Emily's most recent evaluation was completed by a team consisting of a psychologist, special education teacher, speech and language pathologist, and occupational therapist. Various testing procedures were completed in the different disciplines that occurred in a testing environment as well as multiple observations that occurred within more natural settings. As an aside, the individual testing information provided very helpful and informative information, however, it was the observation pieces that looked at how her strengths and needs as identified in testing impacted her functionally within the context of her environment. For example, when utilizing the PDMS -2 (fine/perceptual motor testing), she did not demonstrate a 25% delay. However, when she was observed in the classroom setting, she demonstrated significant difficulties participating in activities that involved these skills. She utilized less efficient grasps, approaches to tasks and decreased abilities to use two hands in a coordinated fashion. Taking into account the information from the sensory profiles that were completed as well as the observational information, it became clear that Emily's sensory processing difficulties in the areas of auditory, tactile, visual, proprioceptive and movement processing were impacting her ability to utilize her discreet skills during meaningful activities within her classroom setting.
Identified strengths and needs and treatment strategies:
Preacademic- knows shapes, colors, letters and numbers with adequate academic concepts reported.
Receptive/Expressive Language- follows 3 step related and unrelated directions, correct use of grammar, articulation age appropriate, age appropriate expressive and receptive skills.
Pragmatic Language- inconsistent abilities to make her wants and needs known, inconsistent abilities initiating appropriately (invades others personal space, inappropriate touch of others), needs facilitation for topic maintenance (her choice and another's choice), decreased abilities to process her own emotions and those of others. Tx strategies to include - face processing activities/games (understanding/reading facial expressions and emotions, self regulation, social initiations, etc...), - role playing to practice various strategies, -social stories, -referencing activities/games (add in "where am I looking" or "look over there and what do you see" games to work on her ability to follow eye gaze -thank you Amy)
Fine/Perceptual Motor Development- decreased postural control impacting her ability to maintain upright static positions while completing fine motor tasks, immature grasp pattern on writing implement, inconsistent but improving two hand usage, motivated to complete puzzles and prewriting activities but is resistant to adult facilitation for correct participation. Tx strategies to include – activities to continue to develop postural control and shoulder stability to increased "stability" for increased "mobility" of hand skills, - hand skill activities to continue to develop strength and control for grasp patterns, - activities to develop more automatic two hand usage
Gross Motor Development- w-sits but will correct when prompted, able to navigate within her environment and participate in motor games and activities, able to coordinate both sides of her body to engage in hopping, galloping and running activities but becomes overly excitable and difficult to calm after. Tx strategies to include – monitor performance in gross motor activities to ensure ability to modulate and maintain appropriate interactions with her peers providing teaching strategies for awareness of body cues and how to go about achieving regulation
Play- preferred areas of play within the classroom needing facilitation to expand her play, shares materials with peers, resistant to transition from preferred to nonpreferred play areas. Tx strategies to include – use of timer to prepare for transitions, - use of visuals, - working on motor planning components to address the possibility of decreased ability for planning of what to do next as is needed to transition to even another preferred activity.
Self-Help- able to care for personal needs and belongings, independent with bathroom and mealtime routines, no reports listed at this time regarding sleep habits or GI issues.
Social-Emotional- attention for preferred tasks is good, decreased frustration tolerance and inconsistent requests for help requiring very quick intervetion from an adult to try to avoid "melt downs" or tantrums (running away from the area, crawling under furniture, screaming, falling onto the floor). Tantrums may occur when frustrated, during transitions, when she does not get "what she wants". Likes adult attention and often engages in attention getting behaviors that are being inadvertantly reinforced in the classroom. Emotions can range from high (uncontrollable giggling) to low (screaming and yelling) within short periods of time. Tx strategies to include – monitoring level of environmental complexity, incorporating environmental strategies to make the right fit for Emily – sensory modulation utilizing strategies for self- regulation (ability to remain organized), mutual regulation (ability to seek or accept assistance from another for support to maintain emotional regulation) and recovery from extreme dysregulation (ability to “recover” from emotional dysregulation or “attentional shutdown” through strategies of self or mutual regulation.)
Sensory Motor Development- postural control deficits impacting functional performance during seated tasks (circle time - attention, table top activities) and peer interactions - may lean on peers. Demonstrating difficulties with self regulation. Sensory processing difficulties in proprioceptive, vestibular, visual, auditory and touch. Tx strategies to include - utilizing the stategies of self regulation (thermometer, engine speed) when in various environments, - activities for increased postural control, - involvement in activities and implementation of strategies to incorporate propriocepive, vestibular and touch inputs.
Coordination with other professionals working with Emily as well as her family for consistency and carryover of techniques and strategies into various environments and with various people.
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Hi Christina,
ReplyDeleteThat was a very complete picture of Emily's evaluation and treatment strategies. I saw your comment on the differences in the way Emily performed in the evalution and how she was able to particpate in her preschool or daycare. I also see the difference on how a child will perform in a 1-1 setting or even when there is a team of individuals assessing in a quiet environment with minimal distractions. The pragmatic language area can look very different also.The interactions with adults, with peers or in a controlled environment when the expectations are quite clear can be very different than those same people in a busy daycare or preschool.