Friday, September 23, 2022

Good Ideas From ABA - ABC charts and task analysis

I'm not a fan of ABA, as people who regularly read my blog could probably surmise. But there are some good techniques that ABA therapy has popularized, that I think should be used by people who aren't using the rest of ABA. Two main ones that come to mind are ABC charts and task analysis.


ABC chart stands for antecedent, behaviour, consequence chart. Basically it's a way of recording episodes of unwanted behavior so you can observe patterns and figure out why the behaviour is happening. For example, let's say you have a child who has tantrums. Every time they have a tantrum, you fill out the chart.


Antecedent - What was going on just before they had the tantrum? What set it off?


Behaviour - What exactly are they doing? You wouldn't put "tantrum" here, but something like "screams, arches back, claws at mom's face".


Consequence - What did people do in reaction to the behavior? What happened next?


For example, in a classic inadvertent operant conditioning situation, you might have the antecedent be that you were in the store, the child asked for candy and you said no. Then the behaviour - they screamed and refused to move while saying "candy" over and over. And then the consequence, you gave in and bought them candy. Let's say each of the other tantrums all followed this pattern - child wanted something and was told no, child had a tantrum, child got the thing they wanted.


This would suggest that the tantrum behaviour is motivated by learning that having a tantrum is a good way to turn a "no" into a "yes", and therefore you can reduce tantrums over time by being consistent about making sure that they don't work to turn your no into a yes.


In contrast, what if the child only tantrums in the store, but not necessarily with a consistent trigger? One time they tantrummed when denied candy, another time they tantrummed when someone accidentally bumped into them, another time they tantrummed when the intercom turned on to announce a new sale on watermelons? And then you look at the consequence, and each time you left the store early and they calmed down.


That would suggest that they're not trying to get candy or other things like that with their tantrums. They might be trying to get out of the store, and regardless of their conscious intentions, it seems like the store is an upsetting situation for them. This could indicate sensory sensitivities of some sort, or social anxiety, or some other issue that tends to be triggered by the store's environment. They might benefit from bringing some sort of comfort tool with them to the store, or by going to a different store or shopping at a different time of day. Or maybe they'd just be better off waiting out in the car, if they're able to be left alone safely or if someone is available to supervise them.


Or, what if the antecedents are stuff like reminding them to go potty, taking away their plate once they've finished eating, telling them it's bedtime, etc? That suggests someone who has trouble with transitions - situations where they have to stop doing one thing and do something else instead. Maybe they need more advance warning. Maybe they need a schedule in a format accessible to them (written if they're literate, pictures if not) to let them know what is happening when.


So, ABC charts are useful. Especially when you aren't using them in an ABA mindset. In an ABA mindset, the tantrumming whenever they're in the store would probably lead to the conclusion that tantrums are motivated by escape and you should keep them in the store when they tantrum, but really, if they're trying to escape the store, you should be asking what it is about the store they want to escape from, and how to make them not want to escape the store, rather than just teaching them that they can't escape. Or, at the very least, teach them another way to escape the store instead of having a tantrum, such as saying "I need a break".


Next, task analysis. Task analysis means breaking down a task into its component steps. For example, getting a shirt on. First, you figure out if the shirt is the right side out and where the back of the neck should go. Then you pull your head through the head hole. Then you put one arm through its arm hole, and then the other arm through the other arm hole. And then you pull the bottom of the shirt down and smooth it out. This may not be the only way you could put a shirt on, but it's a way that works - if you follow these steps, you will end up wearing the shirt.


Which means that when you're teaching a child to put on their shirt, you can focus on teaching each of these steps one at a time. First, you might focus on just getting their arms through the arm holes, and do the rest of the steps for them. Then you might work on them putting their head through the shirt once you've found the right way for it to go. And then finally you teach them how to tell which way the shirt goes on. So, task analysis lets you take a complicated task and turn it into a bunch of simpler tasks that you can teach one at a time.


It also helps you identify exactly where the process is breaking down for a student - for example, maybe the kid can get their head through the shirt, but half the time their head comes out an arm hole instead of the neck hole. That means they're having trouble with the first step, figuring out which part of the shirt is the neck hole. Or maybe they can do the rest but can't get one arm through its arm hole because they have hemiplegia, so you need to modify the steps in some way so that they can get their stronger arm through without help and use it to help their weaker arm through its arm hole.


Again, it can be misused in ABA (and in general) - the most common mistake I see with task analysis is treating the sequence you've figured out as the one true way to do the thing. For example, you can tie your shoelaces before or after putting the shoes on, and either way can work just as well. If you put them on and then tie them it's easier to get the right tightness, but if you tie them first, you have more flexibility about the angle at which you're tying the shoes - for example, if you're too stiff or too uncertain about balance to comfortably reach your feet, you could tie your shoelaces, drop your shoes on the floor, and then step into them. But some therapists resist such modifications, because they have one way they teach shoe-tying. This ignores a lot of the second benefit of task analysis, identifying where the breakdown is, because they're not willing/able to fix that breakdown.


Another way that task analysis can be misused is having a rigid order of teaching the steps. The best way to teach the steps is to start with the easiest step for the student to do that they haven't already mastered, and move from there. This is very individual. One student might be great at tying things but struggle with lifting up one leg, so they're ready to learn to tie the shoelaces but still need help getting the shoe on their foot. Another student might be ready to learn how to pull shoes on their feet but nowhere near ready to tie shoelaces (this would be the usual NT progression). The best approach would be to teach those two kids the same steps in different orders, but some therapists only teach the steps in a specific order, such as backwards chaining, regardless of the relative difficulty of the steps. This can mean a kid getting hung up on one difficult step for a long time and frustrated with a lack of progress.

Monday, August 22, 2022

3-6 Months Advanced Skills

I realized that in my write-up on my goals for 3-6 months, I forgot to mention the areas that my baby is ahead of that range. Here are some goals for older ages that she's been showing progress on.

Life Skills

I've previously mentioned that she can drink a little bit from a cup with help, but I've stopped offering her a cup for practical reasons. Besides that, there's a few other skills she's made a little progress on:

  • Feeds self with fingers. (6-9 months)
  • Uses technology for entertainment (6-9 months)
  • Pushes limb into clothes (9-12 months)

No, I haven't started her on solids yet, but she's started occasionally bringing toys to her mouth to chew on, which I take as a promising sign for future self-feeding.

Regarding use of technology, a few days ago she seemed to have a "lightbulb moment". I'd taken her out to play Pokemon Go and push her around in her stroller, and I'd sat down in the park to take a break. I took her out and put her on my lap, and as I was trying to catch a Pokemon, she decided to start touching my screen.

In response, I switched to an app designed for babies that covers the screen in a solid color and changes the color and plays a bit of music whenever the screen is touched. She's seen this app before and shown no interest, but this time, she seemed to understand that she could actually make something happen if she touched the screen. Physically, touching the screen was difficult for her, but she did succeed several times before she seemed to get tired and started fussing.

Lastly, pushing her limbs into clothes is something my mom started. Whenever she's dressing the baby, she'll put the baby's hand in the sleeve and say "push, push, push" while trying to encourage her to push her arm through. I decided to imitate this practice, and just recently, she's starting to try to actually push her arm through. She's not much help yet, but it's a start!

Motor Development

Here's some advanced motor skills she's shown some progress with:

  • Gets to sitting position (6-9 months)
  • Gets onto hands and knees (6-9 months)
  • Gets from sitting to crawling position (6-9 months)
  • Pulls body into upright position (6-9 months)
  • Grasps feet (6-9 months)
  • Controls fingers (6-9 months)
  • Pokes with index finger (9-12 months)

We regularly play a game where I hold her hands and help her to do sit-ups. On one occasion, she sat up just by flexing her abs when I wasn't helping her, but she has yet to repeat this feat. Similarly, she has once managed to lift her stomach off the ground by pressing her arms down during tummy time.

Technically, she hasn't managed to get into crawling position yet, but she does regularly transition from assisted sitting position to tummy time position, with the only assistance being a precautionary hand to make sure she descends in a controlled and non-painful manner. She flops forward, essentially folding herself in half, and then slowly wriggles her legs out and back.

We regularly help her stand up, either holding under her arms or, when we want to give her more of a challenge, just holding her hands. When she gets tired, her legs tend to buckle and she goes into a kneeling/W-sit position. This morning, apparently, grandma was playing this game with her while I was sleeping, and her legs buckled and she went down, and then she pulled herself back up to a stand.

Grasping feet is a side benefit of elimination communication. The potty position I put her in puts her feet right near her face, easy for her curious grabby little hands to reach. She's been trying to grab pretty much anything she can reach, so it's no surprise that she's been grabbing her toes when she's regularly put in a position that puts them so easily within reach. I think the reason this is rated as an older skill is because they're assuming that the child will first start grabbing their feet while lying on their back, and my baby certainly doesn't have enough abdominal strength to bring her feet within reach in that position yet.

Poking with her index finger occurred during the aforementioned first intentional use of mommy's phone. She wasn't consistent in her hand position, but she definitely seemed to be trying to isolate her index finger and touch the screen specifically with that finger, probably because that's how she saw me doing it when I was trying to catch a Pokemon. Fun fact - while I was pregnant, I read a study suggesting that regular exposure to touchscreen devices is associated with faster development of fine motor skills in infants and toddlers. I suppose this may be an example of that phenomenon.

In addition to that instance, I've seen her moving individual fingers independently on a few other occasions. She's been doing typing-like motions on surfaces occasionally lately. Her grandma does something similar when she's deep in thought (except she's actually typing - she thinks in text and sometimes subconsciously types her thoughts), so it could be imitative. Alternatively, it could simply be an exploration of her tactile environment and her fingers. Either way, it's pretty neat!

Communication

Here's some advanced communication goals I've seen progress on:

  • Holds books the correct way up and turns pages. [cloth or board books] (6-9 months)
  • Recognizes common household words. (6-9 months)
  • Responds to music by bopping up and down and/or turning in circles, swaying side to side, etc. (6-9 months)
  • Babbles "dada" and "mama". (6-9 months)
  • Imitates a large variety of speech sounds. (6-9 months)
  • First ASL signs using simple handshapes - c, a, s, 1, 5 (6-9 months)
  • Complies with simple requests such as "Give me". (9-12 months)

I have several different kinds of cloth books, and they're pretty much her favorite toys. I've attached a couple to her car seat, and she plays with them in the car. Well, yesterday I noticed she was trying to turn the page on one of her tactile books in the car, just like she sees me doing for her regularly. She didn't succeed, but I was still impressed. In my database the only goal related to turning pages was set to Kindergarten level, but I figured it was meant to apply to actual paper, so I made a lower-level version applying to cloth or board books.

It's hard to tell how much she understands, but at the very least, I'm pretty certain she knows when I'm asking if she's hungry and wants milk.

She loves music. Usually she just goes still and listens or does random excited movements, but yesterday morning she was moving her hand in time with Man the Cannons (a song she's heard a lot because I've been perseverating on it lately).

I've mentioned that she's starting to get a few consonants in her babbling. One of those consonants is 'm', so it's not surprising that she's accidentally said "mama" or variations on it a few times. Mostly when she's upset! She doesn't seem to use it meaningfully yet, though.

She has also started imitating speech sounds on rare occasions. The clearest example occurred when I had a bout of mastitis in July - I was pumping and saying "ow, ow, ow" because my breast hurt, and grandpa teasingly improvised a song about it, and then my baby said "ow, ow, ow" imitating his imitation of me.

I've mentioned that I thought she might be signing "hungry" in June, but I said she seemed to have stopped. Well, in the past couple days, she's started signing it again, and added "potty" and possibly "love" to her vocabulary as well. As remarkable as it is, I'm certain that at least "hungry" and "potty" are being used meaningfully, since when she signs them she usually has the need they'd imply.

Of course, she's not physically capable of doing the T handshape, so she's substituted A or C instead, but the position and movement are correct. "Love", meanwhile, she signs exactly like "more", but I haven't used "more" that much with her yet and she doesn't seem to be requesting anything but positive social interaction when she signs it. (I often sign that I love her while having smiley babbly conversations with her.)

It still feels really weird to say that I honestly think my 3 month old can sign to me, and even more so to say she started at 6 weeks of age. But apparently I'm not alone - Aidenofthetower at WeHaveKids apparently also had a child start signing at 6 weeks old! Interesting to note that their son also started by requesting food, though he signed milk instead of hungry.

And that's it for the advanced skills! We'll see how many of these she ends up mastering before the age of 6 months. 

Thursday, August 11, 2022

3-6 Month Educational Goals

My baby is 3 months old now, and that means I’ve hit a checkpoint where I’ll be reviewing and updating my goals for her development. So, first, let’s look at the 0-3 month goals.

0-3 Month Goals

Living Skills

Eating

I set two goals related to eating:

  • Drinks from cup held to lips
  • Getting a decent latch and sucking persistently until no longer hungry
She has made little progress on either of those. As mentioned, I added the cup goal because she surprised me by being able to drink the last few drops from a cup. However, I’ve stopped offering this for two reasons - one, I had to be extremely careful or she’d choke, and two, I have switched over to a different bottle that is both easier to get the last drops in the nipple and harder to drink from like a cup, so there’s no real reason for it. As such, I’m deferring that goal to start working on at 6 months, which is when I’d originally planned to start offering a cup. As for the breastfeeding issue, well, for the past couple months we’ve been trying to get our finances in order to hire a lactation consultant. Hopefully that’ll help. She’s developed an interest in licking my nipples, as well as pretty much everything else, but she still seems to find nursing frustrating and difficult at the best of times and utterly impossible most of the time. In addition, I’ve moved a goal for an older age earlier. This goal was taken from the Standards Based Life Skills Curriculum:

  • Regulates quantity of foods consumed
She’s usually pretty good at letting us know when she wants to stop drinking milk, and I’ve been listening. However, she does sometimes drink too fast, leading to gas, spitting up or choking, so we’re working on that. Overall, latching and regulating quantity remain ongoing goals for the 3-6 month period, and drinking from cup has been deferred to 6-9 months.

Toileting

The news here is much better. I had set the following four goals, taken from the Standards Based Life Skills Curriculum:

  • Cooperates with being placed on toilet

  • Toilets on a scheduled time with prompt

  • Urinates in toilet

  • Voids bowels in toilet


Last update, when she was 3 weeks old, I’d just decided to start trying elimination communication, a potty training strategy with no minimum age. It’s been going really well so far.

Firstly, I should say that I split the latter two goals in two. In addition to "urinates in toilet" and "voids bowels in toilet", I've also entered into my database the goals "only urinates in toilet" and "only voids bowels in toilet". I'm planning to only start working on the latter two goals at a much older age - currently set at 9 months, which is a common age for completion of potty training for elimination communication. The current goals are more about regularly voiding in the toilet when given the opportunity, and not about refraining from using her diaper when she feels the need.

So far, pee has been going better than poop. For weeks, she averaged roughly equal wet diapers vs pees in the potty, and just recently (the past four days), she's started having more pees in the potty than in her diaper. On July 10th I recorded this as mastered, because I'm pretty sure she's peeing in the potty whenever she actually needs to pee when I offer the potty. As of four days ago, I think she may have started trying to hold out for the potty instead of peeing her diaper, though I may also have just gotten better at anticipating her needs.

Speaking of which, “toilets on a scheduled time with prompt” feels like more of a goal for me than for her. I’ve been experimenting with various ways to schedule her pottying, as well as ways of reading her own rhythms, and I really think I’m making solid progress here. When I read about elimination communication before her birth, one thing that EC moms reported that sounded nuts to me was that when they randomly got the feeling that their baby needed to potty, they usually did. Well, it doesn’t sound so nuts to me now. One thing I didn’t realize before I became a mother is just how intuitive parenting is. We’ve got instincts that make us want to do things to care for babies even if we’re not consciously aware of why, and as I’ve been trying to anticipate and meet her needs, I’ve found my intuition coming in tune with her for each of those needs - feeding, burping, attention, play, and yes, elimination as well.

Besides that parenting intuition - which is still hit-or-miss - I have an app that prompts me at random times to potty her, and I have also learnt that when she first wakes from a nap, especially a nap induced by a feed, she will most likely be dry but needing to pee very soon. In addition, when she poops, she usually waits a little bit and then pees. I’ve also found that when she’s fussy, in addition to offering milk, trying to soothe, and trying to burp her, I should also try pottying her and changing her diaper.

While I’m not perfect, I’m doing well enough that I’ve registered this one as mastered.

I mentioned that poop hasn’t been going as well. She seems not to like pooping in the EC position - on several occasions she’s pooped in her diaper shortly after I’ve pottied her, so I think she might be deliberately holding back from pooping in the potty. Which is fine by me, since my real goal with EC was to give her more agency and choice in her toileting. While I would prefer she poop in the potty, it’s her body. Trying to force the issue would be harmful and counterproductive. Currently, she generally poops several times a day in her diaper most days, and only once every couple days in the potty. I’ll keep pottying her and tracking her progress, and see how it goes in the future.

Lastly, there’s cooperating with being pottied. This was initially a big issue, and for the first few tries, she cried quite a bit. It made me feel insecure and afraid and I contemplated quitting, wondering if maybe I was doing something wrong and hurting her or something. But I persevered, and she figured out the routine, and now she’s often calm or even happy being pottied. (Although her favorite part of the diaper change is when I lay her on the changing surface and put her diaper back on, because she can make eye contact and smile and babble at me.) She does still sometimes fuss while being pottied, but only when she’s crabby anyway or when she’s got gas. Or right after her 2 month vaccinations, when her thighs were sore. She’s happy enough most of the time when being pottied, so I’ve registered this as mastered.

Overall, we’ve mastered 3 out of the 4 goals, with pooping in the potty as an ongoing goal.

Motor Development

Equilibrium

These items were drawn from the Montessori Scope and Sequence:

  • Lifts head while being held (MD.E.1)
  • Raises head while lying on stomach (MD.E.2)
  • Masters control of the head (MD.E.3)
  • Supports upper body with arms while lying on stomach (MD.E.4)
  • Stretches out and kicks legs (MD.E.5)
  • Pushes down with legs when held above a hard surface (MD.E.6)

Overall, she’s been making excellent progress here. Her head control is great, and I’ve recorded MD.E.1 and MD.E.2 mastered in early June, and recently recorded MD.E.3 as mastered as well. I’ve also recorded the three limb-related goals as mastered, since she’s been propping her upper body on her arms during tummy time, kicking her legs a lot, and she loves to stand with assistance.

Hand Control

Also from the Montessori Scope and Sequence:

  • Opens and closes hands (MD.HC.1)
  • Brings hand to mouth, explores hand with mouth (MD.HC.2)
  • Instinctive prehension evident in grasping adult finger or object offered (MD.HC.3)
  • Begins to observe own hands (MD.HC.4)
  • Swipes at objects (MD.HC.5)

So far, she’s mastered 4 of the 5 hand control goals. The only one I haven’t recorded as mastered is observing her own hands - while her grandma has said she’s seen her do this a bit, I haven’t. She’s usually looking at the thing she’s trying to grab or swipe at, not at her own hands. She’s using her hands a lot lately. She’s developed a liking for hair and grabs at my and her grandma’s hair pretty much every chance she gets, and she loves her toys. She has a rattle mobile in her play gym she likes to hit, a tactile cloth book about carrots attached to her car seat that she grabs the leaves on, and while she was sucking on her hands as a newborn and likely before birth, now she seems to do it as exploration in addition to doing it for self-soothing when hungry.

The only motor development goal that remains ongoing is observing her own hands.

Communication

Hearing & Understanding

Still with the Montessori goals, here's the ones related to Hearing and Understanding, and the one Auditory goal as well:

  • Responds to loud sounds in environment (L.H&U.1)
  • Calms or smiles in response to human voice (L.H&U.2)
  • Recognizes voice of parent or primary care-giver (L.H&U.3)
  • Moves eyes towards direction of a sound (L.H&U.4)
  • Notices objects that make a sound (L.H&U.6)
  • Responds (pays attention) to music (L.H&U.7)
  • Turns head towards direction of a sound (L.H&U.10)
  • Reacts to different sounds (VA.A.1)

This area is one of the more difficult ones for my child. After failing the newborn hearing screening in one ear, she passed her follow-up hearing test at 1 month. But her response to sounds has been a bit inconsistent. Two of these items I've marked as mastered - L.H&U.2 and L.H&U.7. She loves being spoken to, and not just because she loves eye contact and looking at faces, because she also enjoys listening to people on the phone. Her grandma has on multiple occasions helped soothe her over the phone. And today, her grandpa did it, too. She also definitely recognizes grandma's voice (L.H&U.3), but I haven't seen clear evidence for her recognizing anyone else's voice, so I'm not ready to declare this goal as mastered. The rest of these have been really inconsistent. Sometimes she reacts to loud noises, other times she doesn't seem to care. Some of her favorite toys do make noise, but it's unclear whether she's interested in them for the noise they make. And she rarely orients to noise sources. She does seem to be making progress in her responsiveness to sound, but most of these goals are still far from mastered. So, out of eight goals, six are ongoing into the 3-6 month period, and two are mastered.

Speaking & Listening: Speaking

Here were my goals for the first three months in the area of Speaking:

  • Communicates pleasure through cooing sounds (L.S.2)

  • Indicates different needs through different cries (L.S.3)

  • Smiles when seeing a familiar person (L.S.4)

  • Uses body language to communicate needs (L.S.13)

Unlike my concerns about her auditory responsiveness, her progress in expressive communication has been really good. Most of these skills are ones she has definitely mastered. She loves to coo at us and is often happy-sociable. She has a habit of bursting into a big grin as soon as you make eye contact with her, and often proceeding to coo or giggle. And when she's not happy, she's communicating that pretty clearly, too. She has distinct cries for hunger, tiredness, pain and discomfort that I can usually tell apart.

The one skill I wouldn't mark as mastered yet is L.S.13, because I interpret this one as requiring multiple modalities of nonverbal communication, and she still communicates her needs predominantly by crying. But she has begun gesturing in one context. She has a lounger that she loves, and it has a canopy that can be put up or down. She strongly prefers to have it up, and requests that we put it up when it's down by grabbing at the canopy and trying to push it upwards. So, three out of four of these skills are mastered, and the fourth she's showing progress on.


And from the Pragmatics checklist:

  • Makes requests nonverbally (1-1)

  • Requests help nonverbally (5-1)

  • Complains nonverbally (13-1)

I've marked complaining as mastered, because of her crying, grimacing and writhing or turning away when she doesn't like something. The other two she has shown some progress on, but I wouldn't call them mastered, mainly for the same reason I stated above - her means of communication aren't quite varied enough yet.

And the one Self-Determination goal relevant for this age range:

  • Have a way to communicate they need a break?

Once again, I have seen progress, but I'm not sure I'd call ths mastered yet. She whines in a very recognizable tone when she's getting tired during tummy time, spits out her bottle when she's full or sometimes when she needs to burp, and sometimes yawns and turns away when she's getting tired/overloaded while playing. However, she's still very prone to push past her limits and end up crying from tiredness, and I often need to be vigilant and prompt her to start winding down to sleep instead of her signaling the need for a break herself. This is definitely an ongoing goal.


So, in summary, there are five ongoing goals for communication:

  • Uses body language to communicate needs

  • Makes requests nonverbally (1-1)

  • Requests help nonverbally (5-1)

  • Have a way to communicate they need a break?

Meanwhile, four communication goals have been mastered.


Sensory Development

Visual/Auditory: Visual

Here's the visual sensory items. Most come from the Montessori Scope and Sequence, but the last one comes from the Visual Communication and Sign Language Checklist.

  • Displays interest in black and white mobiles. [or other visual targets] (VA.V.1)
  • Follows moving objects with eyes (VA.V.2)
  • Recognizes familiar objects and people (VA.V.3)
  • Looks at the visual environment with alertness (VCSL 14)

Of those, she's definitely mastered VCSL 14 and VA.V.1 - she's very interested in her visual environment. She was initially pretty much exclusively focused on black and white high contrast things, but lately she's been showing interest in a much greater variety of visual targets.

I think she definitely recognizes her family members, but I'm less sure about whether she recognizes familiar objects. On a couple occasions I've noticed her being wide-eyed and exploratory in new contexts, so I think she's starting to recognize what is and isn't familiar to her. But it's not clear enough for me to declare this mastered.

As for visual tracking, this seems to be particularly tough for her. Sometimes she'll jerkily follow a moving object with her eyes, but usually she loses it and needs some time to find it again. So, of the four visual sensory items, two are mastered, two are ongoing goals.

Gustatory/Tactile

I added one of my own in this area:

  • Chew on or mouth objects with a variety of shapes and textures.

I added it because I was reading that chewing on a variety of shapes and textures can help build oral motor skills to improve the ability to latch for nursing, and on consideration, I also realized that this skill has a lot of merits as a way of exploring the environment.

When I first set this goal, she had basically no interest in mouthing anything except when she was hungry, and would spit out anything that wasn't sufficiently nipple-shaped for her liking. But that's definitely changed! In mid-July, she started developing an interest in licking a sensory ball, trapping it against her face with her arm so she could spend several minutes licking it. She's since started licking pretty much anything she can get her face to, so I've marked this as mastered.

3-6 Month Goals

Firstly, she's already mastered several skills in this age bracket:

  • Chuckles and laughs to communicate joy. (L.S.6)
  • Makes a range of gurgling sounds when playing with someone or when alone. (L.S.8)
  • Maintains a conversation nonverbally/Understands conversation turn taking. (SCS-PC 21-1/VCSL 51)
  • Shows interest when spoken to. (L.H&U.11)
  • Attends to signed motherese (VCSL 7)

She's a giggly little baby, and she definitely has conversations with us. Very often I'll say something, pause, and she'll babble in response, and then wait for me to say something again. She loves when we talk to her, and seems to recognize both verbal speech and ASL as important and worthy of her attention (I use a mix of both SimCom and signing without voicing, and sometimes my SimCom follows ASL grammar rather than English). Her own sounds are a mix of coos, gurgly wookie-like noises, and the occasional consonant sound. So, on to the ones she still needs to learn.

Life Skills

Hygiene

So, there's two new life skills she's working on, both pertaining to her nose:

  • Allows nose to be wiped

  • Wipes own nose on own hands or random objects

One is drawn directly from the Standards Based Life Skills Curriculum, and the other is derived by splitting one of their goals "wipes own nose" into two - the other one being "wipes own nose on appropriate nose-wiping surface", which I've set as a 3 years old goal.
She's been having a lot of congestion lately, which sucks. It causes her discomfort especially when she's trying to drink, so she's ended up crying from hunger but refusing to drink because she can't breathe through her nose. It'd really help if she had better ways to get her nose cleared when she's congested. One of the things I do to help her is wipe her nose. The first few times I did it, she screamed like I was trying to murder her, and was upset and angry for awhile afterwards. However, just recently she's starting to sometimes act okay or even happy that I'm wiping her nose. I think she's starting to realize that it's actually intended to help. Around the same time, she's also started trying to wipe her own nose. She sometimes wipes it with her hands, but most often tries to wipe it on my shirt, or occasionally the cover on her play gym or any other cloth she can get her face to. So she's showing progress on both of these skills, but I'm not ready to declare them mastered yet. My plans for this area are pretty much just to keep wiping her nose when it needs wiping and hope she learns to be more cooperative with it over time.

Motor Development

Equilibrium

Under equilibrium, the Montessori Scope and Sequence has the following for 3-6 month olds:

  • Begins to roll over, turning from front to back. (MD.E.7)
  • Begins to roll both ways. (MD.E.8)
  • Pushes up on extended arms. (MD.E.9)
  • Scoots along floor using arms and legs to propel body forwards. (MD.E.10)
  • Attempts to kick a ball without standing. (MD.E.33-1)

The last of that list, like the nose-wiping goal above, is the result of splitting a skill into two subskills. The original is "attempts to kick a ball", an item for 1 year olds. I split it depending upon whether or not the child is weight-bearing on their legs while kicking, because my child has recently started kicking a ball while in an assisted sitting position, and also kicks in tummy time and on her back.

Rolling is an interesting one, because she's actually regressed a bit. She rolled front to back starting in mid-June and continuing to late July, but hasn't done so in several weeks. I have two theories about why. She hit her head a few times while rolling, which was upsetting and painful for her, so she might be afraid to try to roll. In addition, she has gotten less top-heavy as she's put on weight, so it might be harder for her to roll since she can't pull her whole body over with the weight of her head anymore. Either way, rolling remains an ongoing goal. The other two skills she's nowhere near doing yet, though she's clearly very motivated to learn how to scoot, judging by how she moves in tummy time. Speaking of which, tummy time is my main plan for how to encourage further development in this area. One thing I haven't tried yet because it'd be too frustrating for her now, but I plan to try when I think she's ready, is putting a toy she wants just out of reach in front of her in tummy time. I also plan to continue playing with her in an assisted sitting position.

Hand Control

I have three items from the Montessori Scope and Sequence, and three of my own. First, the Montessori goals:

  • Purposeful grasping and shaking of objects. (MD.HC.6)
  • Uses whole hand, raking grasp. (MD.HC.7)
  • Co-ordinates use of both hands working together. (MD.HC.18)

The last one is supposed to be intended for much older children, but she's started holding objects two-handed occasionally, so I figured it's developmentally appropriate for her.


As for the other two, she's definitely been grasping objects purposefully, but I don't think she's deliberately shaking things. She's just not coordinated enough to actually choose whether or not to shake things yet. She also doesn't seem to have a raking grasp yet, it's more like she opens her hand, touches something and then closes her hand and hopes it grabs the thing.
And now, my three:
  • Brings hands together.
  • Reaching a hand across the center of their torso during intentional manual activities.
  • Frees up hands enough to touch or grasp an object while lying on their stomach.
All of these were added because I saw her starting to do them and realized that I didn't have an appropriate item to capture the accomplishment. I wouldn't describe any of them as mastered, yet, but she's grabbing things in tummy time a lot. The other two items I've only seen once.

Now that she can use her hands in tummy time, that’s definitely going to be part of my plan for encouraging her hand use. Her best position for hand use is flat on her back, so mobiles have been and will continue to be offered for playtime on a regular basis. I have a bunch of toys that I can attach to her mobiles and rotate between them, and a mobile at home and at our family business for her to play with. (Unfortunately the one at the family business is too high for her to reach the toys it came with, but I’m planning to rig up something to get the toys to hang lower.) I also recently tried offering her one of our cat’s toys, a cat wand, and she seemed interested in it, too. Could also have the side benefit of helping acclimate our cat to her by encouraging the cat to play near the baby, though I’ll have to watch carefully to avoid the cat accidentally hurting my baby with a poorly-timed pounce. She’s also got two cloth books attached to her car seat that she loves to grab at. I checked into the safety of attaching toys to a car seat and found that it’s generally safe as long as the toys pass the “ouch” test - that is, if you hit yourself in the head with that toy, you don’t need to say ouch! She’s been grabbing her carrot book a lot, as I discuss in more detail below, and I think she’s working on trying to turn the pages on both books. In addition, I’ve noticed her starting to sometimes use her hands while assisted sitting, though she’s still too unsteady to do much with them in that position.

Communication

In this area, only a few new goals are being added. First, in Hearing and Understanding:

  • Responds to changes in tone of voice. (L.H&U.5)
  • Responds with enjoyment to simple word and movement games and finger-plays. (L.H&U.9)
  • Responds to an adult "pointing" at something. (L.H&U.15)

The last two are redundant with two items on the Visual Communication and Sign Language Checklist. I've been considering marking L.H&U.9 mastered, because she really does enjoy simple interactive games like that, but I think I'll wait for a greater variety of examples. The other two she hasn't really shown any signs of so far.

And in Speaking and Listening:

  • Babbling begins to resemble more mature speech and contains some consonants (p, b, m). (L.S.5)
  • Vocalizes other emotions such as excitement and displeasure. (L.S.7)
  • Responds to spoken "bye-bye" by waving. (L.S.9)

As I've mentioned above, she makes a lot of happy sounds. However, her only unhappy sounds so far are crying sounds, so I'm waiting on more varied displeasure noises for L.S.7. She's also babbling with g and m noises, but no other consonants yet, and she still coos and gurgles more than she makes actual consonant-vowel babbles.


The one she hasn't shown any signs of yet is responding to spoken "bye-bye". I should also mention that this is the first skill I've looked at that could be mastered separately in different languages, and I will be assessing this for all four of the spoken languages I'm trying to teach her - English, French, Dutch and Japanese. I'll count basic mastery if she does this in any language, and full mastery if she can do it in all of them.


There's also one new Social Pragmatics Checklist item:

  • Nonverbally uses appropriate social rules such as greetings, farewells, thank you, getting attention

She smiles in greeting at people, but otherwise hasn't really shown this yet.


And in addition to the items that are redundant with the above items, there's a bunch of items from the VCSL that are now relevant:

  • Hand babbling emerges (ex: opens and closing hands, wiggles fingers, wrist twist) (VCSL 2)
  • Waves "bye-bye" (VCSL 3)
  • Copies physical movements involving the arms, hands, head, and face (VCSL 4)
  • Distinguishes facial expressions (ex: anger or friendliness) (VCSL 8)
  • Joint reference (ex: parent and child look at same object) (VCSL 9)
  • Participates in communicative play (ex: peek-a-boo) (VCSL 10)

VCSL 10 is basically the expressive version of L.H&U.9. However, it's easier to justify not marking it as mastered yet, because she responds to most communicative games in basically the same way she responds to any positive social interaction - smiling, giggling and babbling. For me to mark VCSL 10 mastered, I'd want to see unique responses to different games. As I mentioned in a blog post recently, in June she did some motions which could be interpreted either as sign babbling or as communicative meaningful signs. However, she's stopped doing those, and I haven't really seen much progress in sign babbling or expressive signing lately. I will be watching for it, though. She's been copying facial expressions inconsistently, but her motor skills are still so limited that it's hard to really see much imitation yet. She once tried to pet the cat right after seeing me pet him, though. It's hard to say if she understands facial expressions, with the exception of smiling - she pretty consistently smiles back if you smile at her. She's not waving at all yet and I haven't seen any joint attention, except for one occasion when we were playing a game of knocking over a tactile book. So these are still ongoing. Note that VCSL 3 is similar to L.S.9, but I'm going to treat it as spontaneous waving or waving in response to signed farewells, as opposed to waving in response to speech. For communication, mostly I’m just talking and signing a lot in general, and responding to her attempts to communicate. This week I’m also doing a challenge where I picked five activities we do together every day, and I’ve randomly assigned a different language to each activity for each day of the week. I did this because I was starting to feel like I was getting into a rut with stimulation in non-English languages for her, and it’s been really pushing my limits in Dutch and Japanese in particular. The five activities, by the way, are face-to-face interaction, tummy time, dressing, watching a video and reading a book.

Sensory Development

There's only one new item in this area, specifically a Tactile item:

  • Explores textures. (GOT.T.2)

Just recently, she's been getting really interested in this. She has a cloth book about carrots that has protruding leaves from the top made of velvety cloth, and she's fascinated with them and also with the crinkly cloth of the book itself. She's also been touching the crinkly cloth on the "making sounds" center of her Lovevery play gym. And yesterday, when her stroller finally arrived (it was supposed to arrive two months before her birth, but that's a whole other story!) she was exploring the sides of it with her hands as I was pushing her back and forth in an attempt to soothe her. (Yesterday was a very tough day for her and she fussed and cried most of the day.) Most of the stuff I mentioned in the hand control section is also helpful for exploring textures, so I’ve basically already discussed everything I plan to do for this goal.

Science

This is a new subject area, containing two items from the Montessori Scope and Sequence:

  • Finds a partially hidden object. (OPE.OP.1)
  • Purposefully attempts to reach objects that are out of reach. (OPE.OP.2)

She's shown some progress on trying to reach things that are out of reach, but she's still pretty limited there. She's enjoyed peek-a-boo with me a few times, and once she was fussing right after her ball got hidden behind the cloth cover on her play gym and was happier when I retrieved it for her. So I'd say she's making progress on both of these skills.


I've classified these both under science because to my view, these are both very early milestones in physics understanding.


My plans for object permanence are to continue with peek-a-boo and try reintroducing the Montessori object permanence box I got for her. I tried to show it to her before and she had no interest in it, but I’m pretty sure she was just too young for it. The Lovevery play gym also has a pocket for hiding things in and I’m looking forward to trying that out soon.


For reaching objects out of reach, the activity I described earlier of putting stuff just out of reach during tummy time would be a good opportunity to practice that. She also sometimes knocks her toys out of reach herself while playing, and I plan to wait and see if she can get them herself if she’s not too frustrated.


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Sunday, June 26, 2022

Are Babies Underestimated?

How much is impossible for young children, as opposed to just believed to be?

My baby, who is currently 6 weeks old, has on several occasions made hand movements that vaguely resemble signs. Several times she's made a movement that could be FOOD/EAT or HUNGRY. (More likely hungry, because I've signed that more in her presence.) And just today, she made a motion that could've been the sign MILK, also a sign I use frequently when communicating with her*.

In each case, when I responded as if the gesture was communicative, she reacted in the manner that would be expected if she was making a request. In other words, she seemed like she was signing to request milk, I gave her milk, she drank it and seemed happy.

But she's 6 weeks old! The earliest estimate I've seen for when a baby exposed to sign-supplemented speech might start to sign is 6 months, not 6 weeks. She should be still at least five months away from her first signs, right? And most likely more.

And of course there are alternate explanations. Maybe she's just randomly flailing. The gesture that could've been HUNGRY or FOOD/EAT is very similar to a common instinctive response to hunger in newborns - trying to suck on their hands. This is a behaviour my baby has also shown.

It's also possible that she's started hand babbling in imitation of my signing, but with no real communicative intent. She does like to imitate us, within her ability to do so. She'd be early for hand babbling - the VCSL says about 25% of 4 month olds can do it - but that's less remarkable than actual first signs.

Or perhaps she's been operantly conditioned, unintentionally, to associate hand movements with getting fed, even though she doesn't yet understand that specific hand movements have specific meanings. Certainly, I haven't noticed her appearing to sign in any other context than requesting food. Then again, there's nothing she's as urgently motivated to communicate about as that, and it's also the context I've ended up most consistently signing to her in, so it wouldn't be surprising for that to be her first signed communication function anyway.

And all this has me wondering - how do we know that it's impossible for a one month old to use linguistic communication? We just know it, right? And that means that if a one month old shows behaviour that, in an older child, would be taken as linguistic communication, it's interpreted differently because of the child's age.

But a lot of people "just know" that children don't even begin to develop bowel and bladder control until 18 months, and yet, in many cultures the average age at completing toilet training is younger than that. I've had my share of incredulity at telling people that I started potty training my child at 3 weeks, because so many people see potty training as a process that requires a mobile, verbal child who meets a set of "readiness criteria". 

Incidentally, I know fully continent disabled adults who don't meet the standard toilet training readiness criteria. Especially the ones related to walking and self-dressing. I even knew someone who had poorer motor skills as an adult than my baby does at one month, and yet was fully continent. Obviously, she needed help with the process of going to the bathroom, but she didn't need diapers.

I sought out Mary Ainsworth's book Infancy in Uganda because of her later advancements in the field of attachment theory, which built on her experience in Uganda. But in reading the book, I was struck not by the attachment behaviour (which was basically the same as how babies I've known in Canada acted at the same ages) but by the children's motor development.

You see, Ugandan babies, at least at the time of her study, regularly reached certain motor milestones far younger than the norms in Westernized countries full of European-descended people. This phenomenon has also been observed in Kenyan infants.

Another example is reading. I'm not trying to teach my baby to read, currently, but I have been considering it. The argument I've seen for it argues that sight word recognition is just as possible for young children as recognizing spoken words, provided that they are regularly exposed to text that is actually large enough for them to read with their immature eyes, and presented in real-life communicative contexts. I don't know if that's true. But I do know that, like toilet training, reading is often stated to require prerequisite skills that many people I know apparently didn't actually need.

Of course, disabled people are different from small children. Disabled people often have skill scatter, with some skills way ahead of others, so what they can do doesn't necessarily reflect on the abilities of nondisabled children who are similar in some of their abilities. However, they are informative about what really is or isn't a prerequisite, and that raises questions about nondisabled children who lack the same prerequisites.

And in general, I think people underestimate both how much variation there is in children's abilities, and how much the cultural context can alter early development - even when it doesn't have similar effects on later development (after all, there doesn't seem to be any lasting difference between children potty trained at different ages once they've all completed the process).

There's also a lot of people who clutch at theorized negative impacts of various forms of precocious development. I think this is mostly because they're defensive about their own children being slower than someone else's child, especially if that might be related to parenting choices. Even if the parents of the precocious child aren't in any way trying to claim superiority, some people will automatically react as if they are.

So, is my one month old actually signing? Maybe. I think there's reason to doubt it beyond just the widespread belief that language is impossible for such a young child. But I do think that we should evaluate her behaviour for itself, instead of presupposing what she's doing based on what children her age are widely believed to be capable of. And I certainly don't see any way that responding to hand gestures that might be requesting milk by giving her milk and talking about it could possibly harm her. Even if she's not actually signing yet, that response would help her learn to do so eventually.

* A typical commentary from me would be the following, spoken with the capitalized words signed as well: "Are you HUNGRY? Do you want MILK?" (Sometimes I'll also sign WANT.) Soon afterwards, I generally put the bottle to her mouth and see if she'll drink from it.

Sunday, June 05, 2022

Newborn Curriculum Goals - 3 week update

 So, my child is born now. In fact, she’s* three weeks old as of June 3rd.


In the past three weeks, I haven’t really been active online because I’ve been very focused on adjusting to the challenge of being a parent in a more direct, hands-on way than when she was in utero. However, I have been regularly noting down curriculum goals she’s met, as well as reorganizing some goals.


Life Skills

Eating

When I first discussed my newborn educational goals during pregnancy, the Life Skills category consisted only of four goals related to Elimination Communication. That’s been a bit complicated, but first, let me talk about two new goals I came up with myself, both related to Eating instead of Toileting.


  • Drinks from cup held to lips

  • Getting a decent latch and sucking persistently until no longer hungry


I added these two for two very different reasons. Drinking from a cup was something she was having unexpected success with, and latching onto breast was causing unexpected difficulty.


This and a couple items I'll discuss later also led me to create a new field in my curriculum database for noting concerns related to a curriculum goal. That way, I can more easily track the items she's having unexpected difficulty with or that might be linked to potential underlying issues that make them harder for her.


When she was first born, my child immediately latched onto my breast and nursed quite well, but after that initial success, she proved to be extremely difficult to breastfeed. Although I had plenty of lactation assistance in the hospital and was repeatedly assured that I was doing everything right, she wouldn’t, or perhaps couldn’t, cooperate. She’d start to latch and then turn her head away, she’d recoil from the nipple, she’d act like she’d latched but instead close her mouth and suck on her lip or tongue, she’d try to suck on her fingers and get her hands in the way, she’d latch with her tongue above the nipple blocking her efforts to suck… It seems like there’s a myriad of ways that it’s possible for this baby to get nursing wrong.


After a scare with low blood sugar (due to my gestational diabetes), when a nurse offered me a bottle of formula just to make sure she was fed, I accepted. It was simultaneously a big disappointment and a huge relief, watching her eagerly suck down that bottle of formula. I may not be able to nurse my baby, but at least I can feed her.


Since then, I haven’t given up on nursing, though I haven’t been trying to latch her as much as I probably should. It’s really discouraging to try and fail, so I usually go for a bottle first, but I’ve been trying to do at least one latch attempt each day. I’ve also been exploring resources online for possible theories about why she’s struggling to latch (my current theory is oral motor issues), and I’m looking into hiring a professional lactation consultant to try to help with breastfeeding.


In the meantime, we’ve fed her a mix of formula and expressed milk (though now that I’ve gotten an electric breast pump and built up my supply it’s looking like we’re not going to need to use formula anymore), using either a syringe (though unfortunately our syringe is broken now), one of two different bottle designs that we have, or, bringing us to the other goal, I’ve occasionally fed her directly from a cup.


She can’t drink more than a small amount from a cup at a time - if I pour too much, she’ll choke and spit it out. However, she can finish off the last bit that got caught on the rim of the nipple if I remove the nipple and carefully offer her the bottle as an open cup. I also use this method sometimes to give her vitamin D supplements, since she’s supposed to get a drop of vitamin D supplement every day. I honestly wasn’t expecting to be able to cup-feed a newborn, but I tried it once and it worked, so I’ve kept doing it.


Toileting

As I’ve mentioned above, prior to my child’s birth, I planned on doing elimination communication - a toileting method where you provide children with opportunities to eliminate in a “toilet” (using the term loosely - could be an actual toilet, a potty, a sink, or anything like that) instead of their diaper, long before the age they’re considered ready for conventional potty-training.


However, initially, the whole process of parenting was so overwhelming, and I realized that I basically had no idea how to make EC actually work in practice, so I tabled the idea - even going so far as to reclassify the four EC goals as starting at 3 months instead of birth.


On June 3rd, however, because my child has a diaper rash, I’ve decided to try to make a tentative start on elimination communication (and also started using cloth diapers, which I'd purchased but not tried using until today). And as such, I’ve moved these four goals, drawn from the Standards Based Life Skills Curriculum, back to the 0-3 age bracket:

  • Cooperates with being placed on toilet

  • Toilets on a scheduled time with prompt

  • Urinates in toilet

  • Voids bowels in toilet


Of those, the last one, voiding bowels, is the only one she’s made any progress on so far. She has a tendency to give very clear signals when she's pooping, and also tends to poop a bit, wait, and then poop some more. This habit has sometimes resulted in either soiling a diaper immediately after being changed or pooping on the changing mat mid-change, but it occurred to me that it's also an excellent opportunity for EC.


So, today, when she pooped her diaper and then started acting like she was working on more poop, I took her to one of the many spare sinks in our office (my mom runs a family business we all work in, and the office building used to be a medical clinic so there's a lot of sinks). I've changed her diaper in the sink a few times - this time, I just waited with her undiapered in the sink until she did her next bit of pooping.


It's not the first time she's pooped without a diaper on, but it's the first time she did so when I actually wanted her to, so it's progress. Of course, it wasn't intentional on her part, but that doesn't matter in the early stages of EC.


She was not cooperative, either - in fact, she was crying and struggling, as she usually does with most diaper changes. But I have some ideas on how to make the experience more pleasant for her next time. Specifically, I'm going to run warm water in the sink before I put her in it, so she's not sitting on cold porcelain. I think that was her biggest objection to the process. So hopefully we'll have some progress on the cooperation goal soon, too.


Motor Development

Equilibrium

These items were drawn from the Montessori Scope and Sequence:

  • Lifts head while being held (MD.E.1)
  • Raises head while lying on stomach (MD.E.2)
  • Masters control of the head (MD.E.3)
  • Supports upper body with arms while lying on stomach (MD.E.4)
  • Stretches out and kicks legs (MD.E.5)
  • Pushes down with legs when held above a hard surface (MD.E.6)


She was kicking and stretching her legs a lot in utero, much to my discomfort in the third trimester! She's continued to be very active with her legs since birth, especially during tummy time. She also loves to push her feet against things, and shows a definite stepping response.


Head control seems to be a strength for her. While she certainly does still need help holding her head steady, especially when she's being moved around, I first saw her lift her head deliberately during the first skin-to-skin contact after her birth, and both during cuddling and during tummy time, she regularly lifts her head briefly to reposition it when she wants to look in a different direction or get more comfortable. I'm sure it won't be long until she has a steady head.


She's not pushing up with her arms yet. Currently, in tummy time, her arms are pretty much the only body part she doesn't tend to move. I am not particularly concerned about this, I think this is one of the more advanced goals in this group.


Hand Control

Hand Control goals:

Opens and closes hands (MD.HC.1)

Brings hand to mouth, explores hand with mouth (MD.HC.2)

Instinctive prehension evident in grasping adult finger or object offered (MD.HC.3)

Begins to observe own hands (MD.HC.4)

Swipes at objects (MD.HC.5)


Both of the two goals that were possible to observe on ultrasound were things she'd definitely started doing before birth. Since birth, she's mostly only brought her hand to her mouth when hungry, and often this leads to sucking on her fingers. The nurses at the hospital figured she probably sucked on her fingers prenatally, too, so it's likely that the times I saw her bring her hand to her mouth on ultrasound were related to finger-sucking.


She grasps adult fingers consistently, and also grabs grandma's hair. During feedings, she's also started to grab the bottle, and sometimes is able to help hold it steady. She also swipes at her high-contrast tactile books, which are crinkly black and white books I bought that have so far been her favorite toys. I discuss them more later on in terms of visual response.


Communication

Hearing & Understanding

Still with the Montessori goals, here's the ones related to Hearing and Understanding:

  • Responds to loud sounds in environment (L.H&U.1)

  • Calms or smiles in response to human voice (L.H&U.2)

  • Recognizes voice of parent or primary care-giver (L.H&U.3)

  • Moves eyes towards direction of a sound (L.H&U.4)

  • Notices objects that make a sound (L.H&U.6)

  • Responds (pays attention) to music (L.H&U.7)

  • Turns head towards direction of a sound (L.H&U.10)


And let's throw in the Visual/Auditory: Auditory item, since it seems more relevant here:

  • Reacts to different sounds (VA.A.1)


As I mentioned before, in utero, I noticed strong and clear responses to sounds from outside. My child kicked in response to loud noises, cat purring, and music, and also in response to her grandmother's voice but no one else's.


So I have been very surprised that her hearing has actually been an area where concerns have been raised after birth. During her newborn hearing screening, she failed in her left ear, and she's due for a follow up hearing test later this month. I've also found that she tends not to react as strongly to ambient noise as she did in utero - she sleeps through pretty much any noise, and she's shown no interest in music.


She has, however, startled a few times at loud, sudden noises, and she still seems very interested in her grandmother's voice. She also sometimes orients to sources of sounds, though this is still inconsistent.


Notably, despite her hearing results, she has shown response to left-sided sounds. For example, once when I was overwhelmed because she'd been crying a lot while I was home alone with her, I called up my mother on the phone, and she started talking to the baby soothingly. Even though her right ear was pressed firmly against my arm and the phone was to her left, my child quieted and looked at the phone as her grandmother was talking to her. (Indeed, both times I've recorded her calming in response to human voice, it's been her grandmother. I don't know what it is about her voice, but my baby definitely responds more to her speech than anyone else's.)


She hasn't yet moved her head to look at sources of sounds (despite moving her head to look at interesting sights, as I discuss below). And she hasn't shown any clear responses to music since she was born, only prenatally. But otherwise, she's shown progress on all the hearing items, despite the concern raised by her newborn hearing screening. I have no doubt that she can hear - the question is, can she hear well enough to be considered fully hearing as opposed to hard-of-hearing? We'll know more soon.


In the meantime, this just cements my conviction that I want her multilingual language environment to include ASL as well as spoken languages. If she is hard-of-hearing, ASL could be a very important language for her to know, even if her hearing is good enough to use speech fluently as well.


I researched one-sided deafness when she first failed her hearing screening, and it seems that the biggest concerns tend to be noisy environments and people trying to talk to them from the wrong side, and I could see ASL code-switching being a useful strategy to deal with those situations. It could also be really helpful if she has hearing fatigue, as many hard-of-hearing people do, where situations that require listening carefully are exhausting and lead them to need rest afterwards. Of course, to make effective use of ASL in those situations, I'll need to improve my own ASL fluency as well, which is an ongoing goal I've been working on. (She's not the only one here with educational goals!)


And if it turns out it was just some amniotic gunk in her ear that's since cleared up and she's fully hearing, well, there's a lot of benefits to learning ASL regardless of hearing status, too.


Speaking & Listening: Speaking

Here's my goals for this age period in the area of Speaking:

  • Communicates pleasure through cooing sounds (L.S.2)

  • Indicates different needs through different cries (L.S.3)

  • Smiles when seeing a familiar person (L.S.4)

  • Uses body language to communicate needs (L.S.13)


She's been making pretty good progress on these goals. She has different cries and nonverbal cues for hunger as opposed to pain/discomfort (usually related to the need to burp or poop). Interestingly, I was able to distinguish her cries subconsciously before I could do so consciously - before I could tell hunger cries from discomfort cries consciously, I noticed that hunger cries induced letdown of milk and discomfort cries didn't, and used my breasts' response to her cries to help me figure out how to calm her. As for nonvocal cues, hunger is associated with rooting and mouthing/sucking on things, and abdominal discomfort is associated with arching her back, grimacing, and writhing side to side.


Pleasure is less consistently signalled so far. She has made cooing or burbling sounds sometimes when she's calm and contented, and she smiles occasionally while drinking milk, but hasn't shown any social smiles yet.


Next, this area also includes goals I've drawn from The Pragmatics Checklist, an assessment of social communication skills in Deaf children that I came across. As I mentioned previously, although this checklist was used with 2-7 year old children, several of the easier items had been mastered by all of the hearing comparison group even at the youngest ages, so I figured out appropriate ages for them based on my research on child development. The following items ended up in this age band:

  • Makes requests nonverbally (1-1)

  • Requests help nonverbally (5-1)

  • Complains nonverbally (13-1)


All of these she's definitely been doing. She cries and roots around when hungry, and also cries and writhes when she's physically uncomfortable. It's unclear how much communicative intent she has - in other words, it's hard to tell if she's crying just because being uncomfortable or hungry makes her want to cry or if she's actually trying to tell us how she's feeling by crying. But she does briefly calm and make eye contact sometimes when I touch her or pick her up when she's crying, which makes me think she might be expecting me to fix whatever is bothering her.


Self-Determination

As with The Pragmatics Checklist and the Standards Based Life Skills Curriculum, the Self Determination Goals and Checklists also was designed for older children with disabilities, and I've adapted the ages based on developmental research. Only two items ended up being relevant for this age range, and one of them, "Have a way to communicate that they need help?" is redundant with The Pragmatics Checklist item 5-1 above. That leaves only one item:

  • Have a way to communicate they need a break?


The first time I noticed my child showing signs of needing a break was during the 20 week anatomy ultrasound, which, for those of you who aren't well versed on the usual pregnancy ultrasound schedule, is a standard screening test performed roughly around 20 weeks gestation where the ultrasound tech attempts to get a detailed look at basically all of the baby's major organs.


It's a very long ultrasound, and ultrasounds are believed to cause vibration that the baby inside can detect. My child seemed to find it stressful, since towards the end, she'd decided to turn away from the front and curl up with her arms crossed in front of her chest, resulting in the ultrasound tech not getting a good look at her heart and one of her arms.


After birth, she's also told me when she needs to stop tummy time or other physically effortful positioning by whining and struggling.


Sensory Development

Visual/Auditory: Visual

Here's the Visual items from the Montessori Scope and Sequence for this age:

  • Displays interest in black and white mobiles. [or other visual targets] (VA.V.1)

  • Follows moving objects with eyes (VA.V.2)

  • Recognizes familiar objects and people (VA.V.3)


She is very interested in black and white things. I don't have a black and white mobile for her, but I do have some black and white tactile books, made of some sort of crinkly cloth with interesting textures and some bells inside some of the pages. But she's not that interested in the auditory and tactile elements of the books yet - what she cares about is the simple black and white pictures on each page. She loves to look at them and reach for them, and I've used them to keep her calm during diaper changes (even with a diaper rash!) as well as to motivate head movements in tummy time. I've also Googled high contrast pictures to distract her when she's upset, and gotten her to play with handmade crocheted colored balls and cups by putting the black ball in the white cup and vice versa.


Visual Communication

I found a scale for assessing sign language development known as the Visual Communication and Sign Language Checklist. Two items are relevant at this age, one of which, item #15, is redundant with the Montessori Speaking item L.S.4 above, so that leaves this one:

  • Looks at the visual environment with alertness (item #14)


She's been getting more and more interested in looking at things in the three weeks since she's been born. During tummy time, she looks around a lot, especially at her high contrast books. She's also shown interest in watching the screen while me and my brother are playing video games together as one of us is cuddling her, stared out the window during car rides, and watched my hands and face with interest as I practiced ASL while playing with a children's educational app (Khan Academy Kids) in her presence.


Advanced Skills

There's also two items I've been expecting to be working on later, but which she's shown some notable progress on already. Both of these are from the Montessori Scope and Sequence:

  • Begins to roll both ways (MD.E.8)

  • Scoots along floor using arms and legs to propel body forwards (MD.E.10, 3-6 months)

  • Begins to show preferences in the tastes of food (GOT.G.2, 6-9 months)


No, she's not rolling or crawling yet, and probably won't be for awhile, but she's definitely trying. In tummy time, I've noticed her making movements with her legs that look like a crawling pattern, but without the strength and coordination yet to actually gain traction. And when she's on her back, she often tries to roll to her front, getting stopped only by the fencing reflex. This kid wants to move, that's for sure! I suppose that tracks with how vigorously and frequently she moved in-utero.


As for the food preferences item, I was expecting this to only be relevant once she started getting solid food. After all, if things had gone according to my plans, she'd have only had breastmilk before 6 months old. But she's had formula, too. And as a result, she's had the opportunity to compare two different-tasting foods - breastmilk vs Similac. And my mother has noticed that her facial expressions are less enthusiastic when she's being fed Similac vs my pumped milk. (I agree with her preferences, btw. Similac is gross-tasting, whereas breastmilk is sweet and tastes like almond milk. Meanwhile colostrum is like a cross between sweat and honey.)


* My child is AFAB, and since most AFAB individuals prefer she/her pronouns, I’ll use those until/unless my child indicates a different preference. I considered sticking to they/them pronouns, as I’d been using before I knew her sex, but it’d be challenging within my community context and there’s only a small probability that the choice would make an important difference to my child’s wellbeing. I’d rather know this is a fight that will matter to my child before I pick it. However, although I chose not to use they/them pronouns for my child, I heartily encourage others to do so, because each person who makes that choice normalizes their use a little more.


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