Case Study: Sammy Sensory. Lynn W. Miskiel M.A., CCC SLP/A, LSLS Cert AVEd
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1 Case Study: Sammy Sensory Lynn W. Miskiel M.A., CCC SLP/A, LSLS Cert AVEd
2 My name is Lynn Miskiel and I m presenting a case study. I work for the University of Miami. I have no relevant financial or nonfinancial relationships to disclose. I am the President of AG Bell, FL and Vice President for Option Schools, Inc.
3 Sammy Sensory Male, bilingual, middle SES household 14 months - dx with profound hearing loss 15 months - fit with hearing aids 19 months - Debbie School A-O program 23 months - first cochlear implant 26 months - second cochlear implant
4 Educational Choice Parents focused on providing auditory access and having Sammy learn to listen and talk.
5 Debbie School Auditory-Oral Education Program Full day educational program for children who are deaf/hard of hearing Focus on listening and spoken language Inclusive PreKg classrooms/self-contained Primary classroom Standard curriculum
6 Three Perspectives: Home behavior School behavior Community therapy behavior With Sammy in PreKg, how do these perspectives impact placement and outcomes?
7 Home Challenges with Sammy accommodating to the family routine. Frequently acted up if activities were not his preference. Parents expressed Sammy being Sammy.
8 School Prior to CI, teacher observed isolated play patterns not consistent with his age. Post CI some improvement but solitary play continued including repetitive and selfstimulation behaviors. Off-task behavior during group activities such as laying down. Difficulty engaging in social content.
9 Community Non-compliant during language therapy with mom in the room. Demonstrated aggressive behavior toward mom, hitting and biting. Therapist recommended PCIT but family did not choose to follow up. Parents chose to stop receiving services from this provider.
10 PreKg Concerns/Goals Receptive/Expressive Language delays. Followed familiar verbal directions in context. Had communicative intent but eye contact poor. Vocalizations and a few words. Behavior Impulsive Poor attention/distractible
11 Overall Concern Is there something else going on? A comorbid condition that was masked by the hearing loss and subsequent language delay?
12 What to do? Heading to kindergarten with minimal expressive language and delayed expressive language. Academic skills delayed. Episodes of oppositional behavior at home, at school, and during language therapy sessions. Very concerned that A-O approach not appropriate and that his needs were not being met.
13 Assessment Classroom observation Wechsler Nonverbal Scale of Ability Sensory Profile (Teacher and Caregiver) Autism Spectrum Rating Scales Gilliam Autism Rating Scale (Teacher and Caregiver) Behavior Assessment System for Children (Teacher and Caregiver)
14 Results Classroom observation: Concerns Nonverbal IQ-WNL Sensory Profile: Parents-WNL; Teacher-Concerns Autism Spectrum Rating Scales-WNL Gilliam Autism Rating Scale-Possible Behavior Assessment System for Children- At Risk
15 Strategies Implemented in School/Therapy Redirection Positive behavior management with specific and frequent reinforcement. Sensory input with weighted vest/lap pad. Sensory breaks using a bean bag chair. Sensory balls during transitions.
16 As perceived by the professionals: Parents were in denial, not accepting that Sammy s behavior is not consistent with the hearing loss, that more seemed to be going on. Parents not putting in the time needed to change CA s outcomes. Parents seem to not recognize challenges the teachers have nor to acknowledge the hard work they are putting in.
17 But then they came to us He had swimming lessons over the summer and this impacted his behavior dramatically. It seemed to open the parent s eyes to his sensory needs. They initiated additional sensory activities and therapy.
18 Home Skill Practice Increased! Language experience books with pictures. Use of compression clothing. Communication with school increased. Father available to come by school when behavior extreme.
19 Outcomes While still delayed, Sammy s skills in all areas increased at a faster rate. Sammy was able to stay in an auditory-oral education program with the sensory accommodations. Strength in receptive language and reading skills.
20 Outcomes Social skills continued to be targeted but he improved in his interactions with his peers and with adults. Parents happy with social interactions at home. Reading skills less than half a school year behind. Math skills one school year behind.
21 Key Concepts Keep experimenting and exploring options. Consult with other professionals. Don t assume family is not on board. Parents support their child s progress in their own way and in their own time. Be open to the direction this might take.
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