Aidan is an eight-year-old boy in second grade attending Suburban School. In September he transferred to Suburban from Nearby School because that school would no longer have a special day class for children with autism. Aidan lives with his mother and ten-year-old brother. Aidan was first diagnosed with autism before he was three years old, and has attended school programs for children with autism since he was diagnosed. Aidan's brother, also diagnosed with autism, originally attended special classes for children with autism, but for the last two years has been included in general education classrooms with non-disabled same-aged peers. Aidan's father does not live with the family.
Ms. Eileen, Aidan's T.A., has been Aidan's one-on-one for over two years. When Aidan moved to Suburban, Ms. Eileen moved with him. She indicated that Aidan has been without any vocal speech for the last year and a half. Prior to that time Aidan could make verbal requests using a very limited three or four word vocabulary. She reported there were serious family problems resulting in Aidan's mother obtaining a court order to prevent Aidan's father from seeing his sons without supervision. After that event, Aidan, to Ms. Eileen's knowledge, has neither spoken nor attempted to communicate using spoken words. He has difficulty maintaining attention on classroom work for more that ten or fifteen seconds at a time, tries to leave his seat to walk or skip around the room, stomps his right foot, coughs repeatedly making a very loud raspy noise, and sometimes shows aggression towards Ms. Eileen by squeezing and pushing her upper arm while abruptly moving his upper body and head towards her.
Ms. Deirdre, Aidan's current classroom teacher, had a meeting with Aidan's mother at back to school night in which they discussed Aidan's plan. They agreed, according to Ms. Deirdre, Aidan's academic goals would be to acquire knowledge of the meaning of numerical values from one to two, and to be able to write the symbols from A-M. Aidan's mother was not able to express her vision for Aidan beyond the current academic year. Aidan's mother also indicated that she did not want to attempt other self-help skills such as toileting at this time. Aidan wears a diaper and when his peers line up to use the restroom, Ms. Eileen takes Aidan to the school nurse for changing. Aidan has a very limited diet of solid foods, and Aidan's liquid consumption is limited to what he drinks at home using a baby bottle with a nipple; Aidan consumes no liquids, not even water, while at school. Independence in these self-help activities is not part of Aidan's mother's current plan for him.
This assessment plan includes tools and strategies that will be used to assess what Aidan will need to accesses the core curriculum, social skills, communication skills, fine motor skills, sensory skills, health and nutrition needs and play skills.
Communication is both a fundamental human right and a skill that Aidan must acquire to make progress across all areas of the core curriculum (Bailey and Murray-Branch, 1993, p. 29). Because of his severe disability, Aidan will benefit from structure and routine in the presentation of curriculum materials (Bailey and Murray-Branch, 1993, p. 40). Helping Aidan become familiar with the routines during assessment should help him raise his own expectations for himself and improve his performance over time (Palmer, Wehmeyer, Gipson, and Agran, 2004, p. 437). These are three of the guiding principles that we will follow throughout our entire assessment plan.
Math. Aidan's math goal is to acquire knowledge of the meaning of numerical values from one to two. Aidan's progress towards this goal will be assessed by his matching of one or two real objects to the numerical representation of those quantities, "1" and "2", respectively. Two cards, one with the number "1" and the other with the number "2" will be placed on the table in front of Aidan. We will then inform Aidan that we will be handing him either one or two objects, and after we hand him the object(s), he is to place the object(s) on the correct card in from of him, that is, if we hand him one object, he is to place the object on the card with the number "1" written on it; if we hand him two objects, he is to place the objects on the card with the number "2" written on it. We model this process using another student who has grasped the number concept.
Using the Math: Object-Number Matching assessment data collection form (see Appendix), we will record the date and time of each assessment, the object used (for example, "pennies") the number of cues and physical prompts used (for example, 5/0, for five cues and no physical prompts), and either a "1" or "0" for each trial based on whether Aidan either successfully matched or did not successfully match, respectively, the object(s) that we handed him with the number "1" or number "2" written on cards and placed on the table in front of him. We will make comments on the recording form in order to help us be aware of and understand any situational variables that may be occurring, and to make careful note of clues to how Aidan learns best. We will repeat this process several times on a daily basis. At the end of each day or other accumulation period, we will count the successful versus total trials and compute the percentage correct for the concept of "Number 1" and "Number 2". Aidan's first level objective is to achieve a 50% success rate on 3 out of 5 trials for each number concept using a variety of real objects.
Writing. Aidan's writing goal is to be able to write the symbols from A-M. We will assess Aidan's progress towards this goal by his printing the letters of the alphabet on lined sheet. In order to help Aidan achieve early success, we will scaffold the assessment process. First, we will start out with the letter "A". When Aidan can successfully print the letter "A", we will add the letter "B"; when Aidan can successfully print both letters "A" and "B", we will add the letter "C". In this way, Aidan will demonstrate to himself that he can be successful, and raise his own expectations towards his improved performance.
Using the Writing: Alphabet A-M assessment data collection form, we will record the date and time of each assessment, and make a check mark under the letters that Aidan successfully printed in succession. For each trial and day, we will compute the number of correct letters versus the letters attempted. Periodically, we will compute his success percentage. Aidan's goal is to print 13 letters (A-M) with 60% accuracy in 3 out of 5 trials. Intermediate objectives will be established.
Learning Method. In the core curriculum are we will assess Aidan's learning under two classes of intervention strategies used with children with autism: one using traditional operant procedures, the other using normalized interventions. The traditional approach is characterized by highly structured sessions paced and controlled by the teacher where the child is to respond within the time and space determined by the teacher. The normalized approach is characterized by loosely structured sessions that are paced by the child who initiates the teaching episodes by directing his or her attention to stimuli or by expressing a particular want or need. The traditional approach involves direct instruction episodes with the child seated facing the teacher and ready to learn whatever the teacher has to teach. The normalized approach can occur in various natural or play settings. In the traditional approach the reinforcers are functionally unrelated to the target responses. In normalized interventions reinforcers are functionally related to the target response (Delprato, 2001, p. 316). A simple example of each of the two approaches follows: Aidan's math goal is to acquire knowledge of the meaning of numerical values from one to two. Under the traditional approach, the teacher placed two cards on the table in from of Aidan. One with a "1" printed on it, and the other with a "2". The teacher hands Aidan two plastic pennies and asks Aidan to take the card from the table that matches the plastic pennies that the teacher placed in Aidan's hand. If Aidan responds correctly, the teacher gives Aidan a tiny pinch of broken shoestring potatoes. In the normalized approach, Aidan lays out two large potato chips on one napkin, and a single potato chip on another napkin. Then Aidan takes the number "2" card from the table and lays it next to the napkin with the two large chips. Aidan then signs, "I want 2 chips." The teacher indicates, "Take them" and Aidan takes and consumes the two chips. We will keep track of Aidan's learning experiences using each of these two teaching methods and over time will be able to determine whether Aidan responds better to the highly structured teacher-centered approach, or to the loosely structured child-centered approach.
The other big related question is this: What is Aidan willing to "work for." My initial observation is that Aidan is always hungry, but will literally only eat popcorn, bacon, yogurt and potato chips, plus liquids through a baby bottle when he is at home. It is important that we find multiple reinforcers that are salient for Aidan, because "[f]inding meaningful rewards is likely a factor that pervades all aspects of [Aidan's] openness to learning" (Siegel, 2003, p. 53). The assessment worksheets in each assessment area will be annotated with both the learning methods and reinforcers tried, and then analyzed separately to identify the "best" learning methods for Aidan, and to expand Aidan's list or reinforcers. As Aidan learns and grows academically, socially and communicatively, the learning methods and reinforcers will need to be continuously reassessed.
Common social interaction, appropriate language (either natural speech, alternative or augmented speech), appropriate behavior, and development of a variety of interests are skills needed for success in life. Sometimes challenging behaviors will be reduced over time, as an individual gets older. Sometimes interventions are needed (Welton, Vakil, and Carasea, 2004, p.40). Functional properties of challenging behavior can vary widely across individuals, and interventions based on assessments that attempt to identify possible relationships between challenging behavior and the assumed function of that behavior are more successful than those that do not (Galiatsatos and Graff, 2003, p.124).
The Challenging Behavior assessment data collection form was developed primarily based on the information presented by Hamil and Everington (2002, chap. 8), with one additional behavior: smiling. In observing Aidan, he frequently exhibits the challenging behavior listed: gets up and leaves his seat during instruction and activities, stomps his right foot repeatedly, intentionally coughs, and shows aggressive behavior towards his one-on-one, Ms. Eileen. On occasion, however, I noticed that Aidan would look straight at me, sitting next to me, and smile. I do not know whether that particular facial expression for Aidan is a sign of true happiness or not. But while we are collecting data on the negatives, it seems appropriate to collect information on what may be a positive event for Aidan. As described earlier, salient reinforcers for Aidan are not abundantly obvious. If we can collect data on a possible positive sign for Aidan, so much the better. Favell, Realon and Sutton (1996) found that positive facial expressions such as smiles and laughter were valid measures of happiness for persons with severe disabilities. By computing a happiness index for a variety of activities (subtracting the percentage of unhappy time from the percentage of happy time) the authors were able to determine what interventions made their subjects happy and what interventions made them unhappy. Observing and recording what makes Aidan happy could provide clues to the identification of reinforcers that will be needed in order for Aidan to stay focused and learn.
The Challenging Behavior assessment data collection form is designed to help Aidan's teacher or assistant keep track of the number of times the specified behavior is observed within each time period. Ms. Eileen would simply make a tic mark under the appropriate column when the behavior occurred, make note of the activity being performed at the time, any significant setting event that may have preceded the antecedent event, and note any consequences delivered to Aidan as a result of his challenging behavior. Under the Function of Behavior column, f(x), the first letter for the assumed function is entered, as listed at the bottom of the worksheet. This assessment tool will help us better understand Aidan, why he behaves as he does, and better equip us to design interventions that will help Aidan socially adjust.
One thing is apparent from observing Aidan and talking with those who observe and work with him: Aidan today is severely communication challenged. Goldstein (2002, p.393) asked himself the question: "Are there interventions that have been shown to be efficacious in teaching relatively complete communication systems to the most challenging children with autism?" His answer was "I do not think so." So why do we bother? As mentioned earlier, communication is fundamental human right. Imagine a world where you not only cannot initiate requests for your basic wants and needs, but you cannot respond either. With Aidan we will have to be more precise, Goldstein intimates, and we should expect slower progress. For lower functioning children such as Aidan, our goals should include fostering communication and developing basic learning-to-learn skills. Even children who do not yet produce spoken words can be helped to be more communicative (Volkmar and Pauls, 2003, p. 1137-1138). The optimal system to be used to help children who do not produce spoken words is not known. Recent research suggests that whether the child becomes a more effective communicator with sign language or a picture-based system (PECS) may depend upon individual student characteristics such as motor skills (Tincani, 2004, p. 152). Because there is a lack of clear and unambiguous data in this area, the least dangerous alternative for Aidan may mean the use of multiple modalities, at least until we have a clearer picture of what works best for him.
The Communication Request assessment data collection form is designed to help us assess Aidan's skill at initiating requests for a variety of desired items. The modalities will be either picture cards or signing, or a combination of both. We will track the number of cues and/or physical prompts that we provide Aidan, as well as the number of successful or non-successful requests for each trial. Aidan's short-term objective is to achieve 70% accuracy rate in 2 out of 3 trials. Longer-term, we want to see Aidan achieve that accuracy rate without cues or prompts. We will also evaluate what modality or modality combinations work best for Aidan.
The detection of fine motor problems in developmentally impaired children is important because these problems add an additional burden on the development of the child by impacting the child's ability to play, eat, write and draw; fine motor problems also put children at higher risk for developing learning and behavior problems (Noterdaeme, Mildenberger, Minow, and Amorosa, 2002, p. 220). The major purpose of our ongoing assessment of Aidan's fine motor skills is to identify potential problems early so that timely interventions can be planned. The Fine Motor Skills: Trace Own Name assessment data collection form is designed to help us assess Aidan's skill at grasping a functional pencil and tracing his first and last name. We will track the number of cues and/or physical prompts that we provide Aidan, as well as the number of successful or non-successful tracings for each trial. Aidan's short-term objective is to achieve 80% accuracy rate in 2 out of 3 trials of tracing his first name with minimum assistance. After Aidan achieves this goal on his first name, we will assess Aidan on the tracing of his first and last name.
Citing the works of Firth, Ornitz, Guthrie and Farley, Talay-Ongan and Wood (2000, p. 201) found that unusual responses to sensory stimuli appear to be a significant feature of children with autism. Reese, Richman, Zarcone and Zarcone (2003, p. 90) found that escape from sensory disturbances might increase the probability of disruptive behavior in children with autism. However, a review of the empirical literature with respect to sensory interventions in children with autism showed that the biggest limiting factor is that the studies have failed to directly link changes in the sensory mechanisms, due to interventions, with changes in behavior in systematic and measurable ways. Most of the studies have had too many uncontrolled variables so that one cannot be sure whether the sensory interventions caused the behavioral changes or whether the behavioral changes were caused by other factors (Baranek, 2002, p. 415-416). Baranek (2002, p. 418) also contends, however, that even though all children with autism do not display sensory dysfunction, the "best practice" would be for educational programs "to incorporate appropriately structured physical and sensory environment." Again, in the absence of hard data, the least dangerous alternative would be to measure the sensory sensitivities of the child with autism, and appropriately control the child's sensory environment.
The Sensory Sensitivities assessment data collection form was developed using the categories and sensory context areas described by Talay-Ongan and Wood (2000, p. 205-207). The objective of this assessment is to better understand Aidan's sensory sensitivities that may have an impact on his academic accomplishments, socialization, health and other areas of concern. Understanding Aidan's sensory sensitivities may also help Aidan's mother understand how her inability to connect with Aidan, and Aidan's inability to connect with her, may be the result of his autism, and caused by reduced interactions that started years ago and continue today. The reduced interactions due to Aidan's sensory sensitivities may have reduced the normal opportunities for communication between mother and child and impaired the affective relationship between them. Knowing this will not make things all better for Aidan, but it may help reduce the tension (Talay-Ongan and Wood, 2000, p. 210).
As mentioned earlier, Aidan's entire diet consists of popcorn, bacon, yogurt and potato chips, plus liquid through a baby bottle when he is at home. According to Ms. Eileen, Aidan's food refusal landed him in the hospital several months ago where he was stabilized intravenously. These types of severe feeding difficulties are not unique to Aidan but are common among those with severe developmental delays (Hogan, 2001, p. 34). Holmes (1982, p.66) reported a case study that provided an illustration of how parents of a severely disabled child, with a life-threatening food refusal problem, successfully solved their child's feeding behavior through monitoring. It appears that self-monitoring itself can be sufficient to change behavior.
The Nutrition assessment data collection form was developed using categories reported by Holmes (1982, p. 67). Separate worksheets are provided for home use by Aidan's mother, and for school use by Aidan's caregivers. In addition to a listing of specific foods offered to Aidan and consumed by him, the worksheet contains a column so that Aidan's mother and caregiver can rate the feeding experience as either "Easy" or "Hard" on a 1-5 scale. The nutritional value is to be calculated so that, over time, we will know whether Aidan is getting adequate nutrition. Poor nutrition will affect the development of Aidan's academic and other learning skills, and this information is essential to have available.
Children with autism have difficulty in engaging in play activities. Left alone they do not go through the variety of types of play from symbolic play such as having and imaginary friend, to functional play, such as playing with a train set, or to sociodramatic play, such as playing house. A big concern is that before a child can engage in play activities where he or she interacts with other children at play, the child must develop play skills in isolation from peers (Terpstra, Higgins, and Pierce, 2002). For example, Aidan should not join a baseball team before he knows how to catch and throw a ball.
The Isolated Play assessment data collection form is designed to assess how long Aidan engages himself in isolated play and what level of prompting is needed. The process involves using intrusive prompts if needed to get Aidan to start playing, then fading the prompts, then reinforcing as needed. As Aidan gains successful experience in one setting, the process introduces other settings so that the skills he learns can eventually be generalized for different settings with minimum prompting required. This process and form were developed based on information provided by Terpstra, Higgins, and Pierce (2002).
Developing an assessment plan for a specific child with severe disabilities is certainly not an easy task, nor is something that can be accomplished in a short period of time. In researching the literature it is not easy to find information that is easily applicable to a particular child. For example, most empirical studies seem to use subjects who are not as severely disabled as Aidan. The assessment plan information described here will be useful, but is far from complete. There are many aspects under each of the assessment categories that have not been fully covered in this article. I do believe, however, that the methodology used here will be helpful fine-tuning these assessments and in developing additional ones for Aidan and other children with severe autism.
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