Playtime Progress and Kindergarten Angst

There are several major picture posts that chronicle the past five months (!!!) of our kids' lives in preparation (as in:  I finally managed to download pics and videos to my computer and will at some point soon organize them).  But in the meantime, you will just have to put up with my random thoughts about current events/developments and our upcoming educational endeavors/stressors.

Hallie has made truly amazing progress over the past year, and especially over the past three months.  Here are a few of the great things that are happening for her developmentally:

1.  Pretend Play:  A year ago, Hallie's pretend play skills were at best rudimentary.   At most, she acted out scripted routines that were familiar (so she did things like re-enact fairy tales like the "Three Little Pigs" or "Goldilocks and the Three Bears").  While Hallie still enjoys a good fairy tale or classic story (in addition to the aforementioned, "Jack and the Beanstalk," "Peter Pan" and lots of lots of stories related to princesses are a big draw for her), Hallie has developed the skills she needs to develop her own stories, put on plays, etc.

And since dressing up is so much fun, the entire family has decided to get in on it.  Here's a picture from a Purim party that we attended at the home of Eran, who is one of the girls' school buddies and regular playdaters, and another cute one of "Peter Pan" smiling (since Lea was looking away or frowning in all of the group shots we took).

Back to Hallie:  She's not just doing pretend play with her body and a bunch of costumes but also with small figures (people, animals, etc).  In the old days, Hallie used to line up her toys or perhaps arrange them in some activity (so they might all be lining up to get on the school bus, or surrounding the TV watching a show, or something of that nature).

The configurations and arrangements were extremely precise and she was none too pleased if you disturbed them. 

These days, Hallie's play skills have moved so far beyond this stage.  She's now having the little figures talk, walk, interact with one another, and act out realistic scenarios.  From my eavesdropping in on her play, it's clear that she's playing out the scenarios that matter to her and her life in the process.  Her little figures are having trouble sharing their toys, but when one does decide to share with another, a third will chime in with praise.  If they don't share, the characters might have angry words with one another and they sometimes end up in time out (she has threatened her doll house baby, who may be named "Bunny" and the little girl who inhabits the same structure with banishment to the High Chair (the unfortunate location of her own time outs now that she no longer eats in one) for misbehaving or having accidents.   Her little people go to school, play in playgrounds, go swimming and have a nicely well rounded existence.  Just like Hallie's.

Hallie initiates a lot of this play and doesn't just follow along with others when they are playing in this way.  The other night, Hallie got out the pretend food, took orders from us, and she and Lea served up slices of cake ("gumdrops or strawberries?"), pizza (She had a few slices of plain but was happy to accommodate our request for pepperoni, mushroom, or spicy--which is how she thought of the pepper rings).  She was also very happy to make us triple-decker sandwiches if we were not in the mood for pizza.

Interestingly (and not at all surprising, really), our play space (which still remains cluttered despite repeated attempts at culling and organizing toys) is not nearly as much of a disaster zone anymore.  Less stuff comes out and that which is on the ground experiences more intense, robust play.  And both kids seem much more able and willing to help clean up when they are done.

What's nice is that Hallie is testing out all sorts of emotions in this play.  It used to be that there were no badly behaved or angry characters; the big bad wolf would quickly be recuperated into a positive figure by Little Red Riding Hood or the Three Pigs or whoever because any other alternative seemed too dangerous to Hallie to be tenable.   Now Hallie explores the dark side; there are fire-breathing dragons and scary monsters along with all the helpful snakes and friendly dinosaurs.   Characters can have trouble sharing or get into conflicts and Hallie can devise strategies to resolve problems.  All of this suggests that Hallie is filling in of some of the pieces that had been developmentally missing (or misplaced).  We credit Floortime/DIR with a lot of this progress.  Hallie and her therapist (and Sharon, who takes Hallie to Floortime) have been working with Hallie on exploring and figuring out how to handle uncomfortable, scary, and difficult emotions.  Hallie's progress has gotten even quicker now that she's been attending structured play dates with peers (her psychologist hosts these three times a month) in addition to her regular weekly Floortime session, we've seen amazing things happen vis-a-vis Hallie's play skills.

Hallie isn't just doing all of this stuff at home; she is also initiating play with her peers much more consistently at school.  Her conversations with peers are still more rudimentary than typical 4.5 year old kids but she has branched significantly beyond the social greeting stage.  And she's no longer just playing intensely physical games (lots of running, chasing, duck-duck-goosing sorts of things) with them; now there's more sophisticated, quieter, and smaller-scale play going on.

We saw all of this come together at a play date at our house the other week.  One of the other little girls whom Hallie plays with a lot at school came over for a few hours on Wednesday (my day at home with both kids).  I did little to no hovering or structuring of play.  Rather, Hallie and B. ran upstairs, did some dress up stuff, came down and made puppets and put on a puppet show, and ate lunch (Hallie actually ate more, and more willingly than her friend did, amazingly enough).  At one point Hallie wanted to continue to horse around and chase B., but B. told Hallie that she wanted to do something else.  Instead of letting B. go off and play on her own or act out in some other way, Hallie turned to B. and said, "That's a GREAT idea!  Let's do "x"!" (whatever it was that B. chose to do).   I have to say that I was completely impressed with Hallie and was thrilled that it went so well.  I think that over time the sort of shock (good kind of shock, obviously) that I feel when things go so well will dissipate, but meanwhile, it's nice to have such pleasant surprises.  They also serve as good reminders to never underestimate Hallie.

2.  Social Skills. These overlap with and go hand-in-hand with Hallie's new found play skills.  Indeed, I am now a firm believer in why play is such important work for kids:  it's where they get to develop and act out the "stuff" that they need to interact with the human world around them.  Hallie is much more conscious of other people and other peoples' feelings and very quick to help if something is wrong, someone gets hurt, etc.  She also exchanges more language that is directed at 'social niceties' (she's long been a polite kid whose speech is peppered with 'pleases' and 'thank yous' but she has elaborated on this a lot and can hold basic social exchanges (things like--"How are you?" "I feel fine!" type of stuff that is the cement of daily life exchanges).  She also does more 'small talk' with peers and is initiating a lot of it.

Hallie still has some major issues with eye contact and responding when asked a question (even if she hears you, it looks like she is ignoring you).  Since people like to be acknowledged and it can be quite off-putting if the person whom they are addressing doesn't look up at them, says nothing in response to a question (let alone a statement) and sometimes just walks away when being spoken to, I am trying to work with Hallie on just looking up and acknowledging the person who is addressing her.  This is very much a work in progress but I am hoping that I manage to train her to do this by the time kindergarten rolls around.

3.  Academic skills.  These are Hallie's strong point.  I'm not an early childhood specialist by any stretch of the imagination, but it seems to me that Hallie's math skills are pretty age appropriate for a 4.5 year old:  she has long been able to count objects but is beginning to get the notion of addition when provided with a visual aid, knows what halves and wholes are and the like.  She's great at pattern recognition (remember, she was a champion sorter-by-color-and-shape before she was age 2).  I don't think she's a math whiz; she's just keeping up with her peers quite nicely.  And that's perfectly fine with me.

Where Hallie really blows us away is in terms of her ability to read.  We knew a year ago that she had a lot of sight words and could spell them as well as recognize them.  About six months ago we sensed that the words she recognized included many atypical ones (multi-syllabic, long words that are not hugely common).  What has become clear over the past two months is that she is reading fluidly at what I imagine is somewhere around the end of the first grade level.  When she encounters long words, she sounds them out phonically.  She makes educated guesses by filling in syllables in longer words quickly but in cases where she misreads the word, will happily stop and sound out the word and get it right the second time  (so, for example, the other day she encountered the word "character."  She initially read it as "creature" (which made sense from the context of the sentence); I stopped her and told her that this was a good guess but not the correct word.  She looked at the word, sounded it out (understanding intuitively the 'ch' blend) and read it correctly the second time.    Reading in this manner, Hallie has gotten through entire books at one sitting and is equally happy reading the unfamiliar as she is the familiar.

It's clear to us that Hallie understands what she's reading, too.  She does a good job of narrative retelling (even with her pragmatic language delay), happily answers questions about the content of her books (several years of speech therapy will really hone those skills!) and asks us for clarification when something isn't familiar.  She also responds emotionally to books (getting scared when something bad happens, happy when something good happens, etc).

We love it that Hallie will often come home, pick up a recent favorite book, and just start reading.  And apparently she is having a positive influence on Lea, too, who now does the same thing (including narrative retelling of the story based on the pictures she sees; to our knowledge Lea does not yet recognize letters and/or words).

Reading opens up the world and this is a great thing.  Apropos of this, here's a recent funny Hallie story:  For whatever reason, Hallie has always been fond of China.  We suspect a lot of this has to do with Hallie's love of panda bears, on the one hand, and her Nick, Jr. shows on the other (and most specifically Ni Hao, Kai Lan!, courtesy of which she has learned a couple dozen Chinese words as well as a smattering of cultural practices like dumpling eating on Chinese New Year; given that I will buy Hallie any kind of food she requests, she actually had me out purchasing New Years dumplings this year--which she refused to eat, of course.  So her "Chinese" food consumption is sadly still limited to fortune cookies.  Anyway, I digress.)

At school, a couple of months ago the kids were doing a unit on the world and on travel.  One of Hallie's teachers asked the members of the pre-K class where they had been.  Hallie said that she had been to China.  Hallie's teacher and aide checked with us, and we replied that she had not, in fact, been to China.  (Sadly, Hallie is not well traveled; she has been to New York, New Jersey, Ohio, Maryland and Washington, D.C.).


Apparently this was not just a random comment.  Hallie really wants to travel to China.  She is convinced that this is the only place that she can see panda bears (I hate to break it to her but my suggestion of the zoo will probably yield more in the way of panda bear watching than hanging out in Beijing will).  So Hallie was very very thrilled to read the bottom of one of her rubber ducks (we own a vast collection of these) the other day:  Hallie excitedly pointed to the raised letters and said, "Mama!  I got this in CHINA!"  I wasn't quite sure how to break it to her that most of the stuff we own at this point is likely made in China, but I thought that her comment was awfully cute.

Hallie is also doing a much better job in terms of writing and drawing than she used to.  She still has exceedingly weak fingers and this makes grasping a writing implement with a proper tripod grasp very hard work for her.  When she gets tired she'll revert back to bad grasps.  But her tripod is firmer than it used to be and she is drawing letters pretty appropriately (both in terms of how she produces them and in terms of drawing ones that are smaller and more uniform in size).  She loves to write words and has pretty good spelling for a not-quite-five-year-old.  I suspect she'd be writing even more if it weren't such hard work though.

Hallie does have some difficulty copying out images, though.  We need to keep an eye on this.  This first came up at her last Developmental Pediatrics appointment where she was administered the Beery-Buktenica Developmental Test of Visual/Motor Integration. Hallie was able to copy lines and crosses and circles pretty accurately but had much more difficulty copying more complicated shapes and configurations of lines.  She would often get the number of lines correct but not their spatial placement.  This is curious given how strong of a visual learner she is and how acute her visual memory seems to be.   The big question that Sharon and I had was whether this was related to a VMI deficit or her fine motor skill delay.  But it's definitely something we should monitor and address therapeutically if it turns out to be a real issue.

The other concern that we still have in terms of academics is Hallie's issues with attention.  We raised these at our last Developmental Pediatrics visit (which was about a month ago) and right now we are in a wait-and-see mode.  Given how much progress we've seen this year in terms of Hallie's behavior and learning and gap-closing, it seems to make sense to give her time to mature a bit more.  Great social maturity might even out some of the problems we are seeing with attention.  If not, we can take the next step.  Our first recourse would not be medication; not only would this exacerbate her eating issues but it also might make her focus too much on some of the stuff that detracts from her social skills/communication.  There are plenty of strategies for enhancing her attention that we can try before we get to meds (things like providing her with her own copy of a book when teachers are reading out loud to seating her close to the teacher to minimizing classroom distractions etc).

The attention issue is a big one since it really ties into some of our concerns about school.  In the best of all worlds, we would be able to place Hallie in a school that has small class sizes (12-14 would be ideal), a rigorous academic curriculum, and the potential for supports should she need them.  The only problem is that the first two characteristics are ones that you can more or less find at good quality private schools and the last is one that you can find in the public school system (because of the IDEA, which is the law that covers disabled students).  So there's an obvious disconnect here that will be difficult to bridge.

A year ago (or even six months ago), we probably would never have even considered the private school option for Hallie.  Her support needs seemed so great (we were thinking that she'd need intensive speech, OT, possibly PT, definitely a one-on-one aide).  So the only real option seemed to be moving out to one of the better suburbs on the Mainline that has a school system that supports higher functioning kids on the spectrum (or at least support them right now, since these things change and not always for the better).  Both of us are a bit uncomfortable with the notion of leaving the city; there are plenty of negative things about raising kids in an urban environment (no big back yards for swing sets and lack of space more generally, which is probably evident in every picture we take, is the obvious drawback), but there are lots of really good things about raising kids in a big city:  they become more savvy, world-wise, and edgy (in lots of positive ways), are more open to diversity and appreciating difference.  The cultural opportunities in a city are vast (not just formal stuff, like being able to easily and quickly get to the Franklin Institute or Philadelphia Museum of Art, but also informal ones that allow me to 'teach on the street' and use the neighborhood as a classroom).  And even though the suburb we would choose were we to choose a suburb is close to the city (about twenty minutes by commuter train or car from Center City), the honest truth is that we would probably rarely make it in to Philly. 

Anyway, we are not taking a move to the suburbs off the table, but we are beginning to explore other options.  The director of Hallie's kindergarten (who knows Hallie very well and has observed how much she has changed over the two years she has been at the YCCA) thinks that Hallie would be a very good fit for one of the private Quaker schools in Philly and so we will be exploring that option quite seriously.  Other than the staggering cost (we would need financial aid were we to go this route, unless we chose the one Friends school where tuition is accessible to the middle and lower classes), both Sharon and I very much like this idea.  The class sizes are small, the academics are rigorous and highly structured, and Hallie will probably be among other kids whose parents value education and where hopefully she will blend in with other academically advanced but socially awkward kids.  As a professor, I am more than slightly concerned with the ridiculously standardized testing-oriented environment that now prevails in public schools and would like to avoid this if at all humanly possible (not to go too far off on a tangent, but this form of education seems to train children to be seek 'right' answers rather than real problem-solving skills; teaches the creativity and curiosity out of them and replaces it with an emphasis on rote responses; devalues critical reading, thinking and writing; and is a big part of what is wrong with our education system.  Since so much rests on the results of these tests, teachers are no longer able to teach and instead train students to take tests.  See this interesting article for more about what is wrong about the Pennsylvania system).  Private school students are not subject to the same volume of standardized tests as their public school (or charter school) peers and this is a good thing.

So we will check out the private school option for kindergarten.  Since Hallie already reads fluently and is doing age-appropriate math, even if it turns out that she cannot handle a small environment with few supports, we'll learn this early on and at a point where the experiment will not pose a major impediment to her future academic goals.

We will also explore the public school and charter school options in the area.  I have interviews and open house dates set up at several and intend to set up one-on-one meetings with the principals at the schools that seem like good fits for Hallie.  Should we decide that the Friends schools are not for her, or should she not get into one of them, or should we not be able to afford the tuition, we obviously need alternatives.  And it would be nice for her to be able to go to school with some of her friends from preschool (most of the kids with whom she goes to school now live in our neighborhood and will be attending one of the public or charter schools in Center City or Queen Village/Bella Vista.  Alas, we will not send her to the school for which we are zoned for all sorts of reasons so we will have to get an out-of-catchment transfer, which is not an easy thing to do, or win the lottery for a much-coveted slot in a charter school, which is even harder to do).

And, finally, we will be touring the schools in the close-in suburb that I referenced above and interviewing their principals.

Nothing is off the table.  And the one thing that is always on the table around here is the concept of 'paying it forward.'  Sharon and I are quite nervous about the idea (and reality) of private school tuition (and what it will mean in real terms not only for the household budget but also for college savings).  But if there is one thing we've learned in raising Hallie is that it is essential to pay it forward.  The fact that we've been doing an enormous amount of work with her now -- all of the therapies, all of the over-scheduling, etc -- has really paid off.   Floortime emphasizes a developmental approach; the whole principle behind it is that one must build a strong foundation before moving on to higher intellectual and academic skills.  (Here is a very eloquent formulation of the Floortime/DIR philosophy).

I think these ideas could be generalized quite nicely to the K-12 setting; building a solid academic foundation (paying it forward in school) will enable Hallie to learn anywhere (well, almost anywhere).  It will instill in our kids a life-long love of learning, foster their intellectual curiosity, and give them the critical skills that will enable them to take charge of their education (something that is sadly missing among many of the college students whom I encounter; this is very disturbing to me.  When I started teaching 15 years ago, many more of my students possessed much more in the way of intellectual curiosity than my current students.  And it's not that my students today are worse, in objective terms--whatever those may be--than the ones I had back in the day.  If anything, their test scores are often higher than those of their predecessors.  It's just that they don't appear to be learning as much in high school as they used to.)

Anyway, even if we have an idea of what we want, whether we will find it for Hallie (and Lea, down the road) remains a huge question mark.  And this keeps me up at night a lot right now.  And if this is how I feel about kindergarten, how bad is it going to be when our kids are ready to apply to college?  I can't even think about that right now!

Let's Play Ball!

Sharon and I are headed out to Citizen's Bank Park on this wet and snowy (yes, we did have some flakes earlier) April Fools day for Opening Day of the 2011 season (tickets to this game and five others were my Valentine's Day gift from Sharon this year.  Thanks, Sweetie!).

The kids are all decked out in their Phillies gear (their preschool was awash in shades of red and pinstripe) and very excited about it, too.  So in honor of the Phillies, I thought I'd break my blog silence and post this picture (alas they are not both looking at the camera, but I think we may have a decent Flip Video to upload later).

Let's go Phillies, and may the rain, rain go away and pretty much not bother coming back for a while!

Insight into Hallie's Mind

Having found her voice (or having been given a new, temporary one by the wonderful ENTs at CHOP), Hallie has turned into a chatterbox lately.  We love it.  She still has conversational skills that are well behind those of her peers, but she's making progress and we are so grateful for this and I think that Sharon and I know that there is no going back--we need to make sure that Hallie keeps her voice.

Anyway, since Hallie is talking more, she is also providing us with greater insight into how she thinks about the world.  She had the following conversation with Sharon last night which is interesting on a couple of different levels:

Setting:  Sharon came home late from work last night after running a couple of errands related to our little family party for Lea today. So there had been no time for dinner (and I suspect that Sharon did not have much time for lunch, either, since she was catching up on work having spent the prior two days dealing with doctors visits, sick kids, lost car keys that led to a major crisis that was ultimately resolved when we discovered that Lea had hidden the car keys in our nanny's mitten, and a bunch of other fun stuff like that).  So Sharon was starving and her stomach began to growl a lot as she was reading Hallie her stories before bed.

Hallie looked over at Sharon sympathetically and said:  "Mommy, you have a tummy ache!  Don't worry mommy, I will get you some water and you will feel all better!"

Hallie proceeded to get out of bed, run over to the bathroom, climb up and get down a dixie cup and fill it with water, bring it over to Sharon and ask her to drink it.  Sharon, of course, complied.

Hallie, satisfied, declaimed:  "There you go mommy!  You will feel all better.  You won't have a tummy ache anymore."

This was such an interesting conversation.  First, it shows how empathetic Hallie is.  She notices when others are in need and she really tries to help them.  She is constantly getting things for Lea (and Lea, having learned at the feet of the master, reciprocates by getting stuff for Hallie all the time.  This of course does not prevent them from having knock down, drag out fights over stuff just like any other healthy sibling dyad).  And she uses her own experience to try to figure out how to help others, which makes perfect sense (though down the road I suspect that we will need to work with her on that ever important theory of mind issue to help her figure out that others might want something different from what she desires).

But this was really interesting on another level:  it is clear that, when Hallie says that her stomach hurts, she means (or at least sometimes means) that she feels hungry.  But she has no idea that this is what is going on with her body.   It may also be clear now why it is that she constantly requests water.  She drinks tons of water, all day long.  This is a great thing for her body in general, but not a great way to satiate hunger.

One interesting thing that lately has struck me about autism, or at least Hallie's version of it, is that the communication deficit that is so central to this condition is not just related to communication with the outside world.  Rather, Hallie has trouble communicating with herself.  And if you cannot interpret the signals that your own body is sending you, of course you are going to have problems communicating with others and interpreting their body language, right?  This may be why professionals have noticed that sensory integration problems are prevalent in autism.

Anyway, while all of this is extremely interesting from an intellectual standpoint, what I want to know is how to help Hallie make those connections so that she can feed her hunger appropriately.   Conventional feeding therapy doesn't really do the trick (and it's certainly not going to teach her how to interpret hunger.  It  kind of does the opposite).  If anyone has any ideas about how to do this, please let me know!

Storm of the Week Club

Note to Mother Nature:  I did not sign up as a member of this club and I am demanding a refund of my dues and a rapid transition to 50º and sunny outside weather!

Here in the North East, we seem to be stuck in a weather pattern that is bringing us some variation of snow, sleet, ice, or freezing rain at least once a week and usually on a Tuesday or Thursday.  Since I teach on Tuesdays and Thursdays, this is mucking up my syllabus (I haven't even gotten to know the names of my students yet!) and making me extremely cranky.  Gone are the days when I used to sit by the window wishing and hoping for a nice snow storm that would get my out of a test I had to take (I'd engage in prayer and bargaining with Mother Nature until about 9:00pm every potentially stormy winter night and then buckle down and study for 2 hours when my prayers did not work).

Instead, I read the scary accuweather blogs and forums obsessively, hoping that they are the bearers of happy tidings that a snow event will narrowly miss the corridor between Philly and Lancaster that is the site of my commute and life. 

Alas, they never do, do they?

Last week's storm brought us this:

Oddly enough, we were not the only ones taking pictures at night from our front door.  Our neighbor across the street was doing the same thing.

That was the amount of snow that we had by about midnight on Wednesday into Thursday.  We got about 2 to 3 inches an hour that evening, so by the morning we had an impressive 15+ inches of snow on the ground (from just this one storm). 

This is what Philly's Washington Square looked like on Thursday:

What's not easy to tell from these photos is that we also had a pretty impressive coating of ice underneath all of that snow.  We had gotten a few inches (perhaps 3, total) of snow on Wednesday morning.  This was then followed up with some heavy sleet and freezing rain.  All of that froze and turned into a sheet of ice that was extremely difficult to remove even when one tried hard to do so.  Not that everyone did, of course.  I wonder what kind of revenue stream the city of Philadelphia would have were the cops to actually issue those $50 tickets they threaten to give out to anyone who fails to clear a 3-foot-wide path in front of their property.    It's also amazing to me how bad the side streets are in our neighborhood (which is just south of the busy Center City district).  Even streets that typically are very heavily trafficked are icy, tire-rutted messes.  Lancaster (which appears to have been spared the freezing rain of last week's storm) is in much better shape than Philly.

Hallie was extremely perturbed by the sound of the ice pellets dinging on the house.  She couldn't make sense of the noise.  It seemed to her that snow was falling from the sky but it sounded nothing like snow at all. I finally convinced her that these were tiny little ice cubes bouncing off of our house.  At bedtime on Wednesday she asked Sharon if she could look out the window one last time to see the ice.  I think she was mightily confused when Sharon told her that it was snowing again, not icing.

While no big fan of the winter weather, Lea is a huge fan of snowmen.  She was thrilled by the Frosty that we built in our backyard right after the Boxing Day snowstorm.  But that Frosty did not last terribly long.  His disappearance saddened Lea, who has mournfully exclaimed each and every day since then (and often more than once):  "Where's Frosty?  Frosty melted!"

She would have enjoyed seeing the one that was built quite quickly in the middle of Washington Square Park on Thursday:

Alas, chief snowman technician (AKA Sharon) had to work on Thursday and Friday so we weren't able to get out and build Son of Frosty until Saturday.   But never fear; Thursday's snowfall was still with us by the weekend.  So on Saturday Sharon got to work.  This time around the snow was perfect for forming snowmen and Son of Frosty came out looking quite grand:

I think the juxtaposition of Frosty and our residual summer gear is hilarious.  I'm hoping that posing a snowman with a beach ball, hula hoop, and sand bucket will somehow act as a harbinger of warm, pleasant weather.  


Meanwhile, we brace for yet another event (this one seems to be destined to start as snow, morph into ice and freezing rain, and maybe end as all rain, which will be followed by a major Arctic cold snap and yet more snow.  Holy Snow Squall Bat Man!

Snowy Day

Philadelphia got about six inches of snow last night into today and, after our experience last winter (which featured snow totals in excess of 60 inches), everyone in the city overreacts to the mere mention of the word 'snow.'  The stores were picked clean (and crazy); residents (including myself) were gearing up for snow by mid-morning on Tuesday (and were disappointed by the fact that no snow had fallen by 6:00pm); the city declared a state of emergency (which was excessive) and had sent out fleets of trucks outfitted with plows and salting supplies to pre-treat the roads and prepare for the storm (which is a good thing); and numerous schools decided to close preemptively.  By morning there was snow on the ground and the Philadelphia School District shut down for the day (but Hallie's school was open; sadly, since she doesn't go in until the afternoon on Wednesday, she did not get to play in the yard with all of her friends who enjoyed the soft powder). 

But never mind that; we made our own fun.  Around about 11:00am, I got the kids bundled into their snow suits and grabbed the plastic sled we purchased last winter and we headed out into the elements.  We ran into our next door neighbor's girls who were hanging out shoveling the last bits of snow from the walk in front of their house and they and their nanny and their nanny's boyfriend (who graciously pulled the sled for them) traipsed down the block to the playground.

Amazingly, no one else was playing there so our girls had it all to themselves.  They made good use of it, too.

Hallie and Karina had a blast being pulled through the snow:

Ariana loved it too, but Lea was less convinced of the charms of being out in the snow.  She wiped out on the sled once (which no doubt brought back memories of eating snow when she was on the sled last winter) and didn't really relish getting the stuff on herself.  (This is also how she feels about sand, which is not terribly surprising).  But she had a few good (fairly slow) pulls through the playground in spite of this.

Hallie and Karina soon discovered the charm of snow sliding.  It was a lot of fun to race down the slide and land in a big fluffy pile of snow at the bottom:

Lea was not so sure that this was quite as much fun as her sister suggested it would be:

Hallie and Karina also made snow angels:

Here's Hallie's perfect angel:

And speaking of perfect, Hallie's vocal cord surgery went swimmingly well on Monday.  She is working on yet another cold (which she did not pick up at CHOP; its origins are probably to be found in the epidemiological swampland of her preschool) so it's hard to tell if she has her full voice right now, but it's definitely easier to hear her.  And interestingly enough, she seems much more interested in speaking, and speaking in longer and more complicated and assertive phrases, than she was before the surgery.  We're not sure if she finds it more comfortable to speak (since she needs to strain less to be heard), or is aware that people can hear her better, or is just more confident, but our nanny and Hallie's teachers both mentioned this to us.  And we can definitely hear her better and don't have to walk up to her and ask her to repeat what she's saying a million times over.  She still does not have a full voice, and there's still a hoarse quality to it, but we are very happy that we did this surgery and, all things being equal, we will likely do a more permanent version of this some time this spring (the bulking should last between a year and two years before the medium gets reabsorbed, in contrast to the 3 months or so that this injection will buy us).  Anyway, I will try to capture Hallie's 'new' voice on tape and upload it at some point when she is over this cold.

A Major Milestone

Hallie hit a major milestone today:  for the first time ever, she expressed an interest in baking with me.

Cooking is something I have long look forward to doing with the girls.  Way back when Sharon was pregnant with the twins, I used to walk around talking about how we'd hold 'clinics' in our kitchen where I'd teach them all about spices and how to make flavors 'marry'.  We could have 'spice of the week' weeks and 'guess the ingredient' games and do other fun stuff like that.  And this, of course, would be part of my special time with the kids since I love to cook and Sharon, to put it mildly, does not.  Well, actually, that's not necessarily the case:  she has no idea whether she likes to cook because she doesn't cook at all.  When I first met her she literally had the following in her fridge and cupboard:  salt (which she enjoys more than your average individual does); sugar (purchased for her by someone who wanted to add some to a cup of tea or coffee); Lays potato chips and cheddar cheese (eaten together as a dietary staple); and a stick of butter.  So living with me has been both incredibly frustrating (we have a million things in our fridge and tiny kitchen cabinets and this array is ever expanding) and yet delicious (I hope) since I can whip up a fairly decent gourmet meal at a moment's notice.  Should all the stores in Philly close down for whatever reason, you probably want to head here since I am fairly certain we'll be able to hold out for a few weeks or months with what we have in house.

So, given how much I love cooking (and shopping for cool ingredients), it's been doubly sad that Hallie has such a fraught and negative relationship to food.  It meant that we could not share something that I really longed to share with her.  Lea seems to be heading in the exact opposite direction (she loves to eat, but is especially fond of fruits and veggies and will try almost anything, even foods that are a bit adventurous for a 2 year old like pad thai and curries).  

Anyway, I am sort of digressing.  To return to the subject:  on New Year's Day, Hallie requested chocolate chip cookies.  We didn't have any pre-made ones in the house (I tend not to buy store bought cookies, with the exception of graham crackers and Oreos since she'll eat those).  So, being the mom that I am, I offered to whip up a batch of chocolate chocolate chip cookies for her.  Half an hour later they were ready and, wouldn't you know it, she ate a few.  She proceeded to eat a couple more per day, every day.  She would often just eat part of a cookie and then move on to another one (who knows why Hallie does this, but this is a pattern even when there is no discernible change in taste from one portion of the item to the next.  For example, she'll nibble all around the edges of a Ritz cracker and reject the middle).  No matter about the discarded half-cookies; I considered it a major victory that she was willing to eat something that I actually made from scratch.  (FYI:  I do not consider toasting wheat bread and smearing it with butter to be real cooking).

The kids finished up the last of the cookies this morning and I offered to make some more.  I took the butter out of the fridge to bring it to room temperature and set up the Kitchen Aid Stand mixer on the counter (some day I would enjoy having a kitchen big enough to allow me to leave it out all of the time).  I was taken aback, in a very nice way, when Hallie asked me if she could help.  We read through the ingredient list together and she helped me measure out the white and brown sugars and the flour and cocoa.  She was excited about cracking the eggs (which she did very carefully with my assistance) and eagerly smelled the vanilla.  Dumping the ingredients into the mixer was a hugely fun endeavor but each time I got ready to turn it on, Hallie announced that she needed to go into the living room to hide since the mixer was too loud.  I tried to keep the loudness to a minimum (I only really needed to turn the mixer on high to cream the butter and sugar; the rest could be done at a slower and quiet speed).  And by the end, when I was mixing in the flour, I was doing it at a very low speed to avoid blanketing myself and the kitchen in flour (I hate when it poofs up and coats everything because I forget to take this precaution).

I was in the midst of doing this when Hallie ventured into the kitchen and asked if she could help.  Apparently she was no longer afraid of the mixer.  So she climbed up on the step stool and watched as the flour went in and then dumped the last couple of quarter-cups in as the mixer did its stuff. 

The batter was basically mixed and I turned off the Kitchen Aid and lifted up the arm.  Hallie looked at the batter and said, "That looks yummy; can I taste it?"

I have never heard a more wonderful question in my life.  I responded, "Of course!  You can even lick the bowl!"  So I knocked most of the batter off of the spatula and beater and gave them to Hallie.  She ran to the living room and went to town:

She came back to help me mix in the chocolate chips (which she sampled first; she loves chocolate chips) and helped me form the cookies.  She was eager to make sure that they turned out right and so she asked for (and received) a flashlight that would allow her to examine their progress through the oven window.

I am happy to report that they turned out fine.

What a lovely way to spend part of the afternoon!  I couldn't have asked for anything nicer.

Speech, Speech!

Wednesdays are speech therapy days around here:  Hallie has a half an hour of private speech (and an hour of private OT) in the morning and then an hour of speech at school (which runs coterminous with the Social Skills Inclusion Program that she attends there) late in the afternoon.

While that's a lot for a kid to do in one day (it amounts to 3 hours of therapy, broken up by lunch and playtime), Hallie approaches therapy as if it were play (we used to tell her that we were going off to play with so-and-so but Hallie knew better and started calling it therapy, so now we do, too).  As long as the therapist is a good fit for her*, Hallie works really hard in therapy and likes to please whomever she is working with. 

(*One should not underestimate the importance of a good working rapport between a child and his or her therapists.  There are many therapists and teachers out there who should not be working with kids, or at least not with Hallie.  We usually give them a few weeks to a few months and if they still deem Hallie to be a difficult child or try violate her trust, we fire/replace them.  Likewise, if Hallie has been working with someone and makes no progress in a three month period, we discontinue therapy and look elsewhere.  In such cases, the therapist may be well-versed in whatever it is that s/he does, but it simply is not something that works for Hallie.  The best therapists we've had have looked at Hallie as an individual and figured out what turns her on and then uses this as an avenue for helping her learn to do something that is hard for her to do on her own).

Anyway, I digress.  Back to yesterday.  E. came out of the session with Hallie a few minutes early so that she could talk to me about Hallie's recent progress.  Lately, Hallie has really made great strides in dealing with the problems that she had been having with pronoun genders (she used to mix up 'he' and 'she' and 'him' and 'her' lately; now she gets these right about 80% of the time); with sequencing (being able to organize cards logically so that they show the evolution of a simple narrative sequence); and with describing objects in more robust terms.  She is also doing a bit better in terms of answering "what" questions and in beginning to discuss simple subjects in a free-form way (things like her family, what she did that day, etc.). 

All of this is very good.  The only problem is that this may in fact disqualify her from receiving speech therapy paid for by our insurance.   While, even in terms of these aforementioned exercises (and even more glaringly in real life, a topic to which I shall return in a bit) Hallie is still quite clearly behind most of her peers, she is not necessarily sufficiently behind them to receive therapy.  Apparently the range of 'normal' speech is still quite broad at age 4.5 and one has to be quite a bit behind the lowest level of what is deemed normal to qualify for services.   This is something we're going to have to test (quite literally):  there are a lot of very different assessment tools out there and some of them do a better job than others of evaluating preschool speech.

You might ask me why am I not more excited that Hallie is on the verge of placing out of private speech services?  I think this is a fair question, but it has a pretty complicated answer.  First off, let me state that I am nothing short of thrilled that Hallie has been making so much progress.   She is a hard little worker and she is cognitively quite bright.  She can follow directions pretty well (even for a kid who quite obviously has problems with attention and focus and eye contact and stuff like that) and learns things very, very quickly.  I think all of this will serve her extremely well.  She also generalizes well (though this sometimes can be a problem.  More on this later, too).

But all of that being acknowledged and celebrated, there are some problems with Hallie's speech.  Most of them have to do with pragmatics.  I blogged about this before (and sadly will probably do so again). The issue is that none of the assessment tools (and none of the insurance agencies and educational institutions that rely on these assessment tools for evaluating and treating speech disorders) account for problems with pragmatic speech.  She still had a very difficult time extending communication beyond a formulaic social greeting (she easily says "Hi So-and-So" but has no idea where to go from there) and cannot easily initiate, let alone sustain a conversation beyond one to two very basic turns.  So, for example, she might say to a peer who has a crayon that is the same color as the one with which Hallie is drawing, "Look, we match crayons!" (she loves doing this because she is extremely enamored of matching and categorizing concrete objects).  But beyond, perhaps, saying something like "we both have black ones," the conversation goes nowhere.  This does not become an avenue, perhaps, for discussing even the fact that they are both drawing pictures of dragons with their black crayons, let alone a more abstract and less concrete discussion about their lives.  So no using this conversational turn as an opening for talking about how they both went to parties and had fun in the bouncy house or got new toys from Santa or ate too many cookies or watched a new princess movie or whatever it is that typically developing four and a half year old little girls go on and on about.  Rather, Hallie will note that the crayons match and move on (as in, retreat into herself) from there.

Can Hallie put together a four or five or seven word sentence?  Sure.  Can she use more than two adjectives in that sentence when prompted (turning that black crayon into a big, fat, black crayon)?  Sure.  Can she tell you that so-and-so also has a black crayon and that that makes two black crayons?  You betcha.  But can she sustain any sort of conversation with her peers?  No way.  She might, under duress and extreme prompting, sustain two or three turns with us or a therapist (and in our world this usually involves redirecting her attention at least twice and asking us to look at us in the eyes numerous times).  But this does not make age appropriate speech.


Conversations are always easier (if the above seems easy to you) when they relate to concrete things (like matching crayons, or toys, or clothing) rather than abstractions.  It is enormously hard for Hallie to discuss her feelings (I actually think that it's really hard for her to feel her feelings), especially when these feelings are complicated.  So, she might be able to say that she feels sick and even tell us where (her tummy hurts), but this is pretty concrete.  She cannot tell us that she felt sad or mad or angry when another kid took her toy (though she can act out that anger, at least when it is directed at Lea).  Rather, even when she is the victim of a Lea toy snatch, and even if she is actively engaged in attempting to grab back that toy (and/or pummel Lea), when we attempt to turn such (frequent) events into a teachable moment and ask her, "Hallie, how does it make you feel when Lea takes your toy?" Hallie will respond, "I feel HAPPY!"  She is so very clearly not happy, but we think that she cannot own the feelings of anger and sadness.  First, she has been taught the formulaic phrase "I feel HAPPY!" in much the same way as her first (and not terribly good, and certainly not understanding of Hallie's differences) Early Intervention speech therapist taught her the phrase, "I want please Mommy X" which then got used in lieu of all other spontaneous speech utterances for about six months.  So the only feeling she can name is HAPPY, even if she can feel a much broader range of emotions.  Second, it's really hard to voice anger and sadness when you live in Hallie's world, which is one in which she is so anxious to please everyone.  She is apparently afraid of letting us down.  There may be even more to this inability to voice emotions, but that's my thinking about it for now.

Other sorts of abstract utterances, such as describing what she did today or talking about the weather, the seasons, what is going on at school etc---anything which relates to discussing that which is not in the lived moment---are likewise very very difficult for Hallie.  This situation is beginning to improve a bit so now we might actually learn something about her day from her (but we always need to corroborate this with an outside source who might be able to inform us whether they really did read a particular story, play a particular game etc).  But this skill is slow to emerge.

Even slower to emerge (read: non existent) are complicated "Wh" questions.  Hallie has one question that she asks, which is "What is" that?  She will ask this about things and about people (she modifies the latter a bit and inquires, "What is that named?")  But everything is a what.  There are no "who"s, "where's, "when"s, and most certainly no "why"s.  Hallie asked us "why" once, eleven months ago, and has never uttered the word since then.  We are constantly setting up why questions for her, and also asking her to answer our "why"s.  Hallie has learned (because she is good at generalizing formulae) that one answers a "why" question by beginning her retort with the word "because."  So she does that quite consistently.  The only problem is that her "because" clauses often bear little to no relationship to the questions themselves.  So, for example, you might ask Hallie "Why didn't you eat your toast?" and she might respond "Because it makes you so happy!"  (again with that happiness formula).  Causality eludes Hallie.  Curiosity does not:  Hallie is curious about the relationships between things and loves to read and wants to know what is going on in the world.  It's just that the sorts of relationships she sees between things may very well be different than the ones that we typically focus upon.  I don't quite have a better way of understanding, let alone conveying, this phenomenon.

So the question remains:  can this stuff be taught?  I do think that the social niceties can be taught and that, as Hallie matures and fills in the developmental blanks (which she is doing quite well with the help of Floortime/DIR and her social skills training and just plain maturity, because let's not forget that Hallie does have delays on top of her disorders) that it is likely that she will make further progress on these harder-to-assess fronts, too.  I just don't know what the timetable might be, let alone the route this progress will take.  I do know one thing though:  it will take a lot of hard work, drilling, and the involvement of very good, very attuned-to-Hallie professionals to teach her the things that she needs to know.  This is where our Developmental Pediatrician is spot-on:  Hallie is very bright and is of above average intelligence and learns quickly.  However, the nature of her particular disorder is that she will need to be taught many of the things that typically developing children pick up on their own.  This is why we need to try our best to keep receiving good speech services for Hallie.  We are very involved parents, and certainly we can (and do) read up on how to help Hallie and we apply the lessons we learn from Hallie's various therapists at home so that she gets far more than the seventeen hours of formal therapy she receives outside of the home.  But while we are part of a therapeutic team, we are not therapists ourselves.

One final speech concern:  lately, Hallie has been attempting more spontaneous speech at home.  This is wonderful.  It often involves trying to tell us about stuff that is important to her and, even though we parents aren't all that interested in the TV characters of whom she is enamored, we are always eager to hear what Hallie has to say.  The only problem is this:  the less scripted, the less formulaic, and the longer these speech utterances are, the more likely Hallie is to stammer/stutter in her attempt to get the words out.  She'll often get caught on the first few words of her longer (say seven to ten or so word) sentence and repeat the opening phrase two or three times before the rest jumps out.  Her articulation is very clear, but the words get stuck.  Maybe it's an executive planning issue.  Maybe it's an anxiety issue.  And maybe it's simply a developmental stage.  Whatever it is, I am careful not to finish her sentences or make a big (or even little) deal of it.  Coincidentally, I heard a very interesting show on Marty Moss-Coane's Radio Times (a locally produced, very good NPR news show) titled, "Struggling to Speak," that relates to stuttering and the new Colin Firth/Geoffrey Rush film, The King's English.  Marty had on the film's screenwriter (David Seidler) a well-known local chef, Marc Vetri, who is a lifelong stutterer, and the head of the stuttering program at CHOP.  This provided a lot of food for thought, so to speak, and also another resource to check out if Hallie's stutter gets worse or causes her further anxiety.

Speaking about CHOP and anxiety, all of us have a bit more of this than usual:  on Monday, we'll be heading over to outpatient surgery at CHOP for Hallie's first, temporary vocal cord bulking.  We are all eager to hear what Hallie's voice might be like with a bit of augmentation.  But putting her under always gives us pause.  Not to mention that, as she gets older, Hallie becomes more aware of her medical issues and more concerned about going to the doctor.  She is convinced that Doctor Karen has already fixed her voice (apparently two visits to the Voice Clinic at CHOP were quite enough for Hallie).  So getting her in for a third treatment (this one far more uncomfortable than the first two, which involved having her make noises and get weighed) will not be fun.  Even less fun:  this particular trial substance lasts perhaps three months or so.  So if it does work (and we hope it does), we'll be back for more come the summer.  Prematurity:  the gift that keeps giving!

A Year in the Life of Hallie

As 2010 drew to a close, we've been reflecting on how much Hallie's life has changed over the past year.

This was really brought home to us by the differences we saw in Hallie's response to her school holiday party this year, relative to last.  As I think I mentioned a few posts ago, last year we had to drag her kicking, screaming, and crying back to school on the evening of the party.  Everything was a bit amiss that evening:  Sharon picked her up from school instead of me; instead of getting out of the car at our house, I got into the car with Baby Lea (who was very much a baby at that stage) and a huge dish of macaroni and cheese and we headed back to school.  We tried to explain to Hallie that there was a party at school and that we'd all be having dinner there (never much of a draw for Hallie) and that she'd see her friends and teachers and sing holiday songs.  But Hallie was overwhelmed, in tears, and heard none of it.  Once we got there, things were sort of okay but only just sort of:  as expected, dinner was not much of a draw, and there was a lot of noise and general mayhem.  Kids were racing around and playing with one another but Hallie couldn't make much sense of what was going on.  She sat off to the side when the singing began (as she has done at pretty much every school performance up until just recently) and did not/could not engage with the other kids.  We survived the evening but only just:  our threshold for survival was low and basically entailed making it through without a major meltdown, Hallie vomiting, or Hallie running off through the church hall door when some unsuspecting parent opened it.  It wasn't exactly a low-key, stress-free event and, needless to say, neither Sharon nor I networked or chatted with other parents (which is what parents do at such events).   We kept an eye on Hallie, dealt with Lea who was a bit out of sorts in her own right, and were glad to just to escape unscathed.

Fast forward to this year:  The YCCA had the good sense to break up the dinner/concert into two locations.  The little kids would perform their songs first in the upstairs classroom and then eat.  The older kids would perform an hour later in the big church hall in the middle of the pot-luck feast.  There are only seven families (our own amongst them) who have kids both younger and older, and we were welcome to spend time at both events or either event as we wished.

We opted to head over to the little kid's concert first to hear Lea perform.  Lea, like Hallie, enjoys music immensely and was the only kid in her group (which is the youngest) who participates regularly in sing-along activities.  We knew she'd be psyched to be part of the group.  Hallie also knows the younger kids (the YCCA is small--about 60 or 70 kids altogether--and while kids spend much of their time with their age cohort, they do mix it up with other age groups, especially when they have siblings at school, at various points during the day.  This, plus the fact that Hallie is peer buddy to some of the younger kids in the inclusion program that she helps guide through activities, means that she is quite comfortable with a lot of the younger kids.  So she was excited to partake in the little kids' performance, too.

 

The real surprise for us came when we went over to the main hall of the church for the big kids' party. In stark contrast to last year, Hallie ran in, saw all of her friends, and immediately ran off to join them.  

She was an eager participant in the concert and sat right in the middle of all of the other kids:

 

And, while she wanted no part of eating dinner, she was far from alone in this respect.  After all, it was much more fun to run around the table than to sit down at it:

I know that this video footage was a bit dark and noisy, but it did capture the atmosphere of the holiday party (in other words, mayhem) quite accurately.

So, unlike last year when the four of us were among the first to leave the shindig, this year we pretty much closed down the house.  This suited Lea quite well: she spent much of the final half hour doing an impersonation of Cookie Monster (she went around grabbing cookies from all of the tables, and apparently eating most of them).

 

Towards the end of the evening, I stopped A., the preschool director, to let her know how grateful we were for everything.  I explained that I meant more than just that the school's teachers and staff had organized such a lovely holiday gathering; rather, we were so thankful for the opportunity that she had given our family, and especially Hallie.

A. had allowed us to enroll Hallie outside of the usual waiting list back when we were having so many problems negotiating the agency that runs the preschool (3-5) program for Early Childhood Intervention in Philly.  We were given such a huge runaround and no straight answers and the school in which the agency sought to place Hallie was so clearly inappropriate (and likely unsafe) for her.  I blogged about all of this here and here.  Anyway, even though she didn't really know us and she knew that she was taking on a fairly complicated little three year old who did not talk (Hallie was utterly silent at school for about the first four months), refused to eat, had trouble settling down to nap, was not toilet trained, and was about 30% behind an average kid her age (so closer to being just 2 than just 3), A. was happy to admit Hallie.  It's not like the YCCA needed more kids to make the desired level of tuition receipts either; like most of the decent preschools in the area, the YCCA has a waiting list of children whose parents are eager to enroll them in the program.  A. accepted Hallie because she is interested in providing opportunities for children who have special needs (A. has a Master's degree in Creative Arts Therapy and teaching degrees in Music and  Special Education).  Hallie certainly fit the bill.

Anyway, we were (and are) exceedingly grateful that A. decided to open the doors to the program to Hallie and I just wanted to let her know this.

What A. said in response to me really touched me deeply.  She said, "If I were ever to have the opportunity to make a documentary about the school, I'd want to feature Hallie in it.  I've never encountered a child who underwent such a big change in such a short period of time."

She went on to say that the entire system was ranged against Hallie and that the folks who were responsible for evaluating and placing her were quite happy to write her off as a child who would be forever excluded from regular general education.  Everything they were pushing for suggested that they thought she'd be in a self-contained Special Education system for the balance of her school career.   We were fighting this (and still are) but the reality was that we needed somewhere to place Hallie that did provide an inclusive environment and one where children with special needs were not just accepted or tolerated but actively included.  We needed a school where the staff was trained to work with special needs children, where they taught other children to be buddies with kids who have special needs, and where the curriculum was eclectic enough to be individualized for kids (and not just kids with special needs, either; I think that everyone, special needs or otherwise, learns differently.  A good teacher will be aware of the different ways children learn and a good curriculum will be flexible enough to be adapted to visual learners, auditory learners, etc).  

That's where the YCCA came into things; Hallie has thrived there.  She has gone from a silent, marginal child who watched from the sidelines even when she knew enough to participate to an active, engaged, child who initiates conversations and play with her peers and who is demonstrating real academic strengths that place her at the top of her class (her reading, spelling, counting, and analogizing skills are very obvious to everyone around her, especially her teachers).  

A. believes that Hallie will be fine in a general education setting and that we no longer have nothing to worry about.

Of course we hope she is correct.   Some days it seems to us that this is the direction in which Hallie is headed:  she is eager to read and follows along with words (moving her fingers across the words and sounding things out) almost all of the time.  She wants to know how to spell words she likes to use and, apparently, once she can identify a word, she never forgets what it looks like.  She can pick out which shows she'd like to watch this way and even distinguish between various episodes of these.  (Sadly, this means that she was able to catch me in my fib that our television does not receive Max and Ruby, which is a show that we have refused to let her watch too often because of her capacity to mimic Max's behavior and verbal patterns.  The last time I tried this line, she helpfully pointed out that our Comcast On Demand list did, indeed, contain Max and Ruby).  Hallie loves to learn stuff and I think this will take her quite far.

Still, we have concerns:  her verbal/conversational skills lag far behind those of her peers.  I am not a speech therapist (or any kind of therapist), but I'd guess that she's still dealing with about a 30% delay in this area (making her closer to an early 3 year old than a later 4 year old).  Her interpersonal skills often seem less well developed than Lea's:  Lea is quicker to empathize and comfort; more interested in taking care of others and meeting their needs, be it by ministering to her babies or bringing Hallie her slippers and toys; and Lea watches for your responses and tailors her own relative to these.  Hallie does none of these things and still has pretty horrible eye contact most of the time.  Lea also surpasses Hallie in terms of capacity for imaginative play.  Lea stages elaborate scenarios with her babies (she dresses them, takes them to the playground, plays hide-and-seek with them, feeds them, gets them ready for bed, brings them toys and engages in play with them etc).  Hallie sets up scenes:  she often poses her plastic figures (she pairs off Cinderella, Sleeping Beauty, Tianna and other princesses with stand-ins for their respective Princes, for example) or she might line up all of her figures in front of the television (real or imagined) or stage for a puppet show, but she doesn't actually stage the show or have them do anything beyond this.   Finally, lately, Hallie has been having a really hard time with being flexible.  Things have to be played with a particular way.  If they are not, Hallie tries to step in to right the wrong.  Lea, her most frequent playmate, has her own ideas but Hallie seems not to realize this.  Rather, she gets frustrated when Lea tries to do things in her own way and makes this very broadly known to us.  While some of this is just run of the mill preschooler bossiness, my sense is that this is exacerbated by a deficit in Theory of Mind. 

All of this points to a continued problem that Hallie is having in terms of social skills.  But this will also get in the way of higher order learning down the road.

None of this is to say that the transformation that Hallie has undergone over the past year is anything but huge.  A vast chasm separates where she was when she began school and where she is now.  She has grown cognitively by leaps and bounds and she has given us no indication that she about to stop doing this.  Still, we cannot help but worry what awaits us down the road, and more importantly, plan for how to take on Hallie's residual issues proactively so that we at least smooth them out even if we cannot make them go away entirely.