up the idea of matching, sorting and grouping. I have also been able to get some parent training while Josh is in his ABA therapy. It has been helpful and I've gotten some great pointers on dealing with behaviors that are difficult for our family. We have already seen improvements with sharing toys, playing with Emma, reducing biting (a sensory issue, stim rather than behavioral so my tactics weren't helping), and getting to bed without 20 trips around the house guessing which ball he says he wants to sleep with (his pronunciation for baseball, basketball, soccer ball, and bouncy ball are almost indistinguishable).

Josh had an issue with ingrown toenails on both of his big toes. We did all we could to treat them without antibiotics, but were unsuccessful. He ended up having to take a round of antibiotics, accompanied by an anti-fungal since he'd likely have his yeast overgrowth issue come back in his digestive system. He finished them, then broke out in hives all over his body. It took me awhile, and with input from our local nutritionist, figured out he did not tolerate the sulfate-based antibiotics well. Anyway, his toes have cleared up for now, and hopefully we have dodged the need for surgery to correct his wide nails until he gets older and won't need sedation.

He recently had his 1-year evaluation with ECI (Early Childhood Intervention). It was 1 year ago when we first had him evaluated because we were concerned about his speech delays and head banging. Then, ECI said his speech delay was about 3 months behind. We thought it to be more by most standards, but it was three months by state standards. Now, his speech is about a year behind, but his cognitive language is only a few months behind. It's greatly helped because he knows his colors, shapes and letters.

Josh has an amazing memory (as does Emma) and attention to details. It was so easy to teach him his letters and he's pointing out letters and shapes everywhere we go. He points out the "triangle" every time we see a yield sign in the car. I remember when Emma was two, I was amazed by her memory and sense of where we were at. She would point out where different places were located as we drove through town. She knew EVERYONE's names. Josh has started to do the same. When we drive down the main road out of our neighborhood, he points to our friends' neighborhood, says, "That way. Jennifer and Nate." He points toward their street. As we drive by the road that we used to take to daycare he says the name of our former daycare. Yesterday, when I took him to his ABA therapy, a car pulled up next to us and Josh started saying, "Hi Jake!" I talked with his mom. Jake isn't the child who goes to Josh's therapy center, but a sibling! I was amazed. It just gives me more confidence that he knows so much that is going on, even though we struggle with communication and socialization skills. If we can keep progressing like this, I know we'll be more and more amazed by all that he has inside of him. I know he's a smart and loving boy and I hope he recovers fully someday so that everyone can instantly see what we see.

I had my first phone appointment with the Thoughtful House nutritionist. She was great and gave us some adjustments for his diet and has ordered lab work to check his metabolic levels. I'll be interested to get those results and see how they compare to the initial labs we had done in March. She also gave me some great suggestions for hiding more vegetables in foods for him. I've turned it into a game with Emma, since she's liked a lot of these new recipes as well. She's the taste tester to let me know if the food tastes good or not, then I have her guess the hidden vegetables.

So, now that I'm getting our house and life back under control again (relatively), my blog plan is to blog more often and write less each time. I let my ideas pile up, then figure I don't have enough time to write about them. Emma will also be back in school, so I can get updates done during nap time, I hope. I have tons of Emma stories to share about our summer home together, as well as updates on Kate as her little personality is showing more and more each day. Emma's off to first grade on Monday and is excited about going back to school. I am going to miss her. She is great company going to Josh's therapies and has been a real trooper going all around with us with relatively little complaining. She's given us themes for our weeks, created adventures and games for us to play, helped me with Josh's therapy exercises and provided some good laughs. So, I've loved having her around and I'm sure having her back in school will be easier in some ways and harder in others.

To end on a funny note, Josh's occupational therapist had to explain part of his therapy to me in case it was replicated at home. Josh was completing a farm puzzle, one that we have at home as well. She said he started making the animal sounds for the farm animals and she encouraged it. He got to the goat and stopped. I told her he probably stopped because I was never sure what a goat says when we did the puzzle at home. She didn't either, so she said she told him, "Goats are always eating. Chomp. Chomp. Chomp." Josh repeated back, "Hump. Hump. Hump." We got a good laugh.

Blessings,
Bonnie