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Case Study: Hossein 1

Case Study:
How Learning Disabilities Affect Education: Hossein
Mandy Upton
University of Detroit Mercy
Case Study: Hossein
Are we doing all t!at we can do to !elp our students and c!ildren wit! severe disabilities" Are
we providing t!e# wit! t!e education and services t!at t!ey need to !elp t!e# beco#e independent or
se#i$independent adults" Are we giving t!e# t!e opportunity for an education to ensure a !ig! %uality
life" &!ese are all %uestions t!at educators and society as a w!ole needs to as' t!e#selves w!en it
co#es to all students wit! special needs( especially t!ose wit! severe disabilities)
&!is case study is going to focus on Hossein* a student at special education sc!ool in t!e
+ar#ington Hills Sc!ool District) Hossein is , years old and is in t!e -
rd
grade) His sc!ool is a self$
contained center$based sc!ool for students wit! severe #ultiple i#pair#ents) During a face$to$face
interview* !is teac!er Mrs) Herpic' discussed Hossein.s disability wit! #e) Hossein is eligible to attend
!is sc!ool due to !is severe #ultiple i#pair#ents) He !as /rnit!ine &ranscarba#ylase deficiency
0/&C1* w!ic! causes an e2cess build$up of a##onia in t!e body 0A) Herpic'* personal
co##unication* Marc! 3* 41-1) &!is condition causes develop#ental delay and if not caug!t very
early in life it can lead to sudden deat! in newborns) Hossein received a liver transplant in /ctober to
treat !is /&C deficiency* and was !ospitali5ed for a #ont! after t!e procedure) /nce !e was able to
return !o#e* Hossein received !o#e$bound services for - wee's 0A) Herpic'* personal co##unication*
Marc! 3* 41-1) His !o#e$bound services included visits fro# !is teac!er* an occupational t!erapist*
and a p!ysical t!erapist) &!ere !as also been sc!ool docu#entation stating t!at !e !as partial co#ple2
epilepsy but no sei5ures !ave been observed 0A) Herpic'* personal co##unication* Marc! 3* 41-1)
6!en 7 began #y observation at 8:-4a#* t!e class was getting ready to go to t!e table for t!eir
9Morning 7nfor#ation): &!e class consisted of one lead teac!er* one paraeducator* and si2 students)
&o begin t!is activity t!e teac!er read over t!eir class sc!edule and went over t!e #orning %uestions
t!at are as'ed daily 06!at day is today" 6!at is t!e weat!er today" How does t!is weat!er feel"
6!at do you wear" 6!at are we !aving for lunc!"1 &!e sc!edule itself and all of t!e answer
responses to t!e %uestions were all done wit! e2tensive use of visuals* using t!e software ;oardMa'er)
Case Study: Hossein -
All of t!e students in t!e class are non$verbal and use <icture E2c!ange Co##unication Syste#s or
0<ECS1 attac!ed to =o&al' devices t!at spea' aloud for t!e students wit! responses t!at t!e teac!er
records prior to t!e lesson) Most students were given two c!oices to answer t!e %uestion* and pointed
to t!e <ECS picture to give t!eir response) 6!ile so#e of t!e ot!er students used a one$button =o&al'
device to re$read t!e %uestion aloud to t!e class)
During t!is lesson Hossein was as'ed t!e %uestion 9How does t!e weat!er feel": He was given
t!e c!oice between two picture icons and c!ose t!e correct response of 9cold: by touc!ing t!e picture
on a board t!at t!e teac!er was !olding out to !i#) He was t!en directed to 9as' t!e ne2t %uestion: by
t!e teac!er) He did t!is by pressing t!e one$button =o&al' device w!ic! spo'e t!e %uestion aloud for
!i#) He re%uired #ultiple verbal pro#pts and a few p!ysical pro#pts 0guiding !is !and1 to co#plete
t!is tas') &!e teac!er t!en as'ed t!ree of t!e older students in t!e class to pic' t!eir na#e tag out w!en
given a c!oice of two na#es) Most students needed #a2i#u# pro#pts to co#plete t!at activity) &!e
teac!er t!en concluded t!e lesson by as'ing eac! one of t!e students to identify t!e wee'ly vocabulary
word) Eac! student was presented wit! a c!oice board* wit! two visual <ECS icons( one t!at was t!e
correct response of 9boo': and t!e ot!er of an icon of an 9apple): Hossein re%uired #ultiple verbal
pro#pts and a few p!ysical pro#pts of touc!ing !is !and and #oving !is !and closer to t!e c!oice
board before !e #ade !is c!oice of t!e correct answer) &!is lesson lasted appro2i#ately -4 #inutes)
During t!is ti#e #any of t!e students were fidgeting in t!eir seats* being pulled out for au2iliary
services* and e2!ibiting inappropriate be!aviors 0putting !ands down pants* ta'ing s!oes off* !itting*
and loud vocali5ations1) Hossein spent t!e #a>ority of !is ti#e off tas') He fre%uently was facing
away fro# t!e group and loo'ing out of t!e window* and atte#pting to get out of !is seat and wal'
away) &!e paraeducator !ad to fre%uently re$direct !i# bac' into !is seat) He was also distracted by
t!e staff des' ne2t to t!e group table and was atte#pting to ta'e ite#s off of it) &!e staff re$directed
!i# and finally #oved !is c!air so t!at !e could no longer reac! t!e des') After !e reali5ed t!at !e was
Case Study: Hossein ?
no longer going to be able to escape fro# t!e activity* !e spent t!e rest of t!e lesson putting !is #out!
on t!e table and turning away fro# t!e activity to put !is #out! on t!e bac' of t!e c!air) 6!ile staff
re$directed !i# fre%uently !e continued t!is be!avior regularly t!roug!out t!e entirety of #y
observation)
Directly following #y observation of t!e 9Morning 7nfor#ation: lesson* students began t!eir
reading lesson) &!e teac!er and paraeducator prepared for t!is lesson by giving eac! student !is or !er
own =o&al' device) Depending on t!e students cognitive ability t!ey were given devices wit! a
different nu#ber of c!oices fro# 8 c!oices to c!oices) All of t!ese devices were already prepared
wit! t!e correct picture icons for t!e story and already !ad t!e verbal responses recorded) &!e boo' for
t!is lesson was 97f @ou =ive A Mouse A Coo'ie): During t!is lesson t!e teac!er would read a page and
t!en as' one student a %uestion about t!e page) Hossein was as'ed 96!at is on t!e cover": He !ad
two c!oices on !is =o&al' device* one of a 9#ouse: and one of 9a glass of #il'): He once again
re%uired #ultiple pro#pts to even loo' at t!e device and even #ore to #a'e a c!oice) &!e teac!er also
!elped t!e students co#pre!ension and c!oice #a'ing by supple#enting t!e regular boo' wit! anot!er
boo' t!at !ad two picture icon c!oices on eac! page t!at coincided wit! t!e boo'* and used t!ese
pictures as an option for non$verbal students to respond to %uestions) S!e also used real ob>ects to go
along wit! t!e story t!at students could actually feel* touc!* and !old( as a supple#ent to >ust loo'ing at
t!e pictures in t!e boo') Aeading t!e boo' and t!e %uestion and answer session lasted appro2i#ately
-4 #inutes total) During t!e duration of t!is lesson Hossein fre%uently turned away fro# t!e group*
loo'ed out of t!e windows* and once again put !is #out! on t!e table and on t!e bac' of !is c!air)
Staff !ad to continuously re$direct !i# to appropriate be!avior during t!e total duration of t!e lesson or
!e was co#pletely unengaged)
+ollowing t!e reading of t!e boo'* students were paired up and given various activities related
to t!e story) So#e students were given fine #otor activities t!at !ad t!e# tracing lines and circles wit!
Case Study: Hossein B
pictures fro# t!e story* so#e were given counting activities t!at !ad t!e# counting c!ocolate c!ips on
coo'ies 0once again relating to t!e story1* and Hossein and anot!er student were given a sorting activity
w!ere t!ey were re%uired to sort big and s#all ite#s fro# t!e story) ;ot! Hossein and !is partner
re%uired #ultiple pro#pts to co#plete t!is activity) &!e paraeducator wor'ing wit! t!e# !ad to
basically do t!e activity w!ile e2plaining it to t!e#)
After t!is lesson !is teac!er told #e t!at using t!e one$button =o&al' device was an i#portant
activity for Hossein because one of !is 7E< 0individuali5ed education plan1 goals was to #a'e eye
contact wit! so#e sort of response to a %uestion 0A) Herpic'* personal co##unication* Marc! 3* 41-1)
S!e also stated t!at w!ile Hossein is , years old* !e is only 3$C #ont!s develop#entally) He also !as a
few be!aviors of concern suc! as e2iting t!roug! doors 0including outside doors1 and !e does not
respond to !is na#e w!en staff calls out to !i# w!ile doing so 0A) Herpic'* personal co##unication*
Marc! 3* 41-1) Mrs) Herpic' also infor#ed #e t!at Hossein.s doctors !oped t!at by doing t!e liver
transplant !e would be able to get !ealt!y again and t!at it would !elp !is cognitive develop#ent) His
teac!er said t!at since t!is procedure !e is now #a'ing so#e sounds and verbali5ation but isn.t at t!e
stage of actually tal'ing yet) S!e and !is doctors are !oping t!at wit! #ore ti#e* !is body will !ave
#ore ti#e to ad>ust and t!at !e will be able to #a'e even #ore gains)
His teac!er also gave #e a copy of Hossein.s 7E< so t!at 7 could review !is current acade#ic
standing and !is current goals) His deficiencies and current acade#ic standings are as follows:
Aeading:
Do reading or letter recognition)
Hossein is wor'ing on si#ple pictures and ob>ects t!at are used on a daily basis)
Mat!e#atics:
Do nu#ber recognition)
Case Study: Hossein 3
Hossein can identify 9big: 3BE of t!e ti#e)
Hossein cannot follow 1 step directions or find targeted area wit!out assistance)
6ritten E2pression:
Hossein needs #oderated assistance to !old writing i#ple#ents to #a'e a few scribbles)
Hossein will eat i#ple#ent)
Co##unicationFSpeec! and Language:
Hossein uses vocali5ations* facial e2pressions* and body #ove#ents to e2press !i#self)
He is wor'ing on using a voice output switc! to participate in sc!ool 0!e !as t!e best
success during snac' ti#e1)
Hossein is wor'ing on touc!ing an ite# to e2press a preference wit!out putting t!e
ob>ect into !is #out!)
+ine Motor:
Hossein uses a gross ra'ing grasp to pic'$up ob>ects of interest)
He fre%uently puts non$food ite#s into !is #out! or t!rows t!e# onto t!e floor)
Able to grasp a utensil and bring it to !is #out! at #ealti#e)
Ma2i#al p!ysical assistance to scoop or po'e food)
Hossein re%uires !and$over$!and 0H/H1 assistance w!ile drin'ing and placing cup onto
table)
Sensory:
Hossein puts !ands and fingers into #out!)
He !as deficits in body awareness t!at results in trouble finding and sitting on a c!air
and wal'ing around ob>ects in a roo#)
Deep pressure sensory input see#s to !elp)
Case Study: Hossein C
&ravel:
Hossein needs !elp !oling !and rails w!en going up or down stairs)
He !as li#ited regard for safety and for !is surroundings)
6ears a bilateral articulating an'le foot ort!oses 0A+/s1)
As you can see* Hossein !as #any deficits t!at all ste# fro# !i# being severely
develop#entally delayed due to !is illness) Alt!oug! !is teac!ers and doctors !ope t!at now t!at !e
!as !ad t!e liver transplant !e will begin to start learning and processing infor#ation at a #ore typical
rate* t!ere is no guarantee t!at !e will catc! up to !is neurotypical peers) ;ecause Hossein is only
develop#entally 3$C #ont!s old* we see deficiencies at al#ost all levels) He is be!ind in fine #otor
s'ills* gross #otor s'ills* in !is co##unication* cognitively* and !e also !as sensory deficiencies)
;ecause Hossein !as so #any deficits* !e !as #any 7E< goals t!at need to be evaluated every
#ont!) 7n su##ary* Hossein.s 7E< goals are as follows:
+ine Motor:
Gery basic fine #otor s'ills* suc! as pic'ing up an ite# and placing it into a container
and using two !ands toget!er to pus!* pull* or !old ob>ects)
Using utensils to eat food and being able to place utensils and cups onto t!e table after
use)
=ross Motor:
6ill #anage 1$ inc! level c!anges wit! out tripping and be able to pivot w!ile standing
in place wit! one !and on a stationary ob>ect)
Speec!FLanguage:
Use language to co##unicate effectively wit! a variety of audiences and for different
Case Study: Hossein ,
purposes) Hossein will use a vocal output switc! 0=o&al'1 to participate in classroo#
activities) He will be e2pected to touc! t!e switc! 1 to ti#es and ta'e !is !and off of
it) He will not get credit for t!rowing t!e device or bringing it to !is #out!)
He will listen receptively and interact appropriately in conversations as part of an
audience for 1$ #inutes) &!is includes !i# 'eeping !is fingersFob>ects out of !is
#out!)
Hossein will follow 1 step directions paired wit! a gestural cue* suc! as 9Hossein sit
down*: 9Hossein stop*: 9Hossein co#e !ere):
+unctional Acade#ic Sills:
6ill find a targeted areas: classroo#* bat!roo#* gy#* cafeteria wit! less t!an B pro#pts)
6!en given c!oices* Hossein will answer %uestions* recogni5e !is na#e* or c!ose a
preferred activity or ite#) 01 out of - ti#es1)
Hossein will be involved in water conservation) =iven gestural pro#pts and as'ed
9w!at do we do ne2t to save t!e water": Hossein will co#plete t!e last step of !and
was!ing by turning t!e water off) 01 out of ? ti#es1)
Adapted <!ysical Education:
Hossein will increase !is ability to wal' over obstacles by stepping up and down in an
obstacle course wit! #ini#al p!ysical assistance in gy# class 0 out of - ti#es per
trial1)
Hossein will increase !is ability to wal' over obstacles by stepping over* in an obstacle
course wit! #ini#al p!ysical assistance in gy# class) 0 out of - ti#es1)
According to !is 7E<* Hossein also receives au2iliary services) He receives p!ysical t!erapy for
Case Study: Hossein 8
4$-4 #inutes* to ? ti#es per #ont!* occupational t!erapy 4$-4 #inutes* to ? ti#es per #ont!*
and speec! and language services for B$-4 #inutes* - to ? ti#es per #ont!) &!ese services in addition
to !is acade#ic services are intended to supple#ent !is education in order to !elp !i# #aintain and
develop a !ig! standard of living) Hopefully* once !is body ad>usts to !is new liver* Hossein will
continue to progress in t!ese areas) Until !e #a'es significant gains in t!eses areas 7 believe t!at
intensive interventions in t!ese areas are necessary* and will !elp !i# to progress)
/verall* 7 feel t!at !is teac!er and !is sc!ool are doing well in educating Hossein* !owever
t!ere are a few c!anges t!at 7 feel could be #ade in order to i#prove t!e %uality of !is education)
6!ile 7 was t!ere t!e classroo# was very busy and very noisy) During t!e lessons #ost all of t!e
students were #oving around* atte#pting to get up fro# t!eir seats* and #a'ing noises) Student
engage#ent in t!e lesson was very low) Alt!oug! t!ere is not a lot you can do to #a'e a classroo# full
of special education students %uiet* t!ere are a few interventions t!at #ig!t be !elpful) +irstly* you
could offer brea's to noisy students* allowing t!e# to sit away fro# t!e group until t!ey are ready to
>oin t!e group and sit %uietly) Secondly* you could !ave a staff #e#ber available to re#ove t!e student
fro# t!e classroo# and ta'e t!e# for a wal' or a sensory brea'* until t!ey are ready to %uietly re$enter
t!e group setting in t!e classroo#) C!ildren often disli'e leaving a group activity or setting so t!is
conse%uence #ig!t be enoug! #otivation for t!e# to want to be %uieter during instructional ti#e) +or
c!ildren w!ose disability #ig!t prevent t!e# fro# understanding w!y t!ey need to be %uiet or prevents
t!e# fro# sitting %uietly* offering t!e# a wal' or a sensory brea' #ig!t !elp to cal# or rela2 t!e
student w!ic! in turn will !elp wit! t!eir attending)
;ecause t!e students were not engaged during t!e #a>ority of t!e lesson* anot!er c!ange t!at 7
#ig!t #a'e would be to !ave students wor' in s#aller groups) During #y observation* it see#ed t!at
once one student beca#e loud or distracted it caused a c!ain reaction wit! t!e rest of t!e students) 7
would suggest a few different solutions) /ne solution would be to split t!e group up and !ave !alf of
Case Study: Hossein 14
t!e students do wor' tas's or ot!er acade#ic activities w!ile being supported by one of t!e two
paraeducators in t!e classroo#* w!ile t!e ot!er !alf of t!e students could attend t!e teac!er directed
lesson) &!en !aving t!e students switc! to t!e ot!er activity) &!is would allow for a s#aller group t!at
would be easier to #anage) 7t would also allow for a s!ortened group ti#e w!ic! will !elp wit!
students w!o !ave difficulties sitting %uietly for long periods of ti#e) 7 found t!at during #y
observation two -4 #inute bac'$to$bac' lessons see#ed too long for t!e students to sit( especially t!e
younger students)
Anot!er solution #ig!t be to !ave students participate in an activity t!at allows for tal'ing and
#ove#ent in between t!e two -4 #inute lessons) &!is would allow students to get up and #ove
around* #a'e noise* or !ave sensory ti#e t!at will allow t!e# to return to a teac!er guided lesson
ready to focus) &!ese type of activities #ig!t include #usic wit! #ove#ent* a wal'* or a sensory
activity) &!is will allow for a constructive outlet for energy t!at is causing disruptions during lesson
ti#es)
&!e last solution t!at #ig!t !elp wit! t!e studentHs attending would be do create s#aller groups
of students for direct instruction) 6it! t!e t!ree staff #e#bers in t!e classroo#* you could divide t!e
class into even s#aller groups and !ave direct instruction groups t!at could rotate t!roug! t!e
classroo#) 6it! t!e t!ree staff #e#bers and si2 students* you could essentially !ave a 1: staff to
student ratio) &!is not only allows for s#aller easier to #anage groups* it also allows for #ore
intensive instruction) &!is would be t!e best option in #y opinion to best utili5e t!e ti#e students
spend in t!e classroo#) ;ecause all of t!e students in t!e classroo# !ave severe #ultiple i#pair#ents*
t!ey need #ore intensive interventions to get t!e# up to par wit! #ore typical students) 6it!in t!is
#odel you would !ave t!ree tables or areas t!at eac! staff #e#ber would wor' at and eac! table would
include activities t!at t!e class was doing as a w!ole group* but would allow for #ore direct instruction
and attention) +or instance* one table could be t!e greeting activity* one t!e reading activity* and
Case Study: Hossein 11
anot!er t!e fine #otorFstory related activity t!at students did after t!e reading lesson) Staff could sit in
a #ore inti#ate setting and wor' wit! only two students* allowing t!e# to better evaluate t!eir
understanding and to 'eep t!e# #ore engaged) &!is direction #odel is a #odel t!at special education
progra#s are using all t!roug!out t!e country) 7t is proving to be e2tre#ely beneficial to not only
special needs students* but students w!o #ig!t be on t!e verge of needing special education services)
A 441 study by t!e 6isconsin <olicy Aesearc! 7nstitute concluded t!at 9t!e researc! base for direct
instruction is unusually solid*: and t!at in t!e sc!ools visited* 9teac!ers and principals report t!at direct
instruction !as produced e2cellent results I for regular$education students as well as special$education
students):
/t!er t!an t!ese few c!anges* after #y observation and interview wit! !is teac!er* 7 feel t!at
Hossein is receiving a %uality education) 6!ile 7 a# an ardent advocate for special education student.s
integration into general education classroo#s wit! general education peers( 7 feel t!at in t!is
circu#stance Hossein.s sc!ool is t!e best place for Hossein) 7nstead of #a'ing !i# fit into a general
education sc!ool or classroo#* !e is in a speciali5ed sc!ool t!at is able to offer everyt!ing !e needs)
He not only !as p!ysical and occupational t!erapy services wit!in !is sc!ool available to !i# 0w!ic!
would still be offered in a general education sc!ool1* !e !as #odifications in all ot!er aspects at !is
sc!ool* suc! as c!airs and e%uip#ent* and an entire gy#nasiu# t!at !as been #odified for students
wit! p!ysical and gross #otor deficiencies) ;ecause Hossein.s sc!ool is built specifically for students
li'e !i#* 7 feel t!at t!is is t!e best place for !i# to receive a %uality education) Aat!er t!an try to fit
!i# into a general education sc!ool t!at will not be able to offer t!e full e2tent of #odifications t!at !e
needs* !e is able to attend a sc!ool t!at was specifically built for students wit! li'e needs)