Ary's mother reports that he has chronic ear problems, so some language development may be hampered by a lack of hearing. It is also likely that he still experiences cultural language confusion. For example, in Kazakhstan they routinely overdress the children so it becomes difficult for them to read their own body temperature signals. And the caregivers did not take the children outside during inclement weather, so while Ary may have seen snow and rain through windows, he did not experience weather personally. When Ary's mother first began working with him in Kazakhstan, she concentrated on giving him the English words for basic needs (potty, sleep, play things, foods). After returning to America, the international adoption clinic evaluated Ary and made him use language in order to get his needs met. They advised Ary's mother to "make him talk" instead of pointing to things. Between day care and constant prompting from a verbal mother and caring friends, Ary learned how to communicate in the English language very quickly.