Sunday, April 1, 2007

4 to 5 Years

February 2003 4 yrs 4mos
Dream Team assessed Leo over a period of a couple weeks. We were then up and running with a direct instruction program, and shadowing at daycare and camp (this was summer). Increased: Self-confidence, tolerance for a busy environment, initiation, less anxiety, enjoyment of preferred and nonpreferred activities. Wide repertoire of skills keep him part of the group, does not stand out. Dream Team developed an ideal scenario for Leo’s last preschool year. They looked at the environments, curriculum, style, teaching staff, and most importantly peers. They decided that a combination of daycare and his current preschool would make an ideal social environment for his final year. Goals: Self monitoring skills, monitoring others, interpreting various social situations, peer group entry skills, pragmatics,
perspective taking, abstract reasoning skills

Before this intervention, Leo could never play alone or with a peer without prompting and redirection. Leo now has a wide range of play skills. He can have 5 conversation exchanges with a peer about something that is not his topic. Some of the programs Leo has mastered or greatly improved upon; symbolic play, tell me about, tell me how to, topic towers, gross motor, same/different, senses, WH questions, preferences, intentions, features, inferences, flexibility, barrier games, cause & effect, concepts, constructive play, desires, drawing, emotional causality, fine motor, humor, verbal inhibition, knowing, role taking, sensory perspective taking, social judgement, listen to the story, thinking, TOM, figure of speech.

Reduction or extermination of the following preservative behaviors: question forms, banging with hands, flicking with fingers, stamping with feet (walking and running hard). Chanting made-up words. Banging and chanting at nite b4 bed, stuffing hands in mouth at any time, especially when in transition or ‘shy’ in a novel situation. Staring at drains and toilets. Staring at wheels on cars. Mealtime sensory issues: Over-stuffing, putting hands in mouth. Putting spoon over mouth and pressing hard. Eliminated fear of toilets.

Leo understands and appreciates that I do not know what happens at school, and that I am interested in hearing about it because I love him and that it’s my job. He tells me about things that he knows I want to hear, like about who he played with, what kind of art he did, if he had a special job, etc, with no prompting, He will just tell me about school because he likes to share that information, and he knows it’s what I wantto hear. He’s proud of himself, and likes to please me. Leo will tell me a story about what happened at the grocery store with Dad, knowing that I wasn’t there. He knows what I like and do not like to talk about. He understands that people like to listen to and discuss novel things, not stuff they already know about.

Recently Leo asked for a piece of gum. He knows Sydney isn’t aloud gum because she is too little. She came into the room while he was chewing gum and I was eating a shrimp salad. Sydney immediately asked Leo what he was eating, and he replied "shrimp", and turned and smiled at me. We both laughed, and then I cried.

I picked up Leo after school one day, and told him that we were not going home, that we were going to someplace that’s a surprise. He pestered me for a few minutes, and was really excited about the prospect. He then turned to his 2 ½ yr old sister and said, "Leo, do you know where we are going?". Since she heard me talking on the phone earlier, she said "We are going to Tim’s house!". He smiled at me triumphantly, and then we both laughed.

I heard Leo use the bathroom, and did not hear him wash his hands. He came out and I asked him to go in and wash his hands. He asked me how I knew that, and I told him to figure it out. He told me that I must have not heard the water faucet come on. He was so proud of himself!

While he may not be happy with an event, he does understand that sometimes stuff happens by accident, that a friend may bump into him or that Sydney may ruin a block tower. Leo is beginning to understand that people and animals are not always nice, that they sometimes dobad things on purpose, or that they are just bad (good vs. evil).

Leo guessed that I was talking to his dad on the phone. When asked how he knew, he said “because you answered Hi Honey.”

June 2003 4 yrs 8 mos
Client: Leo Morgan Date of Birth: October 15, 1998
Age: 4 Years, 8 Months Date of Report: June 12, 2003
Submitted By: ABA Supervisor
NOTE: This is not the entire report, just the part about his current level of functioning:

Current Program
Leo’ program has focused on the development of play, social skills, social-cognitive skills, and executive functioning.

Play: Upon initiation of services, Leo had a very limited play repertoire, and virtually no elaborated constructive, pretend, or socio-dramatic play. Leo is now able to participate in constructive (e.g.: block or other bulding materials) play, and to include minimal use of narration and environmental sounds in his play. These are, however, emerging skills, and neither his constructions nor his narration is at the level of sophistication demonstrated by his typically developing peers, and his play tends to be simplistic and/or perseverative. His ability to engage in pretend and socio-dramatic play is also limited to a small number of brief scenarios.

Social Skills: Leo’s ability to respond to and make simple social initiations has improved remarkably over the past year. At this time, independent functioning in this area is at or about 70%. Leo also demonstrates an emerging capacity to employ several alternative strategies in order to gain entry into an on-going play activity. He continues to experience some difficulties with self-regulation, and has not yet learned to discriminate between peer behaviors that are Okay or Not Okay to imitate in the classroom environment.

Social-Cognitive Skills (Theory of Mind): Leo continues to demonstrate marked deficits in the ability to understand that other people have different information, sensory experiences, emotions, preferences and desires. He also experiences difficulty recognizing the social cues that are indicative of these feelings in others. As indicated in the Yale report, he will require intensive training in the areas of cause and effect, emotional causality, sensory perspective taking, preferences, desires, inference, and prediction.

Executive Functioning: The skills included in this area are those that allow one to plan and carry out more complex activities. Leo demonstrates deficits most notably in flexibility of thought. He is not currently able to generate alternative outcomes, solutions, or applications in order to predict and problem-solve.