Don’t miss the interview with a mom who helped her 14-month-old son overcome screen-induced syndrome: Watch it here.
Pediatricians are alarmed that babies and toddlers who spend hours a day on phones, tablets, and around TVs can develop a syndrome of marked behavioral changes. The good news: the changes often disappear when the children stop all screen exposure and switch to face-to-face contact, reading, and play with parents, caregivers, other children, and non-electronic toys.
Two doctors in France are leading an awareness campaign, which they explain in this video.
“Screen viewing several hours a day prevents the brain from developing and generates behavior problems and relationship problems,” reports Dr. Anne-Lise Ducanda, speaking also for colleague Dr. Isabelle Terrasse. “We decided to make this video to warn parents, professionals, and public bodies of the grave dangers of all screens for children between the ages of zero to four.”
The doctors had noticed more and more toddlers with unusual changes in behavior. Some had stopped responding to their names and speaking words, began avoiding eye contact, and had become indifferent to the world around them. Many children lagged behind developmentally for their age and were language delayed.
Drawing on left by a 4-year-old who spends little time on screen media. Drawing on right by a slightly older 4-year-old who was highly screen-exposed..
After asking parents in detail about the kids’ media use and household exposure, the doctors discovered almost all the children had spent large amounts of time on and around screens—in some cases, ten hours a day. But when families stopped the child’s screen exposure and greatly increased social interaction and play with the child, most if not all aspects of the condition eventually disappeared.
Various studies in Romania have come to similar conclusions, one stating “sensory-motor and socio-affective deprivation caused by the consumption of more than 4 hours/day of virtual environment can activate behaviours and elements similar to those found in children diagnosed with ASD (Autism Spectrum Disorder).”
Because this phenomenon has been so often observed in Romania, screen withdrawal there is now a therapeutic protocol for early ASD and a campaign is underway informing parents about the problem.
Romanian psychologist Marius Zamfir coined the term “Virtual Autism” to describe the screen-induced syndrome. He worries about lack of motivation among children exposed to excessive screen content. “Children’s brains are used to getting pleasure without making any effort at all,” he says in this video made for the Romanian public information campaign.
Meanwhile, a study released in 2022 of more than 84,000 Japanese babies and their mothers found that “among boys, longer screen time at 1 year of age was significantly associated with autism spectrum disorder at 3 years of age.”
“With the rapid increase in device usage,” concluded the authors, “it is necessary to review the health effects of screen time on infants and to control excessive screen time.”
Study Proves Observable Brain Changes
A study of toddlers’ brains seems to bear out the behavioral indicators.
Cincinnati Children’s Hospital researchers show evidence in JAMA Pediatrics that young children who spend more than two hours a day on screens have less brain white matter. The brain’s white matter aids in thought processing and organization, as well as performing other vital functions.
“Think of white matter as cables, sort of like telephone lines that are connecting the various parts of the brain so they can talk to each other,” study author Dr. John Hutton told CNN.
“These are tracks that we know are involved with language and literacy,” he continued. “And these were the ones relatively underdeveloped in these kids with more screen time.”
47 healthy toddlers were studied. Screen exposure among them ranged from zero to about five hours a day.
In their report, the study authors did not make a connection to virtual autism nor did they specifically mention autistic-like symptoms.
Astronomical Rise in Autism Incidence
According to the U.S. Centers for Disease Control, in 1975—when VCRs first came on scene—only one in 5,000 children in the U.S. was reported to have ASD. But by 2016, video on demand had become ubiquitous and the incidence of ASD had risen to one child in 68. The CDC now estimates the rate is 1 child in every 44.
Until very recently, “AV (audio-visual) exposure in infancy has been overlooked” as a risk factor for autism, according to research ophthalmologist Karen Frankel Heffler of Drexel University College of Medicine. As she writes in the journal Medical Hypotheses, “There has been an explosion in viewing opportunities for infants over the past 25 years, which parallels the rise in autism.”
“Attention in the vulnerable infant is drawn away from healthy social interactions toward TV, computer screens, and electronic toys,” according to Heffler.
In early 2020, JAMA Pediatrics published an analysis that Heffler co-authored which found that babies who viewed TV and videos at age one had a slightly greater chance of displaying autistic-like symptoms than non-TV watching babies by the age of two. Conversely, the study found, “Less screen exposure and more parent-child play at 12 months of age were associated with fewer ASD-like symptoms at 2 years of age.”
In 2022, Heffler’s team published a pilot intervention involving 9 children between 1 1/2 and 3 1/2 years of age who were diagnosed with ASD and watched at least 2 hours of screen media a day.
As the study shows, when screen time was replaced by increased interaction with caregivers, “Children’s screen viewing decreased from an average of 5.6 hours/day prior to intervention to 5 min/day during the study. Significant improvements were observed in core autism symptoms and parent stress from pre- to post-intervention.”
Heffler’s team also published a case study of two toddlers diagnosed with autism showed that when screen time was stopped and social time increased, there were “marked improvements in developmental trajectories.”
Australian research also shows that babies with early signs of autism may avoid an autism diagnosis if parents are taught communication skills through video feedback.
LEARN ABOUT THE LATEST TODDLERS AND SCREENS RESEARCH HERE FROM DR. KAREN HEFFLER
Researcher has Firsthand Experience with Screen-Induced Syndrome
At the first-ever Children’s Screen Time Action Network conference, I happened to meet Dr. Heffler’s research associate, Lori Frome, M.Ed. Frome is an autism treatment specialist who discovered, also by chance, that the symptoms in one of her young patients who had been diagnosed with ASD disappeared after her screen exposure was curtailed.
Frome then tried the same treatment on her own young son, who also had an ASD diagnosis. Over the course of several months with no screens but intensive face-to-face interaction with herself and other loved ones, he had “a complete developmental trajectory change in the core deficits of ASD,” as Frome describes in this video. In other words, her son became developmentally normal for his age.
Screen media has a “very addictive power,” says Dr. Ducanda. “Little by little the child can no longer do without and demands it more and more. If the parents try and withdraw him, he can go into a real meltdown.”
Doctors Ducanda and Terrasse contend that heavy doses of screen time affect what would be, in pre-digital times, the natural wiring of a child’s brain.
Watching a ball move on a screen, for instance, does not register in a child’s mind the same way it does to manipulate and throw a ball. Says Dr. Ducanda: “The small child’s brain cannot develop without this sense of touch.”
Dr. Andrew Doan, an ophthalmologist and neuroscientist, produced this animated video to show how watching screen media can rewire a child’s brain. In this TEDx talk, I discuss the importance of parent-child Attachment and how digital devices can interfere with early relational health.
Avoiding Screen-Induced Syndrome
So, what’s a parent to do? For one thing: respect the child’s basic developmental needs. For babies and toddlers to learn to speak, reason, and develop crucial social skills, they need face-to-face interaction with loving people and to use all their senses as often as they can.
A study from Iran proves the power of parent interaction and play. Investigators selected 12 toddlers with autistic-like symptoms who had spent half their waking hours on screen devices. Their parents were then given 8 weeks of lessons in how to play with their children, with an emphasis on eye-to-eye contact, loving touch, and continuous communication. While the parents applied these lessons at home, objects that had absorbed the children’s attention were taken away, including digital devices.
At the end of the two-month period, the children’s screen time had shrunk to a bare minimum, their ASD-like repetitive behaviors were greatly reduced, and brain studies showed ASD-like readings had returned to nearly normal.
One of the study’s chief investigators told me consistency is the key. For the intervention to work, the parents had to stick with high-touch, high-talk interaction all day every day during the children’s waking hours. He says researchers can now confidently recommend that children under age three should spend their time playing and interacting face-to-face with caring adults and not using digital devices.
The American Academy of Pediatrics agrees that babies and toddlers should never use screens alone. Any interaction with screens should be limited to video calls with loved ones, with a caregiver standing by.
Preschoolers should not have more than one hour of screen time a day in order “to allow children ample time to engage in other activities important to their health and development,” says the AAP.
The World Health Organization agrees that, for the sake of their health and proper brain formation, children under age one should have no exposure to screens.
World Health Organization Infant Guidelines (Under Age One)
Early Childhood is a Once in a Lifetime Opportunity
When you look through Today’s lens, early childhood has become a rarified, once-in-a-lifetime pre-digital opportunity. As I write in The Durable Human Manifesto: Practical Wisdom for Living and Parenting in the Digital Age, each child begins life as a “wild human”—as free and unplugged as any other animal.
“When toddlers range around, freely using all of their senses to examine, taste and play with whatever they choose, they are making rich and lifelong neural connections.”
So kids can stay on a healthy developmental track, experts including Dr. Ducanda and Lori Frome recommend that you:
- Talk, play, and read with your child every day as much as possible
- Provide materials, toys, and games that require manipulation, such as empty plastic food containers and lids, stacking cups, play dough, finger paints, and a play kitchen
- Go outside at least once a day and make sure the child has time to play alone and with other children
- Not use screens when you are with your young child
- Not hand a phone to your baby or young child (and keep the screen locked, just in case they grab it)
- Keep the TV off around kids under age four, even if it’s TV on in the background and child doesn’t seem to be paying attention to what’s on the screen
- Explain to family members and caregivers why these measures are essential to a child’s healthy development, durability, and well-being
Dr. Heffler points out in her research that characteristics that may resemble those associated with autism in very young children can have a variety of causes. If symptoms do arise, Dr. Ducanda and her colleagues recommend keeping the child away from all screens for at least a month, which will require the cooperation of every household member. If that can be accomplished, she claims, ASD-like problems in many children may “miraculously disappear or diminish considerably.”
Conversely, if a child has a full, well-balanced life with very minimal screen exposure, these types of symptoms may never emerge.
Parent Resources
Watch an interview of an American mother who came forward after discovering information on this post to tell the story of how her 14-month-old son developed and overcame screen-induced syndrome.
This site has links to research and researchers.
Watch webinars with Lori Frome M. Ed. who explains how to detect, treat, and avoid screen-induced syndrome:
See the latest webinar on YouTube:
Also see this earlier webinar:
Download Lori Frome’s specially-curated Parent Resource List from the box on this page.
Finally, in this simple online course, I teach parents why and how to create loving bonds with their babies and toddlers as well as to maximize their brain development and language learning.
Note: This post was last updated on January 7, 2023
About the author:
The mom of three practicing durable humans, DurableHuman.com founder Jenifer Joy Madden is a certified digital wellness instructor, health journalist, digital media adjunct professor, and author of How To Be a Durable Human: Revive and Thrive in the Digital Age Through the Power of Self-Design and The Durable Human Manifesto.
Her work has informed millions on ABC News and Discovery Health Channel, in The Washington Post, Readers Digest and other news outlets.
Hi Lori
Its been along time i wrote here on this thread.
I was waiting for progress in my son’s journey to recover from VA
My son Rohaan who is now 3.10 and he has been on screen fast from last 1year and 4months.
He watched cartoon 24/7 from age 9months till he was 2 and got Autistic like symptoms
His doctor said its due to watching screen he will be fine in few years if he will be given threapies.
So therapies started for speech behaviour n OT.
Rohaan was a child who was hving alot of sensory issues.
Sensory started coming under control.
But they r still there .
He still toe walk which is my concern
He makes eye corner .
He tries to tap two similar things if he is given free time .
Mouthing …puting things in mouth is also there but reducing with time
These r his issues now.
His progress is
His better eye contact.
He recognise people to some extend and he remember roads also which goes to mcdonalds and which road leads to grandparents place.
He is more alert now he can understand few things like give me , open, dont do this
Etc
He accepted the command of No also.
He gives u hi five if u ask for.
He shakes hands n while doing this he can look into ur eyes also.
Speech is not yet there.
He stopped verbal stimming
I give him a microphone n show him we can talk in it. When i say a word in mic and give mic to him he tries to sing in it in his gibberish language . The urge to say or speak is there but there is no word
May be there is not that receptive cognition there yet.
Lori my question here is
Is my child doing progress in a Right way or in with a required speed ??
As his age is increasing n his understanding isnt developing much.
Can u tell me something why he likes to tap two similar things in all the time ??
How n when will he leave this ??
Is it a good progress that he wants to say something in mic ?? That he knows mic is for speaking
Just want ur expert opinion on his over all progress for me he is an improved child but he still needs deep pressures n sensory help.
He sometimes presses the cornor of his eyes while looking things n tilt his head also. Which makes me upset how to improve this habit of him
Thank u for reading
Plz do reply
Waiting
Gull
Regards
Hi Gull,
Nice to hear from you. It sounds like you have concerns that Rohaan may not be progressing fast enough. I understand that as parents we want this to just be over, and always compare our children to others their age or even younger. This is a difficult process when our children are developing slower than or differently than what seems the typical pattern. It can be frustrating and worrisome as a mother. I remember those days vividly, and still sometimes look for signs of it. I’m not sure if it will ever totally leave me, as we just want to be sure everything is going “right” with our children who may have been affected by Virtual Autism.
Max is now almost 12 years old and I sometimes find myself doing this as I look at other friend’s his age we have over to play. Then I have to remember the uniqueness that comes with each child. Max is Max and the friend is uniquely different but no less or no more…each just has their own special talents and personalities and that’s what makes them enjoy each other.
With that said, I want to offer some suggestions that may help with his understanding. I really really want you to try to read to him as much as possible. This will help his receptive language per research and my experience as a parent for Max, a teacher, and clinician. Can you read to him for a total of an hour a day? Maybe 10 minutes every two hours. Just set a timer on your watch and make it your reading time. Please try to do this for at least 2 months and let me know if he seems to understand more. As you read, hold the book in a position where he can see both the book and your face. I liked to put Max in a highchair and do this while we shared a snack. I pointed out pictures excitedly and would ask him where or what something was in the book. “Where is the dog?” “What says “meow?” I would give him time to show me by pointing or looking and wait at least to the count of 3 in my head. Significantly more time than was needed by other children his age. If he didn’t look or point to the picture I wanted then I would point and say, “There’s the dog!” Or “The cat says “meow!” While pointing to it. This will give your son examples. I would also recommend taking your son’s finger and pointing to the picture after you give him this model above and practicing “with you” as you do this labeling too. So first ask a “where” or “what” question, give him some extra time to show you what you are asking him to. If he cannot do this yet after waiting for him to try, then show him where it is and say for him “This is the dog.” Wait and see if he imitates. If not, that’s ok. Then, take his finger and point…and say “This is the dog. Nice work Rohaan! You are right…that is the dog.” This will give him multiple times to hear the word dog, and a chance to show you where the dog is and then also a chance for you to intentionally teach him to understand and show you where the dog is in the book all while you praise him as if he’s doing it himself. These opportunities can specifically teach a him to fill in gaps of what he does not understand or necessarily have in his environment and also motivate him to learn by your praise and quality time together. You can also do something similar while driving with him and point out things and wait for him to imitate what you are saying by making sounds just like he is with the mic. These sounds are the precursor to words!!! Yay!! I am so glad your son is becoming verbal:)
It is so wonderful to hear that he is making sounds into the mic and imitating you doing that. I would recommend you imitate his gibberish too and try having a back and forth conversation like that while smiling at each other. This shared enjoyment and following his lead will hopefully continue to be something that motivates him to imitate what you are saying and doing. He is imitating now with objects with the mic and pretending to “talk.” If he doesn’t already him giving you a turn back would be a back and forth communicative gesture with the mic. You hand it to him he says something, he gives it to you and back and forth. You may then want to target things such as blowing in the mic next or kissing the mic. See if he will make these imitations with his mouth and lips. This will not only allow him to practice imitating with his face, but may give him the opportunity to do different sensory vocalizations and hear how they uniquely sound in the mic and be motivating for him since he sounds like he seeks sensory stimulation from your description of him. Then you may do something exclamatory like…”Yay!!!!” And you put your arms up and say it in the mic with excitement. I would target these things right now with the mic specifically and let me know how these go. Make it the same routine you are looking for each day. At this point we have to intentionally teach our children what comes so naturally to others that are more typically developing, and that is ok…the important thing is giving them more opportunities to learn it and they will!
I understand that putting his fingers in the corner of his eyes is upsetting to you. If he is not hurting himself doing this, I would just turn away and not give it any attention. When we do that we call this “extinction.” Sometimes at this age even saying, “Don’t do that or moving their hand may make the behavior occur even more if it is attention maintained with the sensory component.” Another strategy to give him something to do that is “incompatible” with that behavior. By that I mean, something that he cannot do while doing that to his eyes. You may need to trick him into doing this. An example would be to look at him say “peek-a-boo” with your own hands. Pause and wait and see if he will imitate you while you laugh. If he doesn’t, just act like you are having fun with playing “Peek-a-boo” yourself and smiling at him, but if his fingers are not a safety issue to his eyes I would say nothing and just try to “shape” this behavior into something that is not compatible and yet functional for his developmental stage right now that will share enjoyment.
Toe walking, mouthing, and peripheral staring usually dissipate with time away for screens and involved in social interaction and routines. Please be sure to keep all the music off in the background too especially as his receptive language is delayed so his brain has the ability to just focus on one thing that is natural and aligns with the environment coming into his ear for best understanding and nothing to compete with his attention to you.
I would either join the stim of banging objects and put vocalizations to that if the objects are ok to bang or just let him do that while you stay close to him and maybe sing to him as he “makes music” with whatever he is banging.
Sensory seekers usually benefit greatly from being outside…just like most of our children. But these kiddos usually show a decrease in their sensory seeking behaviors after being outside and given a chance to move and experience. We cannot recreate these experiences inside. Hopefully you can provide outside time daily as well no matter what the weather.
These are a lot of recommendations, but I know you have worked hard and are committed to your son and have also been an active presence helping to support others with your story. Thank you so much for the hope you are giving to others by sharing on this thread! You can do this! Do the best you can every day that you can and be happy that you can! Whatever the day brings, try to be at peace with that knowing you are doing your best. The days add up and before long you will see the fruits of your labor harvested! I’m so glad your son has such a dedicated mother like you on this journey.
Hi Lori,
Regarding the EMI therapy, I should consult the therapists and then i will transmit you, while you have understood well about the issue of concentration, my daughter when she spends time with me concentrates more than when she is with her grandfather. About the issue of work, it is misunderstood, no, Im not working because of my daughter, now I focus on the girl, I take care of her and most of the time she is with me. Hopefully now u would understand me, thank u in advance for everything.
Hi Enea,
It is great to see that you are able to spend a lot of time with your daughter throughout the day. It will be natural for her to pay attention more to you than her grandparents as you have a closer bond with her, for the most part. You can teach them strategies to help her naturally look at them more such as getting down to her level if they are able to do so. That may also mean sitting to play with her, squatting to point things out at her level if she is in the stroller, or laying on the floor a little lower than her as she sits by you.
Another way that may help if you are not already doing this is INVOLVE HER EVEN MORE. If you are giving her choices of drinks such as “Do you want milk or water?” And waiting for her to communicate you can take that to the next level. Instead of stopping there, extend the interaction. Continue by having you help you open the container of milk as you label “open!” And then hand-over-hand assistance if needed as you “close” the container. Encourage her to help you pour the milk and say “Ahhhh!” As a sound after she takes a drink and you smile together enjoying this experience. At the end of this routine, she can help you with putting the milk back in the refrigerator as you help her with this simple routine broken into one step directions such as “1) Open the door, 2) Put the milk in. 3) Close the door, broken down for her as needed.
I hope these things help. Remember to always try to approach her from the perspective of what she has gained and what you can offer her, instead of what she lacks and your fears that she may not make more gains. She is a child that has already made progress, I can tell you are a mom who wants to put in the time with her that it takes. Those two things together will get you very far. Don’t give up, just remind yourself it is a challenge sometimes and you can accept that challenge and triumph! You can do this…remind yourself everyday…you will not give up, it simply is not an option. There were times I had to think this with my son, Max. Had I not known of other children that this had helped I may have given up too. I had to remind myself, it was a process with the children I had worked with before him and they were successful and it would be a process for him and me, too! We would be successful and I would do my best each day to try to remember that. Sometimes I had to put notes around my house that were inspirational quotes etc to remind myself…to look on the light side of things. It is hard work, we are human, and in that humanity we fear failure. When you are the best parent you can be at the time, you are doing everything you can and I hope you feel good about that.
Hi Lori
Thank you so much for ur words .
I will practice all the techniques u suggested to me.
Regards
I m sorry for my bad google translate l wrote you in may native language bake hope, you will understand what l m saying
Thank you very much for the hope and motivation you give us, but I am very worried about whether we will achieve the maximum results until the end, because from the information I received, it is that after the age of 3 the brain starts to slow down, so I get very sad sometimes
Hi Enea,
The great news is that there is much still to be gained by your child and that we see best results with children under 5…but it is definitely the case that the earlier you can intervene the better. I see that your daughter has been screen free now for 8 months and that you are seeing progress. Do the therapists also feel she is making gains?
One thing that matters so much is the average amount of time each day that she is getting with one on one social interaction with you or another primary caregiver. Children in our clinical experience have the best outcomes with the most interaction possible. Usually at least four hours a day, but this also involves her therapy time and any time you are able to involve your daughter in everyday routines, making the most of your time count. There are also times of plateau when her brain and body may be focusing on another area of developmental gain. Are you getting in at least 4 hours a day with her during this critical time? If not, and there are ways you need to brainstorm ideas of how to go about this with yourself or someone else in the “village” of people you have created to help you during this process of intense socialization and zero screen time, let us know. You can do this and those you love I’m sure will be willing to help. There are so many people on this thread willing to help and with suggestions if you continue to need them. Every gain is a blessing. Please remember your daughter needs you to have an “attitude of gratitude” now and celebrate every gain with her no matter how small. If you are at a place of high expectations as you work with her, research shows that the children are more likely to achieve them than parents who set low expectations. She will come along at her own unique pace and I trust you are doing everything you possibly can to help her which is all you can do. You have got this and celebrate the little things each day.
Hello Lori, thanks for the advice, yes, my daughter has been without a screen for 8 months, that is, 0 screens, and with the therapy she follows and the therapists say that she is progressing and doing very well, but also something else, the girl follows EMI therapy as far as I understand and the therapists says that this is more suitable in these cases because the child is not under pressure, but they also tell us that we need to have a little patience because the process takes more time, while for the part at home I work with him personally all the time and when the mother comes back from work, I have left the work and focused on my daughter, when I have the work that I have to do at home, I try to engage the daughter in the routines, the bad thing is that here we don’t have any another child, to help us, the girl’s grandparents are also there, they take her for a walk, but I noticed that when you are with them, she is more distracted, I don’t know why this happens, this happens to me too, so I try to do it all the time At that time, I pay attention, but I am afraid that I will die or maybe we need more people to get involved here and why does the girl get distracted when she is in the presence of someone else, I have a lot of faith in that child that he can achieve a lot, but for the point of my questions that I have in my head are that the therapy that the girl attends if it is appropriate, and maybe she needs to go to private schools where there are small children, is there a need for this as well, I am afraid that she does not feel very isolated even though she spends most of the time passes out, and approximately how much time does the child need to get out of this state even when he is 3 years old, and the behaviors are repeated, I don’t know why they come back sometimes? I am waiting for your answer and I say every day I am glad that I have found you
Hi Enea,
Can you clarify for me what type of therapy EMI is that your therapist is doing with your daughter? Also, am I understanding correctly that your daughter is more focused when she is with you than others such as her grandparents. When she is with her grandparents she seems more distracted. Is this correct understanding? Also, am I understanding that you work outside the home during the day and that someone is watching your daughter while you work, but that when you are home you try to involve her as much as possible in your life. I’m just trying to clarify those questions before I respond to some of your questions. Thanks so much!
hello, I have written here before and I get a lot of encouragement to continue forward, I wanted to ask some questions now with my daughter, she is 3 years old, she has been in therapy since she was 2.4, she is progressing but very slowly, that means she has a lot to do but sometimes I lose hope because she still doesn’t speak, she has only learned to say “I want and don’t want” and she speaks in her own language a lot, again they come back and then they disappear, and they tear up the papers a lot, this makes me to feel always on the ground and sometimes in the sky, please let someone tell me if I’m on the right path or if I should do it, and it seems to me that I’m giving my best, I’m waiting for your judgments
Hi @Enea. Glad you are still here and so happy to learn of your daughter’s progress! Sounds like you have only been screen free and giving her special attention for 8 months, which is a great start, but from many parents we know the journey takes a while, typically more than a year. Besides formal therapy, your daughter needs lots of help from you and others in her life. Reminder to do these things daily: lots of pretend play such as with playthings and play kitchens (you may have to demonstrate at first how to play in the kitchen and then she will copy you), read books, play puzzles, play outdoors where she can move a lot and get exposure to fresh air and hopefully other kids, constantly describe her environment and always say what you are doing for and around her, “Now we are putting on your socks! First one on! Second one on!”, letting her “help’ with routines like stirring foods together when making meals. She needs to hear lots and lots of words and to watch you speaking on her eye level as much as possible. To you keep your own spirits up, please remind yourself of how you are helping her and that she is making progress!