Saturday, April 30, 2011

This Little Blue Light of Mine, I'm Gonna Let It Shine

a guest post by my friend Melody

"Today marks the last day of Autism Awareness Month. I wish I could have done more to bring awareness but I fear I failed. I realize people are living their lives and while I am sure many read the articles and listen... many don't. I think we all tend to pass over things that don't touch our family. But that is just the thing with Autism.... it doesn't discriminate. Boy or girl...one year old or three. Autism doesn't care... in a far away land or Virginia.
It robs children of their voices and the ability to be social with others. It robs families of the ability to just pack up and go to the beach. It makes you take the longer road... the one with lots of hills and curves. The road with rocks, potholes and the occasional herd of cows standing still. Autism will bring mothers to their knees and give them the ability to stand up to anyone when it comes to their child. It tears a hole in your heart and then rebuilds it. It will gut punch you from time to time and slap you across the face when you least expect it.
It also gives to me.... it has given me courage I never knew I had. It has given me a voice in place of my sweet boys. It has given me a new heart... a better one. A heart that doesn't see the difference between the beautiful children playing on my son's special needs playground and the ones running, climbing and talking on the  ‘regular’ one. It has given me a new set of eyes... ones that don't look at the child in the wheelchair and then look away. It has given me eyes that know to look and smile at that child because all children are precious. Regardless of ability they are all perfect and someone's child, sister, brother, grandson, or nephew.
It has given me knowledge and the ability to learn and change and be a better mother. It has rocked my soul and filled me with faith that I know beyond any words he could ever say.... He knows I love him. He knows I would do anything for him and that I will never stop trying to give him everything he needs to grow, learn, live and be happy. And at the end of the day when I count my blessings I realize just how blessed I am.

Yesterday while outside with my boys I heard a voice from above me. It simply said, “I see you have your blue lights on.”
 I looked up to see a man standing on the roof of my neighbor's home. I smiled and said I sure do and he gave me the brightest smile I have ever seen. He shared with me that both of his sons live with Autism and how seeing my blue lights on warmed his heart. He said it made him feel like they belonged and I couldn't agree more. I have seen a few blue lights this month and it is a sign to all of us that we are not alone on this journey. I think our blue lights will remain on for as long as they last at our home... You just never know when someone will see it shining bright and realize that they are not alone and that everything will be okay.... Autism and all. I think maybe I didn't fail after all."


Melody and her sweet son the day she first met him
--the day Faith and I first met Melody --in Korea in May 2006

Thursday, April 28, 2011

Gifts of Joy



Despite the tenor of this past week's blog posts, life is not all serious at our house. Just take, for example, a few of the wonderful moments Joy brought us this week.

*****

Tuesday, at the end of breakfast, Joy made a request: "Beans. Please beans."

Her PCA and I looked at each other. "Did she just ask for the beans?" I asked.

Joy didn't wait for an answer, but repeated, "Beans,"  clarifying, "Downstairs."

Joy wanted to play in the beans I put away downstairs before her surgery at the beginning of March.

Joy got to play in her beans.


*****

This morning, at Joy's first visit to our new (wonderful) pediatric dentist, the hygenist asked me, "How old is Joy?"

Instead of answering her, I asked, "Joy, how old are you?"

"I'm ... four." Joy said in her tiny little voice. Feelling a little shy, she covertly showed four fingers in her lap, not quite willing to go all the way with a stranger.

*****

This afternoon, playing on the floor a few feet from me, Joy began to fuss. I said, "I cannot understand fussing. You'll have to tell me with words."

I was expecting to hear, "Books!" or "Snack!"

Instead, Joy made me laugh out loud when she answered, "Batteries!" pushing her dead toy toward me.

So I changed changed the batteries.

But I didn't turn the game on because I wanted her to put it back together first. Joy wouldn't. So I picked a piece up, put it into her hand and gave the instructions again.

Joy looked me straight in the eye, handed the piece back, and said, "Help, please."

A very polite version of, "Do it yourself, Mom."

*****

"Happy?" Joy begs. "Happy?" This is a request to the nearest grown-up to sing, "If you're Happy And You Know It" so Joy can do the motions:

"...clap your hands"

[the end of] "...give a kiss"


"...pat your head"

*****

Last  week Thursday, Hope and I arrived home from a dentist appointment to find  our mail carrier standing on the front porch holding a very large box posted in Pusan, South Korea, 48 hours before.

The older girls guessed, "It's from Amy! It's from Amy!"

The beautiful box at the top of this post was inside. Inside the beautiful box, we found:


a Happy Birthday puzzle with exactly four candles on the cake



a photo album of Amy since we saw her last October, including her birthday, ballet lessons,
and, if I'm not mistaken, her wedding to a very cute boy in her preschool class



an autographed Hangul edition of Steve Morrison's biography
(Morrison  founded MPAK: Mission Promote Adoption in Korea)



and this little book, autographed in purple marker by Amy, puzzled me until I opened it and found this:



"We're famous! We're famous!" the girls shouted. "In Korea, we're in a book!"
Here are bigger images of the main photos:


This portrait of Amy's family won first place in a photo contest for adoptive families in Pusan. The contest was sponsored by MPAK to promote open domestic adoption in Korea and the award was presented at a picnic for adoptive families we were honored to attend with Amy's family. I assume the accompanying text tells the story of how they found and adopted Amy, Joy's twin sister.



The photo on the right page of the little book is a version of this one: Amy's family and ours taken at our agency in Seoul last October, the day we first met. While I had met Amy when she was 13 months old, Amy and Joy had not seen each other since they were separated on day they were born.


This lovely necklace inside the beautiful box from Korea brought tears to my eyes.
Joy and Amy, joined inseparably by a single heart.

Please Pray for Dorothy's Family

Dorothy called me on the way to the hospital for an emergency MRI for one of their sons. In the past 24 hours, his collection of unexplained neurological symptoms has expanded to include periods of temporary blindness.

Please watch Urban Servant for updates. If she doesn't have the opportunity to post something, I'll ask her permission to update there when I hear anything.

Wednesday, April 27, 2011

What are the Odds My Child Escaped Unscathed?

Conservative estimates are that 75% of children recently adopted from Korea were prenatally exposed to alcohol. Other estimates place it as high as 90%. That makes the burning question in the Korean adoption community, "What are the odds my child escaped prenatal alcohol exposure unscathed?"

Just yesterday, answering a question about our experience getting an FASD diagnosis, I observed, "I don't know if [Hope] is once-in-a-blue-moon, or if there may be other families like ours out there struggling" who don't realize what they're dealing with. I meant: I don't know how rare Hope's case is because I haven't yet been able to find research data following outcomes in at-risk kids.

That just changed.

I just added the e-journal Fetal Alcohol Research (FAR) to my Index of links on fetal alcohol exposure. In the FAR archives, I found a 2010 article by Susan Astly profiling the first 1,400 children with known prenatal alcohol exposure to come through the doors of the United State's flagship Fetal Alcohol Spectrum network, the Washington State Fetal Alcohol Spectrum Diagnostic & Prevention Network. These children were seen between 1993 and 2005 and the data generated by a computer database. The results were:
  • 11% were diagnosed with FAS or PFAS (Partial FAS) *
  • 28% were diagnosed with "static encephalopathy" --permanent brain damage
  • 52% were diagnosed with a neurobehavioral disorder, like ADHD or learning disabilities
  • 9% showed no evidence of any central nervous system (CNS) abnormality
Be sure to click the link at the bottom of the summary page for the full text of this article.

There are some significant points in the full article that contextualize the summary findings. The 1,400 children studied were presented by their parents or caregivers for evaluation. This is significantly different than, for example, if 100% of Korean adopted children with known PAE (prenatal alcohol exposure) were proactively screened for potential effects of exposure. Instead, presumably, some level of concern prompted the fetal alcohol evaluation. The study does not detail the source or the threshold of concern.

But among exposed children about whom there was some concern, only 9% had no clinically discernable effects of their exposure.

That reminded me of our discussion in the comments on this post  FASD in the toddler years. The consensus of moms was that they knew something was very different about their exposed toddler long before anyone else believed them. I think this study suggests that when moms feel concern about their child with known exposure, most of the time, an evaluation will confirm their concern with clinically significant findings.

I highlighted the 11% FAS/PFAS finding  with an * to point out one of the frustrations of interpreting older research on FASD. Uniting all FAS diagnoses under the umbrella term "FASD" (Fetal Alchohol Spectrum Disorder) is comparatively recent. The author clarifies on page e137 of the PDF that all but the 9%  of the children with no CNS findings would fall under the FASD umbrella today. The percentage spread of outcomes does not mean that only 11% have an FASD, but that 91% of the children studied have an FASD.

I guess that makes the next burning question: How many adoptive families of exposed kids have gnawing undiagnosed concerns about their child? Do they know that an FASD evaluation should be their first, not their last, resort?

Our Wake-Up Call

This is the beginning of the story of our quest for an FASD evaluation for Hope.

Our wake-up call came in the middle of the night several miles in the sky above the Pacific Ocean. The word "call" doesn't quite capture the sound. Think shrieks of terror from an almost-six year old being pursued in her sleep by giant hairy spiders wielding sharp knives. Or something on that order.

Despite the din of the airplane engines,  Hope's night terror was wild enough to have flight crew members hovering in the aisle in teams of three for half an hour as Hope thrashed and screamed. No, they said, they'd never heard of a night terror much less seen one. We we sure there was nothing we could do to wake her up? How long would it go on? People were trying to sleep....

Sigh. It was like a meltdown in a store: a puddle of sobbing liquid toddler on the floor blocking the aisle, shoppers hovering, wondering what manner of child abuse produced this spectacle. Except that several miles up in the sky that night, there was no mopping up the spilled child to make a quick exit and put an end to every one's misery.

Night terrors (a nightmare from which the child cannot be awakened) are not a new thing for Hope. She's had them since we adopted her at six months old. They typically happened at night, but even occasionally during a nap. Nothing we tried completely extinguished them. Night terrors are one way her body responds to over-stimulation --like a play date or a birthday party. We did our best to minimize both. But sometimes for the sake of normalcy for the other girls, we attended a close cousin's birthday party, knowing that night terrors were the price we'd pay.

When we were planning a family trip to Korea last fall --our first trip back as a whole family --we considered that jet lag was likely to mess with Hope's fragile sleep pattern.  She needs a lot of sleep but has a hard time falling asleep and a hard time staying asleep. So I tried to compensate by not over-programming our days in Korea, making it a ten day trip instead of seven and asking Grandma to go with us for extra help.

My overriding concern was how Hope would sleep and therefore how she would behave in Korea. Another sigh. How many ways can pride manifest itself? I hoped we could avoid a scene that might make our Korean friends regret they had matched Hope with our family.

It seemed to work. After we arrived, Hope slept better than I anticipated and we had an amazing trip. Our Korean friends were as charmed by Hope as her preschool teachers had been. It seemed confirmation that our worries were simply borrowing trouble.


Hope and her foster mom, six years after they said goodbye


It was our first major trip away from home with Hope and I had no idea that we'd be coming home to a mega version of an after-preschool meltdown. It started with night terrors on two flights and continued for two months at home.

Hope has always been challenging. When she was three I had began to wonder about the small, but nagging, amount of alcohol her birth mother reported drinking. My best friend, Dorothy, was raising several kids with FASD. Hope's behaviors, while in the same ballpark, just didn't seem as extreme. Like I'd never seen Hope rage. Still, it was sobering to find ourselves in an NHA class where every other family was attending because they had a child diagnosed with RAD, FASD, or both.

However, by God's grace, NHA, with significant modifications, helped us turn a corner in our relationship with Hope. It drew my heart to her heart. Rather than wanting to run away and lock myself in a closet lest I have to interact yet again with our baffling, frustrating third child, I wanted to engage with her and help her.

So by the time we went to Korea, we were managing okay as a family. Some days were still awful. But on the whole, they were so much better than they had been that we were counting our blessings and trying to accept the hard times.

Then God stripped away every illusion that by dint of good parenting we could help Hope. She came home from Korea last October with two jet-lagged parents and three jet-lagged sisters. Forget therapeutic parenting. For a while I was barely capable of accomplishing laundry and dinner. Her sleep reserves were exhausted. Her heart had just been through the emotional wringer of being reunited with her foster mother and meeting Joy's twin sister's adoptive family. ("Mommy, was there no family in Korea who wanted me?")

Overwhelmed by so much more than she could process, Hope vanished. The child who stood in her place raged. Destroyed things. Bit her sisters. Most unnerving, her eyes glazed over sometimes and when they did, her human spark was temporarily eclipsed by something that barred its teeth, growled, drooled and gnashed at people. I never-imagined I'd hear myself saying things like, "When she growls at you, go away. You don't have to let yourself be bitten."

We were in damage containment mode for several weeks until God gave us the presence of mind to add it all up. He was showing us Hope without any supports. Hope at rock-bottom. We felt a surge of gratitude that God had enabled us to get by for so long. But there was no way we could live any longer with the illusion that maybe Hope was just an unusually intense child. God had already led us to parent her like a child with an FASD. Without support, she acted like a child with an FASD.

I wish I could share that it didn't take so much for God to finally wrench us from the pride that kept us from pursuing a diagnosis earlier. It was not just our image of ourselves as parents. The adoption world sends strong messages about honoring first mothers so I also had to move beyond the irrational fear that I was betraying Hope's birth mother by following up on her statement that she had consumed alcohol during the pregnancy. And the secular world's messages about the limitations of FASD are so hopeless, we denied the signs as long as we could rather than find our family on that road.

But our resistance was for naught. God delivered our wake-up call. By the time Hope came back to helself, two months after we returned from Korea, when we might have imagined the homecoming interlude a bad dream, Hope was on a waiting list for the next opening for an FASD evaluation. God in his great mercy, saw to it that we were committed and could not go back.


For the next chapters in this story see the Index of compiled links on FASD and scroll down to "Our Family's Journey with FASD."

Monday, April 25, 2011

Teamwork

Last week, a friend asked a question that resurrected memories of Hope as a toddler. Two kids with FASD are no more alike than any two  kids without FASD.  While friends recall their FASD-affected kids' toddler years as being easier than early elementary school years, my experience with Hope has been the opposite. Our hardest years so far, with the exception of two months last fall that I'll talk about in another post, were from the time she learned to crawl until about the middle of her fourth year.

Hope spent those three years being a  two year old. A young two year old:  that leading edge of  the "twos" when typical kids' motor skills take off and parents hold their breath waiting for the child's brain to catch up and begin putting brakes on their impulses. During those years, I was clueless. Now, given six years parenting her and our recent insight into her neurology, Hope's behavior as a toddler makes so much sense.

In fact, just a few days ago, she explained herself to me.

*****

Hope has begun occasionally chiding me, "But Mom. You didn't tell me that." Whether or not I remember telling her before is beside the point. She didn't hear me. It didn't register. It never made it into long-term memory. Whatever.

Yesterday, Hope was badgering her daddy for an answer to a question. She loves him and wanted him to answer, "Yes." I knew she wasn't deliberately being rude. Instead, she was acting like a child who didn't know better.

So I said in my neutral voice, "Hope, it is good to ask Daddy's opinion. But it is rude to ask over and over again. That is called 'badgering' and it is disrespectful. You need to stop repeating and listen for his answer."

Hope stopped repeating the question and said to me, with hurt in her voice, "But Mom. You didn't tell me that." She meant: "I wouldn't be rude to Daddy on purpose. I didn't know I was being rude. Why have I never heard this before?"

It was a tiny epiphany for me. We're a team now, Hope and I. She has come to rely on me to make up for her working memory deficits.She depends upon me to supply executive functioning for as long as it takes to move a rule from working memory into long-term memory. This can take a few years. (I'm on a quest to see if I can learn to facilitate it happening faster.)

But it does happen. Yesterday Hope came in from playing outside to get a jacket. She took off her shoes at the door, crossed the carpet in her stocking feet, put on her coat, walked back to the door, put on her shoes, and went back outside. Sometime in the past year, "Shoes off at the door" slipped into long-term memory.



*****

When Hope was a toddler, she followed me everywhere like a puppy on an invisible leash. She could not stand to be separated from me even for a few  minutes. When I went away from her --say left her playing in the living room while I did dishes in the kitchen --I could count on maybe two minutes of peace before she provoked some trouble that demanded my presence again.

But now I think I get it. As a toddler, there had not yet been sufficient time for Hope to develop much long-term memory or to learn any self-regulation skills. She relied on me to make up for her memory and impulse deficits and was no more capable of acting appropriately apart from me than I would be capable of driving a car without my brain.

Hope and I were invisibly tethered like a lap top to an external hard-drive. During her toddler years, the cable between us was unnervingly short because so much of the information she needed ready access to lived on the hard drive: my brain.

I remember it was exhausting. It was a battle to not resent the constant demands on my attention. And I did resent it because I had no framework for considering it normal. We didn't know Hope has an FASD and in the absence of any visible disability, assumed she was typical. We had not even read up on FASD "just in case" because we did not understand she was at risk.

In the toddler years, you may not be able to confirm that there is any deficit, not to mention that you don't have enough experience yet to know your child's unique threshold for for things like long-term memory and for learning self-soothing. But if you know your child has been exposed to alcohol, try out the theory that she, right now, may be incapable of doing this toddler thing without you.


The only way to get beyond this with your sanity intact is to engage: plug yourself into your toddler and be her brain. The other option is to disengage and incur the havoc wrecked by a toddler on the loose with no brain. Metaphorically speaking of course.

The intensity of these toddler years, the thousands of repetitions, redirections and reminders are an investment in your future. For many kids, at some point, some things will cross-over into long term memory. For the things that take longer, or may never cross at all, you'll be developing supports and work-arounds.

Like this:  Hope just came to me from the other end of the house, bearing her Easter basket. She set it on my desk and asked me to keep it for her, explaining, "I know it isn't snack time and if you are keeping it, then I won't take any candy without asking." That was her own idea. She knows herself well enough to not trust her impulse control, so chose to rely on a support (me) to prevent a problem.

Back in the thick of her toddler years, I never guessed Hope would not be Velcroed to me forever. That she would begin showing she could make sound decisions (sometimes). Obviously, she and I are learning to work as a team. But that is a good thing. Studies show that most kids with an FASD will need a support team into adulthood.

Sunday, April 24, 2011

IQ Myths in FASD, Part II

In the previous post, I shared research showing that 86% of people diagnosed with an FASD have an IQ in the range of "normal." Nevertheless, people who have an FASD are often described as "cognitively impaired." While IQ is a common measure of "cognition" in the world of the non-exposed, the effects of alcohol on the developing brain can leave intellect relatively intact while still having devastating effects on other areas of brain function.

For example, citing Ann Steissguth's work, Teresa Kellerman wrote: "The academic abilities of individuals with FASD are below their IQ level, and their living skills, communication skills and adaptive behavior levels are even further below IQ levels. For example, a person with FAS with an IQ of 80 may have a reading IQ of 78, a spelling IQ of 75, a math IQ of 70, daily living skills IQ of 68, socialization skills IQ of 65, communication IQ of 62 and adaptive behavior IQ of 60. This indicates that when a person with FAS/FAE is evaluated, a battery of tests be done that include a test of level of functional abilities and daily living skills." (Kellerman, 2003, here)

In Kellerman's example, while an IQ of 80 placed the child in the "typical" range, some of the child's academic skills are borderline (which is 70) and the child's daily living skills and ability to fit into his  changing environment are below that. So IQ alone is not predictive.

But what if Kellerman had chosen for her example an affected child with a higher IQ? It might seem like parents of a child with FASD and an IQ of 110 could take some comfort in the wiggle room between their child's IQ and the lower end of the typical range: any lower sub-scores would have to be significantly discrepant to fall below 70.

That's IQ Myth #2: We can expect better outcomes for exposed kids with higher IQ scores. False. The research shows that children with higher IQ scores may actually struggle more because their intellectual gifts may mask significant deficits in other areas. Teachers and parents expect more of bright students and may fail to see that a child's shortcomings arise from brain damage, chalking them up instead to stubborn will, or to lack of motivation. Children with clearly impaired IQs, by contrast, are more likely to receive developmental disability services and special-ed. They may have  have better outcomes because they generally receive the accommodations they need starting at an earlier age.

Let me give an example. Hope's IQ is well into the normal range. She thinks with creativity and originality. She loves art and important fine-motor skills like her ability to print, color within the lines and use scissors are not impaired. I'm sure she would have done fine academically in Kindergarten and the first few years of elementary school because teachers and parents expect to oversee every child's executive functioning.

In Kindergarten, they place a photo of the child on her locker to show that it is hers. The teacher sends home checklists and assignment sheets (for the few assignment there are); parents help the child complete the assignment, put it back in the backpack and, if the child forgets, puts the backpack on the child going out the door.  Back at school, in Kindergarten the folder is removed from the backpack by the teacher's aide. In First Grade, the child has to turn in the folder. But if she forgets, the teacher sends her back out to her locker to retrieve the folder.

I think you can see where this is going. By second grade, when the photos disappear off the lockers, even finding the locker may be a problem. By third grade, when kids are expected to write down assignments in an assignment notebook that parents are supposed to sign and return, it won't matter if the bright child with FASD was given a notebook on the first day of school. The system hinges on her understanding and being able to comply with the record keeping. But she can't write an assignment in the notebook if she has no idea where it is. Her parents understand the blank pages to mean homework is given only occasionally and are shocked when the teacher sends home a note saying either the child makes up a long list of missing work, or she will fail some subjects this quarter.

Even bright kids, when they have invisible, unaccomodated memory and planning deficits, can start to fail when they reach the age where the system expects more of them than they are able to give. They cannot get the "A" they are capable of if they can't remember an assignment was ever given.

You're probably already thinking of simple things that might be done to help this bright child compensate for her deficits. But you have an advantage: you know there are deficits there being masked by this child's IQ.

That's why part of the diagnostic evaluation for FASD focuses on assessing a child's abilities in ten different brain domains, not just IQ. (This is true in Minnesota, where the ten-domain concept was developed. I don't know if this is yet a national standard.) The Ten Domains are:
  • Achievement
  • Adaptation
  • Attention
  • Cognition
  • Executive Functioning
  • Language
  • Memory
  • Motor
  • Sensory/Soft Neurological
  • Social Communication
(For a more detailed discussion, including definitions of each domain, see Jeannette Lang's 2006 article, "Ten Brain Domains...Parameters for Fetal Alcohol Disorder Diagnosis and Follow Up." Definitions are on page 4.)

As Lang summarizes: "Developing intervention recommendations linked to specific functional CNS deficits [within the ten domains] can maximize the value of the assessment and assist individuals and their families to learn to live with the FASD disability. Hence, the multi-disciplinary diagnostic team of professionals creates the road map for the future rather than just pronounce the diagnosis, utilizing the assessment data as the basis for help." (Lang, 4)

So here's the truth: between Hope's IQ and our misunderstandings about prenatal alcohol exposure, we feel blessed --literally --for the wake-up call last October that led to her diagnosis with an FASD. Now. Not several years from now when things begin getting tougher as her peers begin to mature faster than she does in some critical areas.

Saturday, April 23, 2011

IQ Myths in FASD, Part I

I retrospect, I can identify two powerful beliefs that kept me from connecting Hope's behaviors as a preschooler to her known exposure to alcohol in utero.

I've talked about the first one: my mis-impression that the amount of exposure reported was too small to be significant. Exposure was something that had happened to Hope in that gray fog of her past before we knew her --likely, in fact, before her birth mother even knew she existed. I was personally disconnected from it except on an intellectual level: the eight words in Hope's referral describing her mother's alcohol consumption.

Far more powerful was the belief that grew stronger every passing day: Hope was a bright little girl. She was curious and persistent in satisfying her curiosity. She loved books. She was adept at doing puzzles. Sorting by attributes like shape, color, and size came easily. She often chose creative, pretend play. She seemed socially perceptive; very early she figured out our personal hot buttons and engaged those uniquely. Daddy responded to tears; Mommy to noise; Mercy to touching; Faith to messing with possessions.

Almost everything I had read about FASD cited "cognitive impairment" as a feature of the disorder and despite having been a psychology major in college, I never considered that "cognitive impairment" could mean anything besides "lower IQ." Hope did not strike me that way at all.

My idea, wrong as it was, did not develop in a vacuum. Back in the day when the textbooks I read in college went to print,  FAS as a diagnosis was only about ten years old. Fetal Alcohol Syndrome was first identified in 1973 in children born to alcoholic mothers. The first cohort of identified children shared the now-classic facial features, along with microcephally and stunted growth. Today, we recognize that the original cohort represented the most physically affected children, who may also (although nothing is a sure thing) have more impacted IQs.

Those were the children who gave FAS a face and a name. It took time for researchers to begin looking into the phenomena of children born to mothers who drank during pregnancy and to conclude there is a range of outcomes --hence the current umbrella term Fetal Alcohol Spectrum Disorder. In 1996, in a study looking at secondary disabilities in children with an FASD diagnosis, Streissguth and her colleagues concluded:

"The sample of 473 individuals in the study included 178 with Fetal Alcohol Syndrome (FAS) and 295 with Fetal Alcohol Effects (FAE). The range of IQ of individuals with FAS was from 29 to 120, with mean IQ of 79. Range of IQ of individuals with FAE was from 42 to 142, with mean IQ of 90.  Only 16% of all the individuals with FASD in this study legally qualify as having mental retardation.  This means that 86% of the individuals with FASD have an IQ in the "normal" range." (Teresa Kellerman, 2003, here.)

Is that as startling to you as it was to me? My bright little girl with ARND is in the vast majority --in fact, she happens to fall well above the mean. And she still has an FASD.

My ignorance didn't change Hope's neurology. It just kept us in the dark.

Friday, April 22, 2011

Two Little Words

Yesterday
I thought
I imagined it.

Today
when I handed her cup
she said it
again.

Spontaniously.

"Thanks, Mom."


Joy: age 4 years, 1 month

Thanks Grandma!


egg by Mercy

bunny by Hope

Thursday, April 21, 2011

Mercy and iLs

Mercy's choice of free play at the end of her first iLs session

As I shared at the end of my last post on auditory processing, I was surprised, reading Teri Bellis's book, When the Brain Can't Hear, to find internal bells going off about possible auditory processing deficits in Mercy and Joy --more so than Hope.

Mercy so far has played only a supporting role in this blog story because she is just so.... Well, I will say it out loud: easy to parent. Which doesn't give me much to write about. But the truth is: God knew ahead of time we would need one "easy" in our repertoire. Mercy is a great mercy in our family life.

We were waiting in our agency's Waiting International Child program when we received Mercy's referral. Some unusual circumstances led to our match being made in Korea and we didn't even need to see her referral to feel sure that she had been hand-picked for us, then labeled WIC to technically match her with our family. (All speculation of course.) The important thing for this post is: there is nothing in her background to make her at known risk for anything.

Mercy has excelled at just about everything she has tried, including her first standardized tests for home school last fall. One month into first grade, she tested at a third to fifth grade level on every test and sub test --with one exception. She scored slightly below average for grade level on a sub test that required her to select the beginning sound of each word in a list. Not a dismal score since she was still within the range for typical first graders. But it was a 49 point discrepancy from her lowest score on any other measure.

I was surprised (because I had not guessed that), but also not surprised (because I have lived with her for seven years). I recently rediscovered a list of some of her speech quirks at age two, like "The kitty tickled him with my back," when I thought she mean to tell me, "The kitty tickled my back with his tail."

Or, "Hope is my brother." "Honey, Hope is your sister," I corrected. "Yes. Faith is my brother, too."

Mercy mixed up other opposites  like hello/goodbye; hot/cold; happy/sad. And I remember thinking how sincere she was. She made no effort to correct herself. Like she had no idea she had made any mistake. But I chalked it up to her precocious ability to speak. She was talking in short paragraphs at an age when many of her friends were still majoring in one or two word phrases like,"More juice!" and "Night-night!"

She seemed to outgrow many of these speech quirks as she grew older, as I expected she would. Mercy's odd intonation lingered --a slightly muffled quality like she has a chronic sinus infection (even though she doesn't; allergies are under control, too). But everyone understands her and no one has raised any concerns that her voice sounds a bit off. It is just her. So much so that I have found her few remaining quirks endearing. Like until Joy's surgery, it had been a while since the word "hospital" was routinely afloat in the family. Recently, when the word came up again, it made me nostalgic about Mercy's preschool years to hear her still pronounce "hospital" as "hostable."

As an introverted toddler, when taking  her social cues from the environment, Mercy didn't copy audible cues quite right. For a few years, her demeanor at any cousin's birthday was family entertainment. The other kids would be party-happy, but when Mercy copied them, her laughter came out almost manic. When they were sad to leave their fun, Mercy moped like Eeyore.

It all came together reading Bellis's book: could Mercy's quirks reflect what the world sounds like to her?

Solely based on the standardized test finding last fall, I had already decided that since we would be buying an iLs system for Hope, we would also use it with Mercy before next fall's standardized tests and see if it helped pull up her ability to correctly identify the first sound in a word. But after reading Bellis, I asked the OT who will oversee our iLs program (which is done at home) to give Mercy a formal auditory discrimination pre-test.

Besides the iLs pitch discrimination test, she administered the SCAN. Mercy wore headphones, Against background noise for competition, her ears heard words she needed to repeat. The therapist wrote down what Mercy said. I haven't seen the scored test yet, but from what the therapist showed me, Mercy had a hard time discriminating individual words. Many of the words she repeated back (some of which she could not hear at all) were distorted fragments. Like when the word was "find," Mercy echoed "ind"--not just dropping the "f," but also morphing the vowel sound into the first syllable in "Indian." She was better able to echo back whole sentences --because, the therapist explained, the collection of words in the sentence contextualize each other and help her decode a message that makes sense.

The other significant finding is that Mercy is much better at discriminating sounds that go in through her right ear than her left. That also made sense because while her gross and fine motor skills have always been on target, she is clumsy at tasks that require bilateral coordination, like cutting with a knife and fork, and handling balls. The right and left hemispheres of her brain do not communicate very well.

So I laid awake in bed last night (listening to Joy reciting  "Big Pig on a Dig" and "Barn Cat" at midnight) wondering: How long would Mercy have flown under the radar in a bricks-and-mortar school like she did in private-school Kindergarten? An "A" student with model behavior doesn't attract attention. Would I have put it together if I didn't spend all day every day with my daughter? When would I fit in the hour a day of auditory integration therapy? After she came home from school and was worn out from the mental effort of hearing her teacher's instructions over the classroom din?

And what about how hard she has to work to make sense out of what she hears? Might that explain the vaguely anxious, over-eager to please trait that has been part of her personality since the day we met her?

So many of these questions don't have answers. But auditory integration therapy like iLs may be even more crucial for Mercy than Hope. So Mercy started iLs today, too. And with several baseline tests behind each child to compare to post-tests, we won't have to rely on my impression of whether iLs helped them or not.

"When the Brain Can't Hear"

Integrated Listening Systems or iLs has been on my radar for a few years since my friend Dorothy began using it with her children. (Dorothy's experience with iLs is here.) I was reminded of iLs early this year, when Hope's OT evaluation indicated a "probable difference from peers" in auditory integration or auditory processing, which is the brain's ability to make sense of sensory input that comes in through the ears. The ears hear just fine. But the brain cannot accurately comprehend what the ears hear. And if the brain cannot adequately decipher auditory input, it cannot translate it into an appropriate response.


Auditory processing disorders exist independent of FASD. People can have auditory processing differences with zero prenatal exposure to alcohol. But auditory processing differences can co-exist with FASD. In the case of FASD, the common (70%) co-occurrence of ADHD may add another reason why the brain can't hear: it checked out. While the attention switch is toggled to "off," the proverbial tree can fall in the forest and even though Hope is there and her ears hear it, her brain isn't engaged so she essentially hears nothing.

We did not make a lot of progress with Hope in traditional Occupational Therapy --and now that we know her diagnosis, we know why. But we learned a helpful vocabulary for helping Hope recognize her level of energy and very helpfully, worked through a very long list of calming strategies and identified the ones that most help her.

The biggest benefit of OT from my point of view was being able to interact with her therapists. It took Hope several weeks to relax down out of good behavior during therapy. (She has the ability to contain herself for a few hours at a stretch on a good day when she's motivated. That is how she skated through two years of preschool without raising any red flags with her teachers for ADHD.) But once she relaxed enough to be herself, her therapists had some keen insights into her behaviors.

Like this: "What do you think of the idea that Hope has a much easier time attending to things than to people?"

That is one of the things about Hope that made me feel crazy for wondering if she had ADHD. In some cases, like free play or even doing an assignment like a page of handwriting, Hope seems to be able to stay on task. But other times, getting her to attend is like trying to catch a butterfly without a net. I am too close to  her too much of the time to see the bigger picture like her therapists could. They observed a pattern to her inattention that I did not.

While Hope is very social and according to the recent testing, her ability to read and respond to non-verbal social cues (like facial expression and body language) is not impaired, she still has a harder time interacting appropriately with grown-ups. Maybe because her interactions with grown-ups almost always require her to accurately perceive and decode auditory input: what they are saying.

*****

Hope's reaction to verbal requests is unpredictable. But auditory processing differences might partially explain it. Here's an example. With bedtime approaching, I may say, "Hope, it is time to go upstairs, put on your pajamas, and brush your teeth. Then I will read you bedtime stories." In fact we follow that same routine every night so it is hardly news to her --unless she rarely hears (understands) it the same way twice. Listen to how loaded that ordinary request might be depending upon what part of it she hears.

"Go upstairs." She thinks she is being sent to her room (a safe space for collecting herself when she's overwhelmed) which feels like she's being punished which feels unjust because she isn't aware she did anything wrong so she melts down, unable to comply.

"I will read you bedtime stories." But then I don't, waiting for her to comply with the pajama and tooth brushing requests, which she did not hear. It feels like mommy made a promise but didn't keep it so Hope melts down, unable to comply.

"Put on your pajamas and brush your teeth." Hope has no natural sense of time so isn't aware bedtime is approaching. And mommy seems to be giving arbitrary orders with none of the accustomed relationship words, which must mean she is really mad at me about something. But I didn't do anything. So Hope, wounded and angry, melts down, unable to comply.

*****

So what if Hope has a much harder time attending to people because she has auditory processing deficits?

One approach would be to deliver the message some other way than through her auditory system. Like we could make a visual picture schedule labeled "Bed Time," point to the schedule and say "Bed Time" and let the pictures cue her to put on  pajamas, brush teeth and read stories in that order.

But in Hope's case, we know from testing that she doesn't have problems with other key parts of social communication, like non-verbal cues. So she's not confused because people, while talking, also gesture and make facial expressions. She may be struggling in part because she's overly dependent on her non-verbal strengths, which doesn't get her very far in a world driven by spoken language.

Her non-verbal strength suggests another intervention. Rather than issue the bedtime instruction from the other room, I need to engage her non-verbally: be near her, touch her to get her attention, establish eye contact, gesture to my watch and point to upstairs, sign putting on pajamas, brushing teeth, reading stories while I say the words to ensure my spoken message gets across in a way that is meaningful to her.

Yet another intervention is auditory processing therapy: we can make an attempt to help Hope re-wire her neural circuitry to more efficiently process auditory input including spoken language. iLs is one  of several therapies for auditory processing deficits.

In the process of evaluating iLs, I read two books on Auditory Processing Disorder (APD), Karen Foli's memoir of her son's journey with APD, Like Sound Through Water, and When the Brain Can't Hear by Teri James Bellis. I thought I was reading to find out if auditory integration therapy was worth the investment (in time and money) for Hope. But I came away impressed that Mercy and Joy  --neither one exposed --may have even clearer signs of auditory processing deficits for reasons I'll discuss in my next post.

So we're going ahead and starting iLs today with Hope, not quite certain what the results will be (with organic ADHD in play), but willing to try since we are sure it will help Mercy and it may be the only form of auditory processing therapy accessible to Joy.

Wednesday, April 20, 2011

Prental Exposure to Alcohol: compiled links

My Korean adoptive mom friends have asked for an index to the information I've shared or linked to on the subject of prenatal alcohol exposure. I have started organizing the information by subject below and will continue to update this list in the future. Rather than bump it back up to the top each time I add something new, I will put a permanent link to this post on my sidebar under "A Gathering of Days."

Korean Adoption Specific

Considering adopting a child at risk for FASD or other special needs?

Current Reserach on FASD
FASD over the Lifespan

Diagnosing FASD

Parenting in FASD

Resources

Our Family's Journey with FASD

I have to acknowledge how indebted I am to the adoptive mom bloggers in my sidebar, who are women of faith parenting kids with FASD. I have learned so much from them. These women first identified many of the sources I have compiled here: Dorothy at Urban Servant, Kari at Coffee Catharsis, Julie at Not Just an Ordinary Life and Megan at Columbian Brewed. Ladies, God uses you to hold up my weary arms every day.

Monday, April 18, 2011

History Journal 3: The Sixth Minnesota, Company E



"The Union forever! Hurrah, boys, hurrah!
Kill every Indian, papoose and squaw;
The Indians must be slain or driven to the plain
And silence the war whoop forever."
   rendition of “The Battle Cry of Freedom”
attributed to soldiers in Minnesota, 1862

*****

Secondary sources are the door to primary ones. In this case, I need to know more about Louis Thiele and the movements of his company in Sibley's army so I can identify the primary sources, like period diaries, letters and reports, relevant to Thiele's vow to kill Indians. (If this is confusing, click the History Journal tag to catch the beginning of the story.)

I love Google Books. Five years ago, a task like this required a trip to the Library at MHS. Now I just sit down at my computer and Google.


*****

The official history of the Sixth Minnesota Infantry, Company E shows that Louis Thiele, "a Prussian settler of the neighborhood, whose family had been murdered by the Indians," joined Co. E as a Private at Fort Ridgley on August 30. The next day Thiele was assigned to the burial detail that was ambushed and besieged at Birch Coulie. Thiele’s company was held in reserve during the battle at Wood Lake. (The book laments that the company never fought; they spent two hours standing at the ready, itching to shoot.) Next, Company E was assigned to guard the Dakota prisoners at Camp Release. Then they were detailed to accompany the prisoners’ convoy to South Bend, with two men of Co. E assigned to march alongside each wagon of Dakota prisoners.

Verifying Thiele's enlistment I noticed how many men of Co. E were natives of German-speaking countries. So I did the math. 90% of the men who volunteered for that company before the Dakota War began were native speakers of German, as were 15 of the 16 officers in the company. It makes sense that Thiele would join a company of German-speakers.

But what does this finding mean for the story of the attack on the prisoners at New Ulm?

(On Sunday, November 8, 1862, an army convoy of Dakota prisoners under military escort was attacked by enraged German townspeople outside New Ulm in Brown County, Minnesota. The Dakota men, chained to one another and seated in the beds of wagons, were helpless to defend themselves from the stones and clubs hurled at them. Two Dakota died and others were injured.)*

Did Sibley deliberately make Co. E the inner ring of guards because he knew they would be passing through German-speaking territory? Or was it a blunder to make Germans the Dakota prisoners’ last line of defense? Could that explain why the New Ulm plotters put women up front in the attack? Did they guess a German soldier might hesitate to bayonet a German woman? And what of Thiele himself, who had vowed to kill any Indian who crossed his path? Did Thiele vigorously defend the prisoners in the wagon under his charge?
  
It looks like the plan to shell the camp of surrendered Dakota at Camp Release originated in Co. F of the Sixth Minnesota, right next door to Co. E. Someone informed Sibley of the plot after it had been brewing for half a day and Sibley squelched it. Companies E and F were also charged with guarding the prisoners there. The stories of verbal and physical abuse of the prisoners come from those companies, too. Yet if E and F had distinguished themselves as abusive before November 8, why would Sibley put them in positions of close proximity to the prisoners on the march??

I'm not satisfied with the tendency to dismiss allegations of the abuse of Dakota people with the idea that Sibley's men were soldiers under military discipline. They were not. They were largely untrained citizens who were either new recruits at the time the war broke out or who, like Thiele, enlisted after it began.

If the government recruited 911 survivors and assigned them to guard duty at Guantanamo and the prisoners there alleged abuse at the hands of their guards, people would not protest, "The allegations are mere political rhetoric; U.S. soldiers would never behave with such unprofessionalism." They would say, "What in the world were they thinking assigning 911 survivors to Guantanamo Bay?"

Yet that is exactly what we did in 1862.

*****


So now I know I'm looking for period documents from Companies E and F of the Sixth Minnesota Regiment of Volunteer Infantry, for period stories from the Renville County burial party, Birch Coulie, Wood Lake, and the prisoners' march from the Lower Sioux Agency to Mankato --particularly sources commenting on how Dakota people were treated by soldiers in those places.

By the way, I had no idea when I decided to take up the subject of Louis Thiele, that he had anything to do with the story of the attack on the Dakota prisoners outside New Ulm I worked on a few years ago. History is like this: routinely surprising.


*If you want to read more, your library probably has a copy of Bakeman and Richardson, eds. Trails of Tears: Minnesota’s Dakota Exile Begins (Roseville, MN: Park Books 2008). The chapter on the attack at New Ulm was written by a friend, Lois Glewwe. Another friend, Walt Bachman, wrote an appendix on the deaths of prisoners in the New Ulm attack plus a chapter about a later plot to lynch the surviving Dakota prisoners in Mankato. In the last chapter, I explore the historiography of the story of the attack at New Ulm: how it has changed over time and why it lives on in modern memory.



Sunday, April 17, 2011

Can We Talk About the Toddler Years With FASD?

Currently, most adopted Korean children are coming home at 16-18 months or older. Many parents know from their referral that their child has been prenatally exposed to alcohol and those parents watch their kids and wonder: Is this typical two year old behavior, or does it hint at an FASD?

Can I ask those of you raising kids with FASD to look back at the toddler years? What about your child who has an FASD was different during their toddler years than the typical "terrible twos"?

Here are the characteristics MOFAS lists. But you'll see why parents are confused: many of these features could characterize developing attachment and/or be dismissed as within the range of  typical.

Toddlers and Pre-School Children with Fetal Alcohol Spectrum Disorders
  • Poor memory
  • Hyperactivity (can't sit still)
  • Frequent temper tantrums
  • Low hearing threshold
  • Lack of "stranger anxiety"
  • Problems adapting to new things and new situations
  • No natural fear of danger
  • Perceptual difficulties
  • Language problems
  • Poor motor coordination
  • Delayed toilet training
  • Difficulty following directions
  • Easily distractible
  • Short attention span
  • Deveopmental delays
  • Speech, fine and/or gross motor delays
  • Lack of connection between actions and consequences
  • Erratic sleeping and eating patterns
  • Have little or no sequential learning
Source: Minnesota FASDRN binder, MOFAS, no date, no page

So what, if anything, raised red flags for you when your kids were toddlers?

There is no need to reinvent the wheel in the comments section. If you have old posts about this on your blog, please feel free share the links. My friends adopting alcohol-exposed toddlers thank you in advance :).
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Saturday, April 16, 2011

Risk and Protective Factors in FASD

I certainly don't have enough experience with FASD to make recommendations about books. But since MOFAS (the Minnesota Organization on Fetal Alcohol Syndrome) gives this one to parents receiving a new FASD diagnosis, it must be a good one:

Fetal Alcohol Syndrome: a Guide for Families and Communities by Ann Streissguth

I marked many passages of interest, but chose to share this one because of the conversations we're having in the Korean adoption community about this: does growing up in a resourceful,  high-functioning family make a difference in outcomes for children with FASD? Thanks to a couple of friends who are friends to adults living successfully with FASD + supports, we have concluded that this is what we work and pray for.

Streissguth says: "To facilitate understanding, our secondary disabilities study also examined risk and protective factors associated with secondary disabilities. Risk factors are those associated with elevated rates of secondary disabilities. Protective factors are associated with lower rates of secondary disabilities. Our analysis revealed eight factors that were almost universally protective... There were five environmental factors: 1.) living in a stable and nurturing home of good quality, 2.) not having frequent changes of household, 3.) not being a victim of violence, 4.) having developmental disabilities services, and 5.) having been diagnosed before 6 years of age. These protective factors give clear indication to  families, service providers, policy planners, and communities about necessary actions to take to prevent and overcome these devastating secondary disabilities [mental health problems, disrupted school experience, trouble with the law, confinement, inappropriate sexual behavior, alcohol and other drug problems]. There were also several intrinsic factors (characterizing the individuals themselves) that were risk factors for secondary disabilities. In general, higher rates of secondary disabilities were observed for people who had FAE [used here as all FASDs besides FAS]; higher FASB [Fetal Alcohol Behavioral Scale] scores rather than lower; and an IQ score above rather than below 70.

These risk factors give clear indication of who among the population of people with FAS/FAE that we studied were most at risk for secondary disabilities. They are those who are less disabled by conventional standards (i.e. do not have full FAS and do not have mental retardation) but still possess obvious fetal-alcohol behaviors that get them into trouble." (p. 110-11)

Early in the same chapter, Streissguth offered this commentary: "Imagine these disabilities [attention deficits, memory impairment, hyperactivity, disorientation in time and space, impulsivity, arithmatic disability, difficulty abstracting] in a person who generally looks and acts retarded; such behaviors would not be surprising and would probably generate sympathy, nurturance, and the desire to help. If, however, you imagine these behaviors in a person who seems to be quite "normal" in speech and affect and does not have mental retardation, either to the casual observer or according to IQ tests, then it is much more difficult to view these as reasonable behaviors.... Faced with this discrepancy between how people behave and how we expect them to behave, we derive our own hypothesis. If someone has recently been in an automobile accident, we might link the unexpected behavior to some brain trauma. In the absence of a meaningful 'causal event,' it is unlikely that the 'brain damage' hypothesis will be brought into play by the observer.... It is out of this discrepancy between what we expect of people with FAS/FAE and what we perceive them actually doing that the climate for secondary disabilities is created." (p. 106)

This is both hopeful, and sobering. It is hopeful because even if my husband and I had no idea Hope would have an FASD, God knew and matched us to be a family together. Yet it is sobering because given the prevalence and pattern  of social drinking in Korea, I would hypothesize that more Korean adopted children are at risk for physically invisible FASDs like ARND, than are at risk for FAS. "The salience of alcohol for attention, memory, and neurobehavioral outcomes is higher for alcohol exposure during early pregnancy (before the woman knows she is pregnant) and for a "binge" pattern of consumption." (Streissguth, p. 87)

In other words, the Korean kids most at risk for FAS have greater evidence of that risk in their referrals, while the kids most as risk for the potentially more disabling invisible forms of FASD may be adopted by families like ours, who are not really aware of or prepared for that possibility. Yet it is precisely that latter group of children who need parents who are informed, mindful, and know when and how to reach out for help.

Doing it all over again, if we understood we were adopting a child at risk for FASD, I would have read books like Streissguth's we were waiting, just like we educated ourselves about cerebral palsy when we were adopting Joy.

Socked-In


This week spring took a holiday. Did it go to England now that April's here? It was cold; a good week to be stuck in the house. Or rather, it was a should-be-stuck-in-the house sort of week. Except we were too busy.

Joy's discomfort hung like a cloud. I had heard that the first 48 hours after the removal of a spica cast was "tough" and with her cast coming off last Thursday, I did the math and figured last weekend would be the worst of it, so we booked a typical week: a meeting with Hope's Dr., a business trip for my husband, a dentist appointment for Hope, school, and three therapy sessions at FAC for Joy.

The whipped cream and cherry was a sleepover at Nana's for Faith, Mercy and Hope, which allowed me to clean sort and organize the frightful basement (think 18 months of decision making deferred while I was writing) to get ready for the upcoming book and garage sales. The girls had a great time at Nana's. I didn't quite finish, but made a huge dent in the fright while my husband was out of town.

But I didn't calculate for the next night: Hope's staying up way too late, finding it impossible to fall asleep without a photograph of herself and daddy in her hand. This was a first --and surprisingly hard to do now that I've gone digital. I rummaged in our bedroom by flash light so as not to wake Joy and retrieved a spare copy of last year's Christmas card. Hope fell asleep with her face pressed to the photo.

I did not calculate Joy would need narcotics to fall asleep for a week after the cast came off, or that the narcotics would give her nightmares and wake her repeatedly at night. Nor did I know it was Tornado Awareness Day (or whatever Thursday was) when the tornado siren woke Joy both from her nap and again in the evening after she'd just drifted off into over-tired sleep from no nap and the nightmares the night before. The silver lining was I didn't have to wake up just to turn her. The nightmares were my alarm clock.

I forget how much of the evening it takes to put three of four children to bed on my own when my husband travels. (Faith goes on her own.) My husband always puts Hope to bed, which is an hour-long production on a good night and longer on most. (I think he needs to keep travelling so I appreciate him more when he is here.)

It is impossible to forget that Hope has a harder time when her daddy is gone. But this week it caught up with Mercy who grumped her way through exhausted from having less mommy-time and fed up with "bubble-radar" vigilance --defending her personal space from sibling invasion.

And, no: I couldn't NHA Hope out of it. It took the edge off. But her increase in impulsivity and provocativeness came from the changes in routine and disrupted sleep. Her brain functions less-well, period, including to parenting.

Then there was the ordinary routine stuff: making OT and PT and well-child appointments, getting new orders for those appointments, scheduling a sleep study for Hope, clipping the mats out of Daisy's hair. (There is a reason God made most dogs shed. Having hair instead of fur makes Daisy hypo-allergenic, but high-maintenance.)

Some exciting things happened, too. I was asked to consult on a new history project; we got a diagnosis for Hope (and I was blessed with a stack of reading courtesy of MOFAS); and our iLs (Integrated Listening System) set arrived, which should have  me jumping up and down (while alternating hands across midline). Except I'm just too tired to jump.



But if there is a good-kind of tired, I guess this is it. I'm tired because I've been so abundantly blessed, like the Forsythia in bloom, wearing snow. I can't deny the green buds and yellow flowers on the bush, even if, at the moment, they are deep-chilled. Looking out my window, pondering God's goodness, I realized that the forsythia would probably be carrying half the snow-load this morning if not for all the buds and flowers.

God has blessed this bush with roots that go deep into the soil and branches that reach up high to the sun. Into each life a little snow must fall.