It says "This is real in real life." It's the back of this book that Ava drew a while back. I would show the rest, but it's not as coherent as her earlier endeavors -- but there are some great little scenes like this one that I'll post for you. The drawing of the two girls down at the bottom are friends. When I asked Ava what's going on there, she said, "That's real life!" As in, didn't you know? I mean, c'mon! The girl with the long hair is one of the characters in the book. I'll have to show more from this book when I have the chance.
I love the self-portrait there, with Ava showing off her gap-tooted smile. I love it so much that I'd like to see it bigger: