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.
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