CASE TWO: ROSE

The learner will:

1. Describe the characteristics and strengths of the individual with autism/pervasive developmental disorder.

2. Formulate questions to obtain information from families.

3. When presented with information from families, be able to demonstrate the ability to implement parent suggestions.

4. Describe the role and function of different disciplines of the collaborative team.

5. Understand what is documented in an IEP from each discipline and how this is incorporated into overall plans of treatment.

6. Describe the key points of disability legislation as it relates to transition to kindergarten and re-evaluation.

7. Use diagnostic information to describe present levels of performance to determine programming needs.    (Top)

Rose is 5 years, one month old. She has a diagnosis of autism which she was given by the PIE (Preschool and Infant Evaluation) team at 30 months. She communicates for little other than getting her needs met. She typically grabs your hand and takes you to what she wants. Rose is curious and active. She loves playing outside. She also likes tactile play such as beans and the water table. She laughs, giggles, and screeches when she is frustrated or happy. She likes to carry wooden spoons both at home and at school. Her play usually consists of banging her spoons or collecting small items such as paper clips, and small scraps of paper. Rose runs away and darts on the playground. She frequently grabs things from other children’s hands, especially food. If she does not like the activity presented, she pushes it all off to the floor. Rose is a beautiful child and loves her long hair braided.     (Top)

Rose lives with her mom (Lucy Miranda), grandma (Alberta Gonzales), and an older brother (Joe) who is 8 years old. The primary language spoken in the home is English. Lucy has been very happy with the Three and Four Year Old Program that Rose has attended. Lucy is not sure how she will adjust to kindergarten, but she would strongly like her to attend her neighborhood school.     (Top)

For the past two years Rose has attended the Three and Four Year Old Program and has received occupational and speech therapy as part of that program. Debra Delaney has been her teacher for the past school year. In compliance with the reauthorization of IDEA, an IEP is called to develop an evaluation plan and to determine kindergarten placement.

Ms. Delaney has arranged an early morning meeting to accommodate Lucy’s work schedule. She has kept classroom notes about Rose’s progress and has kept a communication notebook with the family. Rose’s therapists have kept progress notes as well.     (Top)

1. What characteristics of a pervasive developmental disorder does Rose exhibit?

2. According to the reauthorization of IDEA, what are the steps that lead up to the IEP meeting?

3. Discuss who should participate at the IEP meeting; what is their role at the meeting?

4. What information would you want to review prior to the IEP meeting?

5) As we progress in this case you will receive the following information in order to respond to questions:

--PIE highlights

--Therapy Notes

--Classroom Records

--Current IEP

--Excerpts from the communication notebook

The following people were in attendance at the IEP meeting. In compliance with the reauthorization of IDEA, the team is attempting to develop a plan for Rose’s re-evaluation.

The family was represented by Rose’s mother, her grandmother, and Trudy Marquez, a friend of Lucy’s who has a 9 year old son with a disability.

In attendance from the Three and Four Year Old Program were Mrs. Delaney , teacher, Jon Tuttle, occupational therapist, Louise King, speech-language pathologist, Marge Devon, early childhood administrator, and Sam Wilkes, evaluation specialist.

In attendance from the home school were the regular kindergarten teacher, and the head special education teacher.

Lucy wonders about Rose attending her neighborhood kindergarten because she remembers the work that Joe had to do there. She also wonders about the number of children in the class and how Rose will handle this. Debra Delaney has serious concerns about the IEP goals written from last year.

6. Compare Rose’s current IEP goals with the daily progress notes written by her teacher and her therapists and respond to the following questions.

a. Do the goals and objectives on Rose’s IEP seem appropriate in light of what

Rose is doing in the classroom and at home?

b. Review the PIE summary. How well does this reflect Rose’s current levels of performance as stated in the IEP? How would you account for any differences?

c. Would you suggest that Rose have a re-evaluation to determine present levels of performance and establish new goals and objectives? Why or why not?

d. In order to develop appropriate goals and objectives for Rose, what are the next steps?

A second IEP meeting has been called following re-evaluation. The main objective for this IEP is to decide the kindergarten class that will be best for Rose. The same people who were in attendance at the first IEP have returned for this meeting.

The evaluation specialist describes two placement options for Rose. The first option is the neighborhood school. At this school, there are four AM and PM kindergarten classes with approximately 18 children in each classroom. There is currently a speech -language pathologist on staff, and the school is recruiting an occupational therapist. The kindergarten teacher here does not have experience with children with autism and feels that Rose’s needs might be better served by a teacher who has a background in special education.

Mrs. Miranda wants Rose to attend the neighborhood school. She feels that the bus ride to the Three and Four Year Old Program was difficult for Rose, and that at the neighborhood school, Rose could walk to school with her brother Joe. Lucy would like Rose to have an opportunity to meet and socialize with children at school who also live in the family’s neighborhood. She is hopeful that Rose will make friends in the neighborhood and have an opportunity for after school play.

A second option for Rose is the developmental kindergarten which is 5 miles from Lucy’s home. This class has an 8:2 student to teacher ratio. Rose will need to take a bus, which will pick her up at her home and drop her off after school. Rose would be in a class with other children who have developmental or special needs and could receive speech and occupational therapy in her classroom. Debra Delaney feels strongly that this would be the best option for Rose given her experiences with her this school year.

Whatever school Rose attends, Lucy would like her daughter to interact and communicate more with the other children.

7A. List the advantages and disadvantages of each kindergarten placement for Rose.

7B. Are there resources to support the advantages/disadvantages listed above? Where could you find these resources.

7C. Discuss Donnelan’s (l984) eight principles related to making educational decisions, and whether any of these would assist you in making a decision.

8. Regardless of the kindergarten choice for Rose, describe a modification/support around Lucy’s goal of increased interaction and communication for Rose with other children. Given Rose’s diagnosis of autism, are these modifications/supports different than ones you would use for a child with another developmental diability?  (Top)

Rose is a beautiful 30 month old girl who is evidencing qualitative differences in her communication and social interaction as well as limited or restricted interests. Her behaviors are consistent with a diagnosis of autism.

Cognitive Summary: The Bayley II Mental Scale resulted in a standard score of less than 50 and an average developmental age score of approximately 8 months with a range of skills between the 6 - 10 month level. Rose had some scattered abilities up to the 15 month level. She had difficulty with tasks requiring interactions with the examiner however was able to complete some tasks with objects. Rose rang a bell purposefully and shook the rattle to hear the noise it produced. Rose demonstrated object permanence in that she would look for an object that was hidden from her view. Rose did not place cubes into a cup or pegs into a peg board. She did not place puzzle pieces into a formboard. Rose did match like objects together. Imitation was difficult for Rose.

Adaptive behavior was evaluated using the Vineland Adaptive Behavior Scales with her mother as respondent. Rose received an Adaptive Behavior Composite of 59 indicating a low level of adaptive skills. Subtest scores were as follows:

Domain Standard Score Age Equivalent

Communication 56 6 months

Daily Living Skills 74 1 year 7 months

Socialization 56 7 months

Motor Skills 72 1 year 7 months

Communication Summary: Rose exhibited significant delay and disorder in all aspects of her communicative development. No formal testing was attempted due to Rose’s lack of joint attention and her difficulties with social interactions. Her play skills were evaluated using the Westby Symbolic Play Scale. Results indicated play skills at a 6-9 month level. The majority of Rose’s interactions with objects were mouthing or banging. Her mother reported that Rose understands the names of family members and pets. Her expressive language is limited to sounds which her mother interprets as requests for food or drink. She is also able to vocalize displeasure and protests.

Motor development was tested using the Peabody Developmental Motor Scales which resulted in a gross motor age equivalent of 18-1/2 months at the 1st percentile, and a fine motor age equivalent of 11 months at the 1st percentile for her age category. Rose exhibited a scatter of motor skills, but overall her average skills were delayed. She also exhibited an unusual quality to her behaviors with decreased eye contact and several preferred behaviors involving sensory stimulation such as stomping her foot and spinning.

Rose is able to walk forward independently and stoop and recover objects. She could walk forward on a line although she frequently walked with one foot on and one foot off the beam. Rose exhibited a fine pincer grasp bilaterally. She enjoyed taking objects out of a container but does not yet put them back. She held a marker with a radial-digital grasp and was able to imitate scribbling with the marker when her mother demonstrated for her.

Medical history and examination are benign and do not reveal a specific etiology for her developmental pattern. Rose passed vision screening; hearing was evaluated and showed normal responses in soundfields for at least the better ear with normal middle ear function bilaterally.

It appears that Rose may benefit from intervention. The determination of the need for special education and related services for a child upon the third birthday is made through the Individualized Education Program (IEP) process.       (Top)

GENERAL:

Rose has been seen this school year for combined occupational and speech/language therapy services. She has received these services 2 times per week in her preschool classroom. These services were provided in a small group and individually.

August l997 - September l997:

Rose has been assessed on an on- going basis during this period to determine her interests, strengths and abilities in a variety of settings. Rose’s activity level is high and transitions are challenging. Therapy has been "child directed" and Rose’s ability to participate in a small group, with assistance, varies. Rose seems to enjoy tactile experiences yet needs to initiate these. She does seem to enjoy vestibular input, especially linear movement (swinging in a net swing with pillows around her). During tactile and vestibular play, Rose seems more engaged with the clinicians. She will look to the clinicians if they hesitate to push her in the swing and at times will vocalize as she looks. Rose has been encouraged to participate in the small group setting, although she is most likely to remain with the group if they are participating in an activity that she particularly enjoys. Rose continues to communicate through motoric means, most notably by taking the clinicians’ hands to direct them to what she wants to do.

October l997 - December l997:

Rose’s primary OT goal continues to be to process sensory information more efficiently and to determine what type of sensory stimulation might help Rose to focus her attention better. Communication goals focus on social interaction/engagement as well as increasing communicative intents with the clinicians during therapy time. We are working to increase Rose’s ability to engage with materials, activities, teachers or peers and to have her appropriately wait for an activity or turn. During this period, Rose appears to benefit more from her individual sessions and schedule changes were made to give Rose two sessions of individual combined therapy weekly in her classroom. We have continued to allow Rose to lead us to the activity she wants; we are, however, visually structuring activities so that they have a clear ending. Rose’s attention for tasks continues to vary daily and she continues to be motivated by tactile and vestibular input. Transitioning from one activity to another is difficult but we have continued to encourage her to use her wooden spoon during transitions. Rose will allow us to place the spoon in a "spoon container" while she participates in activities. She is then encouraged to use her spoon to transition to another activity. Rose is more likely to be engaged in social interactions during familiar activities; the frequency of her communicative intent of requesting has increased.

January l998 - February l998:

Rose has a set routine that she enjoys during therapy time. She appears less stressed than at the beginning of the school year and she certainly protests if her routine is upset. Routines are used as a context for teaching communication; we are marking the steps of various routines with words and we are giving Rose specific information about when she is to take a turn. We are still doing individual combined therapy but we have added one other child to join Rose during her therapy times. Rose does not interact with this child but will allow him within her physical proximity as long as the routine is not interrupted. Oral motor activities have been introduced and Rose seems to enjoy them. Increased focused attention is noticed after this input, however, she is particular about what she puts in her mouth. Progress has been seen and we are thinking of including Rose in the small group again.

March 1998 - April l998:

Rose has completed two months in the small group in the classroom in addition to her individual sessions. We are trying to establish a routine for the small group to assist her participation. Her performance varies on a day to day basis but we want her to be included with the other students. Rose is more communicative and focused in her individual sessions. Her routine include activities to facilitate gross and fine motor development and to assist her in sensory processing. Opportunities for communication are structured and Rose’s communication attempts have increased with more requests generally by motoric means. We have started to pair certain objects with activities and present these consistently to Rose (piece of rope/swing, baggy of beans/bean tent, crumpled paper/magazine). We are not certain how much meaning these objects have to Rose but we are assisting her in a hand- over -hand manner to carry these to designated areas where the activity will occur.

Rose has made tremendous gains in the areas of communication and sensory processing this school year. It is thought by these therapists that Rose will continue to benefit from therapy services to address her communication, sensory and motor needs.      (Top)

Rose has been in the Child Find 3 & 4 year old preschool program for 2 years. This is my first year with Rose. Rose attends the morning program 4 days per week. She rides the bus to and from school and her attendance has been excellent this year. Rose receives both occupational and speech therapy services in the classroom. Below is a general summary of classroom performance.

August l997 - September l997

The beginning of the school year was challenging for Rose possibly due to a change in routine, new staff and a change in the classroom setting. Although Rose seemed content on the bus, the transition to the classroom was difficult. After Lucy (Rose’s mother) told us she liked to carry spoons, we started to present her with a wooden spoon when she came off the bus. She then began to transition to the classroom with less difficulty. These first few months were basically an observation time and a chance for Rose to get use to the many changes. She likes certain activities in class such as the beans and rice table, faucet, and tunnel. Although she likes these activities she will only do them on her own time and in her own way. Rose’s previous IEP goals have been reviewed and I feel I need more on going classroom assessment to determine how I might meet these goals with Rose.

October l997 - December l997

Rose has become familiar with the bus routine and will come into the classroom with no difficulties. We do not need to use the wooden spoon to transition her from the bus. The class has a routine which includes circle time, outside play, therapy, snack, group art or music, and free time. Rose seems to know the routine and she gets upset if it is broken. She loves outside play; she swings on the same swing most of the time or she sifts sand. She enjoys snack and will sit momentarily but when finished tends to take other children’s food. Rose typically will wander around during free time. Her therapists allow her to lead during therapy time. Rose will sit during circle if someone holds her but will leave if she is not held. We are working on attention to task and participating with the class. Rose does not appear interested in tool use such as using markers or scissors and the goals on her IEP have been difficult to address.

January l998 - February l998

Rose had a bit of difficulty adjusting after the holiday break. She now has no difficulty with getting on or off the bus. She will come to the snack table and sit briefly while she eats and when guided will throw her cup and napkin away. She continues to prefer the swing but when presented with sand toys she will pour sand into different containers. Rose will come to any adult in the classroom and pull them to what she needs. Rose has little interest in the other children in her class except for when they are on her swing or in her way. Her way of interacting with them is typically to push them aside. Rose is beginning to become interested in the music portion of circle time and will sometimes sit for this period. She continues to dislike loud sounds and gets very agitated if other students cry. I have been communicating through a notebook with Rose’s mother Lucy to get an idea of what Rose is doing at home so that we can continue to address her IEP goals.

 March l998 - April l998

Rose has made gains this year. She will be moving on to kindergarten next fall and therefore planning needs to begin. Notes in the communication notebook to Lucy have been about this. I wrote to Lucy in regards to having a new IEP to set new goals. Rose has matured this year. She can tolerate different people working with her if she knows what is happening. A timer has been used in the classroom to signify a change in activity and this seems to have alleviated some of Rose’s stress. Circle time regularly begins with music and Rose will sit for 1-2 songs. Rose will sometimes take food from the other children but this varies on a daily basis. Her attention to particular tasks or activities also varies. Rose does appear to notice her classmates more although she still has difficulty in turn taking activities. I have felt that Rose has benefited from this preschool experience and will continue to grow and develop in kindergarten. Rose does appear to get overstimulated with a lot of noise and action in the room. It is for this reason that I think Rose would benefit most from a small classroom of children with a high student/staff ratio.

Debra Delaney

Jon Tuttle, OTR/L

Louise King, SLP - CCC      (Top)

LAST IEP DATE: 4-15-96 THIS IEP DATE: 4-15-97

NEXT IEP DATE: 4-15-98

Rose continues to adjust to her preschool class. She is using markers and crayons and has shown an interest in puzzles and legos. She shows considerable motor activity and continues to have difficulties in communicating her needs. She does not play with the other children.

3. Rose will indicate yes/no to basic questions using either a word or a head nod with 95% accuracy.      (Top)

Guidelines for Educational Decisions

Excerpted from Janzen, "Understanding the Nature of Autism", 1996.      (Top)

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