Cindy's Motor Control and Learning Style:
Motor Control: Cindy demonstrates weakness, instability, decreased muscle tone, joint laxity, bilateral incoordination, frequent switching of hand use, and various grasp patterns. She also demonstrates proximal "fixing" of joints for apparent added stability. She typically leans into people and furniture. She tends to move from one surface to another at a fairly rapid pace, "crashing" into her end goal (chair, mom, etc.). Cindy also has a tendency to "plow" through obstacles without stepping over them or walking around them. Strengths include: navigation of stairs, mark time, and with handheld or handrail assistance; carrying, pushing, and pulling fairly heavy objects around house; creeping in and out of kitchen cupboard; and sliding down a slide.
Learning Style: Cindy does well when activities are rapidly presented one after another. She performs better in a minimally stimulating environment, where clear physical boundaries are present. She has done well with a picture schedule to aid in her anticipation of upcoming tasks. She has recently demonstrated an increase in tolerance and enjoyment to sensory input, demonstrated by increased engagement, eye contact, and vocalizations. In addition to improving social interactions and increasing body awareness, these sensory breaks have been advantageous in increasing arousal for eliciting more on-task behavior during structured play activities. Cindy has also begun to respond to verbal praise. Now, when praise is not offered after each consequtive task completion, Cindy tells herself "good job" : )
Treatment Strategy:
1. Because of Cindy's young age and skill level, my intervention would continue to be frequent and intense, incorporating the aid of Cindy's family and team of EI providers. I would also continue to provide constant practice with a focus on simple movements. Once a good level of mastery had been achieved, I would move to a more variable frequency of intervention, with random practice, and increased expectations in the complexity of movements to increase learning potential and generalization (strategies based on Mass, 2008 article).
2. Considering the findings from the articles by Rinehart, et all (2006) and Vernazza-Martin, et al (2005), I would work on executive function skills to enhance motor planning. I would focus on prepositions like in, on, under, and over as well as categorizing, sequencing, memory, etc.
3. Considering the above mentioned motor control concerns, I would work on increasing body awareness, overall stability, and bilateral coordination.
4. I would work on simple oral motor, fine motor, and gross motor imitations increasing the complexity and number of sequences appropriately over time.
5. It may be advantageous to visually highlight obstables. I have had previous success using orange tape on stairs for example, with other children to aid in their visual awareness and depth perception. Having Cindy listen to music with a slow, steady beat may also help to slow down her movements.
Wednesday, March 25, 2009
Tuesday, March 17, 2009
Module 4 Cognition/Action/Perception/Modulation
Evaluation:
Cindy's occupational performance has been evaluated over time by looking at her strengths and weaknesses in areas of occupation, performance skills, performance patterns, context, activity demands, and client factors. An assessment of the families values, needs, and priorites were also taken into account. This information was gathered using standardized tests scores, parent interview, and professional observation. Results were as follows:
Occupational Performance:
1. Performance Skills:
a. ADL's and IADL's: On the Batelle, Cindy was found to be demonstrating a 64% delay in adaptive development. She currently finger feeds herself, uses a spoon infrequently, removes clothing, and drinks from a sipper cup. Oral and tactile sensitivities hinder development in feeding, dressing, and grooming.
b. Social Participation: Cindy was found to have an 82% delay in social-personal development according to the Batelle. She is an only child in a single parent household. She does not have many social demands placed on her. When she attended a private daycare for a short time, she did not interact with the other children. She actively and passively avoided social situations by withdrawing or by physically removing herself. She occasionally ran into potentially dangerous situations like running toward the road. Cindy does not eat at the table with her mother but "grazes" througout the day. She tends to become overstimulated when out in the community (grocery store, restaurants, doctor's office), demonstrating an increase in challenging behaviors. Cindy has begun to demonstrate improved interactions with her mom however. Cindy's mom recently reported that Cindy will sit at the top of slide and say "ready, set... " and wait for her mother's response to say, "go" before she slides down. Cindy has also recently demonstrated an increase in joint attention, looking for her mother's reaction while involved in an activity of enjoyment. Overall, poor eye contact, difficulty with novelty, delayed speech, and a rigid need for familiar routine continue to hinder Cindy's social success.
c. Play and Leisure: Cindy is beginning to demonstrate interest in what her mother or therapists are doing. Initially, she ignored others and demonstrated narrow interests with a preference for coloring, watching television, or staring at her video boxes. She was highly resistive to unfamiliar tactile and vestibular forms of play. She is now more accepting of movement and "messy" forms of play. Cindy has also begun to show the emergence of imaginative play, feeding her stuffed animals and making her butterfly toy fly through the air. These skills have been learned and an expansion of spontaneous skills has not yet been observed.
d. Educational, Vocational, and Pre-Vocational: Cindy demonstrates a 29% delay in cognitive skills according to the Batelle. She is beginning to learn the expectations of a structured environment by sitting and attending during home-based speech, special instruction, and occupational therapy sessions. She needs to work on completing morning routines efficiently so, when she transitions to a center based program, she will arrive on time and in a fairly calm state. She rides well in a car with her mother. It is anticipated that riding a bus will be anxiety provoking for Cindy. Cindy's cognitive and perceptual skills for success in the classroom will likely be influenced by Theory of Mind challenges (doesn't appear to understand others emotions, demonstrates decreased joint attention and minimal desire to elicit pleasurable responses from others), difficulties with executive function like planning, sequencing, cognitive flexibility, working memory, and monitoring and stopping inappropriate behaviors (Miller-Kuhaneck, 2004), and weak Central Coherence and local to global processing (detail oriented with difficulty in "seeing the whole picture").
2. Performance Patterns:
a. Motor Skills: Srengths: Cindy is able to navigate her home environment independently, climb into adult furniture, climb stairs, and go up and down a slide. Concerns: Cindy demonstrates decreased muscle tone and joint instability, weakness, decreased endurance, a slouching posture, instability, immature and/or atyical grasp patterns, fine motor dyspraxia, no hand dominance, fair bilateral integration of upper extremities, and fair imitative skills.
b. Process Skills: As mentioned above, difficulty generalizing information and applying it to broader, more global terms is challenging for Cindy. She did however, recently run to her room to obtain a toy telephone when we were playing with a puzzle that had a telephone on it. She has difficulty with executive functioning skills. She also demonstrates periods of high and low energy, affecting her ability to actively participate and attend to task. Energy levels are likely influenced by the foods she eats, poor sleeping patterns, and the complexity of the environment.
c. Communication and Interactive Skills: Upon initiation of services, Cindy was jargoning without intent to communicate, repeating phrases from her videos, and tantruming to communicate. At her initial evaluation, she was demonstrating a 2.6 standard deviation belwo the mean in expressive communication. Cindy has recently demonstrated an explosion in labeling, although she has difficulty relating learned labels for functional communication. She demonstraes difficulty understanding questions, interpretting emotions, reading nonverbal gestures and the meaning of stress put on words like "hot" and "no". Overall, she is demonstrating gains in her ability to communicate and interact with her mom and therapists where routines and expectations have been established. She continues to have difficulty relating to unfamiliar people.
3. Performance Patterns: Cindy's current role is to play at home and to periodically go into the community with mommy. She does not have strong demands placed on her in her current environment as her mother has typically provided her with what she desires and has avoided placing Cindy in situations where she demonstrates heightened signs of distress. Cindy will soon be transitioning to a center-based preschool program and will have many new demands placed on her (morning routine of washing, dressing, eating, and getting on the bus; interacting with unfamiliar adults and peers in an unfamiliar environment; being required to attend and participate in potentially anxiety producing situations). Although improved, Cindy has demonstrated habits that interefere in performance (wearing only diaper, staying awake very late into the night, and eating a limited variety of foods). Her desire for sameness in her routine was initially very difficult to break (refusal to separate from television, to color on anything other than 8 1/2 x 11" sheet of paper, grazing instead of eating at table) and met with negative behavioral responses.
4. Client Factors:
a. Sleep: Cindy stays up late. Falls asleep where ever she is tired (on floor, on sofa). She does not sleep soundly, awaking several times throughout the night.
b. Posture and Tone: Cindy demonstrates decreased muscle tone and joint laxity. She also demonstrates reduced endurance, strength, and a slouched posture.
c. Arousal and Attention: Cindy's arousal is inconsistent and tends to go between both extremes, finding it hard to achieve a "just right" level of alertness. Her attention to task varies on the activity and her level of arousal.
d Cognitive skills: Cindy demonstrates some problem solving skills such as moving a chair to obtain an object that was set out of reach. Overall, her reasoning appears impaired. Due to her age and performance, it is difficult to have a good understanding of her memory. She recognizes familiar people and familiar activities.
e. Temperment, Personality, and Emotional Function: Cindy can be very cuddly and loving. Her activity level tends to be too high or too low. She reacts immediately and fully to perceived stressors, demonstrates varying attention to task depending upon the activity, and demonstrates initial apprehension or avoidance to novel activities.
f. Sensory Functions: The Winnie Dunn Sensory Profile for Infants and Toddlers indicated probable differences more than others in: senation seeking; sensation avoiding; and oral processing. A definite difference more than others was found in: low registration; sensory sensitivity; low threshold; auditory; visual; and tactile processing. Overall, Cindy odemonstrates sensitivity to certain sounds, movement, tactile input, and oral input. On the other hand, she was underresponsive to voices and other sounds, craves deep pressure input "on her terms", and is seeking of oral input. She has difficulty regulating her states and sleeping patterns. She demonstrates immediate, intense responses to perceived stressors. He sensitivities have interferred in ADL development (dressing, groom, eating), play exploration, and social interactions.
5. Context: Cindy is definitely influenced by the complexity of her environment. She demonstrates poorer performance in unfamiliar settings, with unfamiliar people, and with unfamiliar tasks. She tends to be overstimulated by a visually stimulating environment and performs best when seated at a small table and chair with limited objects present. She is generally underresponsive to voices and other environmental sounds although she demonstrates a fight or flight response to specific sounds like the vacuum cleaner. She does not appear to be bothered by lighting, smells, and temperature.
6. Family Factors: Cindy's mother is a single parent who wants her child to be happy. She therefore, has a difficult time encouraging Cindy to communicate effectively or to participate in activities to enhance development if it is going to upset Cindy. Finding goals that were meaningful to this family was therefore, somewhat problematic. Dicussing the need for compliance for success in future occupations has been discussed and stressed. Overall, working on skills to enhance mother/daughter interactions has been most advantageous at this time.
(sorry for being a little too long winded and occasionally redundant)
Cindy's occupational performance has been evaluated over time by looking at her strengths and weaknesses in areas of occupation, performance skills, performance patterns, context, activity demands, and client factors. An assessment of the families values, needs, and priorites were also taken into account. This information was gathered using standardized tests scores, parent interview, and professional observation. Results were as follows:
Occupational Performance:
1. Performance Skills:
a. ADL's and IADL's: On the Batelle, Cindy was found to be demonstrating a 64% delay in adaptive development. She currently finger feeds herself, uses a spoon infrequently, removes clothing, and drinks from a sipper cup. Oral and tactile sensitivities hinder development in feeding, dressing, and grooming.
b. Social Participation: Cindy was found to have an 82% delay in social-personal development according to the Batelle. She is an only child in a single parent household. She does not have many social demands placed on her. When she attended a private daycare for a short time, she did not interact with the other children. She actively and passively avoided social situations by withdrawing or by physically removing herself. She occasionally ran into potentially dangerous situations like running toward the road. Cindy does not eat at the table with her mother but "grazes" througout the day. She tends to become overstimulated when out in the community (grocery store, restaurants, doctor's office), demonstrating an increase in challenging behaviors. Cindy has begun to demonstrate improved interactions with her mom however. Cindy's mom recently reported that Cindy will sit at the top of slide and say "ready, set... " and wait for her mother's response to say, "go" before she slides down. Cindy has also recently demonstrated an increase in joint attention, looking for her mother's reaction while involved in an activity of enjoyment. Overall, poor eye contact, difficulty with novelty, delayed speech, and a rigid need for familiar routine continue to hinder Cindy's social success.
c. Play and Leisure: Cindy is beginning to demonstrate interest in what her mother or therapists are doing. Initially, she ignored others and demonstrated narrow interests with a preference for coloring, watching television, or staring at her video boxes. She was highly resistive to unfamiliar tactile and vestibular forms of play. She is now more accepting of movement and "messy" forms of play. Cindy has also begun to show the emergence of imaginative play, feeding her stuffed animals and making her butterfly toy fly through the air. These skills have been learned and an expansion of spontaneous skills has not yet been observed.
d. Educational, Vocational, and Pre-Vocational: Cindy demonstrates a 29% delay in cognitive skills according to the Batelle. She is beginning to learn the expectations of a structured environment by sitting and attending during home-based speech, special instruction, and occupational therapy sessions. She needs to work on completing morning routines efficiently so, when she transitions to a center based program, she will arrive on time and in a fairly calm state. She rides well in a car with her mother. It is anticipated that riding a bus will be anxiety provoking for Cindy. Cindy's cognitive and perceptual skills for success in the classroom will likely be influenced by Theory of Mind challenges (doesn't appear to understand others emotions, demonstrates decreased joint attention and minimal desire to elicit pleasurable responses from others), difficulties with executive function like planning, sequencing, cognitive flexibility, working memory, and monitoring and stopping inappropriate behaviors (Miller-Kuhaneck, 2004), and weak Central Coherence and local to global processing (detail oriented with difficulty in "seeing the whole picture").
2. Performance Patterns:
a. Motor Skills: Srengths: Cindy is able to navigate her home environment independently, climb into adult furniture, climb stairs, and go up and down a slide. Concerns: Cindy demonstrates decreased muscle tone and joint instability, weakness, decreased endurance, a slouching posture, instability, immature and/or atyical grasp patterns, fine motor dyspraxia, no hand dominance, fair bilateral integration of upper extremities, and fair imitative skills.
b. Process Skills: As mentioned above, difficulty generalizing information and applying it to broader, more global terms is challenging for Cindy. She did however, recently run to her room to obtain a toy telephone when we were playing with a puzzle that had a telephone on it. She has difficulty with executive functioning skills. She also demonstrates periods of high and low energy, affecting her ability to actively participate and attend to task. Energy levels are likely influenced by the foods she eats, poor sleeping patterns, and the complexity of the environment.
c. Communication and Interactive Skills: Upon initiation of services, Cindy was jargoning without intent to communicate, repeating phrases from her videos, and tantruming to communicate. At her initial evaluation, she was demonstrating a 2.6 standard deviation belwo the mean in expressive communication. Cindy has recently demonstrated an explosion in labeling, although she has difficulty relating learned labels for functional communication. She demonstraes difficulty understanding questions, interpretting emotions, reading nonverbal gestures and the meaning of stress put on words like "hot" and "no". Overall, she is demonstrating gains in her ability to communicate and interact with her mom and therapists where routines and expectations have been established. She continues to have difficulty relating to unfamiliar people.
3. Performance Patterns: Cindy's current role is to play at home and to periodically go into the community with mommy. She does not have strong demands placed on her in her current environment as her mother has typically provided her with what she desires and has avoided placing Cindy in situations where she demonstrates heightened signs of distress. Cindy will soon be transitioning to a center-based preschool program and will have many new demands placed on her (morning routine of washing, dressing, eating, and getting on the bus; interacting with unfamiliar adults and peers in an unfamiliar environment; being required to attend and participate in potentially anxiety producing situations). Although improved, Cindy has demonstrated habits that interefere in performance (wearing only diaper, staying awake very late into the night, and eating a limited variety of foods). Her desire for sameness in her routine was initially very difficult to break (refusal to separate from television, to color on anything other than 8 1/2 x 11" sheet of paper, grazing instead of eating at table) and met with negative behavioral responses.
4. Client Factors:
a. Sleep: Cindy stays up late. Falls asleep where ever she is tired (on floor, on sofa). She does not sleep soundly, awaking several times throughout the night.
b. Posture and Tone: Cindy demonstrates decreased muscle tone and joint laxity. She also demonstrates reduced endurance, strength, and a slouched posture.
c. Arousal and Attention: Cindy's arousal is inconsistent and tends to go between both extremes, finding it hard to achieve a "just right" level of alertness. Her attention to task varies on the activity and her level of arousal.
d Cognitive skills: Cindy demonstrates some problem solving skills such as moving a chair to obtain an object that was set out of reach. Overall, her reasoning appears impaired. Due to her age and performance, it is difficult to have a good understanding of her memory. She recognizes familiar people and familiar activities.
e. Temperment, Personality, and Emotional Function: Cindy can be very cuddly and loving. Her activity level tends to be too high or too low. She reacts immediately and fully to perceived stressors, demonstrates varying attention to task depending upon the activity, and demonstrates initial apprehension or avoidance to novel activities.
f. Sensory Functions: The Winnie Dunn Sensory Profile for Infants and Toddlers indicated probable differences more than others in: senation seeking; sensation avoiding; and oral processing. A definite difference more than others was found in: low registration; sensory sensitivity; low threshold; auditory; visual; and tactile processing. Overall, Cindy odemonstrates sensitivity to certain sounds, movement, tactile input, and oral input. On the other hand, she was underresponsive to voices and other sounds, craves deep pressure input "on her terms", and is seeking of oral input. She has difficulty regulating her states and sleeping patterns. She demonstrates immediate, intense responses to perceived stressors. He sensitivities have interferred in ADL development (dressing, groom, eating), play exploration, and social interactions.
5. Context: Cindy is definitely influenced by the complexity of her environment. She demonstrates poorer performance in unfamiliar settings, with unfamiliar people, and with unfamiliar tasks. She tends to be overstimulated by a visually stimulating environment and performs best when seated at a small table and chair with limited objects present. She is generally underresponsive to voices and other environmental sounds although she demonstrates a fight or flight response to specific sounds like the vacuum cleaner. She does not appear to be bothered by lighting, smells, and temperature.
6. Family Factors: Cindy's mother is a single parent who wants her child to be happy. She therefore, has a difficult time encouraging Cindy to communicate effectively or to participate in activities to enhance development if it is going to upset Cindy. Finding goals that were meaningful to this family was therefore, somewhat problematic. Dicussing the need for compliance for success in future occupations has been discussed and stressed. Overall, working on skills to enhance mother/daughter interactions has been most advantageous at this time.
(sorry for being a little too long winded and occasionally redundant)
Treatment:
1. To improve sensory processing: a) increase acceptance to sights, sounds, and feels for social, play, and ADL development. b) achieve a homeostatic level of arousal for learning. c) attend to task for age appropriate lengths of time. d) decrease negative reactions to noxious stimuli.
Strategies: sensory based strategies to calm/alert nervous system appropriately; adapt environment to decrease complexity; gradually introduce new sensory experiences, environments and people.
2. To improve motor skills: a) grasp patterns. b) bilateral coordination. c) handedness. d) strength. e) stability. f) muscle tone. g) endurance.
Strategies: develop arches in hands; grasp and release; bilateral activites; midline play; midline crossing; weightbearing; working at a vertical surface; walking and sitting on unstable surfaces; creating obstacles within the environment to step over, crawl under, etc.; gross and fine motor imitations; clapping to songs; two step clapping sequences; resistive materials.
3. To improve ADL's: independence in utensil use; drinking from open cup; dressing and undressing; fastens; washing; brushing teeth; hanging coat on hook; placing objects in and out of bookbag.
Strategies: scoop and dump dry materials like rice and beans; other tool use like wooden knife with velcroed foods or writing implements; drinking water from small dixie cup; dress-up with large clothing; doll dress-up; practice with zippers, buttons, and snaps; hang hood of jacket and bookbag on doorknob, try toothbrush without paste to begin with, try vibrating toothbrush, have Cindy brush her own teeth.
4. To improve social skills: for appropriate engagement and enjoyment from peer and adult interactions
Strategies: turn taking games; anticipation "ready, set.... " waiting for an engaging response; play groups; make-believe age appropriate scenerios; imaginative play to love or feed crying baby etc.; books on emotions
5. To improve cognition: to understand
Strategies: memory games, following simple directives; categories; labels; create age appropriate challenges that require problem solving, generalizing.
6. To improve language: to elicit functional communication.
Strategies: labels, identifying emotions, pointing, choosing, signing, pecs, nouns, verbs, pronouns, songs.
7. To improve behavior: for peace and success in all occupations.
Strategies: monitor complexity of environment, teach calming/alerting techniques as appropriate; prepare for events ahead of time via role playing, etc., use immediate reinforcement, tokens, use picture schedules to aid in anticipation of future events.
Wednesday, March 11, 2009
Module 3 Environmental Complexity
Initially, "Cindy" demonstrated significant difficulty handling new people and activities in her safe, familiar home environment. Prior to therapy, Cindy was content watching movie videos, fixating on video boxes, and self-stimming by twirling in circles. Very little demands were placed on her, providing for a peaceful home environment. Cindy would spend the day in her diapers because she refused to get dressed and stay dressed. Her hair was generally dirty and tangled due to her refusal to take baths. She grazed on the few food items she would eat, from the coffee table or floor and she demonstrated meltdowns whenever her pacifier was taken away. When therapy was introduced, Cindy avoided it by screaming and running to the other side of the room. Attempts to calm Cindy and redirect her were met with kicking, hitting, scratching, and screaming. Cindy's mother also became very distressed when any attempts were made to increase her child's compliance and on-task behavior. The initial plan was to help Cindy utilize self-calming techniques so she could effectively sit and participate in an activity. Very few strategies were effective however (gentle swinging in a blanket, "hotdog" deep pressure input, reducing distracting lights and sounds, etc.) as Cindy did not tolerate input that was received from others. Instead, we allowed her to acheive homeostasis in her own terms before proceeding. This generally included her pacifier and snuggling in tightly with mom. Once a calm, alert state was achieved, we began to introduce new activities to aid in her development. As suspected, unfamiliar tasks were resisted. Taking a few steps back, we started with familiar actvities and objects that were perceived as "safer". Even familiar, enjoyable tasks were difficult to expand upon however. For example, even though Cindy loves to color with crayons, she would only color on an 8 1/2 x 11 inch piece of paper. Eventually, we were able to move to coloring on paper plates, coloring on paper taped to the door, etc. Use of favored video boxes were also beneficial reinforcers at the completion of short-term tasks.
To add to the challenges of Cindy's rigidity, her home environment was very stimulating. The floor was covered with clothing, food, toys, and other debris. The television was always on and the volume was very high. When the television was on, Cindy was underresponsive to others in her environment. When it was off, the visual complexity of the items on the floor, appeared to significantly increase her activity level. Requests were made to keep the televeision off as much as possible, especially during therapy sessions. Cindy's special intructor purchased a child size table and chair which was beneficial in helping Cindy identify this space as her therapy/work space. The table was placed in a corner of the room to minimize distractions. Cindy made steady gains in her acceptance of new challenges although transitions from preferred activites continued to be difficult. A picture schedule was recently introduced to help Cindy predict what was going to happen and what would be expected of her during the session. Although this new strategy was only implemented a week ago, immediate gains have been observed.
Cindy continues to participate in therapy in her diapers with tangled hair and a pacifier as needed. When looking at our priorities at this point and time, we have found it more important for Cindy to feel "comfortable" while developing her language, cognition, motor skills, etc. We have also worked on increasing her tolerance to various forms of sensory input with the long term goal of increasing her acceptance to clothing, grooming, etc.
To add to the challenges of Cindy's rigidity, her home environment was very stimulating. The floor was covered with clothing, food, toys, and other debris. The television was always on and the volume was very high. When the television was on, Cindy was underresponsive to others in her environment. When it was off, the visual complexity of the items on the floor, appeared to significantly increase her activity level. Requests were made to keep the televeision off as much as possible, especially during therapy sessions. Cindy's special intructor purchased a child size table and chair which was beneficial in helping Cindy identify this space as her therapy/work space. The table was placed in a corner of the room to minimize distractions. Cindy made steady gains in her acceptance of new challenges although transitions from preferred activites continued to be difficult. A picture schedule was recently introduced to help Cindy predict what was going to happen and what would be expected of her during the session. Although this new strategy was only implemented a week ago, immediate gains have been observed.
Cindy continues to participate in therapy in her diapers with tangled hair and a pacifier as needed. When looking at our priorities at this point and time, we have found it more important for Cindy to feel "comfortable" while developing her language, cognition, motor skills, etc. We have also worked on increasing her tolerance to various forms of sensory input with the long term goal of increasing her acceptance to clothing, grooming, etc.
Thursday, March 5, 2009
Cindy's Behavioral and Communicative Strengths and Challenges
BEHAVIORAL 
Strengths:
*Sensory: Calmed by pacifier, blanket, stuffed animals, and deep pressure input (on her terms).
*Attention: Good attention to task and participation in activities that include pictures, books, and puzzles. Improved on-task behavior for fast-paced presentation of activities.
Strengths:
*Sensory: Calmed by pacifier, blanket, stuffed animals, and deep pressure input (on her terms).
*Attention: Good attention to task and participation in activities that include pictures, books, and puzzles. Improved on-task behavior for fast-paced presentation of activities.
Challenges:
* Sensory Processing Differences to include:
-Low Registration: i.e. under responsive to name, inattentive.
-Sensory Sensitivity: i.e. limited food intake, minimal tactile exploration.
-Sensation Avoiding i.e. avoiding of certain sounds like vacuum cleaner.
-Sensation Seeking: spinning self and/or toys, fast paced television programs.
-Difficulty Regulating States: immediate aggressive response to stressors, difficulty sleeping.
*Injurious Behaviors: Head banging, digging, scratching, and pulling own hair.
*Aggressive Toward Mother: hits and pinches.
*Rigid Need for Routine.
* Difficulty "waiting"
COMMUNICATIVE
Strengths:
* Is occasionally able to communicate desires via pointing.
* Is quickly mastering identification of simple labels.
* Is beginning to sign "more".
* Is beginning to ask for help.
* Increased jargoning
* Sensory Processing Differences to include:
-Low Registration: i.e. under responsive to name, inattentive.
-Sensory Sensitivity: i.e. limited food intake, minimal tactile exploration.
-Sensation Avoiding i.e. avoiding of certain sounds like vacuum cleaner.
-Sensation Seeking: spinning self and/or toys, fast paced television programs.
-Difficulty Regulating States: immediate aggressive response to stressors, difficulty sleeping.
*Injurious Behaviors: Head banging, digging, scratching, and pulling own hair.
*Aggressive Toward Mother: hits and pinches.
*Rigid Need for Routine.
* Difficulty "waiting"
COMMUNICATIVE
Strengths:
* Is occasionally able to communicate desires via pointing.
* Is quickly mastering identification of simple labels.
* Is beginning to sign "more".
* Is beginning to ask for help.
* Increased jargoning
Challenges:
* Severe limitations in receptive and expressive language (verbal and nonverbal) for age.
* Poor to fair engagement
* Uses whining and aggression to communicate
* Does not read facial expressions
* Does not know purpose of language
Recent team meeting: decided to implement a picture schedule board
Recent team meeting: decided to implement a picture schedule board
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