Therapy Tip: Time for More Therapy??

Welcome to Therapy Thursday- the day I give a tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs. Today's tip is:

Private Therapy: To Do or Not to Do??

One question that many parents of children with special needs often ask themselves is: Should I get extra therapy for my child outside of the school therapy program? I have asked myself this question many times over the past several years.

There are many factors to consider when thinking about obtaining therapy from a speech-language pathologist, occupational therapist, or physical therapy in private practice, at a clinic, or in a hospital setting.

Why are you wanting private therapy??
First, as a parent, you have to understand why you want private therapy for your child. Is it because your child has a diagnosis that warrants extra time in therapy? Do you want your child to learn something specific? Is there a problem with therapy from the school?

I have put Jaycee in private therapy at different times in the past few years for a few reasons. The first time Jaycee had private therapy was at 3 years old because she was not feeding herself. I sought out an occupational therapist with experience with Down syndrome with hope to attain the specific skill of self-feeding. I really wanted her to become independent at meals. There have been other times I've gotten Jaycee private therapy because she was recovering from an illness and not attending school. Private therapy replaced school therapy until she started school again. I have also sought out private therapy for issues that the school therapist didn't seem to understand how to address. After the evaluations, I shared the reports with the school, so they could address the problems. In other words, I used private therapy to get someone's expertise in a particular area.

It is really important to understand why you want private therapy and what you hope the outcome will be. When you answer this question, that will help you determine if private therapy will be done short term or a long term undefined amount of time. Three of my private therapy experiences have been short term (around 3 months). But, once I had Jaycee in a long term, undefined therapy situation that lasted over a year. For me, I will never do the long term thing again!

Here's some things to consider:

Pros of private therapy
-Private therapy is almost always a one-on-one session.
-Typically, sessions are 45 minutes to an hour, so private therapy may mean more time in session compared to sessions at the school.
-In private therapy, you will most likely have more of a say on what is being addressed. If there is a particular skill that is important to you, you can ask that therapy address it.
-Because you are taking your child to and from private therapy, you often have more opportunities to speak directly to the therapist, ask questions, and get feedback on how your child is doing.
-If your child has had the same therapist at the school for a number of years, private therapy allows you to get another person's professional opinion. Sometimes, change is good and finding a person with a fresh perspective may make a difference.
-You might find someone with a speciality that isn't available at the school. Sometimes, you don't always have a choice of therapist when it comes to who works with your child at the school. But that isn't the case with private therapy. You can research therapists, find out if anyone has experience with your child's condition, and possibly find someone who has been trained in approaches that interest you.


Cons of private therapy
-Private therapist does NOT always equal better. Sometimes parents think a school therapist isn't as "good" as a private therapist. The truth is that every therapist is unique with their own treatment approaches and experiences guiding them. One is not better than the other. So, don't automatically assume the private therapist is going to be a magic worker. Do your research on the therapist's experience before starting therapy! There are good and bad therapist everywhere!
-Private therapy will most likely bill your insurance or medical card, which can evoke major headaches! So, you will need to do your homework to find out what your insurance covers and if there is a cap on the number of visits a year your child can receive. For instance, some plans will allow 25 visits per year. You will need to know this information and keep track of the number of sessions so you don't go over. Don't assume the private therapist will keep accurate records of this. If your insurance has a cap on the number of visits per year, I recommend you use those visits over the summer when the school may not be providing therapy.
-Private therapy can be very expensive. If you have insurance co-pays or if your insurance doesn't cover the therapy, you may be stuck with an expensive bill. I have personally seen charges for $100-250 per session, so that can add up very quickly if you are paying for it!
-Burnout happens! You do not want to burn your child out of therapy especially if you are paying for it! If your child is going to school, receiving therapy at school, or involved in other activities, private therapy could be too much. I found that private therapy after school was totally pointless for Jaycee because she was so tired. Sometimes, the private therapy in addition to my job and home responsibilities was just too much for me, so I got burned out first.

In the end.....
There are reasons why private therapy may be a good idea. But, it is not for every child and every family. It is a difficult decision to make, especially if you are really concerned with your child's development. I personally always recommend that a child receives therapy from the school since your tax dollars are paying for it. And if you decide to add extra therapy on, I think it's important to understand why you are choosing private therapy for your child, what you hope to get out of it, and how it will affect your family. That will help you determine if the therapy is a success or not.

Faith, Fear, & the Future

In less than a month, the house we are in will belong to someone else. We will be busy decorating our new home and settling in to a new routine. The new owners will be busy making changes to our current house. More than likely, they will see my artwork on Jaycee's bedroom wall and paint over it.

As we are starting to pack up our belongings, this special wall is one thing that cannot go with us. I think back to almost 10 years ago as I traced Jaycee's hands and feet, cut out the pattern, drew the prints out on her bedroom wall, and then painted them.

These hand and foot prints have a special meaning for me. It's true that I traced these when Jaycee was a newborn to mark her time as a baby, but it went beyond that.

When this paint went on the wall, I was in an all out spiritual battle. I was caring for this sweet newborn girl as I adjusting to the news of her Down syndrome, AV canal heart defect, congestive heart failure, and pulmonary hypertension. Her future seemed so uncertain. I was worried about many, many things including if she was going to survive the next year.

When I decided to paint this, it made her nursery more personalized. But, the main reason I did this was to have a permanent marker in her room in case something happened to Jaycee before, during, or after her heart surgery. I was afraid she was going to die. Fear motivated it and a dozen other things I did in case the worst happened. While I had fear, I also had faith. I prayed for Jaycee to be fine and to live. I wanted her to be alright but I wasn't 100% sure she was going to be.

Years later, I now know that my worst fears didn't come true. Time gives us a perspective that we all wished we had sooner. The only way to get through those tough times is to live through them, which thankfully we all did.

In a few weeks, I'll have to say good-bye to the hand and foot prints on the wall as we head to our new house. I have something better than painted prints on a wall for our new house- I have Jaycee!

Therapy Tip: Speech & Language with Potato Head

Welcome to Therapy Tip Thursday!  This is the day that I share a tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs.

Today's tip is:

3 Ways to Use Potato Head for Speech & Language Treatment

I love using the classic toy, Mr. Potato Head, in sessions. In early intervention, this toy is quite useful in speech therapy in different ways. Plus, this toy is easy to find and relatively inexpensive. Here's just 3 ways to use this toy for therapy.

1. Body Parts: This is the most obvious way to use the potato head. Going over body parts as you place his parts in is a simple way to reinforce the parts. I like to pause before handing the child a new part from potato head and have them show me where their nose/ear/eye is before giving them the part.

2. Spatial Concepts: It is easy to reinforce simple spatial concepts such as in/out and on/off while putting the potato head together and apart. 

3. Articulation Cues:  When I have a child who is struggling with how to make a sound, I like to use the lips, teeth, tongue, and mouth pieces of a full potato head set to provide a visual cue. So, if I am trying to have a child say a /p/ sound, I might hold up the lips as a cue while I say, "Use your lips." I don't have the actual potato part around--just the piece the cues for the sound placement. These same parts can be used to introduce a sound to the child as you explain to them how to make it.

Therapy Thursday is for educational purposes only and not intended as therapeutic advice.

Why I Hate St. Louis (Nothing Personal, St Louis Citizens)

The list of things I hate is fairly short.

I hate birds that are within five feet of me, onions, dogs that insist I pet them, snakes, crowds, and St. Louis.

St. Louis, I actually love your impressive arch, your baseball team, your delicious Imo's pizza, and your malls.

But, I hate what St. Louis represents to me---health problems.

When my daughter was born in 2006, she was taken by a helicopter to a hospital in St. Louis. She was born with Down syndrome and an AV canal heart defect. She spent 10 days in the NICU there in St. Louis, 120 miles from my home. My husband and I stayed in St. Louis until Jaycee came home.

After she was released from the hospital, I made a few trips a month to St. Louis. In my exhaustive state of caring for a medically fragile newborn, these two hour trips to St. Louis to see a doctor for 30 minutes or so and then driving two hours home became miserable. I hated the traffic which doesn't exist in the small town I live in. I hated people honking at me when I didn't react with lightning speed at a green light. I hated being lost in this town where I couldn't just pull over and ask a friendly person for directions. The drive and the unfamiliar city just added to an already stressful situation.

In the past 10 years of raising Jaycee, I have made countless trips to St. Louis. The more trips I made to St. Louis the more familiar I became with traffic patterns and the areas around the hospital. As my comfort level of driving to and around St. Louis improved, the dread of going to St. Louis grew.

There were drives to St. Louis for my baby to undergo two separate heart surgeries. These drives were filled with trepidation as our lives were about to change for a time.

Then, there were the plain scary drives to St. Louis. In 2009, Jaycee had a hemorrhage after her tonsillectomy. Our local ER examined Jaycee and sent her home. But, the ENT that I spoke to at the St. Louis hospital requested we come in for observation overnight since Jaycee was at risk for more bleeding. My husband drove while I sat staring at Jaycee for the two hour drive watching for another bleed that thankfully never happened. But the stress of the original bleed on my 9 month pregnant body sent me into contractions. That was a drive that none of us enjoyed!

Then there was the frantic drive at 2 or 3 in the morning in 2009. Jaycee was being transferred from a local ER to the St. Louis hospital in an ambulance for respiratory issues. After Jaycee left in the ambulance, my mom and I started the drive over too. I remember eating a sausage biscuit on the way in an attempt to stay awake after an exhaustive day with Jaycee's breathing. I am not sure if it was exhaustion or stress but that was the best tasting sausage biscuit I ever ate.

One of the worst drives over to St. Louis happened in 2011. After Jaycee was put on a helicopter for a tachycardia caused by Wolff-Parkinson White syndrome, my husband and I drove over as fast as we could. We were warned by the doctors who loaded Jaycee on the stretcher that she might have more problems during the transport but they were prepared for them. Those words echoed in my head as I wondered what state we would find Jaycee in when we finally arrived at the hospital.

There were more trips to St. Louis transporting Jaycee for respiratory problems with our oxygen tank and oxygen saturation monitor in the van. These trips were stressful to say the least. If I told about every trip over to St. Louis that was frantic, this entry would be way too long.

At some point over the last 10 years, I started to hate driving to St. Louis. St. Louis became associated with stress, anxiety, bad news, scary times, unpredictable events, and doctors. I found myself griping the steering wheel so tightly as I drove to St. Louis that my hands hurt by the time I arrived at the hospital. The emergency drives had somehow caused my body to start reacting with stress even when the drive was just for an ordinary doctor's appointment.

I dreaded going there for any reason at all. Well, I still do. The Down syndrome organization that we are members of is based in St. Louis. Naturally, their events are also held in St. Louis. Each time, an event is announced I debate on whether or not I want to go because that would require me to drive to St. Louis. Sometimes, I sign up for an event and then can't get motivated to go to a town that has left me scarred as a parent. If someone suggests doing a fun activity in St. Louis, I usually decline for that same reason.

I tell this story not because I am proud of my bizarre dislike with St. Louis. I tell this story to show how medical issues and health emergencies can affect your thinking. It is almost like a post traumatic stress response that I have developed from years of being in a place that has given me scares and ugly emotions. Even when physical health issues improve or become stable, there are emotional and mental scars that remain.

For any of my fellow moms who have a place that they hate due to a negative memory, I feel for you. I pray that one day these places will just become another place on our map with no bad feelings attached to it.

Therapy Tip: Pace Cards for Phrase Development

It's therapy Thursday! This is the day that I share a therapy tip based upon my job as a pediatric speech-language pathologist and a mom of a child with special needs.

Today, my therapy tip is:

Pace Cards for Promoting Phrases

What is a pace card? Great question!

A pace card is a visual representation of a phrase or sentence. Since I work with toddlers, my pace cards are made for two and three word phrases. Here are two examples. The pace card on the left is a visual for a two word phrase and the right is a three word phrase. Pace cards are very simple, easy to make, and can be a great technique for some children.

I first read about pace cards in a book titled, Early Communication Skills for Children with Down syndrome.  This book is written by Libby Kumin, a speech-language pathologist who is well known within the Down syndrome community. I was able to listen to her speak at a Down syndrome conference once and learned so much from her.

When I read about pace cards in Libby's book, it was new information to me. I thought it was a great idea. Many children with Down syndrome are visual learners, so the pace card is a great tool for children who learn best visually.

After I read about this technique in her book, I started using it in my speech therapy sessions with a variety of children none of whom had Down syndrome who were struggling to talk in phrases. That was almost 10 years ago! Since then, I have used pace cards many times. Sometimes, the child will connect with it on the first exposure to it. Other children seem confused by the pace card. I have had a variety of responses. It isn't a magic fix. Like any technique used in speech therapy, not everything works for everyone.

How do you use a pace card?

Here's how I introduce a pace card with a toddler:

1. First, I model some two word phrases using the pace card. I point to each dot as I model each word. ("My turn.") Usually, I follow that with, "Did you see that?" Then I repeat the pointing at each dot and the words. Depending on the child, I may do this for a complete session before moving on to the next step. Other children move to step two on the same day.

2. The next step is to try to get the child to repeat both words of the phrase using the pace card with a pause between the words. After I use the modeling as described in step one, I then say, "Your turn. Say my (pause for child to say), turn. Great! My turn!" Again, I point to the dot that corresponds to each word as I am saying it. Some children will get stuck here for quite awhile as they will not combine words without the short pause.

3. Finally, the child will progress into repeating the phrase with no pause while I continue to model the phrase while pointing to each dot.

4. When I start to hear some spontaneous phrases, I usually discontinue the pace card. Some children use the pace card several weeks and some just need it a session or two.

Who should you try it with?
I have tried the pace card with a variety of children. I tend to try the pace card for children when I am not getting phrases from the usual methods. Again, some children click with it right away while others do not. I give it a few sessions before deciding if it's a method worth continuing with.

My recommendation would be to try pace cards if you are unsuccessfully trying to get phrases or longer sentences with a child.  

Therapy Thursday is for educational purposes and not intended as therapeutic advice.

A Mother's Thoughts When Her Child Doesn't Speak

When your child has delays in language, you experience many emotions and thoughts as a mother. When my daughter was born with Down syndrome, I knew she would have delayed language as children with Down syndrome begin speaking at a later age. However, that later age came and went with no words.

Today at age 10, my daughter says about 20 words clearly. She communicates mostly with sign language and her speech generating communication device. She is approximating more words than ever in the past year as she tries to make the vowel sounds in words while leaving off the consonant sounds.

I have had 10 years raising a child who was classified as either nonverbal or minimally verbal. As a speech-language pathologist working with toddlers, I am in constant contact with mothers who are concerned about their child's talking. With these experiences in mind, here are common thoughts a mother has as she waits for her child to speak.

1. "My child isn't talking, but it's still early."
This is the time when the mother starts to notice some delays with their child's language and speech. These are the early concerns. Some mothers at this point might seek help and have their child's development evaluated. Others might brush off these concerns and give the child more time.

When Jaycee didn't speak early on, I tried to find other reasons to be hopeful. When she learned the sign for more, I took comfort in the fact that she could learn language if she wasn't saying it.

2. "My child still isn't talking. She should be talking by now. Why isn't she talking?"
After some time, this stage of thought starts and lasts months or years. This is when a mother begins to question things they see or hear (or don't see and hear). By this time, the mother has most likely evaluated their child's language and has started some type of intervention. The mother is starting to get very worried as they see their child's peers saying much more than their child. The delays are becoming obvious to the mother and other people. This causes the mother stress and anxiety as their child's future may not seem to be taking a perfect path.

When Jaycee was 2.5 years old and only saying a couple of words, I had these thoughts often. I was stressed and worried about her. I threw myself into helping her at home working with her on sign language, oral-motor exercises, and verbal speech drills. I was convinced that I could do something to change the situation.


3. "A new sound/word! I heard it! It's coming!"
There will be a point when the child might say something new. Perhaps it's a new sound or noise. Perhaps, it is a new word. It will be exciting because you have been waiting for this moment. It will give you hope. It is the positive moment in your child's life that you have been waiting for. It will be met with celebration.

From here, mothers tend to take two routes. For some mothers, their child will go on to improve and speak. Their worries will slowly die down as their child begins saying more and the delays get smaller. For others like myself, the new word or sound stays just one word or sound. Nothing happens after that. This victory is short lived. Those of us mothers who continue waiting for a significant amount of words will continue on this thought process.

I remember the time Jaycee said "mama." I had waited for that word. It was exciting! Not only was it a new word but it was also the first time she had made a /m/ sound. I had reason to believe that Jaycee would now start saying more words and sounds. More words did come but months between them. Nothing happened quickly.


4. "She's not really talking yet. Something is seriously wrong."
By this stage, there is a minority of mothers who still find themselves with a child with minimal or no words in their spoken vocabulary well past the age of when these language milestones should occur. At this point, the mother realizes that something is very wrong. There has to be an underlying reason why the child isn't speaking. Now, the mother might seek out a second opinion, ask for more speech therapy, ask for a new treatment approach, or seriously consider alternative methods of communication. Tough decisions may have to be made and the mother may find themselves stressed at times over this thought.

When Jaycee was 5 years old and barely saying anything, I sought out a second opinion from someone with more expertize in this area. I was done waiting for words to come. It turns out my concerns were valid as Jaycee was diagnosed by the second opinion with severe childhood apraxia of speech, which was no surprise to me. It was then that we started the process to obtain Jaycee's communication device.

5. "My child may never be verbal."
Now years into a journey, a mother has come to the realization that their child may never talk at all or very little. This is a painful time for the mother. While this thought has always been in her head, the mother is now fully accepting this idea and coming to terms with what this may mean. This will affect the child's future educational and vocational options. This may also affect the child's ability to live independently. The mother does keep some hope of their child saying new words but some realistic expectations are now the focus.

For me, I had to sit with this thought for sometime to fully comprehend it. Even though this thought had caused me great fear years prior, it was now evident that it had validity. What did it mean for me and Jaycee if she never really talked? The scenaros played out in my head for months. I learned that I wasn't giving up on Jaycee talking if I accepted the fact that she never become very verbal.

6. "My child isn't talking much but any communication is good."
The thoughts in this stage with the mother revolve around thankfulness. Their child may not talk, so the mother is thankful for the things that she can do. The child may be using sign language, pictures, communication devices, or simple gestures to communicate. For the things the child can do, the mother is thankful. After years of hoping and dealing with emotions related to talking, the mother has reached a new level in her thinking. She is not focused on what the child is not doing but on what the child can communicate. When friends or family ask about why the child isn't speaking, the mother can talk about it plainly and without emotion.

For me, I went through this stage with Jaycee when she was about 8 years old. I didn't feel the need to compare her to other children anymore. I didn't feel guilty for not working on her language and speech at home. I started fully encouraging a total communication approach (sign language, spoken words, gestures, communication device). I was grateful that Jaycee had ways to communicate with me. Words didn't seem as important as communication in general.

7. "My child will probably not be able to have a conversation with me, but that's fine."
After years of hard work, questions, fears, and opinions, a mother has now come to the last stage. As she has watched her child grow older, the mother has truly come to terms with the fact that their child may never talk enough to hold an actual conversation. This now seems like a fact and not a loss. Her child is still her child with or without speech. They have found ways to communicate and bond that surpass words.

For me, this has been the last stage. As Jaycee has developed a small vocabulary, I doubt that Jaycee will ever speak in sentences or hold a conversation with me using words. But, it's ok. I'm not sad about it. We have our inside jokes, special sayings, and ways to communicate. Jaycee says what she can say and that's fine.




If you are a mom worried about your child not talking, hang in there. It's not easy. But, I can tell you that your perspective will change even if your child doesn't. No matter where you are on this thought process, then just know that you are not alone!

Therapy Tip: Getting Rid of Pacifiers

Happy Therapy Thursday--the day I share a therapy tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs.

Today's tip is:

Getting Rid of Pacifiers

Pacifiers. They have their uses for your baby. But, sometimes your sweet baby sucking on a pacifier turns into a toddler completely attached to it. A two year old with a pacifier in his mouth all the time is never a good plan, especially if your child is having delayed language.

Prolonged pacifier use can lead to problems with teeth. Teeth can become misaligned or misshapen due to pacifier use for long periods of time. There are some children that I have seen with open bites (a space between the upper front teeth and the lower front teeth) due to thumb sucking or pacifier use. Pacifier use also promotes an immature tongue forward position in the mouth due to the child sucking. This can result in a tongue forward position when speaking making speech sound errors. Like a bottle, the sooner you get a child off of the pacifier, the better.

How do you help your child get off the pacifiers for good?

First, understand that this won't be easy for some children. If it were, then it would have happened already. If you are dreaming of the day your toddler takes out his pacifier and declares that he is done with it, then you will be waiting for a long time. You are probably going to have to start this process.

Second, you need to be willing to try a variety of methods more than once to determine if they work or not. Many parents try something once and give up. Don't do that!

Third, some parents choose to strip all the pacifiers away and go cold turkey. Others fade the pacifiers away. Parents will allow pacifiers only at night or for decreasing times during the day. This is a decision best made by the family since they are the ones implementing it.

Some methods to try:

1. Keep the pacifier out of sight! I cannot stress this enough!! Find all the hidden pacifiers and put them up! Once your child wakes in the morning, get the pacifier and put it out of sight.

2. If your child asks for the pacifier, don't give it immediately! Determine beforehand what your plan is. If you are working on decreasing the time with the pacifier through the day, your plan will be different than those going cold turkey. If you are decreasing your time with the pacifier, then choose your next move. If they ask for the pacifier, you can -ignore, -wait until the child asks 5 times before giving in, -or wait a certain amount of minutes before giving it to them. Determine what your plan is and stick to it.

3. I have heard of people who have used a pacifier fairy as a cold turkey method. Basically, the child turns in the pacifier to someone (i.e. doctor) or leaves them on the porch for the pacifier fairy to pick up. If you do this method, just know there's no going back.

4. Several families I have worked with have snipped the ends of pacifiers to make them less desirable. I have always been leery of this approach because of safety and possible choking issues. I really don't like this method and personally don't recommended it. Some people love it though.

5. Another approach is to replace the pacifier with a different activity. Some children who are attached to pacifiers are constantly chewing on things and seeking oral input. To combat this need for putting things in their mouths, the child may benefit from other suitable things such as: chewy tubes, gum, sour candy, a toothbrush, or another food that is high in flavor.

6. A final method I have come across over the years is putting the pacifier in a special spot during the day. This spot could be a cup of water (to clean the pacifier) or a special box the child has helped decorate. This spot is the pacifier's home during the day and can only leave it when it's night time.


If you have a toddler that is strongly attached to a pacifier, then I hope one of these can help you. You can do this!!

Therapy Thursday is for educational purposes only and not intended for therapeutic advice.

Mothering & Communication Fails

I have noticed that I am messing up in some areas lately. Communication with Jaycee is different. Due to her Down syndrome and severe childhood apraxia of speech, Jaycee's spoken vocabulary is limited. She uses gestures, sign language, verbal speech, and a speech generating communication device for a total communication approach.

I am a speech-language pathologist who knows about best communication practices but I am also a mother. Like any mother, I have instincts with my child. I can anticipate her moves. I know what her mannerisms mean and what her preferences are. This is very helpful in many situations and circumstances. However, this also causes me to step in when I should be allowing Jaycee opportunities to be independent and communicate for herself.

As my 6 year old son grows up, I learn about new aspects of communication from him. He's constantly trying to negotiate with me, asserting his independence, and letting his preferences be known. He begs for sodas when I say no. He asks for 5 more minutes when I say it's bedtime. He sees something on television, and he asks me for it. My communication with him makes me see the areas I am failing in with Jaycee.

• Restaurants: Most of the time, I ask Jaycee what food she wants since she has all the food items on her communication device. However, I usually don't have her tell the waitress what she wants. I tend to order for her, which is a communication fail. In the past, Jaycee has ordered the wrong thing (an item not on the menu) or will get sidetracked on her talker and go off topic. But, I need to let her learn and make mistakes. Other times in the past, the waitress will look at Jaycee as she communicates on her device as if Jaycee is speaking a foreign language. Sometimes my tendency to speak for her in restaurants is to prevent these awkward social situations.

Jaycee's restaurant food page on her communication device

• Clothing: On the weekends, Jaycee chooses her clothing for the day. During the week, I tend to pick out her clothes. This may seem insignificant, but I haven't been choosing my son's clothing for some time now. Jaycee in general doesn't protest about what I suggest she wear. (Except for that one time.) But, I do need to do better at involving her in the process and giving her a chance to express her preferences.

• Waiting: My son often tells me to wait. He asks for more time for playing. He tells me he'll do something in a minute. He can respond to my commands in ways that Jaycee can't. If I tell her to do something, I expect it to be done almost immediately. If she protests by throwing herself on the ground, I don't try to negotiate. This is a big communication fail! I need to give her the same types of options that I do her brother. Maybe she just needs one more minute with her priceless I-Pad and things will go smoother.

So with these things in mind, I will try to do better with my daughter. I will try to help her to be more independent and to allow her to use her methods to communicate in these areas. I will try to remember to examine my routines with her periodically and remember that she is maturing.

Perhaps, I will have a restaurant success story to share here one day!