Individualized Education Program School: Watertown Elementary School Student Name: Richard H.

Age: 4 Student ID#: 123456 Date of Birth: 12/20/2009

Disability Classification: Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS) Student Information: Street: 400 Commonwealth Avenue City: Boston State/Zip: Boston, 02120 Phone: (123) 456-7890 Native Language: English Medical Alerts: N/A Additional Information: Thomas is a four-year-old boy diagnosed with PDD-NOS. His mother claims to have a lot of trouble controlling his behaviors at home. Stated behaviors are bolting in public places, hitting his brother, trouble with limit-setting, and trouble with bedtimes. At school, his teacher has explained that Richard has a hard time working or playing successfully in groups with other students. County: Suffolk Current Grade: Pre-Kindergarten Ethnic Group: Caucasian Gender: Male

Parent Information: Parent/Guardian Name(s): Helen H. Street: 400 Commonwealth Avenue State/Zip: Massachusetts/02135 City: Boston Phone: (123) 456-7890

County: Suffolk Gender: Female

Ethnic Group: Caucasian Native Language: English

General IEP Information Date of Initial Referral: 1/01/13 Date of Initial IEP Meeting: 2/12/13 Date IEP Initially Implemented: 3/15/13 Projected Date of Next Review: 2/12/14

Current Meeting: Date: 12/14/13 Type of Meeting: Attendees: Karen Thomas (Occupational Therapist) Lucy Phillips (Speech Therapist) Rachel Henry (Teacher) Robert Stokes (Principal) Helen H. (Mother) Janice B. (Grandmother) Arianna Jones (Behavioral Specialist) Nancy Shaw (Sleep Specialist) Initial Requested Review Annual Review

If Requested Review, Reason for Request: Speech Therapist (Lucy Phillips) has requested a review meeting because Richard seems to be back-tracking in his speech work; She claims to have noticed baby-talk and gibberish becoming more prominent during sessions; especially when Richard wants to escape any demands placed on him. Richard is asked to use his words, which he is capable of doing, but will refuse to do so. Richard has a younger brother, whose speech is not fully developed, and it is suspected that his interactions with him are influencing his current speech patterns and behaviors.

Current Needs: Student Strengths: When prompted, Richard is able to verbalize his wants and needs. Many times Richard can make these verbalizations without prompting, but only when he is in good space. When Richard is frustrated, it becomes difficult for him to verbalize, and instead, he is known to tantrum, cry, throw or hit things. When properly engaged, Richard can follow directions as well as maintain conversations. Although at times, he can become distracted, most times, it is easy to re-engage him in the activity or conversation. Richard enjoys board games as well as playing with toy cars and puzzles. Richard has no difficulties with completing activities of daily living, such as brushing his teeth, taking showers, appropriate toileting, etc.

Parent Concerns: Richard has a lot of trouble at home around bedtimes. At bedtime, Richard becomes very hyperactive and will distract his brother or run around and play games instead of going to sleep. He is often non-compliant and will tantrum

when requested are made to do something that he does not want to. He will fight with his younger brother and hit him when he does not get what he wants. He has a lot of difficulty taking turns, while playing games, and also with sharing toys and other belongings with his brother. It is difficult to keep him engaged in order to complete his homework from school.

Teacher Concerns: It is difficult to engage Richard in the classroom. He seems to ignore what he does not want to hear, and is only interested in the activities that involve toys or games that he enjoys. Has difficulty engaging and sharing with other students. Presents behaviors such as hitting or throwing things at other students when he does not want to play or share with them.

Student Needs: Specific Student Needs: Richard needs a lot of one-to-one attention in the home and classroom. Richard has been seen to perform at a much higher level in one-to-one situations or in small group settings compared to larger classroom settings.

Specific Ways Disability Interferes with Academic Abilities: Richard becomes very distracted during times of academic work, which is hindering his progress. His frustrations with being corrected in the classroom have also added to this. Transitional Needs: N/A

Current Student Performance and Accommodations:

Current level of knowledge, level of intellectual functioning, expected rate of progress, current accommodations: Richard is academically functioning at the preschool level and should be functioning at a kindergarten level. Richard has been moved to a classroom with fewer students where he can be given more individual attention. Richard is expected to make significant progress in this setting over the course of the academic year.

Social Development and Current Accommodations: Richards social development is well below his age, and is being accommodated through a smaller classroom setting as well as after-school social skills groups and social skills being worked on during his one-on-one sessions. Over the course of this academic year, Taylor is expected to be able to function at an age-appropriate level with his peers in the classroom.

Physical Development and Current Accommodations: Richard is physically developing at an age-appropriate rate.

Annual Goals: Goal: Conversation Skills Evaluation Criteria: When Richard can respond to a conversation question as well as pose the question back to the person asking to maintain a conversation Procedures for Evaluation: Richard will be evaluated based on the frequency of being able to maintain these conversations (Mastery of skill will be based on 80% frequency in 5 consecutive trials)

Evaluation Schedule: Weekly

Goal: Age-Appropriate Speech Evaluation Criteria: Pronunciation of words and sentences at an age appropriate level Procedures for Evaluation: Will be conducted at the discretion of the speech therapist during sessions Evaluation Schedule: Weekly

Goal: Social Skills Evaluation Criteria: Turn-taking, sharing, etc. Procedures for Evaluation: Richard will engage in games and play with the behavior specialist while focusing on turn taking and sharing. Evaluation schedule: Data will be collected during each session

Recommendation Services and Programs: Service: Speech Therapy Frequency: Four times a week Duration: One-hour sessions Location: At school (Watertown Elementary School) Start Date: 12/15/13 End Date: When progress goals have been met

Service: Occupational Therapy Frequency: Three times a week Duration: One-hour sessions Location: Boston Childrens Hospital Start Date: 12/15/13 End Date: When progress goals have been met

Service: Behavioral Intervention Therapy Frequency: Two times a week Duration: Two-hour sessions Location: In the students home Start Date: 12/15/13 End Date: When progress goals have been met

Testing Accommodations for State and District Achievement Tests: Is Student eligible for Testing Accommodations? Student will participate in testing: If not, state reason: N/A Yes Yes No No

Student will participate with: Testing Accommodation: N/A

Grade Level Peers

Chronological Peers

Conditions for Accommodation: N/A