8/29/08

You win some, you lose some. Tyler bit Ben pretty hard on the arm last night, enough to leave both upper and lower teeth marks, poor guy. We aren't exactly sure what happend but we assume they were paying cars and Ben had both of them adn woudn't give one to Tyler so Tyler bit him. Darn it. Ok, so we know the brotherly love will come and go right, it happens with all siblings.

On a lighter note, Tyler's Angels is the #1 fundraising team right now and Steve is the #1 fundraiser. One of his clients sent us a big donation. THANKS! !!!!!

8/27/08

Great news. When Ben woke up this morning, he said "I want to play cars with Tyler!" Apparently last night, Dad, Tyler and Ben all played cars for 30 minutes straight. Tyler was engaged with Ben and Dad the entire time. The boys were even hugging each other, Ben hugging back! YEAH.. over 2 years in the making but looks like that brotherly love is finally coming to fruition!

WOO HOOO!

8/26/08

Yeah, playgroup went a lot better today. The instructors helped by changing things up a bit so that Tyler's frustration would be limited. It really worked.

we are getting ready to start those changes we mentioned a few weeks ago to rid Tyler's body of yeast. We've started gathering all the new medications and doing the necessary research into the diet. We still have a few unanswered questions, but the doctor said to transition slowly so we'll figure those out as we go. What I know now is that I need to change his bread. We don't use bread often so hopefully the taste change won't be too big a deal, especially since we mainly use it for french toast and with syrup (although we have to get special syrup now) hopefully it won't be too yucky. Also, one of our staple snack foods are GF pretzels ($7 per bag!!) and those will be a big no-no so I need to find something to replace those. They are so simple to pack up and take on the road. I started reviewing my GFCF cookbook last night cause they have many recipes for yeast free too so I'm hoping to find some snacky foods in there I can make up in large batches and then take with us on the road. I've found alternatives to ketch up too and we need to replace applejuice and sugar. Our DAN doc said no splenda but the cook book said splenda ok so we'll play it by ear and see what seems to work. I need to transition both boys onto juice with splenda (not regular sugar) and then we'll just keep it watered down like we do now. I hear almond choclolate milk is good (expensive though) so I'm hoping that can replace applesause as a way to get all the supplements in him. I guess we'll just make our own pear sauce but first we need to get another mini food processor, ours broke. But we did start to get him pear flavored applesauce to get him ready for the transition. Ok, sorry, I'm rambling here. Anyway, we are actively working towards ridding his body of yeast.

Grandma was with us for an extended period of time this weekend, thanks grandma. She actually watched the boys on Monday for us because our daycare was on vacation. Over the weekend, Carrie visited to help Grandma and Steve with feeding time and any other concerns they had in terms of working with Tyler. The meeting went very well. It also gave mom some time to spend alone with Ben. we went to the museum and grocery shopping, Ben was great and I bet he really enjoyed the mom time. We all went to the park on Sunday and we worked with Tyler on gross motor skills, and then talking/oral motor stuff/word approximations during swinging. Everything can be an occasion to work with Tyler once your mind is trained that way. AND... Ben finally went down the big slide by himself! He's been scared to do that until now.

P.S. Tyler still has a cough, Ben's finally seems to be going away. Will we ever all be healthy at the same time again?

That's about all I have for now. Tyler's Angels is in 3rd place for fundraising right now, yeah!

8/21/08 Update

Carrie will be coming this weekend (we've missed her) to help Daddy and Grandma learn how to foster communication with Tyler during mealtimes which will give mom and ben a chance to have some alone time. Grandma is staying through til Monday to help us out as daycare is on vacation right now, thanks Grandma!

Tyler and Ben were playing together again this morning. Ben was hiding behind the curtain and Tyler would wait for Ben to appear and I'd shout "boo" and everyone laugh. It's such a treat to see them interact. Tyler is also hugging Ben more, in general, Tyler is definitely liking his hugs lately. Ben has been resisting the hugs (whining when Tyler hugs him) so I'm trying to work with him on that. You can't blame him cause there aer times when Tyler gets that close that he hurts ben by pulling his hair or scratching him so I'd be leery too. I also asked that Steve mention this to carrie so she can give us her expert advice as to how to make Ben enjoy his hug a bit more. What I'm trying to do is really really praise them whent hey do hug and I also join in so I can be an intermediary so Ben feels more comfortable/safe but we are all still hugging. It seemed to work this morning anyway.

Also, I'm sure you remember me talking about the Judson Center before http://www.judsoncenter.org/page.php?catID=118&page=What%20We%20Do&id=7&catName=Autism%20Connections they are a great local organization. I've also talked before in the blog about Stephanie Harlan before who is the Director for the Judson Center. Her son Justin is recovered from autism and he's just an amazing inspiration and so is she. She never gave up no matter what the cost and her hard work paid off. Justin is such an inspiration. Anyway, they host an annual Duffy Adams 5K run to benefit the Judson Center. It was the first race I ever ran last year and am planning to do it again this year. They also have a 5K walk or a 1K walk; if anyone is interested in signing up go to http://www.active.com/page/Event_Details.htm?event_id=1560186&assetId=6e42a340-4303-4aa7-a97d-6dc56913090c it goes to a very good cause.

8/20/08

I received a really good compliment today, well really it's a compliement for Carrie because she did such a wonderful job of teaching me. I sent the playgroup leader Tyler's presentation to show her how much progress he's made since the beginning. This was her response:

Wow, this is an amazing story!!! I am so happy for you and your family. Watching you today interact with Tyler was a joy. It is clear that he will continue on his way into the world. I am sure your presentation and just seeing you in action will be an inspiration for other families.

The structure at playgroup is to be group activities at the beginning and the end but then the in-between play time is just supposed to be between the parent and child and then the leaders of the playgroup kind of oversee the play and give feedback along the way on how to improve and get more chances for communication. The leader, Dorte, is a Speech Pathologist. So when she says "watching you today interact with Ty ler was ajob, and that it is clear he will continue on his way into the world" well...I'm not sure it gets much better than that. Basically that says, Mom, you are doing all that you can do and doing a great job. It's really great to hear professionals say things like that because obviously they know a lot more than I do! So once again.. THANK YOU CARRIE for all you taught me.

8/19/08

This morning was the first play group session for the second part of the study. Although I was a little anxious about how things were going to go, I felt comfort in knowing that Tyler was already familiar with the room from our Friday clinic sessions. Right now there are only 2 families in the group and the other little girl was late so it was just Tyler at first with 3 staff members from U of M. He did great at first showing off his communication skills.. sounds/gestures/eye contact. He also did well at handling frustration. I was going over some paperwork with the leader of the play group and another person was trying to engage Tyler in a game. It was frustrating him and he kept coming tome gritting his teeth and I'd give him squeezes, but he was able to maintain his frustration there and go about with the activity. This was great because it was all new people in the room and he kept seeking comfort from me but continuing the activity.

They had a sensory table set up with beans. Beans are one of his favorite activities but it can sometimes be hard to keep him engaged socially because he likes them so much. Around this time the other girl showed up and things got a bit trickier after that. Tyler didnt' like someone else playing with the beans and got a little frustrated but then seemed to want to go back and play but would get frustrated again. I requested that beans be an activity we get out towards the end of the play group vs. the beginning. It's very hard for me to get him to engage as I said before as well as get him to end the activity on a good note, especially when there isn't something more motivating for me to transition him too.

Which brings me to what happend today. We were all trying to end the bean activity to move towards a group activity; parachute. I gave Tyler many warnings that we'd be ending soon and then tried to transition as best as possible but there wasn';t much available yet (they were transitioning activities in and out of the room), So I held him and tried to swing him around in the air and up and down which usually he likes but it wasn't working today and then wham! I got a big head butt to the temple...ouch... luckily right after that they had the parachute ready and we started to play parachute. Then we moved to ring around the Rosie. Tyler is used to pushing down the players on the "all fall down" part" of the song. anyway, he got frustrated when everyone fell down w/o his pushing them and that led him down a spiral of over stimulation. I tried to calm him with juice. They were doing a calming group activity with books and stuffed animals but if Tyler isn't actually touching the book, he isn't interested in them yet, plus he doesn't sit still long enough to gain interest! So I kind of tried to keep him playing around the rest of the group and do things in reference to the book that i thought he'd enjoy like making duck sound when that part of the book came and making doggie sounds, etc. but this wasn't really working either. He lead me to the door at point which is his way of telling me he wants to go. I told him we'd go soon. Anyway, when class ended he was definitely ready to go. On our way out, he was walking at first but just seemed beside himself and wanted up so I picked him up and we were walking out and another head butt to the mouth, ouch...didn't see that one coming since he wanted to be picked up. Tyler was definitely not happy that we stayed at playgroup as long as we did and he wanted to let me know. Can't blame him for communicating right! Mom gave him some juice which not only helped to calm him down but also preventing me from receiving any further injury. We got out to the parking lot to an eagerly waiting dad who was taking him back to daycare.

Tyler also is beginning to get a cough, Ben's is still not gone and I feel like we are no in this vicious cycle of illnesses/injury that we can't get of. We haven't all been healthy at the same time in over 6 weeks. I'm hoping it is just pollen in the air that's bothering Tyler right now.

Go Tyler's Angels. Tyler's Angels are currently in 4th place for fundraising for the Autism Speaks Walk, yeah! Steve is the 5th place fundraiser!

8/18/08

This weekend was a reminder of how far we've come and just how far we have to go. Went to the sprinkler/fountain park yesterday. After playing in the fountains for a while, Tyler started running around the perimeter (which is a big circle) of the fountains laughing. You all may think this is normal, however, I know and knew that if I had tried to get him to go in the opposite direction, he'd strongly resist, so that's exactly what I did (I swear I"m not mean, that's what I'm supposed to do). So I ran out a few times and said stop and got him to giggle thinking stop and go was funny but he wasn't really wanting to go in a different direction, so picked him up and turned him around and bounced him in the other direction, singing and laughing and trying to make it fun. As soon as I let him go, he immediately, bent down and went to bang his forehead into the concrete. Normally I'm prepared for this which I was but he usually gives a bit more warning so I can get into proper position, this time he just went quickly and luckily I was able to catch him. Tyler loves to run in circles and if at all possible, it's not something we should let him do freely, we should either get him to engage in other activities or make the running around into an activity of some sort where he's interacting with you and he has an active role in the activity. However, he came out of the near head bang very well and didn't seem to be too bothered by it all which was great.

This morning I witnessed something fantastic. I dropped him off at daycare and he was very attached to mom this morning, wouldn't let go of me and kept pulling me to different places in the house and then he pulls down on your arm which means he wants you to sit down. he pulled me over to the vacuum cleaner. He loves the vacuum and we've worked on this as a routine, in fact, I've actually gotten a bit of constructive criticism in regards to our vacuum routine in the beginning because it was too entertaining and not enough of an interaction/role for Tyler. That really wasn't that long ago, i mean in terms of months, maybe 3 or 4 at most? What I tried to do in the beginning is to get him to say "on" and I was taught to turn it off about every 10 seconds or so and model the word on and wait for him to say it or some sort of verbalization before turning it on. Ok, so back to what happen today. He brought me to the vacuum and pulled my arm down and probably about 15 times said as loud as he could "ahh, ahhh, ahhhh, ahhh, ahhh" No prompting, no anything, he just was saying on and using vocal communication, eye contact, and a gesture to get me to respond. It was killing me not to turn the vacuum on but their son was sleeping on the couch right next to the vacuum. I said "On" back and said we can't turn it on now and gave him lots of praise for talking.and tell me what he wants and then found something else for him to play with. I was a very happy mama & therapist today!

8/14/08

Not only can Tyler identify his colors, shapes, animals and many letters, but we discovered last night he also knows his numbers, at least #1 - 9. He and I were looking at the clock and I'd say, Where's #5, and he'd point to 5! And then I'd say where's 9 and he'd point to 9. This morning I tested him. He had a book that had a number and the corresponding number of items on each page. When he was on the number 1, I asked him to find the #3 which meant he had to turn the pages until he found the #3 and he did it! Actually I asked him to do this 2 or 3 times and he was successful each time. His pointing opened up a whole new world of communication for us. And think, it was only a few months ago that he started pointing and in that time he's learned all of those things! Way to go Tyler.

We haven't started the yeast free diet yet, I wanted a few weeks of health in our house before we started and so far we still haven't gotten there. Poor Ben never fully recovered from the illness we all get after vacation. We ended up taking him to the doctor on Monday due to a really bad cough. They put him on antibiotics, steroids, and breathing treatments. I fear he'll develop asthsma since he seems to have recurring respiratory issues each time he gets sick.

Speech went well this morning, Tyler said "red" and a few other words, although he was very stubborn when it came to eating. He was doing great until I was making him hold his own spoon or touch his own food and he didnt' want any part of it after that. In fact, his resistance spilled over into daycare as well as she said he wouldn't eat his midmorning snack. What 2-year old isn't stubborn, right, I take this as a good sign. At least he knows what he wants and he doesn't want to touch anythign with texture. Sorry buddy... you gotta do it! Its so easy to give in as a parent, especially when it comes to eating and you want your kids to eat, right. Tyler is around 25 lbs and Ben is only 26 lbs so it's certainly can be tough to do whats best for the long haul vs. what you want to do as a parent to give your child nutrition. It's a lot easier just to feed him and then he'll eat and everyone's happy but that's not what's best for him at all. I figure tomorrow is a new day and we can try again. He's not always resistant to feeding himself, the otehr night he ate a hot dog all by himself, sometimes and some things he's just not wanting to touch. This is very common for childen with autism due to their sensory issues. That cookie I made him touch could have very easily felt like high grit sand paper to Tyler.

We went to a petting zoo this past weekend in hopes that it would be something both boys would enjoy. Tyler was really not interested in any of it and was feeling insecure but handled it all very well. Ben however had a fantastic time with the exception of the chicken that pecked his finger. He rode a pony, it was so cute. He also got to see baby piglets who were only a few days old and he really liked the caboose that was on the property, he loves his trains. After the visit to the zoo, we decided we'd stick to more of the gross motor outtings for a while as both boys really seem to enjoy those.

8/11/08 - Brotherly love!

I have the best news to report. Last evening I was up stairs getting the boys pajamas and the boys were down stairs watching a video. I heard a lot of laughter so I peeked downstairs and they were playing together! They were chasing eachother around the living room and both were giggling and laughing. It was so cute. And truly the first time I've witnessed them both playing HAPPILY together. We often try to set up situations where they have opportunities to interact and sometimes it works and sometimes it doesn't but even when it works it's usually short lived, maybe 30 seconds. This is honestly the first time I've witnessed them initiating play on their own adn having a great time. By the time we got out the video camera it was too late, but it was such a beautiful thing. Most parents probably take for granted that their kids play together, for us, it's as if we have 2 - only children. So it's so beautiful to see them play together.

8/8/08

As promised, I wanted to provide you with a list of supplements that Tyler currently takes or will soon be taking as a result of our most recent DAN doctor appt. Just a reminder, Tyler's DAN Doctor is an actual Medical Doctor.

Methyl B12 injections
Taurine
Digestive Enzymes
Vitamin B5
Spectrum Complete Multi Vitamin
Magnesium
DMG
Vitamin C
Vitamin E
Zinc
Cod Liver Oil
Vitamin A & D
Calcium
Fish oil/Omega 3
Melatonin
Probiotic
and in the short term:
Diflucan
Niacin
Charcoal

Due to his age, we have to find sneaky ways to get him to take these medications, some, like digestive enzymes, are taken at every meal so when you add everything else in, we are sneaking in medication all the time. He's no fool though, he often tries to steal Ben's cup cause he knows Ben's tastes better than his, ha! So now that brings us to the elimination of the yeast. The easiest way we can hide medication is in Tyler's applesauce which is going to be a no-no when we go yeast free so I've heard of pear sauce. Not sure if they sell it already made or we'll have to make our own but that's my current plan. Again, still need more time to fully research the in's and out's of yeast free combined with his current restrictions but without some sort of applesauce substitute, I have no idea how we'll sneak in all that medication! And unfortunately, other than the diflucan and niacin, none of the other supplements are covered by medical insurance :( It's astonishing to me that 1 out of every 94 boys has autism and yet parents have to find ways to pay for these treatments. You may ask why we do it? Because it works. We've seen such improvements in Tyler. Each time we take a biomedical step forward in the protocol, we see changes. Nothing earth shattering but there are always improvements. Each of those improvements allows Tyler to better concentrate and learn from his other therapies and he gets better.

08-07-08 - Update

Tyler's language is still coming on in full force. At day care yesterday, Karen was play with Tyler with an wooden alphabet board and the letter spin. He had pointed to one of them and it was turned in a way that Karen couldn't see the letter so she said "what is it"? On the next one that Tyler pointed to he said "is it"!!! Speech had to cancel on Monday so she made up a session yesterday at daycare (I was at a parent interview at U of M which I'll talk about later) and then we had our normal session with her this morning at our house. Tyler said Yes, Out, Push it, and Lisa!!! he said her name when she was modeling.."bye Lisa" when it was time for her to leave. let me back up a minute, Tyler was eating breakfast when Lisa arrived and he has a clear view of the doorway from his chair. He made very good eye contact with her when she came in and Lisa commented on it and how she has seen significant improvements in him since even she has started to see him. His language is improving every day.

We had to do a parent interview for the first words/toddler project which we began when Tyler was around 15 months I think? It was a very frustrating time for us becuase he hadn't been diagnosed yet and was at the stage where we were going through evaluation, interview, test, more evaluations after evaluations and appts after appt and not feeling like we were doing anything to actually help Tyler. It was very frustrating. So the first time we did the interview which is extensive, I think the first time it took almost 3.5 hours? I think. Anyway, all teh questions were a sharp reminder of just how serious Tyler's condition was and just how frustrated I was that the only therapy he was getting was 1 hour of speech a week. I just so badly wanted someone to tell me how to help him! I cried many times during that first interview. So yesterday's parent interview was such a blessing! Here we are a year later and so many changes! It was actually fun to answer some of those questions. One of them asked how many words he understood, in past interviews I knew he must understand a lot but I had no way of knowing what he understood. Now I know what words he undesrtands, because we have ways to communicate together. I can ask him to get something or touch something or find something or sign something. Or say we are going somewhere and he'll head up the stairs or to the door or to the bathroom. I didn't shed 1 tear, in fact, I left the office feeling so happy that all of our hard work and dedication (including Tyler's cause he has to tolerate it all!!) is really paying off. I can't wait to look back a year from now because he's just doing so great.

080508 Transition Week

So we are wrapping up a lot of things this week to transition into the next segment of the study. Tyler had an evaluation at U of M today and I have a Parent Interview scheduled for tomorrow. The evaluation today went ok. When we had agreed to have Tyler help out with the ADOS-T training, I had some concerns about the timing. The evaluations aren't always fun for him and I was afraid with his real evaluation coming up that the training evaluation appt may have an affect on his behavior and unfortunately I did see a little of that today. I actually had trouble just getting him to leave the area of the car. I had intended to walk with him from the parking structure to the building by holding his hand but he wasn't having any part of that. I tried to pick him up and give him a toy to hold on to but that didn't work either. My saving grace was the stroller, he didn't seem to mind going in the stroller, thank goodness.

He never quite seems himself at the evaluations. part of the reason is that he has to sit in a chair at a table for a large portion of the evaluation and sitting still isn't so easy for him. He also has a bit of a runny nose and is obsessed with putting his finger in his nose, I think eh just figured it all out so that was kind of distracting him today too. There are things I know he can do and does at home but he does not demonstrate in the evaluation room. carrie had mentioned there is usually a 2 month time lag for skills to generalilze into other surroundings. During our 10 minute play time (has to play with the same toys each time), he did however demonstrate his interest in pretend play by playing with the farm animals. It's the first time he did this with those toys during the play sample. Usually he plays iwth the cars and the shape sorters so I was really happy about that. He also said yes a few times and that was also great. Diaper change prior to departure was a struggle. Since it was a stinker, I had to recruit helpers to help me get through it w/o making a huge mess.

At home the boys are doing great. Ben is super excited because he now has a pillow in his bed! Steve had a golf outing last night so the boys and I played "jungle" which is basically anything we hide in like under the blankets or in a thomas tent, etc. Ben calls it all a jungle. So after bath last night we played jungle under teh blanket. It's a great way to get both boys engaged in the same activity. Ben loves the jungle and Tyler loves animal sounds and signs so they both have a great time. We also worked on "joint" reading. Tyler isn't at the stage where he can sit still while you actually read an entire book and they aren't always patient in waiting for me to finish reading to the other child so I had Ben find certain items in his book and then I labelled things for Tyler. Still working to get Ben to label items for Tyler. This will be a great way for them to interact together!

Which reminds me. I had mentioned to Carrie about my concerns betweent he relationship between Ben and Tyler and how I wish that they'd play together more and ways we work (but not force) to show them that eachother can be fun. She said that siblings are oftent he best therapists! Many times siblings learn and enjoy therapy time with their brothers/sisters with autism. She said give been another year and he'll be ready to work with and enjoy his brother a little more. There are also Sib Shops offerred at the Judson Center. We'll likely enroll ben in these when he gets more school aged to help him cope with being the sibling to a kid with autism.

On to this weekend, Grandma is coming, yeah! We haven't seen grandma in a month and are all looking forward to her visit. we are hoping to take the boys to a petting zoo. Wish us luck :)

8/4/08

So everyone is finally healthy, yeah! We had another sleepless night with Ben on Friday night so we decided to take him to the doc on Saturday and by Saturday evening he seemed to be doing much much better. Dad also started to get better on Saturday.

As for Tyler, he was absolutely amazing. He did so many wonderful things, I'm afraid I may forget to list them all. Let's see... when I picked the kids up from daycare, Tyler seemed very interested in the other kids. I picked up Tyler to give him a hug and he was watching the other kids run around and was laughing. Then since he knows it's time to leave when mom comes, he started waving goodbye to everyone! He usually takes quite a bit of prompting to get him to wave goodbye and even then it only happens maybe 1/3 of the time. Daycare again had said how he was saying "yes" at appropriate times througout the day.

When we got home I first took Ben in the house and came back for Tyler. I undid his belts and then said "out (pause), out (pause) and then he said OUT! Yeah. When we got inside we were all playing with Ben's Thomas tent and we had brought in some miniature plastic farm animals. Tyler wanted to throw the horse back and forth and I would have him say "horse" as I was throwing it back and forth. I use a lot of techniques to help keep Tyler calm at the dinner table and one of htem is to softly tickle his arms. He's so cute because he'll hold his arm up so he can get as much tickle as possible. Anyway, when I stopped.. he then started to tickle my arm. We went through this cycle 3 times. This is a fantastic social exchange that he's never done before. Then when it was time for to get out of his dinner seat, I asked Tyler if he wanted down. I asked twice and modeled "yes" and he said yes! Anyway, all of that happend in about a 2 hour period on Friday. Everyone is agreeing that the language erally seems to be coming in. Daycare commented that it seems like he's in the babbling stage.

We had a videotaping session on Saturday mornign (to make up for the one we missed on Tuesday). Steve took Ben to the doctor during this time. Tyler did very well. Even though he didn't talk as much as he had the night before, he showed some new skills/interests. One of the things that Florida State wanted us to start working on was immatation play. we moved the farm/tractors (took out batteries for sound) to an area on the front room hoping it would promote better play. The kids were ignoring it in its current location. Anyway, Tyler actually wanted to play with the farm and at one point moved the sheep to a grassy area on the farm to play. I gave him lots of reinforcement by making animal sounds. This is the first time he's been interseted in pretent play like that, woo hoo!

Saturday marked the official end to the first 9 months/parent intervention part of the study. It didn't hit me until Sunday, but I no longer had the pressure to get in my 25 hours with Tyler. Not that I don't plan on working with him and using the skills I've learned, I plan to use those every day. It's hard to explain unless you live it, but there is an incredible amount of pressure to turn everything into "therapy" for Tyler, in fact, we almost had to in order to meet the 25 hours. Every family walk was turned into ways to foster communication with Tyler, i.e. stopping and going with teh stroller, signing, etc. It was never just a relax and walk with the family kind of event. Sunday was the first time that we didn't have that pressure. Lunch time was great because Dad fed Tyler. Normally mom would need to feed Tyler all meals on weekends as it was part of our routines for the study adn in order for time to count, mom needed to be the one to work at meal time. Sunday I was able to each my own lunch, at my own pace, with both hands! It was very excited. Now, I'm going to work with Dad and Grandma on mealtime techniques. They've both seen me work with Tyler but until you do it yourself, it's hard to take it all in. So many little things to remember.

Anyway, that's the latest with us. Another big week this week as we transition into the new study. I have a huge parent interview at U of M this week, takes about 3 hours and is heart wrenching (did it for the previous study) and then Tyler has an official evaluation this week as a conclusion to see how he progressed the first 9 months of the study compared to baseline. Then next week we start the new study. There is a parent education class as well as Toddler Play Groups. The caregiver has reading assignments from the More Than Words book. It's quite a bit of reading!