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ETE 324 Family Case Study

December 6, 2016

SUBJECTIVE (20 points)

Child’s Initials (use initials throughout report) B.P.
Date of Birth October 12, 2013
Dates of project October 4th-December 6th, 2016
Current age 3 years old
Diagnosis Developmental Delay
Reason for referral
At present, mom expressed concerns about memory, ability to transition and adapt to
requests and changes. There is a continuing concern for expressive language ability.
Developmental/Social History
Prenatal and birth
B.P. was carried to full term and had a healthy birth weight.
Medical History
At 3 months old, he experienced respiratory failure and was diagnosed with
stridor, croup, and rhinovirus. At 5 months old, he was diagnosed with Pyloric Stenosis.
B.P. had a blockage in his stomach, a narrowing airway, and a hernia repair. He suffered
from frequent ear infections and has had tympanostomy tubes placed in both ears. B.P. is
diagnosed with asthma and uses a prescription inhaler for symptoms.
Developmental milestones
Cognitive:
Physical:
Social/emotional:
Communication:
Adaptive:

Family history of developmental delay or special education

There is a family history of hearing loss (biological father), Autism
and ADHD (maternal uncle), and Down Syndrome (maternal
cousin).
Caretakers
Parents- Mr. and Mrs. P.
Teacher- Kim Burd
Doctors and therapists
Elizabeth Ash, Speech and Language Pathologist
Other doctors and therapists names were not reported
History obtained from: Mom; T. L. McNamara; Karen Nelson, OTR/L; Shannon LoPiccolo,
MPT; Michelle Threw, M.A., CCC-SL;, Vicky Jordan, M.A., CCC-SLP; Andrea Bartlett,
LCSW; Kim Burd; Carrie Kerr, M.S., CCC-SLP/L
Where the child was observed: Child’s home and ECE classroom at John L. Hensey School
Who was present at the session/class/meeting: Classroom teacher, speech and language
pathologist, and mom (during speech therapy)

Behavior observed
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In the classroom, B.P.’s social behavior was observed . Specifically, his sharing
skills were taken note of. B.P. does not like to share and will break out in a tantrum if he
does not get what he wants. Mrs. Burd has to remind him to ask for permission before
taking from other children. During the class reading time, as the other students crowded
around a to listen to the book that was being read, B.P. shouted “Hey! It’s my turn!”. He
then attempted to snatch the book, but he was reminded that he needed to be patient and
wait his turn. This behavior was repeated during both visits multiple times.
Clinical observation (your clinical input, not input from formal evaluations)
At the present time, B.P. is displaying difficulty interacting with peers and in
transitioning to non-preferred activities.
Tests or measurement tools used during sessions (if any)
None used

OBJECTIVE
Data collected during sessions
What measurable data did you collect that you can report on?

Type of Data Measurable Result How and where Who was involved
Observation Request permission Ask teacher for Taylor, Grecia,
before acting 3/x permission to leave Raelyn, Mrs. Burd
table from snack, ask
to throw away trash,
and ask to go to the
bathroom

Observation Ask for help 3/x During speech Taylor, Grecia, Ms.
therapy to unstack Ash, Mrs. P.
legos and put them
away

ASSESSMENT
What was assessed (discuss the five domains)
Cognitive
Attention: B.P. changed the focus of his play. He would briefly pay attention to
stimuli offered by peers or the play facilitator, but the attention would not last for an
extended period. B.P. was able to attend to different characteristics of the toys during
play and spontaneously categorize them based on size and color. The primary deficit
observed was his inability to maintain attention to a non-preferred activity without
experiencing frustration or anger.
Memory: B.P. remembered the name of people and objects in the play setting and
could repeat play routines. He did not participate in recall of nursery rhymes or sing-song
activities and did not talk about about events or recreate typical home routines within his
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play. His parents reported that he is able to follow routines, can remember familiar visual
stimuli, remembers various types words, and what to do with a variety of objects.
Problem solving: According to his parents, at home B.P. can solve problems with
some support. During assessment, B.P. used the play facilitator to figure out how items
worked and did not display a lot of independent problem solving.

Communication:
His receptive, expressive, and phonological language development is age
appropriate. He has difficulty expressing needs and asking for help.

Physical:
His fine and gross motor skills fall in the 30-36 month range so there is no
evidence of a delay.

Social/emotional:
B.P. showed difficulty in comforting a peer in distress, showing understanding of
other’s feelings, and self-regulating emotions and behaviors. His emotional expression is
around 18 months, there are also delays in behavior and emotion regulation, sense of self,
emotional themes in play, and social interactions.

Adaptive:
B.P.’s adaptive behavior skills are delayed as he shows difficulty when adapting
to changes in routine and in transitioning between activities.

How it was assessed

The Transdisciplinary Play-Based Assessment 2 was used to assess all domains of
development. The Vineland Social/Emotional Behavior Tool and the Vineland Adaptive
Behavior Scale were completed as well.
Description of interventions
B.P. is receiving 750 minutes of special education every week so he is in special
education 100% of the time he is at school. This allows for individualized instruction and a
structured classroom environment. He is also receiving speech therapy once a week from Ms.
Ash.

Procedures for activities presented

Ms. Ash initiates the play-based therapy by giving B.P. simple one-step instructions, such
as getting the bucket of Legos off the shelf. In this case, Ms. Ash and B.P. were building a school
together. Ms. Ash prompts B.P. by asking if he needs help. She will not assist him until she hears
him say “I need help”. The second activity requires B.P. to choose the object that completes the
picture he is shown, he must ask Ms. Ash for the object that he needs rather just grabbing for it.

What materials were used

Legos
Picture cards
Objects that match picture cards
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The results
Your interpretation of the program and the benefits to the child
The program is play-based, so B.P. enjoys the activities that are presented to him. The
activities directly relate to fit B.P.’s everyday needs. B.P. has trouble expressing his needs, so
Ms. Ash focuses on getting B.P. to do so.

Your interpretation of needs that are not being addressed through current program (if
any)
We feel that all of B.P.’s current needs are being addressed in the current program.
Progress made in current program
B.P. has just started in ECE and he appears to be making progress. He has began potty
training, asking for help with prompts, and practicing appropriate social skills with peers.
Child’s strengths
B.P. is described as talkative and friendly. He is able to count to twelve with only a few
skipped numbers. He has some color and body part knowledge as well as animal sounds. He is
able to label items in the classroom. He can enter into playing with peers after play has already
been initiated.

Remaining areas of concern

B.P. is not able to adapt to new situations or take direction. He has difficulty
transitioning to non-preferred activities. He has trouble with quick recall of words for objects
and actions.

PLAN
Recommendations
The team recommends that B.P. continue with current ECE placement with speech
therapy. If need arises, an evaluation with occupational therapy and physical therapy.
Eligibility for different programs
Only qualifies for ECE services.
Home programs
Parent Education
Therapy
Speech
Referrals for other services
Physical therapy consult, if need arises
Occupational therapy consult, if need arises

Child’s Name: B.P.

Date: December 6, 2015

SECTION 3: PRESENT LEVELS OF DEVELOPMENT ________

(May be used as an Annual goal statement for Part B Preschool Services)
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What do we want for BP and our family?

We want BP to be able to communicate his needs so they are met.

How will we achieve this
outcome (List strategies
and/or activities designed
to facilitate the
achievement of this
outcome; and/or steps to
be taken to link us to
services and/or secure
funding for services if
not required to be
provided by the Part C
Early Intervention
System)
What Part C EI and/or
other services and
supports would help us
with this?
Fund Source Upon review, how are we
doing? Has our outcome
been achieved? Should
our outcome, strategies,
activities and/or services
change? If so, how?
Written parental consent
required to change any
services.

Parent education Speech Therapy- Early Intervention

Modeled play 1x/week
Prompting

The primary setting for young children is within the context of the family, their home,
their community, lifestyle and daily activities, routines and obligations. To the extent
appropriate, services must be provided in types of settings in which young children
without disabilities, and their families, would participate. Are all Part C EI services
needed to achieve this outcome being provided in natural environments? ✓ Yes □ NO

Note regarding Fund Source: Services required to be funded by the state are listed in Section 4: Part C EI Service Plan
(Although named individual providers may be changed by giving notices). All Part C Early Intervention Services must
be pre-authorized. For all other services identified as needed but not required to be provided by the Part C Early
Intervention System, indicate the fund Source (i.e. Medicaid, DSCC, private insurance) Which is either responsible for
payment or from which payment is being sought.
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LOG OF PROJECT
Date Length of time Type of Meeting Who was involved
10/21/2016 30 minutes Home visit: Parent Taylor, Grecia
interview

11/11/2016 2 hours Classroom visit: Taylor, Raelyn,

Observation Grecia

11/18/2016 2 hours Classroom visit: Taylor, Grecia

Interview with speech
therapist
Speech therapy:
observation

Brief narrative of each meeting and how it shaped your project:

Grecia and Taylor observed in the home setting to get an idea of who B.P. is and what his
home life is like. B.P. was only seen for a brief moment in the observation but this showed his
developmental delays through his lack of social skills.
The first classroom observation offered us the chance to see B.P. interact with his peers
in the classroom and outside on the playground. This helped us to see how B.P.’s delays affected
him in an education setting.
The second school visit was beneficial because we were able to go off and observe
speech therapy and see strategies used in that setting.
During speech therapy, Grecia and Taylor observed how B.P. worked with Ms. Ash.
Although it took a couple of tries, B.P. met his goal of asking for help.

INTERVIEWS
10/21 with mom:
We interviewed mom at home where we first met B.P., his parents, and little sister,
Rowan. We learned from mom that she stays home with her children and that B.P. lives at home
with both parents. She described B.P. as a friendly and talkative child who enjoys doing puzzles.
She told us that she feels their family strengths include spending time together and advocating
for B.P. She expressed that she is concerned about B.P.’s behavior and feels he continues to
need ABA therapy. She shared with us that prior to turning three, he was receiving speech
therapy, occupational therapy, physical therapy, and ABA therapy services through early
intervention services.

11/18 with speech therapist:

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Ms. Ash revealed that B.P. has no speech concerns. His speech sounds, for his age, are
clear and functional. There are no issues with pragmatics, articulation, or comprehension. The
problem with his language has to do with executive function. This is evident in his ability to
express needs. He has trouble finding words to communicate his wants and needs. B.P. also
exhibits problems with his working memory. He has trouble retelling what he did in a short
period of time. B.P.’s therapy is played based, which he enjoys. Ms. Ash’s goals for B.P. include
working toward following 3-step directions in the classroom (memory), expressing his basic
wants and needs, imitating grammatically correct 5-word sentences (memory), and showing no
more than one word finding difficulty.

After speaking with Ms. Ash, I understood B.P.’s behavior a lot more. In the classroom, I
noticed that when he wanted something, he would have a tantrum. I now know that it is because
he was not finding the words to express himself. B.P. to me, spoke like a normally developing
three-year-old. He is three years and one month, so I was not expecting him to speak like a five-
year-old. When speaking to him, I noticed him not answering questions because he had trouble
retrieving the words to form an answer.

SUMMARY OF EXPERIENCES
This project has helped us experience how many people and how much information is
needed to come together to create the IFSP, or in our case the IEP. We observed B.P. in multiple
settings, like the home, in the classroom, and in speech therapy. We were able to see how he
interacts with different people, including his teachers, therapist, family members, and peers. In at
least one of the settings, we observed his developmental delays as well as measurable data for
strengths. These included his cognitive abilities, communication, physical, social/emotional, and
adaptive abilities. We also had the opportunity to see how a speech therapist works with a young
child. It was interesting to see a play-based language therapy and how it involved mom. This
experience stems off what we have been learning throughout the semester on how family
involvement is crucial to development.