Tuesday, November 29, 2022

6-9 Month Educational Goals

My baby is 6 months old, which means we've come to another checkpoint for her curriculum goals.

So, how is she doing on the goals I set for her three months ago? And what goals are we going to be working on next?

Life Skills

Eating

3-6 Month Goals

The current eating goals for 3-6 months were:

  • Getting a decent latch and sucking persistently until no longer hungry
  • Regulates quantity of foods consumed

The breastfeeding issue has been a serious struggle. She saw the lactation consultant and was diagnosed with a lip and tongue tie, and I was having some success with a nipple shield. I was full of hope.

Then I got her lip and tongue tie fixed, and the post-procedure exercises (which are painful) led to oral aversion. The lactation consultant gave me some advice on reducing the oral aversion, which worked, but also recommended a procedure that I think backfired badly. She called it the "24 hour cure", I called it a "maternity ward redo". Basically, I spent all day in bed with my baby and every time she showed hunger cues, I tried to breastfeed. She hated it, I was miserable, and it ended up with me feeling very depressed and her screaming anytime I even bring my nipple close to her mouth.

Since then, I basically gave it up for a while. I did get some breast-shaped bottles (Nanobebe) to mimic breastfeeding to reduce her aversion, with some success, but I've been too scared to try actual breastfeeding for quite awhile.

There have been some benefits to the tongue and lip tie release, even though it didn't do what I'd hoped. Last time, I commented that sometimes she'd drink too fast and have trouble with gas, spitting up or choking. Turns out it wasn't so much how fast she drank as how she drank that resulted in those issues, because she has been having much less issues since her procedure. She's also dripping less milk from the side of her mouth.

I also got a new type of bottle by LacTek called a direct pump to baby bottle. It's designed to allow you to pump into the bottle while simultaneously the baby is drinking from it. Basically, it's a double-ended bottle, with one end attaching to the pump and the other to a tube leading to a nipple for the baby to suck on.

I mention this because it's also become a new context for communicating hunger vs fullness. One of the most frustrating things about the direct to baby bottle is that she tends to lose the nipple and can't put it back in her mouth independently (though she tries!).

But this varies depending on her hunger. When she's desperately hungry, she keeps it in easily, by just sucking it consistently. When she's hungry but not totally desperate, she'll suck it a bit, stop and it falls, and then start fussing and trying to get it back. When she's only slightly hungry, she'll be less frantic trying to get it back or maybe not try at all, just wait for my help. And when she's full, she closes her mouth and doesn't accept the nipple back.

In addition, just recently, I finally had some success using an at-breast supplemental nursing system. Basically, this is a tube you attach to your breast that's connected to a bottle you can fill with formula or pumped breastmilk. I've most often heard of this used to compensate for low milk supply, which is not an issue for me. However, bottle-fed babies are used to a faster flow of milk, and my baby has been getting frustrated too quickly to actually trigger my letdown.

Watching her with the direct to baby bottle was part of my inspiration for this. I noticed how after her first few successful feeds with that system, she was a lot more willing to keep sucking on the nipple while waiting for me to get pumping. It's raised the hope that a few good feeds at the breast could encourage the same persistence with breastfeeding.

It's too early to tell if that's going to work, but I have managed to get one good breastfeed with the supplemental nursing system. She nursed longer than I've ever seen her nurse before, and I could feel her getting milk out of me.

6-9 Month Goals

Here's the goals we're starting on now in this area:

  • Feeds self with fingers
  • Drinks from cup held to lips
  • Reaches for and picks up cup
  • Returns cup to table
  • Drinks from a straw
  • Can be spoon fed and swallow the food without gagging
  • Feeds self with spoon

Several of these items have to do with solid foods. Her first experience with solid food was a bit of a false start for Thanksgiving (which is Oct 10 in Canada). I tried giving her mashed potatoes, but she looked very confused and then spat them out. So I decided to wait a while, and then on November 6th, I gave her a taste of peanut butter. Since then we've tried a few things, some she's liked and some she hasn't.

I have to admit that my approach has been less systematic than I'd planned. I always pictured myself preparing a bunch of one thing, feeding it for several days in a row, and then trying the next food. However, instead, I've found myself just offering her tastes of food I see her showing interest in. I don't know if I should feel guilty about this, but I do.

I have finally gotten a bit more systematic by making a batch of applesauce with breastmilk for her and feeding it to her 1-2 times a day for a few days. She seems to have mixed feelings about it, partly because I unintentionally picked a fairly sour strain of apple, but she has enjoyed it several times. I've also since tried some other recipes as well.

My feeding method has been a mix of giving her stuff on my finger, spoon feeding her, letting her try to spoon feed herself (at her insistence!) and just letting her play with purees and make a mess. I try not to pressure her, just encourage her to experiment with this new way of eating.

I haven't really tried much stuff with cups yet. I have a couple sippy cups, but she's hated every attempt to use them so far. I don't think she's ready for that yet, but we'll work on it.

Hygiene

There are no new goals in this area. I had two hygiene goals, both pertaining to nose-wiping:

  • Allows nose to be wiped
  • Wipes own nose on own hands or random objects

Not much progress has occurred on these goals. She's been wiping her own nose occasionally, but not consistently, and she still regularly has a stuffed nose she can't clear independently. And as for allowing me to wipe, she's actually regressed there. She's gotten more adamant about resisting it and her improved mobility is making her resistance more effective.

Neither of these skills are really late, of course. I've recently started plugging in max ages as well as base ages for skills, with the max age being the point at which I'll worry about her falling behind, and the max ages I've set for these two skills are 3 years for self-wiping and 4 years for letting me wipe her nose.

Toileting

Here's my current goals for toileting, with no new ones yet.

  • Urinates in toilet
  • Voids bowels in toilet

Previously I'd said that peeing in the toilet was mastered. Well, she's had a bit of a regression here, too. I've been focusing more on trying to get her to nurse and kind of let EC slide on the backburner, and now I'm having more trouble catching her pees. On the good side, she's pooped in the potty again a few times recently, after quite a while with no poops in the potty.

I'm tossing around a few ideas for how to progress here, but I haven't settled on any yet. One of my thoughts involves getting a toilet training attachment for my toilet, since she's getting better at sitting upright and might be ready for a more adultlike toileting position. I've also considered getting a potty, but the idea of the cleanup involved grosses me out, so I'm hesitant to do that.

I'm also considering trying some more diaper-free time, either naked or with clothing that gets wet more obviously, but the logistics of that is complicated by the fact that she's getting more mobile. In addition, I've had some bad experiences with diaper free time where I didn't notice her peeing, so I am trying to figure out a way to make it more noticeable.

Toileting is not my biggest priority right now, but I feel really proud when it's going well, and I know I can get results if I try harder, so it might be worthwhile as an ego boost for me when I'm feeling down. I know it's silly to compare, but I like the thought that I'm able to get my baby to do something that many kids years older than her struggle with.

Dressing

So far there's no age-appropriate goals in this area, but she's been showing progress on advanced skills in this area:

  • Pushes limb into clothes.
  • Removes socks.

She's especially motivated to remove her socks. She has cute little socks with stuffed animals decorating the toes, and has figured out that pulling on the stuffed animals can help her take the socks off. (She's also pulled one of those toys off of the sock!) She doesn't seem to like wearing socks, but I don't want to take her out in a Saskatchewan winter with nothing on her feet, so if her outfit doesn't come with feet she gets socks whether she likes it or not.

On rare occasions she's pushed her arm through the sleeve as I'm getting her dressed, and the same for pushing her leg in her pants.

Motor Development

Equilibrium

3-6 Month Goals

Here's the 3-6 month equilibrium goals:

  • 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)

As I was writing this post over the course of about a week, she's made a drastic leap forward in this area. When I started writing this, she was rolling back to front consistently - obsessively, in fact - but couldn't consistently roll front to back, resulting in much frustration and disrupted sleep. That's not true any more. She is now readily rolling both ways. In addition, she's starting to crawl. She's still slow, but there's definite forward momentum.

She's pushing up on her arms occasionally, but still not doing it consistently. She has been kicking a ball from a seated position occasionally, but is more interested in hitting objects lately. That's not a really important goal, though, I added it mostly because I was impressed that she started doing it. In general, these two goals haven't shown much progress, especially compared to the drastic changes in other motor skills.

6-9 Month Goals

And now for the new goals. One of which has already been mastered:

  • Grasps feet. (MD.E.22)

She's been grasping her feet for a long time. I marked this as mastered on October 8, and she'd been doing it for awhile by then.

She first started doing this while being toileted. The elimination communication hold puts her feet in very easy reach, while toileting is also somewhat boring. However, it wasn't long before she started grabbing her feet while sitting in her car seat or with support on the ground, and grabbing them as she lay on her back or side.

And for the ones that still need work:

  • Sits, supporting self with hands. (MD.E.12)
  • Sits without support for short periods. (MD.E.13)
  • Gets to sitting position without assistance. (MD.E.14)
  • Gets onto hands and knees. (MD.E.15)
  • Gets from sitting to crawling position without assistance. (MD.E.16)
  • Stands with support./Supports whole weight on legs. (MD.E.19/21)
  • Pulls body into upright position. (MD.E.20)
  • Climbing on or off of things.

The climbing goal I added myself because she's learned how to climb out of her car seat. I've gotten into the habit of putting her in it for naps away from home, or just to be able to do things I can't do while holding a baby. But I'll have to learn new habits, because now whenever she's awake in her car seat and isn't strapped in or being distracted by milk, she's climbing out. First, she rolls over to her tummy and then slides her legs off. Then she bounces up and down on her legs a bit until she tips the seat way forward, and then she pivots around to climb off. I'm not counting this as mastered yet, though, because this is the only thing she has such success climbing off of, and she can't climb back on.

She's sitting a lot better lately. I'm waiting for some more reliable balance to mark the sitting goals as mastered, but it's not far off, I'm sure. Currently I still need to be ready to catch her, but she's able to sit quite a while without my help. She's also getting a lot better at maintaining balance seated while she's simultaneously playing with her hands.

She's not great at transitioning in and out of sitting, though. She's shown no ability to get herself sitting upright from lying down, and going from sitting to crawling position is still mostly just falling and then making the best of it.

She's been able to stand with an adult's help for a long time, as well as pulling to a stand while holding our hands. She still can't pull to a stand on furniture, though she is trying. She can often stand quite a while supported by furniture, but her balance is poor and I keep having to catch her. The cats are great motivation - she loves to stand and look at them sleeping on the couch or the rocking chair, and then reach out to touch and grab their soft fur. I've also been working on supporting her lower - she can stand pretty much indefinitely with upper body support, but can also stand with effort with just hip or thigh support.

Her current crawling technique involves face planting as she lifts her butt and then pushing forward, and she can't really do the hands and knees thing yet.

Mainly what I’ve been doing to encourage her development here is just playing on the floor with her regularly. She’s very motivated to chase this one particular large, knobbly yellow ball she has, and will readily crawl towards it if I put it a few feet ahead of her.

Advanced Goals

  • Walks with assistance. (MD.E.23)

Recently she's figured out that when I'm holding her standing, she can step towards things she wants. Sometimes I'll help her walk all the way across the room, following her lead to something that caught her attention. She gets tired sometimes, but she's getting stronger.

Hand Control

3-6 Month Goals

Here's the 3-6 month goals for hand control:

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

I've never seen her show much interest in observing her own hands, but I feel like we're getting past the stage where that particular milestone is relevant, and it's not really essential. She's definitely been working on hand-eye coordination while manipulating objects, anyway. She's also regularly bringing her hands together - often to hold an object in both hands - and she's very good at using her hands during tummy time now.

She's definitely mastered purposeful grasping of objects, but isn't really shaking things consistently. She's starting to bang objects, which I'll discuss later, and has been banging her maraca instead when trying to imitate me shaking it. So that half of this goal is still ongoing. She's also still working on crossing the midline.

I actually deleted the raking grasp milestone, because I couldn't figure out how to distinguish it from just general grasping. If too many of the examples for multiple milestones are the same, I feel like it's a sign that they're not distinct enough.

6-9 Month Goals

Here are the new goals for 6-9 months:

  • Transfers objects from hand to hand. (MD.HC.10)
  • Purposefully grasps and releases objects. (MD.HC.11)
  • Controls fingers. (MD.HC.12)
  • Intentionally works with hands to manipulate objects. (MD.HC.8)
  • Holds books the correct way up and turns pages. [cloth or board books] (2S6-1)

These are all ones that she's showing definite progress on. She's definitely been purposefully grasping for a long time now, but I'm not sure how purposeful her letting go of things is yet. She transfers hand to hand sometimes.

She still has trouble controlling her fingers, but she's making a lot of progress there. Just recently, she's gone through a leap in her ability to provide inputs to a touch screen*, and instead of just random touches, she's now specifically reaching for interactive elements on the screen to touch. She's also been working on the difference between grabbing and stroking with cats' fur and uncle's beard, and learning that living creatures like being stroked better than having their pelt grabbed and pulled on.

Incidentally, the turning pages one is another goal I've split in two, with the version involving paper pages being a kindergarten goal from the Monseigneur Bekkersschool curriculum, which I used to find reading goals for Dutch. I split this goal when I was blown away watching her trying to turn the pages on her crinkly carrot book, and realized that the closest goal in my database was for 3-5 year olds.

I'll also throw in a goal from the Standards Based Life Skills curriculum here:

  • Uses technology for entertainment

She's definitely been working on learning how to play with technology. In addition to the tablet skills she's starting to show, she's also learned that hitting the spacebar and number pad on the keyboard causes interesting reactions from YouTube videos. I even got her to play a minigame from one of my first childhood video games - Jam Dance from 102 Dalmatians, which is a music game where hitting buttons changes the music a puppy is dancing to.

Advanced Skills

And speaking of which, here's one advanced skills for this area that she's making progress on:

  • Pokes with index finger. (MD.HC.15)

This one I credit to my lack of techphobia. She's just starting to make a few attempts at one-finger touches on touch screens. She still finds it hard to isolate her finger, but she's working on it.

Communication

Hearing & Understanding

3-6 Month Goals

Here's the goals in this area for 3-6 months:

  • Responds to loud sounds in environment (L.H&U.1)
  • 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)
  • Turns head towards direction of a sound (L.H&U.10)
  • Reacts to different sounds (VA.A.1)
  • 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)

Last time, I expressed some concerns about her responsiveness to sound. Not anymore. She's mastered almost all of these items already, except for tone of voice.

I do think she probably understands different tones of voice, but I'm not sure, so I'm not marking it as mastered yet.

And for more visual forms of communication:

  • Distinguishes facial expressions (VCSL 8)
  • Joint reference (ex: parent and child look at same object) (VCSL 9)
  • Participates in communicative play (ex: peek-a-boo) (VCSL 10)
  • Responds to an adult "pointing" at something. (L.H&U.15)

Like with tone of voice, I suspect she understands facial expressions but I'm not entirely sure. She's just starting to notice pointing, and still seems confused by it.

She loves communicative play and I'm considering this one as mastered.

6-9 Month Goals

Here's the new goals for this period:

  • Responds to music by bopping up and down and/or turning in circles, swaying side to side, etc. (L.H&U.16)
  • Recognizes common household words. (L.H&U.12)
  • Recognize that signs produce meaning. (C.FS.K.1c)
  • Responds to "no" by briefly stopping activity and looking at adult. (L.H&U.14)

I was going to track another goal, related to following eye gaze, but then it occurred to me that I can't follow eye gaze well enough to know if she's following my eye gaze. So I'm not going to worry about tracking that one.

She’s very interested in music, but she’s not consistently trying to move in time with it yet. She’s done it a few times, though.

She’s shown signs of understanding English words here and there, like getting mad when I mention to grandma that I should probably clean her nose. So far she hasn’t shown clear signs of understanding any of the other spoken languages she’s being exposed to, but I suspect she understands a few signs. She hasn't shown any sign of understanding no.

Expressive Language

3-6 Month Goals

Here’s the 3-6 month expressive language goals she was working on:

  • 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)
  • Nonverbally uses appropriate social rules such as greetings, farewells, thank you, getting attention (SCS-PC 17-1)
  • 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)

She’s mastered L.S.7. She makes this really distinct and wonderful happy coo noise when she’s excited, especially when she’s interacting with the cats or when grandpa is playing with her. She also laughs at the dog, at uncle bouncing her ball, and other things she finds entertaining.

She has been consistently making ‘m’ sounds, but only occasionally makes ‘b’ sounds and I haven’t heard any ‘p’ sounds yet.

She hasn’t tried to wave goodbye yet, either in response to the words or spontaneously. She also doesn’t really show any signs of trying to greet people or thank people yet. She is starting to show more deliberate attempts to get people’s attention nonverbally, but that’s not consistent yet, either.

She was hand-babbling a bit around 3-4 months, but hasn’t been doing it as much lately.

She’s been imitating more and more actions lately. I’m not marking this as mastered yet because she’s not doing it consistently yet, but we’re definitely seeing progress in this area.

6-9 Month Goals

Here's the new goals for this age:

  • Babbles "dada" and "mama". (L.S.10)
  • Babbling includes a range of sounds and gaps which resemble phrases. (L.S.11)
  • Uses sounds [other than crying] to attract and hold attention of others - communication. (L.S.12)
  • Imitates a large variety of speech sounds. (L.S.14)
  • Laughs when seeing fingers approaching to tickle. (VCSL 16)
  • Choose from an array of preferred and non-preferred items? (CM4)
  • Nonverbally compares and contrasts qualities of two objects, actions or situations. (SCS-PC 42)
  • Criticizes others nonverbally. (SCS-PC 27)

She's been babbling "mama" for quite awhile, but not "dada". I don't think it's just because she doesn't have a father - she doesn't seem to know how to make the d sound yet. She's not yet getting sentence-like cadence in her babbling, either.

As I'll mention later, she's actually starting to say a few words, and she seems to be using them meaningfully to get attention.

She's shown some attempts at imitating speech sounds, but she's not consistently doing that yet. She's also starting to recognize signs that she's about to be tickled and get excited, but this is still emerging.

I've tried to get her to choose options a few times, but I don't think she understands that concept yet. She's shown no sign of trying to compare things yet either. Both of these ones I'm just guessing at appropriate ages for, so it's possible they're too advanced.

Around 3-4 months old she developed a reproachful look that she uses to show disapproval. She has used it to let me know that I should hold her bottle properly instead of trying to hold it with my chin so I can free up my hand, for example. So she's definitely starting to criticize things nonverbally!

Advanced Skills

And here's advanced goals in this area that she's making progress on:

  • Has some recognizable words. (L.S.18)
  • Says "mama" for specific person. (L.S.15)
  • Uses gestures to communicate (VCSL 28)
  • First ASL signs using simple handshapes (ex: c, a, s, 1, 5) (VCSL 30)
  • Uses appropriate social rules such as greetings, farewells, thank you, getting attention using 1-3 words (SCS-PC 17)

So, as I mentioned above, my baby has started using spoken words meaningfully. She's been consistently using "mum-mum" and "hi". She uses both words to request attention, and "mum-mum" especially when she needs help or is distressed. (She's starting to show a preference for me over her grandparents and uncle when she needs comforting.)

She's got a stander toy that I put her in sometimes when she's full of energy and I'm not. She likes it for a while, but when she gets tired, she wants out. I've been doing a routine where before I take her out, I hold my hands out and say "do you want out?" or "do you want to be picked up?" and wait for her to put her hand in mine. She's since generalized this to other situations where she wants to be picked up as well.

I've previously discussed her using signs really early. She hasn't made much progress there, but she did recently imitate Ms Rachel signing "more". I've been trying to sign more often to her lately, so hopefully she makes more progress in signing as well.

Science and Sensory

I've decided to combine these for now since they both fall under the heading of exploring her physical environment.

Sensory Development

3-6 Month Goals

Here's the sensory goals from 3-6 months:

  • Recognizes familiar objects and people (VA.V.3)
  • Looks at the visual environment with alertness (VCSL 14)
  • Chew on or mouth objects with a variety of shapes and textures.
  • Explores textures. (GOT.T.2)
  • Makes sounds with objects and reacts to the sounds produced. (VA.A.3)

All of those have been mastered. She's very visually attentive and clearly recognizes her family, favorite toys, milk bottles, and other things. Pretty much everything she can grab goes straight into her mouth. She's fascinated by textures and loves to stroke things. And she loves to play with toys that make noise and definitely understands that she can make noises with them.

6-9 Month Goals

Here's the new goals in this area:

  • Eats food with varying textures. (GOT.G.1)
  • Begins to show preferences in the tastes of food. (GOT.G.2)

Obviously, both of these relate to starting solid foods. She's been doing pretty good with purees, but struggles when I don't make her food smooth enough, so the texture thing is still a work in progress. She's definitely starting to show taste preferences - sour apples aren't very nice whereas egg puree (dehydrated egg crystals mixed with breastmilk) and grandma's stew taste amazing to her.

Science

3-6 Month Goals

Here's the goals from 3-6 months in science:

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

She's mastered OPE.OP.2, since she's starting to crawl and assisted walk towards things she wants to explore. She's starting to figure out partially hidden objects as well.

6-9 Month Goals

  • Here's the new goals for this age range:
  • Purposefully explores objects through shaking, banging, throwing, dropping, etc.
  • Reacts to anticipated future events.

She's been shaking and banging things a lot, but not throwing or dropping much yet. She's also starting to recognize and predict routines sometimes, such as dance routines we do to Super Simple Songs.

Learning Plans

I found Imagination Learning's Infant Year Long Lesson Plan online while looking for ideas for inspiration for learning activities. They just have the name of the activity and the objective for it - I'm guessing that the description of how to do the activity is elsewhere, not available online. But that much information is enough to give me fun ideas, and if I'm really stumped or don't have the necessary equipment for something I can just skip it. I've got an app that lets you track school assignments and check off ones you've completed, and it's been really helpful for giving me a sense of completion and helping me get ideas for fun things to do to help my baby learn.

And then I decided to expand it. Since before my baby was even born, I've been trying to practice the ASL translations of the monthly words from PrAACtical AAC's Year of Core Vocabulary, but I haven't really been very consistent. This time, I decided to try using the calenders by [insert name] for inspiration for interactive ASL activities with my baby each month. So, I added some ASL Year of Core activities to the mix.

And then I found Nattalingo Productions' daily French challenge and decided to try that, too. And then I thought about getting more Japanese practice, so I set some goals to pick a sentence structure and practice it with different words to model Japanese to my baby - for example, saying (noun)をください (o kudasai = o marks the object of the sentence and kudasai means please) with various Japanese nouns.

I may have gotten a bit excessive, to be honest. I'm going to refrain from adding any more activities for a bit and just try what I've already got. And be ready to ditch some activities if I'm getting overwhelmed.

But I think this is good practice for the more systematic learning activities I'll be doing once she's older, like teaching her to read.


* I don't believe that "screen time" in general is bad for children under 2, especially not now that I've seen how my baby learns from it. I think leaving your kid with non-interactive media as a "babysitter" too often is bad for them, but playing interactively with media is just as beneficial as playing interactively with anything else. And touch screens in particular have been linked to better fine motor development, for reasons I think my baby is currently demonstrating. Currently, she has very little interaction with tiny targets that need precise touches, because they're a potential choking hazard. But she can't eat something on a touch screen, so we can work on more precise touches that way.

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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. 

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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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