Assistive Technology in the classroom.

I have a classroom of students with multiple delays.  So over the years we have used a number of assistive devices in our classroom.  Currently, we have two chairs that give back, side and foot support for students that have difficulty supporting their bodies.  We have a child who uses a walker.  Her first walker this year was one that had a seat for her to sit on while she used her feet to propel herself.  She has progressed to a  walker that does not have a seat and now she must use her feet along with her arms and upper body to support herself.  We have support bars in the bathroom to provide assistance for children when using the bathroom.  We have a four button Easy Speak that can be programed with the teacher's voice to make comments.  It's easy to change the messages, so the device can be used at meals, or at circle or at a center.  We have lots of picture communication systems in the room:  picture schedules, task analysis cards, and picture communication boards in the centers.  We have adapted scissors and paint brushes.  One year we had an adapted tricycle that rode down low like a "Big Wheel" and had straps on the pedals.  One year we had a child who was tube fed and needed an adapted chair for positioning during her feeding.  One year we had a student who was learning to use a communication computer with a field of 25 buttons and several layers - or pages of buttons that he could access.  We have several books in the classroom adapted with velcro pictures.
There are many uses for assistive technology in the classroom.  The DEC Recommended Practices textbook lists several of these uses:  communication and language, environmental access, social-adaptive skills, mobility and orientation skills, daily life skills, social interaction skills, health, position/handling.  In our classroom we most often use assistive tech. for communications needs.  But when we have children with cerebral palsy or other physically handicapping conditions, we really depend on assistive technology to help us with fine and gross motor needs.

Resources:
Sandall, Susan, Hemmeter, Mary Louise, Smith, Barbara J., & McLean, Mary E. DEC Recommended Practices.  A Comprehensive Guide for Practical Application in Early Intervention/Early Childhood Special Education.  Missoula, MT:  SOPRIS WEST Educational Services.  2005.

Task Analysis for Toothbrushing

There are many self-care skills that my case study student needs to learn.  Zipping her coat is a big one, but we are starting to move out of the coat-wearing weather and I may not have much more time to work on this skill.  Toothbrushing, on the other hand, is something we do everyday after lunch.  And not only will my case study student benefit from a visual task analysis of the procedure, but all my students will benefit.  I have a visual sequence of the hand washing steps on the mirror over the sink, and all my students like to comment on those pictures.  We may have just as much interest in a toothbrushing sequence.

Steps for brushing teeth - along with visuals for each step:
1.  get toothbrush wet
2.  put a spot of toothpaste on toothbrush
3.  brush bottom teeth on both sides
4.  brush top teeth on both sides
5.  close teeth and brush front of teeth
6.  brush tongue
7.  rinse toothbrush

There are many smaller steps in-between such as opening/closing the toothpaste and turning on/off the water, but when there are too many written or visual steps, it becomes confusing and cumbersome.  My student may need more detailed verbal instructions as she learns to brush by herself, but for the purpose of posting picture cues, I'll use these 7 steps to see how they work. I don't know yet how I'll get pictures of the steps.  Maybe my case study student will be accommodating enough to let me take pictures while I help her brush her teeth....?

Communication Skills of my case study student

Sally is 4 1/2 years old, but her communication skills are at a much younger age level.  She had a multidisciplinary evaluation prior to starting preschool when she was 2 years, 11 months old.  At that time her auditory communication skills were at the 3rd percentile, and her expressive communication skills were at the 1st percentile.  She is delayed in all areas of development:  cognitive, adaptive behaviors, social/emotional, motor, language and educational.  She attends a full-day developmentally delayed pre-k class with 11 other developmentally delayed students. Although she is not identified as having autism, she demonstrates many autistic characteristics.

Sally is an interesting child.  I chose her for my case study because she intrigues me, perplexes me and frustrates me all at the same time.  She expresses interested in her environment and in interacting with her teachers, though she is not particularly interested in her peers.  However, she is inconsistent in her desire to respond to her teachers' directions and participate in the classroom activities.  She likes music, but she struggles to attend and even tolerate circle-time activities.  Sally has some sensory integration differences and needs to chew on a "chew-toy" during circle time and table-top activities.  She quickly becomes frustrated or loses interest and will run away from her chair, or cry/fuss, or become aggressive.

Sally has some surprisingly clear language at times, though it does not seem that she always has full control of when and how she uses her language.  Sometimes she is very responsive to our efforts to talk to her.  We may ask her simple "what, where, who" questions, or ask her to "tell me about...." and she can answer in simple 4-5 word sentences.  At other times, she sucks her thumb and stares at us blankly.  We use a variety of communication strategies to encourage Sally to use language. We engage her in a dialogue about the toys she is playing with or the food she is eating (she loves food).  We prompt her with verbal and visual cues, responding to any of her attempts to communicate.   We provide a very consistent daily schedule and routine procedures.  The classroom daily schedule is presented as a picture schedule with photographs which we review throughout the day and remove as we complete each activity.  Sally has her own picture schedule on her table with Boardmaker drawings.  She is not particularly interested in this schedule, and we need to replace or supplement it with photographs of her doing the activities.

When we speak to Sally and all the students in the class, we speak in simple sentences.  We try to make our point with just the key words.  I'm just sure that our students hear the Charlie Brown adult-speak "Whaah-Whaah-Whaah" when we talk too much.  We also use sign language to supplement some of our frequent commands such as "no, yes, stop, wait, listen, eat, drink, more, toilet, finished, play, work, clean up, talk, sing, read, sad, angry, happy, hungry, thirsty."

The text book suggests the use of PECS with children with autism.  I'm not sure this system is appropriate for Sally because she has some language skills already. She has a functional vocabulary and functional sentence construction.  The trick is to get her to use them consistently.  The text also stresses the need to control the amount of extra auditory stimulation in the room.  It helps all the students when the room is quieter and less chaotic.  We use visual and auditory cues when we have 2 minutes left to play, and when it is time to stop playing.  We have a visual/verbal transition cue we use routinely.  Our day is very predictable.  These are all helpful strategies for students with delays of any kind.

I want to help Sally communicate her wants and needs better in the hopes that she will stop fussing/shouting, running and hitting/throwing.  I would like to make a choice book for her.  It can have appropriate choices for the various times of the day.  She may not get to do exactly what she wants when she wants, but she will have some choices that I can live with, and hopefully she can live with too.

Source:  Cook, Ruth E., Klein, Diane M., Tessier, Annette.  Adapting Early Childhood Curricula for Children with Special Needs. (7th ed.).  Upper Saddle Rive, New Jersey, Columbus, Ohio:  Pearson Merrill Prentice Hall, 2008.

Motor and Self Help Skills

My case study student is a 4 1/2  year old girl named Sally.  She has some interesting motor delays.  Her Preschool Multidisciplinary Assessment reported that her gross motor skills were at "average skill acquisition for her age level." Even though she has "average" gross motor skills, she is unbalanced and walks with a clumsy gait.  She walks on her toes. She stumbles often, especially on uneven terrain.  Her fine motor skills were rated at 70 on a scale of 100 = average.  This puts her in the significantly delayed range.   She needs help establishing a tripod grip on a marker, getting her fingers in the scissors and cutting along a line, and fastening zippers, buttons and snaps on her clothing.  Her IEP fine motor goals include imitating prewriting strokes (vertical line, horizontal line, circle), using scissors in the "thumbs up" position to make 10 snips along the edge of the paper and then cut along a 3-4 inch piece of paper, using a functional grasp on a writing utensil to color in 80% of a shape, and manipulating preschool materials.  Everyday after hanging her coat and backpack in her cubby, Sally signs-in.  We help her grip her marker appropriately and trace the letters of her name.  Everyday she puts on her own coat to go outside and we help her fasten the zipper.  During table-top activities, Sally uses a variety of preschool materials such as:  scissors, crayons, play dough, puzzles, beads, pegs, lacing cards, shape sorter, tongs and paintbrush.  She holds a small cup to drink her milk or water.  She uses a spoon and fork to eat her food.  She holds the toothbrush while I help her brush in and out, up and down. Sally is able to pull her pants up and down when using the toilet. She washes her own hands adequately.  She needs help getting her socks on, but she is able to put on her own shoes.  We tie the laces.   Sally enjoys jumping on a mini trampoline, pushing a baby buggy, and riding a tricycle (she pushes the ground with her feet, does not use the pedals).  She likes to run in the grass, but she stumbles and falls often.

When assessing Sally using the Creative Curriculum Developmental Continuum, I found her to be at the "Foundational 2 or 3" level for all gross motor skills, and at "Level 1" for all fine motor skills.  I find it interesting that she scored higher for fine motor skills considering her rating of "average" for gross motor and significant delay for fine motor.

Sally does not yet show a preference for using her left or right hand.  According to Cook, Klein, Tessier (2008), a preference for handedness is not expected until 6 years. old.

According to Cook, Klein, Tessier (2008), a child at 36 - 48 months should be able to pour from a small pitcher, spread soft butter, button large buttons, and blow her nose when reminded. Sally is 53 months old and is unable to do these things.  At 36 - 48 months she should be able to walk on a line, balance on one foot, hop on one foot, pedal a tricycle, jump over a 6 inch high object and catch a bounced ball.  She is unable to do these things.

Sally has definite delays in both gross and fine motor skills.  These motor delays effect her self-help skills.  Motor and self-help skills are very interconnected.

Resources:
Creative Curriculum for Preschool.  2001.  Teaching Strategies, Inc.  Printed in the United States.

Cook, Ruth E., Klein, Diane M., Tessier, Annette.   Adapting Early Childhood Curricula for Children with Special Needs.  (7th ed.).  Upper Saddle River, New Jersey, Columbus, Ohio:  Pearson Merrill Prentice Hall, 2008.

Social Story for case study student

     Social stories are a great way to help students understand social norms and expectations.  They are little stories that teach social skills, daily living skills  or behavior management skills.  According to The Interactive Collaborative Autism Network (ICAN), the purpose of a social story is to:
1. describe social situations and appropriate responses
2. correct student responses to a social situation
3. personalize instruction for each student
4. break goals into easy steps
5. teach routines for better retention and generalization
6. help the student cope with both expected and unexpected transitions
7. address a wide variety of problem behaviors
(from http://www.autismnetwork.org/modules/social/sstory/index.html)
Social stories are written in the "first person" so the children can identify with the character in the story.  They can be general enough so that anyone can relate to the story.  Or, they can be specific to a child, using that child's name, picture, and personal associations.
     I use several general social stories in my classroom.  For example, "I Can Be Calm." and "My Hands Are Gentle." and "I Want To Play." and "I Can Be Quiet."  My students are interested in these stories because the characters have strong emotions that the students can relate to.  For example, in the social story "I Can Be Calm" the character sometimes feels angry, or sad, or frustrated.  I use board maker pictures to illustrate the text.  The students love to see pictures of strong emotions.  In this story, the character shares some things he can do when he has these feelings:  breath in and blow out like a balloon, go to a safe place to be alone, tell a teacher or a friend.
     My case study student has a hard time with transitions.  She does not want to move from the tables to the circle rug, or from play to clean up, or from the playground to the classroom, or from her cot to the bathroom, etc.  Even though we use a two-minute shaker (rain stick) to give advance notice of an upcoming change, AND we tell her personally that we are about to change to the next activity, AND we give her a reward when she comes to the next activity without teacher assistance, she still resists almost every transition.  So perhaps a social story telling how she can stop one activity and move to the next activity will help her.  It will have pictures of her doing the things she is supposed to do.  It will have text that says how she likes to play and she does not like to stop.  But when the bell rings she can go with her friends to the next activity.  When the teacher calls her name, she can say "OK" and get up and go.
     We have a picture schedule for this student, but they are not photos of her.  They are board maker pictures (icons).  I think she will respond better to photos of herself and a little story of how she, Sally, can make choices that will help her have fun in the classroom.

source:  Social Stories:  Introduction from http://www.autismnetwork.org/modules/social/sstory/index.html

Embedding IEP goals into routine activities

     Embedding learning opportunities into the routine daily activities is an important method of instruction for early educators, particularly those with students with special needs (Cook, Klein, Tessier, 2008).  Although special activities and games are fun ways to learn new skills, the daily practice that is embedded into routines and procedures gives the children a more functional way to learn the desired skills.  For example, if a child has a social skills goal in which she is to greet her peers with eye contact and a verbal or  gestural greeting, then it makes sense to practice this each day when she and her peers arrive at school. Role playing during morning meeting or group times is valuable, but the best time for daily practice - when the greeting makes most sense, is during arrival time.  The same is true for other social skills goals, self care goals, classroom behavior goals and motor development goals.  Specifically teaching these skills during the natural times when these skills would occur will offer the students the best opportunities for successfully learning the skills.
     Other learning opportunities can be embedded into  play centers as the text book suggests.  The dramatic play center is a great venue for practicing dressing skills, manners, turn taking, multi-step play schemes, cooperative play, problem solving... the list is endless.  Generating and expanding language can occur at any center.  If the teacher is in the center playing with the children, she can work on IEP goals relating to social communication, vocabulary and sentence expansion.  Many students have IEP goals relating to problem solving and conflict resolution.  Any center provides a good opportunity for the teacher to facilitate the development of these skills.  
     With my own students, I have found that students socialize and generate language much more on the playground than in the classroom.  It may be because there is less structure and fewer restrictions on the playground.  This gives the teachers many opportunities to facilitate language and social skills.  There are many opportunities for the teacher to help students with self-advocacy skills.  Of course getting ready to go outside is when everyone is working on self-care skills such as putting on coats and buttoning and zipping. And for those students working on gross motor skills, the playground may offer the best place to move freely without barriers and obstructions.
     I have a class of 12 students with developmental delays.  Nearly every moment of the day is an opportunity for these children to practice the skills they are developing.  From the moment they get off their transportation and greet the teacher,  to the moment they get back on their transportation and say goodbye,  the children are practicing daily living skills that come naturally to the rest of us.

Cook, Ruth E., Klein, Diane M., Tessier, Annette.  Adapting Early Childhood Curricula for Children with Special Needs (7th edition).  Upper Saddle River, New Jersey, Columbus, Ohio:  Pearson Merrill Prentice Hall, 2008.

The importance of collecting data on IEP goals

After a child has had a comprehensive evaluation made up of a variety of assessments,  it is time for professionals, educators and parents to collaborate on writing educational goals and objectives for the child.   The data collected from these various assessments is what provides the information for making decisions regarding specific goals.  Without the assessments and the data collected from them, the IEP team would not have a comprehensive view of the child.  They would not know the child's present level of performance for each of the domains.  They would not have evidence in which to base their decisions for setting goals for the upcoming year.  According to Cook, Klein and Tessier (2008), "... when quality goals are based on what is learned during assessment better child outcomes are produced."  It is the evidence collected from the assessments that drives the child's education plan.  If we recognize the importance of collecting data in order to write the initial IEP goals, then we must recognize the importance of collecting data as a means for monitoring the progress of the child in meeting his IEP goals.  The IEP goals are written based on the child's current levels of performance.  As the child grows physically, matures socially and emotionally, develops motor and adaptive skills, learns cognitive concepts and expands his communication skills, data must be collected to identify and monitor these changes.  All those involved in implementing the IEP are responsible for collecting data.  The information gathered from the data will help the teachers and professionals determine if the child is progressing in his goals.  If the child is making adequate progress according to the data collected, then the interventions and instructional strategies being used are appropriate to the needs of the child.  If the child is not making adequate gains as evidenced by the collection of data, then the teacher or professional may need to reconsider either the appropriateness of the goals, or the appropriateness of the interventions and instructional strategies.  As Cook, Klein and Tessier (2008) state in the text,  "Instructional strategies should be informed by meaningful assessments and reflect evidence-based practices."  The educator can make adjustments to her teaching strategies, or decide to convene a team meeting to discuss the appropriateness of the IEP goals.  In any case, it is the information gained by monitoring the progress of the child that helps the educators make on-going decisions about the delivery of instruction.

Works cited:
Cook, Ruth E., Klein, Diane M., & Tessier, Annette.  Adapting Early Childhood Curricula for Children with Special Needs.  (7th ed.).  Upper Saddle River, New Jersey,  Columbus, Ohio:  Pearson Merrill Prentice Hall, 2008.