Thomas is now four years of age. Molly and Ian describe him generously as "a handful." In spite of their deep love for their son, they are worn out from his seemingly constant tantrums. While his speech has improved somewhat, he still struggles to communicate his basic needs, and much of the time he seems to prefer simply being alone.
Thomas' tantrums made it impossible to continue in the Montessori school that he attended for a couple of months. The staff of the school made a real effort to include Thomas, but his difficulty with social relations was too much for them - and for the other kids. The final straw was Thomas biting another child, something that Molly and Ian had only seen him do at home.
For them, in any case, Montessori seemed like years ago. Their days now are filled with trying to guess what Thomas is thinking and feeling and attempting to meet his needs before he tantrums. Sometimes they are successful, and sometimes they have to contain Thomas physically so he doesn't hurt himself or others. In these episodes, it is not uncommon for Molly to get scratched and bitten; Ian is limited in how much he can assist owing to being wheelchair-bound. Molly winds up taking the brunt of Thomas' aggression, something they both know he can't control but that nonetheless makes their life incredibly challenging.
Sometimes Ian can soothe Thomas by having him crawl up in his lap. Ian will roll around the house with him, and, for some reason, Thomas seems to enjoy the sensation.
When Thomas is "on," he is incredibly inquisitive and creative. His big brown eyes tell his parents that there is so much more going on in his head than he is able to tell the world - they wish so much that he could express himself better, but they know that there is much more to Thomas than most people see. And this keeps them going when he does tantrum.
Ian and Molly are careful not to allow Thomas to see TV all that much. He can become easily fascinated to the point of tantruming when the TV is turned off or it's time to go to bed. Once in a while they will allow him to see a movie, and he even knows how to work the DVD player. He will repeatedly play the same section of 'Finding Nemo' over and over until his parents redirect him.
[
See the following vignette (video) about a 4 year old non-verbal child who is having a tantrum (a fairly manageable one):
http://www.youtube.com/watch?v=rvC5gzmwq_8
]
* Describe the typical developmental milestones for a four-year old including physical, cognitive, emotional and social domains.
* Describe the process of transitioning from IDEA Part C to IDEA Part B. What additional services are available to him under Part B that were not under Part C?
* What is the likely classification that Thomas will fall under regarding IDEA Part B? In other words, what "label" is he likely to have within the local school district?
* Discuss the degree to which many children with Autism have sensory challenges with regard to stimulation (from lights, fabrics, sounds, etc.)
DECISION POINT ::: Do Molly and Ian take Thomas to a child psychiatrist? Why or why not? What considerations inform their (your) decision?
In addition to the questions above, please also answer the
following questions posed to you by the other groups (not all questions are
included from all groups) :::
From the Wendy Marianna group :::
1) Does every child with autism act in the same manner? Are there
specific diagnostic criteria and/or manifestations that must be present
to be diagnosed with an Autism Spectrum Disorder? Is it possible for
Thomas to have a savant skill?
From the Ahmad Nassar group :::
1) At what point in a child with Autism's development is it "time" to bring
in further specialists such as behaviorists? How helpful have they
shown to be?
2) Since Thomas doesn't always cue his needs, what are some adaptive strategies Ian and Molly could use to allow Thomas to further express himself?
2) Since Thomas doesn't always cue his needs, what are some adaptive strategies Ian and Molly could use to allow Thomas to further express himself?
From the Lisa Yoo group :::
1) What are some ways that Molly and Ian can cope with Thomas’ diagnosis
on the ASD spectrum? It has already been stated that there is a
negative impact emotionally on the Molly and Ian, but what resources do
they have through their community or possibly through IFSP?
Week 6 Posts:
ReplyDeleteQuestion 1:
During the fourth year, a child typically develops quite rapidly when it comes to the physical aspect. A normal developing four year old will show improved balance, hop on one foot without losing balance, throw a ball overhand with coordination, and be able to cut out a picture using scissors. Running becomes more controlled and most are able to turn somersaults. Four year old children will be able to use a spoon and fork skillfully and be able to dress themselves, brush teeth, comb hair without much help. Around the four year old mark, they should be able to print some letters.
The typical 4-year-old has a vocabulary of more than 1,000 words and is able to easily put together sentences of four or five words. A normal developing four year old will often be able to learn and sing simple songs. Four year old children often tend to commonly have imaginary playmates at this stage and are capable of telling the difference between two objects based on things like size and weight. They also understand order of daily routines (breakfast before lunch, lunch before dinner, dinner before bedtime). Some more developmental cognitive milestones include being able to ask and answer who, what, when, why, where questions. They are capable of engaging in 1 activity for 10-15 minutes and can name 6-8 colors and 3 shapes. Four year olds are often able to follow two unrelated directions like “Put your milk on the table and get your coat on”.
Some typical developmental milestones emotionally and socially include being able to take turns and share (most of the time), understand and obey simple rules (most of the time). Four year old children like to talk and carry on elaborate conversations and persistently ask why. They may name call and enjoy showing off and bragging about possessions. They tend to have a difficult time separating make-believe from reality. Four year old children enjoy to shock others by using “forbidden” words and they still throw tantrums over minor frustrations. Lastly, they love to tell jokes that may not make any sense at all to adults.
Question 2:
The most difficult transition for families is from the family-focused services of early intervention (Part C) to the child-centered education programs of Part B. In Part C, family involvement is mandatory and parents are expected to be the decision makers for their child's services. Throughout the Part C years, families are taught to provide and advocate for their children's needs. When they enter Part B programs at age 3, the school assumes the primary educational responsibility. The school district where the child lives has responsibility for Special Education. The school must call an IEP meeting in order to develop a program for the child that best suits his/her needs. The school district must provide services free of charge to the parents. Some of the services included under IDEA are special education; related services such as physical, occupational, and speech therapy; and supplementary aids and services, such as adaptive equipment or special communication systems. Part B applies to children from age 3 up to age 21.
Part B of IDEA provides Special Education and Related Services under the Free and Appropriate Education Act whereas Part C provides Early Intervention Services to every eligible child and their families under the federal grant program. Part B utilizes an IEP(Individualized Education Program) with the child and their families while Part C utilized an IFSP (Individualized Family Service Plan). Part B provides services in the least restrictive environment and Part C provided services in their natural environment.
This transition period is filled with the evaluations and meetings that are required by the law, and families often feel rushed to make decisions. As a result, parents frequently feel the need for additional conversations to answer questions about their child's potential services.
Question 3:
ReplyDeleteIDEA legislation classifies Autism as:
“a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences,” Thomas received his Autism diagnosis at age two, and he continues to exhibit the aforementioned manifestations at age four. Therefore, under IDEA Part B, Thomas clearly qualifies to receive a variety of disability services because Autism has been identified as his disability under IDEA, but he can possibly qualify in other disability categories as well because he is currently receiving help for his speech and language difficulties. The more areas he can be diagnosed in, the more services he can receive. IDEA, Part B, states that all individuals with a disability are entitled to a free and appropriate education beginning at the age of three, (Thomas already qualifies because he is four), and this continues until age 21. Thomas’s family and school staff must immediately set up an Individualized Education Plan, (IEP), in order to set academic and life-skill goals for Thomas in the school setting. Thomas’ IEP must be editied, monitored, and evaluated every school year, until Thomas is 21, to ensure that Thomas’ needs are being met in the school setting. Thomas’ parents need to figure out if Thomas has a disability related to his speech and/or language, and with that diagnosis Thomas can be labeled as a student with Autism, and as well as speech and/or language disabilities in the local school district.
Question 4:
Many with autism have sensory challenges with regard to stimulation. These people have difficulty managing their sensory input. These sensors can include tactile, visual, aural, and several others. Some over react and others under react. It can affect one’s life so much that they are unable to participate in typical life activities. Light and sound can be too overwhelming for the individual to handle. When it reaches this level, the person can become diagnosed with Sensory Processing Disorder. They will then have sensory integration therapy which is provided by an occupational therapist.
Sensory processing refers to “the ability to take in information through our senses (touch, movement, smell, taste, vision, and hearing), organize and interpret that information, and make a meaningful response. For Most people, this process is automatic. We hear someone talking to us, our brains receive that input and recognize it is a voice talking in a normal tone, and we respond appropriately.” Individuals who experience Sensory Processing Disorder, however, react a little differently to the senses. This is because their brain actually interprets the information that comes in differently. It also affects how they respond to that information and whether their response will be emotional, physical, etc.
Individuals with Autism are very prone to having sensory challenges. Based off of research, some individuals have sensory integration problems so bad that they have to have sound proof rooms in their homes, soft cotton clothing, only eating certain textures, and only watching sensory proof films. The life patterns of those with sensory issues differ dramatically than an individual without these problems. There are different techniques and strategies that are done to help calm down the individual when he or she experiences a problem with senses. Parents become trained for these techniques as well as other family members. These techniques do not cure the individual, but help relieve the symptoms they are experiencing.
Other blog’s questions:
ReplyDeleteWendy Marianna:
Each child with autism acts in his or her unique way. There are many common characteristics and manifestations seen in individuals who have Autism, and these are used to help diagnose a child with Autism Spectrum Disorder. According to the Autism Speaks website (2012), the Diagnostic and Statistical Manuel, (DSM-IV), has pinpointed specific characteristics that will determine whether or not a child has Autism, and they are as follows:
“I. A total of six (or more) items from heading (A), (B) and (C) with at least two from (A) and one each from (B) and (C):
(A) Qualitative impairment in social interaction as manifested by at least two of the following:
Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture and gestures to regulate social interaction.
Failure to develop peer relationships appropriate to developmental level.
A lack of spontaneous seeking to share enjoyment, interests or achievements with other people, (e.g. a lack of showing, bringing or pointing out objects of interest to other people).
A lack of social or emotional reciprocity.
(B) Qualitative impairments in communication as manifested by at least one of the following:
Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime).
In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.
Stereotyped and repetitive use of language or idiosyncratic language.
Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
(C) Restricted repetitive and stereotyped patterns of behavior, interests and activities as manifested by at least two of the following:
Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
Apparently inflexible adherence to specific nonfunctional routines or rituals
Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
Persistent preoccupation with parts of objects
II. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(A) Social interaction
(B) Language used in social communication
(C) Symbolic or imaginative play,” (Autism Speaks, 2012).
In addition to displaying these
ReplyDeletecommon characteristics, children with Autism may have seizure, genetic, pica, and/or gastrointestinal disorders, as well as the struggle to sleep and/or deal with certain sensory stimulations(Autism Speaks, 2012). Overall, children with Autism display social
and communication impairments, as well as some repetitive behaviors. Asperger Syndrome, PDD-NOS, Rhetts Syndrome, and Childhood Disintegrative Disorder are also included under the umbrella of Autism Spectrum Disorders(Autism Speaks, 2012). Parents are usually
the first to recognize that their child is not developing in a typical manner, and some early signs of Autism include: a child’s lack of eye contact with their parents, repetitive behaviors, and a lack of speech/babble at a time when typical children begin
to talk. Also, children can show signs of Autism as early as one year old, and screening for Autism can begin when the child is 16 months of age(Autism Speaks, 2012). The M-CHAT, Modified Checklist for Autism in Toddlers, can be done with children at a very
young age, and overall this checklist aims to pinpoint and discover how many characteristics of Autism are being demonstrated regularly by the child. (Autism Speaks, 2012).
According to Edelson (2012),
"Autistic savant" refers
to individuals with autism who have extraordinary skills not exhibited by most persons,” and “the
estimated prevalence of savant
abilities in autism is 10%.” The most widely found forms of savant skills include exceptional math, art, music, and memory abilities. Some individuals with a memory savant skill can recall which day of the week a date in history took place on almost immediately,
and other individuals have a great ability to memorize music after only looking at the music for a brief amount of time(Edelson, 2012). Currently, we do not know why certain individuals with Autism have savant skills, and others do not, but a key characteristic
in having a savant skills is intense concentration. Therefore, it cannot be determined at this time whether or not Thomas has a savant skill because he has not shown any special skill sets yet.
Lisa Yoo:
ReplyDeleteMolly
and Ian will be dealing with a stressful situation in the next few years concerning Thomas. It will be important for them to look out into the community and find any local or state resources to further help them with support and decision making. Molly and
Ian can cope with Thomas’ diagnosis by enrolling him in social skills groups where they can be part of the therapy. Additionally, we felt that it would be helpful for Molly and Ian to enroll in family counseling weekly to talk out their frustrations and stress
that may be placed on their marriage. It would be a terrible thing for Molly and Ian to suffer relationship issues which could in turn affect Thomas and his prognosis. The first place that Molly and Ian can look to would be the Harrisonburg/Rockingham community
services board and the Virginia Department of Behavioral Health and Developmental Services. Virginia has many state wide autism groups including Commonwealth Autism Service and Infant Toddler Connection of Virginia to name a few. The Commonwealth Autism
Service has support group meetings and workshops for parents. The Virginia Autism Council has several chapters throughout the states that offer meetings and support groups; however, there are none through this program in the Rockingham Harrisonburg County.
The closest would be the Autism Outreach Inc. in Fredricksburg. Directly in the valley, Harrisonburg’s 5k Walk/Run for Autism is taking place in April and this would be something the Mahoney family could do together, even though Ian is wheelchair bound;
it would be a great support for Thomas. By reaching out into the community, they can speak with other parents that are struggling with the same issues that Thomas is facing including lack of social skills and increase in uncontrollable tantrums in the last
three months. Because Thomas is now over three years of age he is no longer eligible for services through IFSP, but when Thomas enters the school system he will be eligible for an IEP instead and will receive services through that.
Ahmad Nassar:
ReplyDelete1.
Children with autism obviously do not follow the typical patterns of child development. There are times that one can see hints of future problems as early as birth, but usually the problems are noticed as the child grows up and is not developing the same as
other children his or her age. As parents, it is obvious that Ian and Molly are feeling the frustration in trying to communicate with Thomas and trying to get to the root of the problem when it comes to his outlandish behaviors. A number of different treatment
options for the behavioral outbursts that accompany autism have been developed since it’s identification. There are therapeutic programs that focus on replacing dysfunctional behaviors with more appropriate ones while simultaneously focusing on their skills
and interests so that they are more attuned to the therapy. Researchers suggest that creating a specific schedule each day that the child can follow reduces these dysfunctional behaviors and outbursts a great deal because the child is at ease knowing what
he or she is doing next.
Behaviorist
training draws on the principle that children are more likely to continue a behavior if they are rewarded for said behavior. This process is highly repetitive, structured, and time-intensive but has been shown to work effectively. For instance, if a behavioral
therapist was attempting to get Thomas to sit still in chair, he or she would sit Thomas in the chair and reward him every time he did not get out of the chair with something he enjoys---whether it be chocolate, juice, etc. Children with autism do not grasp
the concept of getting rewarded immediately which makes this process very time intensive. Learning to sit still and focus can help Thomas with many other learning behaviors. Today, these behavioral therapies are even more focused on the individual interests
of the child and currently, most researchers believe that the early these therapies are introduced into the child’s life, the better. They also believe in training the parents to perform these therapies on their children while in the home. If the child is
receiving rewards and reinforcement in and out of the home, they are more likely to pick up on the proper behaviors. The National Institute for Mental Health is conducting extensive research on behaviorist treatment approaches to determine the best time to
begin treatment, the most effective methods depending on the severity of the child’s autism, and the proper intensity and duration of the treatment.
2.
Some adaptive strategies that Ian and Molly can integrate into their lives with Thomas include things like making a picture board of different things and activities that Thomas can point to or velcro on and off and using the behavioral strategies and reward
systems we mentioned before. Many behaviors, such as consistent banging on surfaces, can be adapted into something more productive by the use of instruments. It has been shown that drums and other musical instruments prove soothing to children with autism
because it is a way for them to express what they are feeling while also producing an outcome of music rather than a banging and temper tantrum. Also, using an “emotion chart” helps by allowing the child to point to different faces expressing what kind of
emotion they are feeling. One of our group members, Heather, worked with an autistic child at a summer camp this past year and attests that the “emotion chart” was one of the most effective strategies in trying to pinpoint the child’s emotions and attitude.
Decision
ReplyDeletePoint:
We think he should receive services from a child psychiatrist.
We think it will only benefit him in the future and help him cope with some of the challenges and struggles he will face in his life
Our group also thinks that Molly and Ian need to consider
the realistic expectations of a child with autism before jumping the gun to enroll him in therapy with a psychiatrist. An overall evaluation could possibly be helpful though to see if there is a co-occuring issue?
We think it would be helpful for Thomas to see a psychiatrist
sometime in the future, but right now he has a lot of trouble communicating his thoughts/needs, therefore we don’t know how much a child psychiatrist could help him at this time. It has some emotional/aggression issues and we think he does need to see some
kind of specialist to help him recover when he has a tantrum.
Sources:
ReplyDeleteAutism Speaks: (2012).
What is autism.
Retrieved February 23, 2012,
from http://www.autismspeaks.org/what-autism
Edelson, Stephen M. (2012).
Research: autistic savants.
Retrieved from Autism Research Institute on February 23, 2012: http://www.autism.com/fam_autistic_savants.asp
Education Law Center. (n.d.).
Individualized Family Service
Plan . Retrieved February
23, 2012
Developmental Services
(n.d.). Retrieved February
21, 2012, from http://www.dbhds.virginia.gov/
Mannhein, J. (2011, November 07).
Developmental milestones
record - 4 years. Retrieved
from http://www.nlm.nih.gov/medlineplus/ency/article/002015.htm
Oesterreich, L. (2008, September).
Four-year-olds growth & development.
Retrieved from http://www.exnet.iastate.edu/Publications/PM1530F.pdf
Johnson, C. D. (2005).
Hands & voices.
Retrieved from http://www.handsandvoices.org/articles/education/law/transition.html
Department of Education, Special
Services, State of Maine. (n.d.). Part
c & part b - what's the difference?.
Retrieved from http://www.maine.gov/education/speced/cds/partb_partc.html
Rudy, L. (2011, July 04). Sensory
integration,sensory processing disorder, and autism. Retrieved from
http://autism.about.com/od/treatmentoptions/a/whatisspd.htm
(n.d.). Retrieved from http://www.bbbautism.com/sensory_integration.htm
Child Development Institute (2012).“Understanding
Autism and Autistic Disorders.” Retrieved
February 22, 2012 from http://childdevelopmentinfo.com/child-psychology/understanding_autism.shtml
Centers for Disease Control
and Prevention. (2011).Centers
for disease control and prevention.
Retrieved from http://www.cdc.gov/ncbddd/cp/treatment.html
U.S. Department of Education. (2012).
Building the legacy: idea
2004. Retrieved February
23, 2012, from http://idea.ed.gov/
Harrisonburg City Public Schools:
Policy Manual. (1995). Instructions:
programs for students with disabilities (722). Retrieved
February 25, 2012, from http://web.harrisonburg.k12.va.us/policy/722