Saturday, October 20, 2007

"High-Functioning"

I had a BIG debate the other day on the DSTNI list. The DOCTOR that runs the list actually told a worried new mom that "kids with DS are not on a par with normal kids". WHAT!? I was so angry to hear that.

Inevitably, I mentioned the things Ciarra can do that ARE "on a par" (While pointing out what "on par" means...it means equal, as valuable) People take offense everytime someone points out the things that they themeselves will say are "high-functioning" in the next sentence. It is difficult to give hope to a new mom being told that her baby CANT or WONT do things and not give specific examples. And then be seen as a braggart. Sometimes, I feel ostracized with the DS community, because I am "not allowed" to brag about the things I am excited about. I have learned to not talk so much about the things she is doing and focus instead on ability in general.

I absolutely fight for the rights of all kids with DS, but if we are going to be fair, as a community, we need to start seeing ourselves as we seek out "high-functioning" role models. We ALL want to share every high-functioning story we read, from Karen Gaffney to Sujeet & Carrie. They give us hope. I was saying in my back and forth with the doc, basically, if we are going to, as a community, continue to point out gleefully the ones who are highly successful and put them on pedestals, then we better be prepared to have some intellectual honesty regarding our OWN issues. We cant tell the world that it doesnt matter until we, ourselves, stop making it seem that the "cream of the crop" are somehow DIFFERENT than our OWN kids. Yes, we aspire for the best for them all. Yes, some will find their ways more easily. YES, we need those role models. Any of us that have ever blogged or written about or posted a story about a person who has done something the rest of the world would be surprised by are JUST as responsible for this.

I talk about my daughter's ability. If she were working on potty training at 9, you can bet I would be bragging when she got that, too. Im happy for her when she gets stuff, we all are. I dont much care what things she is doing, just that she is doing them. Im proud of her. I have heard the term high-functioning SO many times. I have USED the term myself. You will NEVER catch me saying or thinking "low-functioning", because it is abhorrant. But in the eyes of the world, we use labels. Ciarra is "high-functioning" and thats ok with me. I know that gives people hope sometimes. But it doesnt mean that I or ANY other person sees her as more valuable. She is NOT. Cindy and I have had this discussion so many times, and I wish more people could see it without all the crap that inevitably comes along. The truth of my child is what it is, the truth of HER child is what it is. They bring different things to the table, they are valuable in SO many ways. Ciarra might be the one doing the talking someday, but you can bet your butt she will be thinking about the gentleness and heroics of the Noahs that dont have the same voice. ALL of our kids bring something to the table. In our rush to use the right words and not offend anyone, we are talking out both sides of our mouths, often. We CANNOT be so quick to point out the "superstars" and then chastise someone for wanting to see that in their own kid. If we dont admit that we hope and pray for it for them, we are full of poop. If we make people who do talk about the things their kids do, even when those things are deemed "high-functioning" then we have our own prejudices to deal with. I hope this makes any sense at all. It is very hard to articulate well.

All I want is to not feel like somehow we dont fit the DS mold. My dd has DS, regardless of where on the spectrum she falls, her abilities and disabilities should not define her. There is no magic *I* performed to make my daughter do the things she does. There was no magic pill, no therapy, she was born with a certain ability to dodge some of the big DS issues. It was not me trying harder that made her this way. Although, I completely believe it was in large part that I didnt hold her back and believed in her that those God-given abilities shined through. She was lucky, her heart healed itself. No gastro issues. Poor vision and chronic sinus crap, but otherwise very healthy. I dont use the term "lucky" because that implies otheres werent lucky. She is who she is.

I think if we are going to talk about accepting people for who they are, then that means the ones on both ends of the spectrum. I love my friends kids who are less able to make their way in the world. Not because of DS, but because they are people. I dont define them by what they can do. I am thrilled mine can do what she does. But it doesnt define her. It just hurts when people discount it in so many ways, either by saying it cant be done or she must have a "mild case" of DS. She is precious to me for so many reasons, not the least of which is the many ways she teaches me about my own prejudices. Blanket statements dont apply to ANY of our kids. All I want is for my own child to be seen for who she is, and that is not dictated by her number of chromosomes.

baby boy

just shot his first deer. Not sure how I feel about it. They just called, apparently he took it in one shot, cleanly. It is a big buck for a little kid, 6-8 points they said.

I am happy for him, and for his Dad, who has been teaching him about hunter safety and respecting the hunt and the animals since birth.

I am sad because a beautiful animal died.

I am happy because the meat will be donated to feed a hungry family.

His voice breaks now when he talks, he is almost taller than I am. And today he shot his first deer. No more baby boy screaming and crying when Dad brings home a deer. He used to cry, telling daddy the deer was "hewt Daddy, wet him go"...so much so that daddy used to take the deer to a friends house because Jesse was SO upset. Now he is fine enough with it to shoot it himself.

I asked him last night, driving home from football, if he was sure he was ready to kill a living thing. He looked at me like I was crazy. "You dont have to do it just because dad loves hunting, y'know" He replied "Mom, *I* love hunting too." So there it is. No more baby boy. Almost a man.

Friday, October 19, 2007

"They are SO happy"...but who is THEY??!!

I have spent the last 9 years of my life trying to do my part to dispel some of the myths of DS. People first language was a biggie, that seems mostly accomplished now. No one in our lives wants the lecture, so "Downs kid" just doesnt come out of their mouths lol. There is still one nurse who calls Ciarra "A DOWNY"...after repeated requests not to. Recently, I called her supervisor. Let's see what she has to say to him on the matter?

Setting the bar for her has been a bigger challenge. It was one I learned not to do early on. She taught me to smarten up quickly the day I was in the living room on the phone and her barely 2 year old self dug oven mitts out of the drawer, opened the oven, took out the cookies, placed them carefully on top of the stove and announced..COOKIES DONE! Once I chased my wildly beating heart back into my chest, I sat staring at her, looking at her tiny hands again and again, wondering HOW she knew to use the mitts. HOW I could be SO stupid as to leave her anywhere near a hot oven. But even more, HOW on God's green Earth I could have ever believed she wasn't SMART!? Oh boy, that'll teach ya! I didn't know whether to beat her or hug her. In the end, of course, I hugged her. Then I bought an oven lock. But I never underestimated her again, and I refuse to allow anyone else to. This year she is in a regular third grade, with no aide. She does 3rd grade work for the most part. She is not treated very much differently than other kids her age. She sets her own bar, and she sets it high.

The biggest challenge for me has been overthinking her relationships. I wanted her to dodge that awful loneliness that I read so much about. I wanted her to have friends. I wanted...inexplicably, for her to be the HAPPY little girl with DS that everyone told me she would be. You know, "[i]they[/i] are ALL such HAPPY little people". That statement bugged the snot out of me. "They", who?! Ciarra wasn't a they. She was her, she, an individual. She was not a member of some subspecies. She wasn't in a herd or part of a pack. She..SHE...was my daughter. A daughter prone to smiling, to be fair. Ok, a daughter prone to...happiness. Ok, ok, so she was HAPPY. Not in the condescending, drawn out "Haaaaaaaaaaappy" kind of way so many people told me she would be when she was born and the diagnosis bestowed upon her. Not THAT kind of happy, not the clueless, dont-know-better kind of happy they meant. Ciarra was happy just living. She smiles a lot. She is...happy. She sort of exudes...happy. But, she can be pretty darn UN-happy sometimes too. She has a temper. She has even learned some words to show just how unhappy she can be. "Butthead" is a word that comes to mind.

But overall, this kid giggles in fits of laughter for a good part of her day. She is animated, blessed, blissful, blithe, captivated, cheerful, chipper, chirpy, content, convivial, delighted, ecstatic, elated, exultant, flying high, glad, gleeful, gratified, jolly, joyful, joyous, jubilant, laughing, light, lively, merry, mirthful, overjoyed, peaceful, peppy, perky, playful, pleasant, pleased, satisfied, sparkling, sunny, thrilled, tickled, tickled pink, up, upbeat, easy, easygoing, lighthearted, fanciful, resilient, sprightly, whimsical....you get the picture. Ok, darnit...she's HAPPY. ;)

This morning, Ciarra got all dressed up in her new knit dress and leggings from Gap. Put on her little black shoes with the sequins on them, and set out to make a Birthday card for her best friend. Today is that friend's Birthday, she turns 10. She is having a big pool party on Sunday, to which Ciarra is invited, along with a dozen or so other young girls. But today is special. It is her real Birthday. And she called last night, asking if Ciarra could get off the bus today after school to go do something fun to celebrate. Just the 2 girls and Jade's Dad. Ciarra has been, at times, jealous of the other kids who her BFF plays with. This morning, with a glint in her eye, she said "Just me?" And I said yes, just you. "Not Haley? Just me, no other kids?" Nope, just her. She smiled one of the biggest smiles I have ever seen. And I realized just how much it meant to her to be THE ONE, chosen because she is the BEST friend. It struck me how that is all any of us want, to be special to someone, to mean something. To be HAPPY.

The big bus lumbered down our road and pulled to a stop at the end of our driveway. Ciarra stood looking for a second, scanning the windows, looking for something. and then there it was. Jade was in the window, smiling back at her. Ciarra's hand shot out, pointing straiught at her "Jade, I'm going to YOUR house after school. JUST ME. Best friends!" I saw jade smile back, then stand up to make room for Ciarra beside her. Ciarra likes the window seat, and Jade is a good friend to let her have it. The last I heard was Ciarra excitedly telling the bus driver, "I'm going out with Jade, it's her Birthday. Im SO HAPPY."

Ok, baby girl. Happy is one thing your Mom can live with.

Thursday, October 18, 2007

What is Inclusion?


Inclusion is not just a place a kid goes. I used to kind of think that way, like...if shes in that classroom, with typical kids, THAT is inclusion. But it wasnt. Inclusion is sort of a state of mind, a commitment to educating a child with a disability while seeing them as completely capable individuals with their own strengths within the classroom. A child might be IN a classroom that calls itself Inclusion, but still not really be INCLUDED.

Inclusion means someone is taking pains to make him a part of the community within the classroom, and holding him accountable too, to being a member of that community. For instance, Ciarra has long been IN an Inclusive classroom. But it wasnt working, she was withdrawing a bit the last 2 yrs, pulling away, sort of afraid to emotionally open herself to the other kids. Intimidated, I thought. Her teacher was wonderful...but....she clearly and fully saw Ciarra as different, and not in a way that made her want that challenge. She assumed things couldnt happen that could have, with care. She loved Ciarra, and so she tended to baby her a bit. To be fair, there was no program around her that supported her Including Ciarra, either. "Here is this kid, educate her" was how it happened.

This year, we went into third grade with a strong belief that what we were seeing before was NOT Inclusion. It was a place, plain and simple. There was no scaffolding to support any of them, Ciarra, the teacher, or the other kids. If Ciarra turned away from other kids or was intimidated by them, then that was fine, "we wont push". THIS year, we have set about creating an Inclusion atmosphere. It is in every second of the daily planning, and it took a LOT of work and a LOT of faith by the staff (and by ME) that it was at least worth a shot. This morning I had my first monthly meeting. And I was told, point blank, [i]we didnt believe this could happen. But it IS happening, in fact it is awesome![/i]

A teacher committed to Inclusion will make it work. She will find things the children have in common, whatever those may be. She will see at least ONE thing in your child he can be successful at and build on that. An example for a little older kid would be...if a child is a good photographer, he/she might take photos for a group project. His or her contribution is valuable, important, and equal.

COMMUNITY is vital to Inclusion. Creating a community in which the child feels valuable, capable, smart, is so important. A good teacher will find those things and let him shine. She will encourage friendships by assigning tasks to groups, by having your child choose 2 friends to take the lunch money to the office with, encouraging friendships along the walk, she will ask kids to make goals that involve personal attributes...things they can do that make the community work better. Like manners, helping one another, being a real friend. She will teach the children to give him time to respond when they speak to him, and find ways to encourage them to need to speak to him within the context of the classroom. "Johnny, are you having white milk or chocolate at lunch today?" and wait for his reply.

If you arent sure about how your teacher will handle this stuff, go to the guidance counselor and ask her to research Lunch Buddies or Circle of Friends. Elicit the help of everyone there to make him feel successful and WANT to engage. Ask the Spec Ed teacher to brainstorm with the reg ed teacher, to come up with a plan. Often, it isnt the placement that is the issue, it is the scaffolding around that placement.

Is it the Ginkgo Biloba?


Ciarra has now been taking GB (2.5 mg per pound) for about 5-6 months on a regular basis. Since she learned to swallow pills, it has been a daily thing.

In June, she had NWEA testing, state testing to measure her ability. She did "ok", but was obviously not completely on track academic wise. SHe has been staying close, but slightly behind, her peers for a year or so now. In some areas, she is very much on track, in others, such as math, she has to work her cute little butt off to be in range.

In September, she was retested on the NWEAs. She jumped 40 points in math! 4 months had elapsed, 4 months of summer, no summer school. Basically vegging, the park, hanging out with mom and a babysitter while mom works.

So what is the difference? What caused that big a jump in scores? Well, either one or the other test was flawed, or something is going on here. She has been back in school about a month and a half now. One after another after another, people approach me to tell me that there is something going on here.

"She has more depth to her language."
"She GETS it!"
"What is going on, she seems like a different person?"
"I cant put my finger on it, but Ciarra has matured in huge ways..."

Yeah. Something is definitely going on here.

I wont say 100% it is the GB. But you know what? This doubting Thomas is starting to believe it.


ETA:
A friend asked about the Ginkgo Biloba, what I knew about it. So I'm guessing others may be curious, too. Here is what I sent to her:

Hi Cindy, I have done SO much research on Ginkgo. The active ingredient in it is Bilobalide. Have you seen the studies done this summer at Stanford? Craig Garner is one of the lead researchers, and he and I have talked at length. Safety was my biggest concern, and so I researched for almost a year before we decided to go for it. Craig's study was the deciding factor. This is gonna be a LONG email, so bear with me, k? The youngest kids I know taking it right now are about 2, maybe slightly younger. PLEASE talk to your doc. Now Foods is a good brand, nowfoods.com can tell you where you can buy it locally. Good luck!

PS this site (I really dislike the name) explains GB in VERY English terms.
http://www.curingdownsyndrome.com/index_files/Page342.htm


Warnings, Interactions, Adverse Effects

During the past 20 years, an estimated 2 billion daily doses (120 mg) of ginkgo have been sold. The most important potential clinical problem with ginkgo is caused by its inhibition of the platelet-activating factor; this makes the use of ginkgo in conjunction with warfarin (Coumadin), aspirin, or other antiplatelet agents a matter of clinical judgment. A recent safety study37 of the interaction of ginkgo and warfarin showed no change in the international normalized ratio. Ginkgo should be discontinued between 36 hours and 14 days before surgery, based on either pharmacokinetics or consensus opinion.38,39

ME: (GB can make blood flow faster, so you have to monitor for injuries or be extra careful prior to surgery. ALWAYS talk to your doc before you start GB)

Herbal medications that may increase the risk of bleeding if used concurrently with ginkgo include the following: feverfew, garlic, ginseng, dong quai, red clover, and other natural coumarins. Several case reports of bleeding complications associated with ginkgo use include subdural hematoma,40,41 subarachnoid hemorrhage,42 intracerebral hemorrhage,43 and hyphema44; the causality of these events has not been established. One case report45 discussed an elderly patient who developed elevated blood pressure while taking a thiazide diuretic and ginkgo. The patient's blood pressure returned to normal when both substances were discontinued. This reaction is paradoxical in light of the known pharmacologic actions of these agents.45

ME: (To date, NONE of the 50 plus families who have tried it have seen a single bleeding issue.)

The unprocessed ginkgo leaf contains ginkgolic acids that are toxic. Hypersensitivity to ginkgo preparations is a contraindication to use. Ginkgo is generally well tolerated, with side effects being rare, usually mild, and including nausea, vomiting, diarrhea, headaches, dizziness, palpitations, restlessness, weakness, or skin rashes. Although no studies have been performed to support any restrictions on the use of ginkgo during pregnancy or lactation, it seems prudent not to administer ginkgo in the absence of any data.1,2

ME: (I researched, called, emailed EVERY company whose product I tried. I did not settle on any of them until they told me in human terms EXACTLY how much ginkolic acid was in their particular product. If they cat tell you or say they dont know, do NOT use that product. GOOD ingredients and their amounts should be looked for: 24% ginkgo flavone glycosides and 6% terpene lactones)

Nutrivene puts out a brand specifically made for kids with DS, I believe they send free samples too:
http://nutrivene.com/view_item.php?ProductID=167&

Dosage

For patients who have memory problems and dementia, the dosage of ginkgo is 120 to 240 mg daily, taken in two to three doses. The dosage for patients who have tinnitus and peripheral vascular disease is no more than 160 mg per day, taken in two or three doses. An initial period of six to 12 weeks is recommended to assess the effectiveness of ginkgo, although results have been seen as early as four weeks.13,46,47 The monthly cost for the usual daily dose of 120 mg is approximately $15 to $20.


ME: (the suggested dosage for kids with DS is 2.5 mg per pound of body weight. My understanding is it isnt a great idea to exceed 240 mg, although Ciarra is still quite small and only gets 180 mg daily now. We give it to her at bedtime, one 120 mg capsule, and one 60 mg one. We tried Liquid GB, YUCK. Mixing it with orange juice helps, or a VERY strong koolaid concoction. Grape, the pharmaceutical companies tell me, is the best taste to mask it. )


www.aafp.org/afp/20030901/923.html


GB in the news:
WASHINGTON (Reuters) - An old drug once used to study epilepsy can help improve learning in mice with a form of Down syndrome and also might help people, U.S. researchers said on Sunday.

The beneficial effects the drug, called pentylenetetrazole, or PTZ, continued for two weeks after treatment. This suggests the drug, like some other psychiatric drugs, can make long-term changes in the brain.

The finding, published in the journal Nature Neuroscience, also can help scientists understand what causes the mental retardation seen in Down syndrome patients.

"This treatment has remarkable potential," said Craig Garner, a professor of psychiatry and a director of the Down Syndrome Research Center at California's Stanford University.

"So many other drugs have been tried that had no effect at all," Garner said in a statement. "Our findings clearly open a new avenue for considering how cognitive dysfunction in individuals with Down syndrome might be treated."

Down syndrome is the most frequent genetic cause of mental retardation and occurs equally around the world, in about one in every 800 births. About 5,000 children born in the United States each year have Down syndrome.

It is caused by the presence of a third chromosome, known as chromosome 21. Most people have two copies of each chromosome and the additional activity of the genes on the third copy of chromosome 21 is believed to cause the symptoms of Down syndrome.

Symptoms range from moderate mental retardation to very mild disability. Many Down's patients also have health problems, especially heart trouble.

Fabian Fernandez, a student in Garner's lab, was exploring the possibility that the brains of Down's patients are too strongly affected by a chemical called GABA, a neurotransmitter, or message-carrying chemical, that stops brain cells from becoming too excited.

DAMPING DOWN LEARNING

"In general, learning involves neuronal excitation in certain parts of the brain," Garner said. "For example, caffeine, which is a stimulant, can make us more attentive and aware, and enhance learning."

Inhibiting this process can interfere with learning.

PTZ does this by causing more GABA to be available in the brain. Overdoing this process can cause seizures and PTZ was once used to study epilepsy. But it is no longer approved for use in people.

Fernandez gave daily doses of PTZ to mice specially bred to have many of the same genetic differences that cause Down syndrome.

"My idea was that it might be possible to harness this excitation effect ... to benefit people with Down syndrome," Fernandez said.

He gave the drug to the mice and then gave them a maze test. Normal mice tend to explore first one arm of a T-shaped maze and then the other, while the Down mice are more random in their exploration.

But after 17 days of treatment, the drug made the Down mice explore and learn more like normal mice.

"Somehow the drug treatment creates a new capacity for learning," Garner said.

More tests showed that daily doses were required for several days before any effect was seen, and the mice acted more normally for up to two months after the drug was stopped.

That may suggest the drug is changing brain structure, Garner said. His team may explore testing the drug or a similar compound in people as a possible treatment for Down syndrome.



www.newscientist.com/arti...alth_rss20

Ginkgo could aid memory formation
03 March 2007
From New Scientist Print Edition. Subscribe and get 4 free issues.

Tools


MEMORY could be boosted in people with Down's syndrome using a ginkgo tree extract.

People with Down's syndrome often find it difficult to remember facts and events. This could be because neurons in the hippocampus - an important area of the brain for memory formation - are overinhibited by a neurotransmitter called GABA.

The ginkgo extract, called bilobalide, and another drug called pentylenetetrazole (PTZ), both block GABA. In a mouse model of Down's syndrome, mice that drank PTZ in chocolate milk, or received an injection of bilobalide, once a day for 17 days did significantly better at memory tests, such as recognising which of two objects they had not seen before. The improvements lasted for up to three months after the mice stopped taking the drugs, suggesting that they had caused long-term changes in brain activity (Nature Neuroscience, DOI: 10.1038/nn1860).

"With time you're teaching the brain to suppress the excessive inhibition in the hippocampus," says Craig Garner of Stanford University in California, who led the study. He says PTZ has the most immediate potential because it has already been rigorously tested in humans and can be taken orally.

From issue 2593 of New Scientist magazine, 03 March 2007, page 17



this one is interesting but a bit pessimistic:

In a study that could hold promise for children with Down Syndrome, Stanford University researchers have found that a long-discredited drug can improve the mental abilities of mice with the genetic disorder, which causes mental retardation in humans.

The mice were better able to navigate mazes and recognize new objects after receiving the drug, and the gains continued for months after treatment stopped. The researchers ultimately hope to test the drug, known as pentylenetetrazole, or PTZ, in people with Down syndrome.


"It's a very exciting piece of work," said David Patterson, a Down syndrome researcher at the University of Denver who was not involved in the study. "This is really the first time that I've seen such a striking effect in terms of reversing the memory and learning difficulties the mice have."

Both Patterson and the Stanford researchers caution, however, that the research is preliminary and it is too early to tell if the drug will be successful in people. Although PTZ was once used as a heart stimulant, it was taken off the market and now is used only in research. The process of doing further tests and getting government approval to use it as a Down syndrome treatment could take more than a decade.

Quality of Life Improvement?
A genetic disorder caused by an extra copy of the 21st chromosome, Down syndrome occurs in one of every 733 live births. More than 350,000 Americans have the condition, according to the National Down Syndrome Society. The disorder typically causes mild to moderate mental retardation and can increase the risk for Alzheimer's disease, leukemia and congenital heart defects.

Because people with Down syndrome are now living much longer, with a typical life expectancy of 56 years, researchers increasingly are studying ways to improve their quality of life. Some studies have examined whether Alzheimer's drugs could improve their mental abilities, with little success, said Craig Garner, codirector of Stanford's Down Syndrome Research Center and one of the authors of the new study.

In the study, published online Sunday by the journal Nature Neuroscience, mice genetically engineered to display the symptoms of Down Syndrome were fed 17 daily doses of milk containing PTZ. After treatment, they performed as well as "normal" mice in running mazes and recognizing objects for up to two months.

It took some time for the drug to work -- an effect seen with many psychiatric drugs, including antidepressants. The mice also received two other compounds similar to PTZ, which worked about as well. The "normal" mice did not see any cognitive benefit from the compounds.

Releases the Brakes
Stanford researchers believe that PTZ and the other compounds may work because they block a neurotransmitter that slows brain function. That neurotransmitter is believed to work too well in Down syndrome patients, hampering learning and memory.

Garner said these compounds help "release the brakes" on chemical impulses in the brain that drive cognition. "If you drive the car with the brake on, you don't get anywhere," he said.

The Stanford researchers want to continue studying PTZ, rather than the other compounds used in the study, because it was once approved for use in humans.

The drug pentylenetetrazole was used as a heart stimulant and has been used experimentally to study seizures. When used in high doses, it can cause convulsions. The U.S. Food and Drug Administration removed the drug from the market in 1982 because it was not effective in treating disease and could be harmful, Garner said. However, Garner believes the drug can be safely used in very small doses.

"We think we're slowly being able to understand what's causing reduced cognitive ability in people with Down syndrome," he said, and there are new approaches and strategies that could improve their quality of life. Still, he added, "This is not a cure. We're not making a kid with Down syndrome normal. There are limits to what medicine can do.
-------------------

Drug shows promise for Down syndrome
LOS ANGELES, Feb. 26 (UPI) -- Researchers at California's Stanford University report a drug known as PTZ can improve the learning and memory of lab mice with Down syndrome.

After receiving once-daily doses of PTZ, or pentylenetetrazole, researchers found the Down syndrome mice could recognize objects and navigate mazes as well as normal mice, The Los Angeles Times reported.

The improvements lasted up to two months after the drug was discontinued according to a report by the researchers in the journal Nature Neuroscience.

Lead author Craig C. Garner, a professor at the Stanford School of Medicine, told the Times that after more preliminary studies his lab will prepare for conducting human trials.

Down syndrome is the leading cause of mental retardation. It results from an extra copy of chromosome 21.

--------------------------

and Craig's entire scientific report, with his permission

Published online: 25 February 2007; | doi:10.1038/nn1860
Pharmacotherapy for cognitive impairment in a mouse model of Down syndrome
Fabian Fernandez, Wade Morishita, Elizabeth Zuniga, James Nguyen, Martina Blank, Robert C Malenka & Craig C Garner

Department of Psychiatry and Behavioral Sciences, Nancy Pritzker Laboratory, Stanford University, Palo Alto, California 94304-5485, USA.

Correspondence should be addressed to Craig C Garner cgarner@stanford.edu

Ts65Dn mice, a model for Down syndrome, have excessive inhibition in the dentate gyrus, a condition that could compromise synaptic plasticity and mnemonic processing. We show that chronic systemic treatment of these mice with GABAA antagonists at non-epileptic doses causes a persistent post-drug recovery of cognition and long-term potentiation. These results suggest that over-inhibition contributes to intellectual disabilities associated with Down syndrome and that GABAA antagonists may be useful therapeutic agents for this disorder.

Ts65Dn mice, like patients with Down syndrome, show comprehensive deficits in declarative learning and memory1. Previous research suggests that these cognitive deficits are not due to gross abnormalities in Ts65Dn neuroanatomy2, but rather derive from selective decreases in the number of excitatory synapses in the brain3 and corresponding changes in synaptic connectivity4, 5. These findings are supported by in vitro studies showing that synapses in the Ts65Dn hippocampus can express normal long-term potentiation (LTP), but that excessive GABA-mediated inhibition impairs its induction6, 7. Assuming that triplicated genes found in Ts65Dn mice shift the optimal balance of excitation and inhibition in the dentate gyrus (and perhaps other brain regions) to a state in which excessive inhibition obscures otherwise normal learning and memory, we theorized that subtly reducing the inhibitory load in the Ts65Dn brain with GABAA receptor antagonists might rescue defective cognition.

After establishing that the pattern of cognitive impairments in Ts65Dn mice (3–4 months of age) matched those observed in children and young adults with Down syndrome (Supplementary Fig. 1 online)8, we then assessed whether a non-epileptic dose of the noncompetitive GABAA antagonist picrotoxin (PTX; intraperitoneal (i.p.), 1.0 mg per kg body weight, a dose used extensively in classic rodent studies on memory consolidation)9 could improve Ts65Dn object recognition memory. Although pilot studies indicated that a single dose, 1 d before testing, did not rescue Ts65Dn object recognition performance, a chronic 2-week daily regimen had clear beneficial effects (Supplementary Fig. 2 online). We therefore initiated a 4-week longitudinal crossover study. Here, wild-type and Ts65Dn mice (3–4 months of age) were randomly assigned to groups receiving daily i.p. injections of saline or PTX (1.0 mg kg-1), and were submitted to four weekly repetitions of object recognition testing, in which the animals were serially presented with four different object sets. At the 2-week midpoint of this experimental period, wild-type and Ts65Dn mice that had been receiving saline were randomly segregated into groups that either continued to receive daily saline injections or began daily injections of PTX. Conversely, wild-type and Ts65Dn mice that had been chronically administered PTX in the first 2 weeks of testing were now switched onto a saline regimen. Alongside saline and PTX, we also evaluated the efficacy of bilobalide (BB; i.p., 5.0 mg kg-1)10, a PTX-like compound that could be safely administered for the whole 4-week experimental period.

Not surprisingly, Ts65Dn mice injected with saline during the first 2-week period of novel object recognition testing, or those receiving saline over the course of the whole experimental period, did not show novelty discriminations significantly above chance (DI > 0; t16 = 0.8169, P > 0.4260, and t40 = 1.524, P > 0.13, respectively; Fig. 1). In marked contrast, Ts65Dn mice treated with PTX during the first or second 2 weeks showed normalized object recognition performance, as did those that received BB throughout the study (Fig. 1). Moreover, unexpectedly, Ts65Dn mice that had undergone chronic PTX administration during the first 2-week period of novel object recognition testing maintained their improved performance when evaluated 1 and 2 weeks later (Fig. 1 and Supplementary Table 1 online). Notably, wild-type and Ts65Dn mice did not differ in total object exploration time, invariably spending 25% of their experimental sessions investigating objects (Supplementary Table 2 online).


Figure 1. PTX and BB rescue Ts65Dn performance in the novel object recognition task.

Shown are DIs of wild-type and Ts65Dn mice involved in a 4-week crossover study. (a) In the first 2 weeks, untreated and saline-treated Ts65Dn mice did not show a preference for novel objects (DI > 0; t17 = 0.7737, P > 0.4497, and t16 = 0.8169, P > 0.4260, respectively), whereas PTX- and BB-treated Ts65Dn mice discriminated object novelty (t9 = 4.083, P < 0.003; and t15 = 4.390, P < 0.001). (b) Saline-treated Ts65Dn mice given PTX during the second period of object recognition testing (Sal PTX) started out with the same deficits as those continuing to receive saline (Sal Sal), suggesting that there was no sampling bias for animals in later treatment groups. (c) During the second 2 weeks, saline-treated Ts65Dn mice switched to PTX discriminated novel objects similarly to wild-type (WT) mice (t8 = 3.756, P < 0.006). PTX-treated Ts65Dn mice switched to saline in the second 2 weeks also maintained their ability to discriminate novel objects (t6 = 3.250, P < 0.02), suggesting a persistent change in brain function had occurred. (d) Compilation of WT and Ts65Dn mouse novelty DIs with no treatment or treatment with saline, PTX or BB, showing that PTX and BB normalized Ts65Dn object recognition memory (F5,187 = 5.204, P < 0.0002; all post hoc comparisons with Ts65Dn control, P < 0.05; all other post hoc comparisons, P > 0.05). Control observations were pooled from untreated and saline-treated (PTX-naive) mice, and PTX observations from mice given PTX in either the first or second 2 weeks. DIs for each condition are tabulated and defined in Supplementary Table 1. Error bars, s.e.m. All experimental procedures were approved by the Stanford University Institutional Animal Care and Use Committee (IACUC) and conducted in compliance with the US National Institutes of Health Guide for the Care and Use of Laboratory Animals. See Supplementary Methods online for experimental details.



Full Figure and legend (38K)


To extend these findings, we next evaluated the effects of pentylenetetrazole (PTZ), a noncompetitive GABAA antagonist with a long history of medical use11, on declarative memory in the novel object recognition test and in a modified spontaneous alternation task. To mimic the most typical route of drug administration in humans, wild-type and Ts65Dn mice were administered PTZ (3.0 mg kg-1 in milk; a non-epileptic dose that can be safely given to rodents for up to 1 year)12 via voluntary oral feeding (see Supplementary Methods online). In total, wild-type and Ts65Dn mice received 17 daily doses of milk or a milk-PTZ cocktail and were subjected to two repetitions of novel object recognition testing, or to three daily T-maze sessions at the tail end of the treatment regimen (Fig. 2). In agreement with previous results, milk-fed Ts65Dn mice showed an inability to discriminate object novelty in the object recognition task. PTZ-treated Ts65Dn mice, by contrast, showed discrimination indices (DIs) on a par with those of wild-type mice (Fig. 2a and Supplementary Table 1). In the spontaneous alternation task, milk-fed Ts65Dn mice also showed a pattern of impairment similar to that of untreated Ts65Dn mice. However, mice receiving oral PTZ showed normal levels of alternation of 70%13 (Fig. 2c,d and Supplementary Table 3 online). Notably, wild-type and Ts65Dn mice and those on PTZ did not differ in object exploration time in the object recognition task and did not show arm biases in the spontaneous alternation task (Supplementary Tables 2 and 4 online).


Figure 2. PTZ elicits long-lasting cognitive improvement in Ts65Dn mice.

Novelty discrimination indices of wild-type (WT) and Ts65Dn mice directly (a) or 2 months (b) after an 2-week treatment with PTZ. (a) Although Ts65Dn mice on milk did not show a net novelty preference (t17 = 1.099, P > 0.2 , those receiving PTZ performed as well as WT mice receiving either milk or PTZ (F3,71 = 3.356, P < 0.03; all post hoc comparisons with Ts65Dn on milk, P < 0.05; all other post hoc comparisons, P > 0.05). (b) The normalized object recognition memory shown by Ts65Dn mice immediately after treatment was sustained 2 months later (F3,38 = 5.134, P < 0.005; all post hoc comparisons with Ts65Dn previously on milk, P < 0.05; all other post hoc comparisons, P > 0.05). Discrimination indices are tabulated in Supplementary Table 1. (c,d) Alternation scores (%) of WT and Ts65Dn mice across 3–6 sessions of testing in the spontaneous alternation task. In contrast to WT mice, which showed optimal alternation percentages (70%), untreated or milk-treated Ts65Dn mice showed significantly lower alternation percentages (t83 = 5.051, P < 0.0001). However, PTZ normalized Ts65Dn alternation scores to WT levels (F3,272 = 5.998, P < 0.0006; all post hoc comparisons with Ts65Dn control, P < 0.05; all other post hoc comparisons, P > 0.05). Alternation scores for each condition are tabulated and defined in Supplementary Table 3. Error bars, s.e.m.



Full Figure and legend (45K)


To better define the longevity of Ts65Dn cognitive improvement after GABAA antagonist administration, we subsequently evaluated Ts65Dn mice in the novel object recognition task, exactly 2 months after the termination of a 17-d oral PTZ regimen. Consistent with the post-drug recovery in cognition observed with PTX, Ts65Dn mice that had been administered PTZ showed normal object recognition performance at this time point (Fig. 2b).

The ability of animals to learn and remember is thought to be encoded at the synaptic level, and it involves the ability of synapses to undergo long-term changes in synaptic strength. Indeed, recent work has provided compelling evidence that LTP in the hippocampus occurs during learning14 and is required for memory15. Accordingly, we assessed LTP in the dentate gyrus, the structure that shows the most pronounced inhibition-related pathology in the Ts65Dn brain4. Specifically, we examined, at 3–4 weeks after drug treatment (a time window congruent with performance improvement by Ts65Dn mice in the novel object recognition task after PTX treatment), whether LTP deficits at perforant path synapses in Ts65Dn mice had been rescued by chronic oral PTZ administration. In agreement with those behavioral findings, we found that PTZ-treated Ts65Dn mice showed normalized LTP in the dentate gyrus 1 month after the cessation of drug administration (Fig. 3a–d; P < 0.05). We then assessed the relative permanence of this LTP rescue in Ts65Dn mice, and found that the Ts65Dn dentate gyrus continued to show greater LTP in PTZ-treated mice than in milk-fed ones for up to 3 months after the drug regimen (albeit diminished relative to that of wild-type mice) (Fig. 3e–h; P < 0.05), in keeping with Ts65Dn behavioral improvement 2 months after PTZ administration.


Figure 3. PTZ rescues LTP at medial perforant path–granule cell synapses in Ts65Dn mice.

(a,b) Averaged data for LTP induced in wild-type (WT; a) or Ts65Dn mice (b) treated with milk (WT milk LTP: 115 4.3%, black circles, 2 mice, n = 7 slices; Ts65Dn milk LTP: 104 3.2%, black squares, 2 mice, n = 7 slices) or PTZ (WT PTZ LTP: 110 2.9%, gray circles, 3 mice, n = 9 slices; Ts65Dn PTZ LTP: 113 2.1%, gray squares, 3 mice, n = 9 slices), evaluated 1 month after the cessation of drug administration. (For comparison, data from milk-treated WT mice are also shown in b (white circles).) (c,d) Cumulative probability plots of LTP observed in WT (c) or Ts65Dn mice (d) fed milk (black line) or PTZ (gray line) after high frequency stimulation (HFS). (e,f) Averaged LTP graph for WT (e) or Ts65Dn mice (f), 2–3 months after discontinuation of milk (WT milk LTP: 117 3.6%, black circles, 5 mice, n = 14 slices; Ts65Dn milk LTP: 108 2.1%, black squares, 3 mice, n = 12 slices) or PTZ treatment (WT PTZ LTP: 115 2.9%, gray circles, 5 mice, n = 16 slices; Ts65Dn PTZ LTP: 113 2.1%, gray squares, 4 mice, n = 13 slices). (For comparison, data from milk treated WT mice are also shown in f; (white circles).) (g,h) Cumulative probability plots of average LTP for WT (g) or Ts65Dn mice (h) previously fed milk (black line) or PTZ (gray line). Sample traces in a,b,e,f are averaged from ten consecutive field excitatory postsynaptic potentials (fEPSPs) taken at the indicated time points. Accompanying scale bars are 1 mV, 5 ms. Values are expressed as mean s.e.m.



Full Figure and legend (96K)


In summary, we have demonstrated that chronic administration of noncompetitive GABAA antagonists (at non-epileptic doses) ameliorates cognitive deficits in Ts65Dn mice for a period of months extending beyond the window of drug treatment. Likewise, we have shown that drug-mediated improvements in Ts65Dn learning and memory are accompanied by rescue of impaired LTP, the most prominent synaptic correlate of learning and memory in the hippocampus. These results point to over-inhibition, in at least some brain regions, as one possible mechanism that reduces cognitive performance in a mouse model of Down syndrome (see Supplementary Discussion online), though further experimentation will be necessary to more directly test this mechanism and to elucidate the neuroadaptations that are orchestrated in response to repetitive GABAA antagonist administration. The results also highlight the potential clinical utility of noncompetitive GABAA antagonists in Down syndrome (including BB and PTZ), providing one window into how cognitive impairment in Down syndrome may be pharmacologically mitigated over time (see Supplementary Discussion online).

Note: Supplementary information is available on the Nature Neuroscience website.

Author contributions
F.F. designed and executed all behavioral experiments with the assistance of E.Z. and J.N. W.M. performed all of the electrophysiology experiments. M.B. provided technical expertise in breeding and genotyping. F.F., C.C.G., W.M. and R.C.M. wrote and edited the manuscript.

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Received 3 January 2007; Accepted 31 January 2007; Published online: 25 February 2007.

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Acknowledgments
We thank the Down Syndrome Research and Treatment Foundation (DSRTF), the Hillblom Foundation, the US National Science Foundation (NSF), the US National Institute of Health (NIH), Jax West Laboratories, the Stanford Down Syndrome Center and W.C. Mobley for their support.



Ciarra and Dr Mobley: Dr. William C. Mobley is Professor and Chair of the Department of Neurology and Neurological Sciences as well as the Director of the Center for Research and Treatment of Down Syndrome at Stanford University.

Friday, October 12, 2007

AWESOME- thanks Jesse!

http://newmedia.funnyjunk.com/movies/Puppet.flv


sorry, had to delete the actual video, the sound came on automatically and jumped people.

Tuesday, October 09, 2007

Mr. Blue Sky-makes me blue



http://www.mrblueskymovie.com/main.html


Mr. Blue Sky Plot Synopsis:

An unconventional love triangle between three childhood buddies; two girls, one born with Down syndrome, and one boy, who all grow up fighting who they are inside, how they are perceived by society as a whole, and who they ultimately strive to become as individuals through the obstacles that are inherently present.

Mr. Blue Sky is a ground-breaking film that explores the romantic relationship of a woman born with Down syndrome and a "normal" male, as perceived by today's society. Mr. Blue Sky attempts to break down society's barriers, much like "Guess Who's Coming To Dinner?" did in the 1960's, as it aims to "change lives" through "changing minds."

Mr. Blue Sky is a heart-grabbing story that will ultimately change the way society views all people as "individuals" first and foremost.

The title is derived from a little girl's hope and love through the sun (Mr. Blue Sky.)




This new movie will be out soon, and I am having mixed emotions about it. It is a beautiful premise, girl with DS loves typical boy, they grow up and fall in love. It is a fairytale in a way Cinderella never was. Because Cinderella never had to overcome anything but poverty. Her beauty defined her, in the movie. We never got to know any more about her than that she was beautiful. For her Prince, that was enough.

My daughter is what many call "high-functioning", a term wrought with misunderstanding. Ciarra lives a fairly normal life. She has wonderful typical and some atypical friends. She attends a regular third grade and plays on a regular baseball team. But...Ciarra still has Down syndrome. As loved and accepted as she is, there is not a soul in her world who does not see her features and make some supposition about who she is. Not necessarily a correct supposition...but anyway. We who love her love her more for the DS, not in spite of it, but in ways we never may have had she been born "normal". She has taught us about dignity and unconditional love. And she has taught me about the world, the good and the bad. And that is why this movie scares me to death.
Normal is what we live every day, despite the DS. But I dont have any visions of Ciarra going off to college in the same way I do for my other 2, she will need some supports, or getting married to a typical young man. I dont dream of grandchildren through her. That is painful to write, more painful to feel. and I dont set the bar for my daughter. But I dont want her to think she has failed somehow if she doesnt attain...that...either.

Right now, she is 9, and we are enough. We fill her days with laughter, and take every opportunity to make it special. We adore her, dote on her, would pull the moon from the sky if we could. We live every day hopeful, with an eye on the future and one on the past. Ciarra, like many with DS, is breaking the old mold. Her life is wide open ahead of her. And yet...a life in which a handsome, healthy, beautiful young man with a normal component of chromosomes falls in love with her and overlooks her obvious innocense, her failure to grasp deep concepts, her...differentness...seems almost cruel to imagine. It is a beautiful theory, indeed. But every year that passes brings a new and knowing look to her classmates and peers. They love her, to be sure, but as much as that is true, they love her despite her DS, they do not overlook it altogether.

Perhaps I should wait to decide how I feel till after I see this movie. But right now, it makes me want to cry. Because as beautiful as it is, it really is nothing more than a fairytale. And a fairytale that my princess just might believe could come true. I dont want to have to pick up those pieces.

Thursday, October 04, 2007

she's gonna be the death of me

we have this big, fat Maine coon cat named Callie. She is like 12 years old. Weighs probably 17-18 pounds. BIG furry cat. Ciarra loves her, and this poor cat loves C right back. Ciarra can do anything to her, she has dressed her like a baby, rolls her around in a doll carriage, has put clothespins on her ears, etc. Cat just doesnt care.
Yesterday Ciarra scooped Callie up to walk down to the bus stop with her. Holding her like a baby, belly up.I watch through the living room windows, buyt the driveway is long, and they are fairly far away. So I look, and there is C with the cat. Look again, and no cat. Ciarra is bent over her backpack, messing with the zipper. Bus comes, and she hoists this suddenly VERY heavy backpack up, and is trying to get it on her shoulders. Backpack isnt THAT heavy...wth? Then it occurs to me, faster than I can blink...shes got the damn CAT in her backpack! I go to yell, see her take the first step onto the bus, sort of teeter backwards from the weight shifting going on....and see one not very happy ears laid back freaked out cat come squeezing out of the TEENY little hole where she hadnt completely gotten it zipped, hit the bottom step of the bus, and tear off. Ciarra turns to my voice, shoots me an "ALMOST DID IT" grin, scrunches her shoulders as if to say "I dunno" and gets on the bus to a chorus of her best friend hollering her name....this kid is gonna be the death of me!

Tuesday, October 02, 2007

not just treading water anymore

sometime soon, I am going to take the time to post about Ciarra's new teacher, Mrs. C, and maybe even some of the incredible things she has written to me in our communication notebook. The notebook is something we have in the IEP, and have had for years. Until this year, however, it has not ever been anything more than an occassional tool to tell me what is going on in Ciarra's school life. This year, in so many incredible ways, is different. THIS year, we have Mrs. C.
Don't get me wrong, Ciarra has been blessed with teachers who were wonderful, caring, awesome people who did their best to make her school life the very best it could be. But there is something different about Mrs. C, something...awesome. Mrs. C is a former Special Education teacher now teaching a regular 3rd grade class. 15 kids (perfect!) who think she hung the moon. I am starting to believe it, myself.
I am still trying to wrap my head around the things she says about my daughter. Intuitive, remarkable, insightful, honest takes on what she thinks is best for this child of mine. I fought hard for Inclusion this year. At first, I was told it couldn't be done, that our school doesn't really have what it takes to make it work. They were wrong. Initially, they wanted to put Ciarra in the special ed room more often, to mainstream her versus including her. The difference between the two is subtle, but very real. Inclusion means the child is in the regular ed classroom for the vast majority of their day. mainstreaming means they are technically a "Special Ed kid", who is sent into the regular classroom for things like gym, art, music, and lunch. Mainstreaming is not what I wanted for my bright, funny, engaging daughter. But it is, in effect, what she was having up until this year. She was pulled out for 2 plus hrs every morning for reading and math, went from there straight to lunch, then recess, and then electives/specials. In the afternoons, she was pulled out for therapies, Speech, and OT. Her actual classroom time was nowhere near what I had believed it to be. I believed she was included, but she really wasn't.
At the end of 2nd grade, we had our IEP. I came into it knowing how little actual class time Ciarra had. I had seen for myself the many things she missed out on, for instance phonics. She is a STRONG reader, missing things like phonics with the class made no sense. Her schedule seemed to have no rhyme or reason. Why Spanish, for instance, for a kid struggling badly enough with English? Could that time not be used for speech, so she would lose less classroom time? The answer, I was told, was no. or, to be more accurate, "Ciarra couldn't handle it", "We can't teach her the things she needs, what will she work on?" "We don't want an aide sitting there doing the work for her." All very valid issues, when you get right down to it. It would be tough to make true Inclusion work, but it was her right, it was the law, and it was the right thing for her. Now, HOW to make it happen? I needed the school to believe, in themselves and in Ciarra, too.
The first thing we did was call in Maine's Disability Rights Center. They had an attorney work with me to figure out what I wanted, what barriers there were, and what steps needed to be taken. They sent an Advocate to the IEP meeting, and she made some wonderful suggestions. The school initially wanted to "wait and test her early in 3rd grade to see where things stood." That meant starting the year in the Special Ed setting, not in a classroom. Not with her peers. I voted "no". The Advocate suggested we get an evaluation by the Center for Community Inclusion, a group that helps schools make Inclusion work. The school wanted to hold off till this year, I fought to have it done right then, at the end of 2nd grade. In the end, I won. On virtually the last day of 2nd grade, a man came to the school and spent the entire day watching, making notes, observing Ciarra. He met with her teachers, the Special Ed Director and teacher, and he met with and listened to me. In the end, his report would point out all the great things they were doing that would facilitate Inclusion, made some great suggestions, and some poignant observations. Among them, that Ciarra was loved immensely in her classroom, met with a hug upon arrival, and enjoyed being there very much. He also noted that she did very well listening, and that she was definitely a candidate for Inclusion. With every word I read, my shoulders puffed up higher. She could do this. WE could do this. But...would they?

(more to come, soon!)

Monday, October 01, 2007

this is my normal



we are well into the routine now, up and going bright and early for school. It definitely makes life on a schedule necessary, unlike the lazy summer days when the kids have almost nothing scheduled. Ciarra, I must note, is not a morning person. If school just started at 10 instead of 8, she would be much easier to get moving in the morning. But alas, lol, I cant change the entire schedule just for her. And so every weekday I walk into her room at quarter to seven, snuggle in beside her and wake her up as gently (but firmly) as I can. If I have stuck to the schedule, she will have had her shower the night before, and clothes are laid out ready for her to argue over and re-pick. That is, after she is standing upright and semi cooperating in the morning rush. Motivation is the key with this kid. And so sometimes I have been known to resort to bribery. "If you hurry, we can call a friend to come over after school." Two weeks ago, after 15 days of school, the deal was she could invite a friend or two to go bowling.



Well now, Ciarra has a real problem with "one or two". I ended up with her PLUS 4 others!
(How do you say no, though, when you are so busy doing cartwheels that the kids WANT to come?)Apparently, someone forgeot to tell my daughter that "kids with Down syndrome don't HAVE friendships." Uh huh. Tell that to the kids clamoring to come hang out every time I walk through the door of her classroom.

And so we bowled










And we laughed, and we had tickle fights.









We played video games:




And made scary faces:



Played hide n seek...lol








And some air hockey:





I love these kids, I really do. And gosh they are cute! But I gotta admit, when it comes to cute, aint NOTHIN as cute as the one that's got the butt wiggle thing goin on.



9 years ago, you never could have convinced me that my life would be overflowing with laughter, happy children, hugs, warmth, and love. Now, it is normal. It feels natural to be known as "Ciarra's Mom" or "Jesse's Mom" or "Kristin's Mom". And it feels completely natural to have this amazing little spirit in my life, reminding me that normal is relative.