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Lauren Salmon

Case Study Report:

Background Information: Mia is a seven-year-old female with autism spectrum disorder. She is a student in an ASD Nest classroom, which has a total of sixteen students, four of whom have autism spectrum disorder. This is Mias third year at PS 112; she began in an Intensive Kindergarten program (6:1:1 ratio) followed by an ASD Kindergarten (12:2 ratio). It takes Mia over an hour to get to and from school by school bus. Mias parents are actively involved in her home and school life maintaining a close relationship with her teachers through written entries in Mias Communication Notebook as well as during parent teacher meetings and classroom community events. Mia is pulled out for Social Development Intervention (SDI) twice a week as well as Adaptive Physical Education (APE) five times a week. Mias Individualized Education Plan was not obtainable therefore background information was collected through interviews of teachers and professionals who have worked with her as well as Communication Notebook notes.

Language/Communication o Expressive: Mia has fairly strong expressive language skills and when she desires is able make her thoughts, needs and ideas known. Mia speaks quietly in a robotic monotone manner, expressing little emotion in her speech as well as in her facial gestures. Mia demonstrates difficulty holding a conversation and must be prompted by a teacher or peer in order to continue dialogue.

o Receptive: Mia appears to have receptive language deficits, demonstrated by her difficulty following one and two step directions such as line up for lunch. Mias difficulty attending to the speaker and/or activity at hand interferes with her ability to participate and interact with her classmates and teachers. During minilessons Mia is unable to answer a question posed by a teacher unless her name is called prior to being asked, giving her an opportunity to refocus on the discussion.

Cognition According to her recent assessments, Mia is at or above grade level in most academic categories such as reading, and writing. She writes legibly and with appropriate punctuation however often has difficulty writing and drawing creatively, choosing to focus on the same topic herself, her parents and her brother either at home playing the game Clue or waiting for the school bus. Compared to most peers who typically enter first grade reading at a level C (on or about grade level), Mia reads at a level I, however, she is only able to comprehend what she is reading up until level G. When focused on a task, Mia demonstrates her ability to be productive and efficient.

Social Skills Mia engages in minimal social interactions with peers throughout the day. She demonstrates an inability to initiate and sustain conversation with peers and teachers. Unless specifically instructed to do so, Mia rarely makes eye contact. When she does engage in eye contact it lasts for only a few seconds. Mia does not reference peers to see what they are doing, often being the last student remaining on the rug or at the desks before moving onto the next activity.

Motor Skills Mia has strong fine motor skills, which can be observed as she holds a pencil with a pincer grasp and manipulates the zipper on her coat. She also demonstrates strong gross motor skills, observed as she runs, skips, hops, jumps and throws objects during APE.

Adaptive and Coping Skills Mia has age appropriate adaptive skills. She is able to use the toilet independently as well as pack and unpack her backpack, and undress and dress herself in her outer gear. Mia follows school rules and appropriate protocol during fire and lock down drills. When anxious, Mia tends to withdraw by zoning out and fixating her eyes onto something off task such as looking out the window or into the hallway. During these times she can often be found self-stimulating by rubbing her fingers together near her lips or eyes.

Observation During the first few days of the school year Mia was arriving to school late and tired due to busing issues. By the second week of school the issues were resolved but regardless, she wakes up earlier than most of her peers (6:15 am) and is on the bus for over an hour to get school. Mia is a sweet and pleasant student who has shown compassion for her peers, appearing curious and concerned, asking on two separate occasions why a classmate was upset. Whereas many of her peers were often found engaging in social interactions, talking and laughing with one another (even at inappropriate times of the day), Mia was rarely seen conversing or interacting with her peers. Mia was never observed laughing, something seen often with her typically developing peers. As noted by Berk, by age seven a child should be interacting in a

more cooperative and prosocial way with peers. Friendships begin to immerge at this age as seen with her typically developing peers who have begun to show preference to some peers over others (Chapter 11). Aside from being given the direction to pick a partner on a few different occasions, Mia never initiated or opted to spend time with a classmate. Throughout the day when a peer of Mias is reminded to be a part of the group or use whole body listening they usually regain focus and begin to attend or participate appropriately. Mias ability to attend seems to be fleeting and she was observed zoning out during a variety of activities at a variety of times through the weeks during the observation, such as during APE while hitting balloons, during science while making honey comb observations, throughout whole group instructional lessons and during snack while her table group was engaged in informal, friendly conversation. During a recent lockdown drill, members of her class either acted nervously, scared or overly energetic and disruptive whereas Mia displayed no observable affect appearing to be unaware of this unusual disruption in her day. Mia enjoys reading and occasionally has needed to be reminded to stop reading and focus on the current activity. While reading a new book one day, Mia became fixated on the expression on a cats face on the first page of the book and could not get past it even though it wound up being a completely insignificant part of the book. When probed for more information about the book it became apparent that she was not able to understand it even though she was able to read the words. While in whole group instruction, Mia is often called on to participate. When her name is said first before a question is asked Mia is typically able to refocus and provide an answer, which may or may not be correct. This behavior appears typical to students who are caught off guard not paying attention and then quickly recover by tuning back in to provide an answer. When a question is asked prior to calling out her name, most often Mia is unable to contribute any answer. Whereas most students in the class are

eager for teacher attention, demonstrated by asking questions, seeking out 1:1 time and participating in discussions, Mia was not observed seeking out the assistance, support or company of teachers (or peers).

Goals & Objectives Immediate Developmental Need Through observations it was apparently that Mias ability to focus and attend dropped significantly during teacher led instruction, particularly on the rug during mini-lessons. While the teacher taught, Mia was observed looking around the classroom or down at the rug, turning her body away from the speaker and in a general unfocused state of being. When she is called on, Mia is rarely prepared to answer the question, as she has not been actively paying attention. Goodman & Williams found that, Students diagnosed with ASD often present unique and challenging behaviors that impede their success in inclusive classrooms...Those deficits can jeopardize student learning, not only because they interfere with relationships but also because they interfere with the learning environment for students with ASD as well as for others. As it is crucial to her academic and social success for her to pay attention on what is being taught during these times, the behavior chosen to focus on strengthening was her ability to attend to the speaker on a more consistent basis so that she remains a part of the group and retains necessary information. Goal Mia will be able to attend to the speaker with greater frequency through the use of whole body listening when sitting on the rug during mini-lessons. (Whole Body Listening = eyes on the speaker, ears to hear what is being said by the speaker, a quiet mouth, hands in lap or by her side, legs crisscrossed, brain to think about what the speaker is saying and a heart to care about what the speaker is talking about.)

o Objective Within a ten-minute period of time during a mini-lesson Mia will look directly at the speaker (her teacher or a peer) while she/he is speaking at least 50% of the time. o Objective Within a ten-minute period of time during a mini-lesson Mia will have her body turned in the direction of the speaker 90% of the time. o Objective Within a ten-minute period of time during a mini-lesson Mia will answer one question asked by her teacher without the question being repeated. Having Mia work on the above mentioned objectives, eyes on the speaker, body turned towards speaker and answering a speakers question (indicative of ears and brain on speaker), will assist her in working towards whole body listening, an important age appropriate behavior which her typically developing peers engage in.

Intervention Plan After observing Mia for several days, it was apparent that a significant challenge for her was attending to the speaker (namely one of her teachers) while on the rug during a mini-lesson. Mini-lessons typically last ten to twelve minutes in Mias classroom. It was decided that the most effective way to measure attending to the speaker would be to monitor her eye gaze. Before beginning the baseline data, Mias eye gaze behavior was timed for several minutes during a mini-lesson to see the average length of time of a gaze to ensure that the planned baseline data collection was appropriate for her specific behavior. For instance, initially the plan was to collect data on an eye gaze of 30+seconds until it was determined that in actuality Mia rarely attends to the speaker through focusing her eyes on them for over 5 seconds. Baseline data was taken to determine the frequency to which Mia focused her eyes on the speaker (Appendix

A). Baseline data was recorded in one-minute intervals through the use of a digital timer, for ten minutes during all three trials. A data point was marked when Mia had her eyes on the speaker for at least 5 seconds. All three baseline trials as well as the later intervention trials occurred during Reading Workshop mini lessons in order to rule out preferential differences in subject matter. The goal in recording data was to devise a strategy that would support and aid in increasing Mias ability to attend (measured through eye focus) while on the rug during mini lessons. In order to increase Mias attention on the speaker, an intervention plan was put into place with the intention of adapting her environment to meet her special needs. Once a baseline was established, a small folding chair was introduced to Mia during the first day of the intervention phase. The chair had a back and sides/arms. After meeting with an occupational therapist who pushes into the class for group activities and knows Mia, it was decided that this was the intervention to begin with. The rationale here was that a chair could keep Mia upright and keep her body stable and facing in the direction of the teacher leading the lesson. While baseline data was recorded it was noted that Mia often turned her body away from the speaker, even at times with her back to the speaker. On other occasions, Mia who was seated directly in front of the teacher was observed touching or playing with her teachers shoes. The goal of using this chair (positioned slightly further from the teachers feet) was to help give her a sense of her physical space and provide her with boundaries with which to keep her body. By having her body facing the right direction and properly supported, the hope was that this would positively affect her attention and focus. Data was recorded through the use of a digital timer while the observer sat facing Mia so she could accurately monitor eye focus just as they did during the baseline data collection phase.

Data was collected over the course of three days during three Reading Workshop mini lessons (Appendix B). Opposed to an exercise ball, a small folding chair was used so as not to introduce something potentially distracting and/or intriguing to other students during the initial intervention. According to Buron & Wolfburg (2008) a chair provides additional boundaries and cues for indicating where the student is expected to beto define the students space and reduce distractions.

Results Graph See Appendix C

Monitoring Progress and Response to Intervention During the 3 days of baseline data collection, Mia was observed in off task behaviors such as rolling her pant leg while looking down, twisting her body around while seated on the rug and looking off into directions other than that of the speaker. When she appeared to be looking in the direction of her teacher, she was typically looking past the teacher either at the blackboard behind her or at the wall. On three separate occasions during the baseline collection, Mias teacher called her name, which quickly brought her back to focus and an immediate increase in attention was observed. During the 3 days of intervention data collection, Mia was observed in nearly as much off task behaviors but this time in addition to her typical behaviors such as looking elsewhere and twisting her body she incorporated new behaviors. New behaviors included playing with the straps attached to the folding chair and rolling backwards as if she was in a rocking chair.

Although the intervention data did at first show a slight uptick in frequency of eye focus, by day three it had dropped back down to a level even lower than baseline. Unfortunately the intervention was not successful and there was not a significant increase in attention to the speaker. In fact, there was an increase in off task behaviors due to the equipment used in the strategy. While in theory it would seem that by placing Mia in a chair her body would not be able to turn away from the speaker, she was able to engage in alternative ways of not attending. She did however seem receptive to the idea of using a modification to support her, which is promising and gives way for alternative interventions in the future. Although her peers did try to sit in the chair when she was out of the room or away from the rug they did follow the teachers direction that the chair was only for Mia when she was on the rug. This is important, as it seems her typically developing peers understand and respect support strategies meant for her that might not be appropriate for them. In future intervention plans it would be interesting to see whether Mias behavior would be affected by having her sit on a chair that is elevated making her almost at eye level to the teacher and removing the distraction that being on the rug seems to generate for her. It would also be worth incorporating a fidget as a way to give her hands something to stay busy with and as a sensory output rather than twisting on the rug or rocking in the folding chair. Depending on the mini lesson Mia also may benefit from higher levels of personalized engagement whenever possible, such as giving her the job of turning the pages of a book, or handing the teacher the dry erase marker or materials. Visual reminders such as an image of eyes or a body in whole body listening could potentially also help Mia by providing her with something tangible to look at to assist her in attending. By reducing Mias need to seek visual and/or physical stimulation through the use of an appropriate

and well-received intervention(s) observers should see a marked change in her ability to attend to the speaker.

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References: Berk, Laura (2009). Child Development. New York. Pearson

Goodman, Gay; Williams, Cathy M. (2007). Interventions for Increasing the Academic Engagement of Students with Autism Spectrum Disorders in Inclusive Classrooms. TEACHING Exceptional Children, 39, 53-61.

Buron, Kari Dunn; Wolfberg, Pamela (2008). Learners on the Autism Spectrum. Kansas. Autism Asperger Publishing Company.

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Appendix A:

Baseline Data:
# of times Mia has eyes on speaker for 5+ consecutive seconds: 1-Oct 3-Oct 4-Oct

Minute:

0-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10

2 2 2

2*

1 1 1 1* 1

1 3 2*

* = Mia's name called prior to period of attending to speaker

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Appendix B:

Intervention Data:
# of times Mia has eyes on speaker for 5+ consecutive seconds:

Minute: 0-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10

8-Oct 1 3

15-Oct 1

16-Oct 1 1 1 3*

1 1 1 2

1 1 1 2

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Appendix C:

Mia
# of times within a 10 minute minilesson Mia looked at the speaker for 510 seconds consecutively 10 9 8 7 6 5 4 3 2 1 0 1

Baseline

Intervention

Attending to Speaker
2 3 Days 4 5 6

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