Preschool Graduation

Graduation. It's usually a time of happiness, excitement. The feeling of completion before you hit your next stage in life. And for some maybe some sadness mixed in but it's still a happy time. You cry, you laugh, you take a deep breath and reflect on your (or your child's accomplishments. It's not just college students and high school students that reach this plateau. Preschoolers (and kindergarteners) get to celebrate. 

Today Liam's preschool class graduated. They all dressed up, wore hair bows and bow ties. They walked across the stage with confidence and pride that rivaled college grads. They smile as they received their personalized metals. They sang their songs, took hundreds of pictures, and ate cake. It was a great day for them. 

As they walked across that stage I started shaking. Then I was hit with emotions. My son wasn't among the 24 boys and girl crossing the stage. He wasn't sitting in his chair singing and smiling. My son didn't get to walk up, shake MRS H's hand and receive his metal. 

My eyes filled up and the tears threatened to escape. For a moment all I could think about was the injustice that my son wasn't here on what should have big a BIG day for him. It wasn't fair. This isn't how it's supposed to be. I was supposed to watch along with all the happy parents as their children stepped on stage. In stead in his place was a stuffed minion. 

Then the dreaded moment hit. I didn't know for sure it was going to happen but I had a feeling it would. MRS H made a speech. Saying every morning the kids put their hands over their heart, take a deep breath and think of Liam. I couldn't hold back the tears. Then she called me up and presented me with Liam's certificate, metal and pictures. I couldn't stop. I walked up their crying. 

I imagine it felt similar to when a fallen soldiers family received a metal of honor or the flag. Liam's metal was unlike their other (red, white and blue striped lanyards). I guess in a way he is a fallen soldier. He was a warrior after all in his own right. He spent his entire life fighting. His certificate was special as well. Instead of a graduation certificate they made his an outstanding participation certificate with a seal and everything. Again it makes my heart feel like it's been ripped out because this isn't how it's supposed to be. 

I had several parents walk up and hug me. They thanked me. For what I'm not sure. Maybe for working with their babies. For always being willing to help. I was also presented with a certificate stating that I volunteered approximately 88 hours this year. The most volunteered hours they had. 

After the tears, there were smiles and laughter. And lots of pictures. I watched all these kids excited about graduation and moving onto kindergarten. I watched as they ran around and laughed and posed. I watched their happiness and soaked in as much as I could. I used it to give me strength to get through the next few hours. It was important that they see me happy for them and I didn't want to give them anything less. 

I smiled and took pictures of happy parents with their babies. Memories I'm sure that will last forever. Inside I wished for that. Sad that I couldn't too be truely happy without the tenge of sadness and misery. 

Lanie and her friend Miley joined us and passed out flyers to the parents attending graduation. I was glad to have Lanies support and to have her there to pick up the pieces of receiving Liam's metal when I couldn't. 

When Lanie and I got home, we decided to release a balloon in Liam's honor. Lanie said a few words then set it free. We watched until we couldn't see it anymore. And I cried. 

For you little lamb. I hope this reacted you and you feel my love. I miss you so much. Everyday is a struggle but I keep my promise always to try and be "Liam Strong" 

Being Prepaired

          If there's one thing I've learnt on this medial journey with Liam, and if there's only one piece of advice I could give those dealing with CDH in their lives, is to be prepared....

BE PREPAIRED. 

          I don't mean become a dooms day preper and hoard canned foods and bottles of water. (Although maybe one day that would come in handy). 

          Know your child's health, inside and out. Memorize the symptoms or actions that indicate your child can't breath or has reherniated (just examples). Don't rely on machines to tell you how your child is doing. Example:

          Liam shows signs of desatting or difficulty breathing long before the numbers on a pulse ox machine drops. 

          Today I volunteered in his preschool class and because of the horrible time he'd been having with his sinuses and gtube infection, I went packing inhalers, a stethoscope and oxygen. Thank God I did because as I sat there at the "breakfast" table with him and his friends, I watched as Liam suddenly got very quiet and the color drain from his face as his eyes glossed over. I scooped him up and took him into the little preschool office and hooked him up to oxygen.

          By then he had already started having some difficulty breathing. He felt better within 5 minutes. Within 10 minutes he was able to take 2 small bites of food and within 15 minutes started chatting with his friends again. By the end of school he was back to acting normal, minus his normal spunk and hyperness. 

          It wasn't until nearly 4pm however until we tried to go without oxygen. Well in normal Liam fashion, he ripped that cannula off and said he was all better. His spunk and hyperness returned two fold. It wasn't until bedtime, after he'd fallen asleep that I hooked him back up. His lite lungs were just working too hard and needed a rest. 

          This wouldn't be the first time being prepared has saved us from catastrophe. Knowing Liam inside and out has saved us as well. So many times I've rushed Liam to ER and caught pneumonia or rsv at the very early stages and it's saved him from getting sicker than he should have. 

          But today. I probably turned a few shades paler when I watched Liam suddenly change. The teacher nearest us, Mrs C, who had her back to us, said she heard Liam get quiet and knowing he's not normally like that, she turned and saw him get suddenly pale as well and knew something was wrong. Thankfully the teachers all stayed calm and acted like nothing was wrong. 

          Knowing that these teachers saw first hand how quickly Liam can go from great to bad in seconds and seeing the symptoms gives me comfort because they were able to tell me what they saw and now recognize when he will need to be put on oxygen again in case I'm not there. We created a little safety net plan in case this happens again. From now until the end of winter, oxygen will be take  to school daily in case this happens again because there's not enough time to run him to the nurses office and hook him up. 

          I feel confident that I can leave Liam in their care and not have to worry if they can take care of him. It's such a breathe of fresh air that I could cry. I've worried that this day would come and they'd refuse to let him stay unless I was there. But no. I watched as they navigated Liam and his oxygen tank to different centers without any problems. 

          After being put on oxygen, all the kids were curious as to what it was. They had me explain to the kids how Liam just had trouble breathing sometimes and needs extra help. One kid asked if it was the same as the astronauts used in space and then all the kids thought it was so cool how Liam was like an astronaut. I love how accepting children are of their differences. 

          Mrs M, the district special education teacher came to see Liam today and since I was there we had time to chat about her view points of Liam's progress and what I can do to help him achieve his goals. There wasn't much I wasn't already doing, which she was very happy to hear. We are now using a new app to trace the alphabet and this helps Liam with his fine motor skills, something he needs lots of help with. She was going to talk to the OT and see about getting him those services to help with his fine motor issues. But for now no other changes are being made. 

          Today was a good day and a win against CDH. Nothing will keep my baby boy down and we have a great team standing beside him to help him through it all. 

Learning To Thrive

(Image above is Liam chewing down on Mt Mikes Pizza)

Liam's first full week of school went great. There's been a lot of progress and discovery.

His physical therapist said he's doing worse than she remembered. That was upsetting. I work with Liam every day and I didn't think he was getting worse. I didn't see him get a whole lot better either. Two days ago the special education teacher called me. She had spent two hours with him in the class and said that his teacher was a perfect fit for him.

She also said that she thinks that Liam's low muscle tone is affecting his ability to use the

bathroom. The theory is that Liam can't control his urine flow and that he doesn't know when he's peeing. It makes perfect sense considering I've been working on potty training him for 2 years now. Now we're doing a timed training method where we have him sit on the potty every hour on the hour. It helps but it isn't accident free. I'm worried how Kindergarten is going to go if he's not potty trained. It's in his IEP that he's not potty trained but still.

(Liam flexing his muscles in his superman shirt)

Liam has always had texture issues. It's been a large problem his entire life. Finger painting

has been something he hated. Yesterday and today he finger painted and loved it! His teacher Mrs H taped off one of the carpet squares just for Liam so every day he knows exactly where he's supposed to sit and he gets really excited.

Every morning the class eats breakfast together. The teachers are working hard to get Liam

to drink milk. That helps me out because he needs the calories. He's been doing very good eating breakfast with his "friends". He still doesn't eat a lot but it's a start. We're also working on keeping his hands out of his mouth. We tried bracelet he could chew on but he just took it off, had it on the ground wrapped around his shoe so his teacher took it away. So no more bracelet for Liam. He just has to learn to control the stimulation without using his mouth.

Liam's speech has improved drastically. It's almost like he's a new kid. The speech

therapist hasn't even seen him yet but because speech is so ingrained into this school he's improving daily. He's using more complete sentences and talking clearly. Finally he's able to tell me what he wants, how he feels or even just about his day and I understand his without having to decode him. He still has times or days where his speech isn't very clear and that happens more when he's tired.

(Liam loves to get on stage and dance and sing along at church on Wednesday nights)

We were having problem with him tolerating his night feed, then he got better and worse again. This whole week Liam has handled his feed so much better. He's up to 105 mls per hour for as close to 12 hours as I can get him. Unfortunately he got into a coughing fit early this morning and I had to turn off his feed an hour earlier so he wouldn't vomit.

Every morning I wake up Liam at 6:45. He then sits on his potty in front of the tv and watched cartoons for 45 minutes to an hour like that in an attempt to empty his bladder. This helps. After he uses the potty he gets to pick something from the prize box that's full of little toys and stickers. This reinforces potty time for Liam and gets him excited to use it.

Liam and our kitten Ozzy have continued to bond. Liam and Ozzy continue to play chase everyday and Ozzy has taken to sleeping with Liam. Ozzy likes to sleep on Liams pillow and Liam likes to sleep with his feet on his pillow and his head at the foot of the bed. Its funny to see this.

All in all everything is going good. Liam is learning how to thrive finally. We still have a long road ahead of us in life but the story has to start somewhere.

Liam's 1st and 2nd day of Preschool

Liam had his first day of preschool yesterday. First day of his second year of preschool anyway. 

This year he goes 5 days a week. His first day went well. He needed some redirection but listened very well. His preschool teachers said he did good on the playground equipment as well. 

Because Liam's gtube isn't the common Mickey button, no one can touch it and since none of the teachers are gtube certified they can't touch it. I wrap his stomach with an ace bandage everyday so that there's no chance it'll get pulled out. 

I've done everything I can to make it easier on the teachers. I offered to be there everyday and be the one to change his diapers and deal with all that but they declined saying they wanted to try him at school without me for a few days to see how he does and first day was a success. 

Liam had his very first homework. They gave him a paper plate and said for him to decorate it any way he wanted. Liam choose to glue on shaped buttons, beads and puff balls. He had a blast doing this and was proud to give it to his teachers today. 

Today was Liam's second day of preschool. He woke up cranky this morning and getting him out of bed was some work. Getting him to leave the house was even harder. He threw a fit until I told him if he didn't stop crying I would take a video of him and all his friends would see him crying. 

It was an empty threat but it worked. He instantly stopped crying, looked at me with confusion and said "what!" Lol. He had a good day at school...mostly. 

His physical therapist went to work with his at school today then called me after. The school is limiting what she can do with him and when she can work with him. She was very frustrated by this. After hearing what the preschools "rules" of her were, I was irritated as well. They made it to where he can't use the high part of the playground equipment even though she needs too to help him better and they want her to come only during their recess so she can't work with him alone without other kids running around the playground equipment she needs to use. 

Because of this we have to set up times and days for therapy at a different school so he can get the help he actually needs. On top of that she said he's doing worse than she remembered. That's not news any parent wants to hear. 

While in line at pickup, Liam decided to pull down his wrap and pull the gauze off his gtube. Mrs H came running out to get me out of line. I picked the gauze up off the ground and threw it in the trash and took his wrap off. Liam said he did it because the gauze was wet and hurting him. 

Mrs H then scolded me for throwing it in the trash saying there was a procedure they had to do (double bag it and give it to the janitor to dispose of). If that's the case, then why did they let it sit there on the floor where other kids can touch it. 

She then had a talk with me about how his fingers need to stay out of his mouth and we really need to get him potty trained. 

I'm so irritated by this because just yesterday I had a long talk with them about signs of overstimulation for him and what he does to regulate this. One was putting his fingers in his mouth. I also told her I've been working on that because of germs. I also explained how we've been working on potty training for two years. Yesterday I had just told her that I was hoping that seeing how the other kids get up and use the potty would help him to do that as well because sitting on the potty every 20-40 minutes wasn't working. 

I felt like I was being scolded today and it was frustrating and maddening. They just didn't listen to anything I said. It's already hard being a special needs parent but having outsiders make it harder is unnecessary and aggravating. I don't need this stress but it'll never go away and it won't get easier from here. 

We have a full life ahead of us with this and I just need to get prepared, pull up my boot straps and take it one day at a time. 

Surprise Phone Call

          Despite going to bed with a headache last night,

waking up at 11:30p with a horrid migraine that had me in the fetal position in tears,

and waking up still with a headache,

I honestly thought today would be better.

I had gotten both kiddos off to school,

came home and was going to enjoy the peace and quiet.

Justin was at work so I had the house to myself,

and I was going to enjoy every minute of it,

and nurse my aching head.

I couldn't fall asleep so I took ibproffen.

Then I decided to make myself some food.

I ate in quiet and decided to do a bit of blogging.

After all...

I was proud of the post.

It was emotional and true.

Truth is important to me.

How can I give an accurate picture of what CDH does in our daily lives if I'm not truthful?

So again I spewed by guts out.

And for that I was proud.

(You can read the post here)

I decided to work on my book blog and marketing.

Then my phone rang.

(That's when the morning took a turn)

Surprise (yes genuine surprise)

It was Liam's school.

They noticed he was shaky.

His arms shook when they usually didn't.

His legs were shaky as well.

His equilibrium was off causing him to fall.

His face paler than normal and marbled.

And to top that cupcake off...

He was retching.

They knew this wasn't Liam.

He'd never behaved this way.

They called the LVN to the preschool rooms to have a look at him.

They called me right after to inform me.

As soon as she said Liam was acting weird I grabbed my keys.

I was out the door before she could finish telling me everything.

I told her I'd be there in 5 minutes.

When I got there I noticed all these traits as well.

Not just that but when I picked him up,

his entire body was trembling.

'Let the good times roll' I thought to myself.

One symptom on its own would be no biggie.

All these mixed together was another story.

Mix all those with what else he had exhibited at home and I knew something was up.

He had also slept 12-13 hours last night.

Liam never sleep that long.

He had diarrhea for the last 3 days and a killer diaper rash because of it.

This morning he was breathing heavier.

He seemed better after the treatment.

He was a bit quiet this morning,
and there was that whole conversation this morning.

I'm not sure what it all adds up too,

but he sees his pediatrician tomarrow.

Good day for a check up as well.

For now all I can do is comfort him.

He's cranky today and needs his mommy and cartoons.

School Days

Liam loves school. Every school day we show up early. It's part of the routine and routine is important. That and I don't do it purposely. Lanie has to be dropped off first then we drive across town to Liam's school. Today he only had to wait 5 minutes before being able to go into class. 

Are you ready for Liam? Cause he's ready for you!!

School days put Liam in such a happy mood in the mornings. And doesn't he look adorable in that popeye shirt?! Ironic I know since he's a skinny boy but that's probably why I like it. 

At pickup I snuck into the room so I could watch him interact with the other kids and teachers. 

Today they were singing a song about a whale. Last wensday it was circles. (There are other kids there but I cropped the picture where they wouldn't be seen)

Liam loves music time. Today he seemed a bit tired even during this time. 

Liam made some art work today. It's so exciting to finally have art work come home from him to hang. 

Wensday they worked on hands, counting fingers. 

This came home today but was worked on wensday. 

Today they focuses on feet and counting toes. 

Try actually traced Liam's shoes to make these. Even thought this is his shoe size his feet are much smaller. His shoes just have to be big to accommodate the braces. 

I love having art work to show off. 

After getting home Liam spent some quiet time playing in his room. I had just changed his bedding this morning. 

Have I ever mentioned what a lucky little boy Liam is? For his birthday he received not one but two Thomas the train blankets. Liam loves Thomas the train so when I changed his bedding this morning and took the last Thomas blanket off his bed I decided to put another one on. This made him very happy when he came home. 

Liam would carry both blankets around the house every day if he could but he's been good and settled on snuggling with them in his bed. 

We've been so blessed that Liam has come so far. We know it could have been way worse than it was. We love our monkey boy. 

IEP

When the words "special education" was used Monday during Liam's IEP meeting my heart sank. Not because he needs the extra assistance it provides but because my fear that others will lump him into a category and make fun of him or think ill of him. I fear that they will tease him and call him names like "stupid" because that's what kids, and even some adults do these days.

I fear they will never give him a chance. Liam is very smart. He is bright, intelligent and adorable. He's just behind because of all the time he spent at the hospital due to being sick. Thanks again for that CDH! But now he is stronger, and healthier. He's starting to catch up and will do so quickly with the help of merely observing his peers. 

So why special Ed? Well during the IEP meeting I was given report by a physical therapist, phycologist, speech pathologist, special education teacher and more. I learned a lot about my baby boy as well as saw him through a different light.

As much as I hated hearing that Liam required Special education, I not only knew he would but expected it. I want Liam to get the best and get caught up as best be can as early as possible. This great team of ladies who assessed Liam had his best interest at heart as they worked with him to evaluate. They were all in agreement that he is behind but they feel that its because of all the medical needs he had and spending so much time in the hospital. They all feel that he will thrive in a preschool setting with other kids his age who are developing typically. Intellectually Liam doesnt qualify for special ed but they feel that because he still has many medical needs that he will benefit greatly from being apart of these classes.

Everyone who was a part of Liams IEP assessment was smitten with with. The education Specialist told me that looks alone dont fool her and although he is very adorable but his personality is sweet. What you see is what you get.  The report I was given and discussed in our meeting were lengthy and numerous. I sumerized them as best I could so that you could still get an idea of Liam.

Yes I am sharing them because I am not and will not ever be ashamed of my son. His progress in the last year alone has been HUGE. In the last year he started talking, walking, eating and becoming his own person. I am very proud of his progress. Along the way he has become more onry (a typical boy at the age of 2) but has continued to keep his sweet personality and mentality.

Liam was born the "underdog" with all the statistics stacked against him. Time and time again he has proven the victor, the survivor, the one to prove everyone wrong. I will always stand by cheering him on as he goes through life doing the impossible. Everything Liam does is "impossible" because he wasn't even expected to survive. The doctors were positive CDH would win and that my baby boy would grow wings and fly up to heaven to be with God. But Liam decided he wanted to fight. He wanted to prove them wrong and show everyone that nothing is impossible "for the very word impossible says that everything is possible".

With each new experience I go through with Liam I learn something new, get a new outlook on things. This process of IEP meetings and assessments has taught me a few things:
1) IEP's aren't as bad as I was told they'd be. I'm sure it depends on who your working with but the team we have are amazing people.
2) Special education is just another word for extra help. Liam's always needed extra help along the way rather its breathing, feeding, walking or now learning. I feel lucky and blessed that this team wants to help Liam and are doing everything they can to do so.
3) I am actually ready and excited for this next stop in our journey with Liam. Preschool!! It's a crazy thought but to think we've gone from almost constant hospital stays and from one illness to another to preschool. Again I feel blessed that Liam has come this far and is now actually able to attend preschool! This time last year even daycare was NOT an option because a "simple" cold would land him in the hospital. But here he is. Healed, on the mend and oh so blessed!!
4) I need to stop being such a worry wort and let Liam fly. Liam falls, or runs into the wall because he wasn't looking or whatever and I freak out. He however just laughs and takes off again. Liam doesn't need me to worry about him constantly anymore. Its time I start treating him like a "normal" almost 3 year old. He can't succeed if I continue to baby him. However I can still kiss the boo boo's when he asks and cuddle as he wished. And sneak in as many kisses as I can before he grows out of that! *sigh* My baby is no longer a baby. He's not even a toddler really but a little "big boy".

So without further adue, Liams IEP Assessment:

Please keep in mind Liam was 34 months old when the assessment was done.

Speech and Language Assessment:
cognitive: 24-30 months understands the concept of 1. Identifies rooms in the house. demonstrates use of objects, enjoys tactical books and engages in make believe play.
receptive language: 24-30 months follows 1 step directions, points to pics and names animals and objects, and knows many body parts.
expressive language: 24 months. Liam uses 2 word sentences, uses elaborate jargon, uses intelligible words 65% of the time, echoes prominent or last word heard and imitates environmental sounds.
comments: Liam made good progress from the transitional planning meetng (TP). During the assessment meeting he imitated alot of words and it was hard to determine what an imitation was and when he was trying to communicate something because he imitated what the assessors would say or ask.
non-speech test for receptive language: 29-34 months
non-speech test for expressive language: 22-26 months.

**Speech Therapy is recommended

Physical Therapy Assessment:
Gross Motor Functional Level: Complete to 20 months with scattered skills to 26 months.
Meaning that developmentally on the physical level Liam can do all goals for kids up to the age of 20 months but only some goals for kids 20 months and up. He can walk up the stairs using holding onto someones hand or a rail putting one foot on the step followed  by the second foot on the same step but doesn't alternate feet or do one foot on each step. Liam does not jump but easily walks sideways and backwards.
Playground motility: Liam requires moderate assistance accessing the climbing walls. He is able to go up and down the stairs and slide down the slide on his own and transition from level to unlevel ground.
Mildly low muscle tone, mild muscle weakness overall, range of motion is within normal limits. Liam exhibits moderate pronation of both feet. Left foot exhibits mild forefoot adduction. Exhibits ankle instability bilaterally.
Gait: walks forward with a mildly wide base of support. Exhibits mild foot drop in swing phase of gait and tends to trip when walking and running.
Posture: exhibits wide base of support in sitting and very mild upper thoracic scoliosis with mild rib malformation.
Object Manipulation: throws a ball forward underhanded but does not catch. Kicks a ball with his right leg.
Strengths: Liam is a very social little boy who enjoyed exploring the therapy environment. He enjoys climbing activities, and attempting new motor skills. He exhibits good walking and running skills and easily squats in play and resumes standing.
Concerns: Liam exhibits mild to moderate delays in his gross motor development. He is not yet jumping and exhibits difficulty descending stairs. He is not yet catching a ball. Liam requires moderate assistance climbing on the playground climbing equipment.
Reccomendations: It is anticipated that Liam will be independent in his classroom mobility. He will require stand by supervision to moderate assistance. Liam would benefit from educationally based physical therapy services to address playground safety and mobility ans stair climbing.

Bright Start Present Levels:
                                                 28 Month age Equivalent   ;   35 Month Equivalent
Fine Motor:                                       19 months
Gross Motor:                                     18 months                          24 months
Cognitive Delevopment                       18 months                         24-30 months
Communication Development
Receptive:                                         18 months                           24-30 months
Expressive:                                      18 months                             24 months
Social/Emotional:                          24-36 months                          30-36 months
Adaptive:                                       12 months                                  18 months

Development Assesment: Cognitive 87 19th percentil, age equivalent 27 months, average
Communication 18%tile adequate
Daily living skills 12%tile moderate low
Socialization 45%tile adequate
Motor skills 2%tile low
Adaptive Composite 10%tile moderately low

Special Education: Liam doesn't qualify based on intellectual disability but does because health reason.

Education Specialist Report:
Pre-literacy: Liam was able to right a book, turn the pages of a chunky book and look at the pictures with interest.
Pre-Math: When presented with color bowls Liam was able to sort like colored bears to corresponding bowls. With minimal verbal prompts, he was heard to count by rote from 1-8 when pointing to objects in a book.
*According to Bright Start developmental levels. Liam is able to show the concept of one and give one of many. He is able to engage in simple make believe activities.
Communication skills:
Receptive:According to mom Liam can talk but there are days that he is quiet, but he can be prompted to use familiar phrases such as "thank you". According to Bright Start levels Liam is able to follow one step directions, knows many body parts, and can point to pictures of animals and objects.
Expressive: When comfortable, Liam will repeat prompted one or two word expressions. He is able to identify verbally a variety of farm animals, colors and familiar request.
Fine Motor skills: During assesment Liam was observed to use his left hand more often than his right when doing fine motor tasks and he used light touch when grasping items. (Liams touch, speech were light. She feels that this just might be a part of who Liam is)
Gross Motor Skills: Parent stated Liam has difficulty running due to the braces on his feet (needs them for pronation. Because of the pronation he falls) He can push with two feet when on a bike. According to Bright Start Liam is able to step up and down the stairs holding onto the rail and can climb up onto furnature.
Social Emotional/Behavior: Liam was cooperative and friendly during the assessment with adult examiners. He was interested in the testing tools and made good effort to comply with adult requests. According  to Bright Start levels Liam initiate own play requires supervision to carry out ideas. He makes his demands known and can initiate his own play.
Skills Adaptive/Daily Living Skills: According to mom, Liam shows awareness that he has a soiled diaper but is not yet potty tained. Parent stated that he assists in dressing. Mom states that Liam is still tube fed but does not deny food. He is efficient at "chew and swollow" and mom is not concerned about a chocking hazard.
Conclusions: Liam has health issues that need to be addressed for present levels from the nurse. Mom reports that Liam enjoys doing puzzles and playing with cars and trains.

Recommendations:
1) It is recommended that Liam participate in preschool activities that support language opportunities throughout the school day and appropriate social interaction with typically developing peers.
2) It is also recommended that Liam participate in preschool activities that introduce curriculum that prepares students for Kindergarten.