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Written Summary of Progress

Demographics
Child’s Name: Mark
School: N/A
Date of Birth: 6/14/ 2016
Age: 15 months
Phone: (208) 569-3987
Address: 114 West 5th South Sugar City, ID 83440
Parent/ Guardian: Dave and Liz Batt
Evaluation Date: October 3-17, 2017
Evaluator: Taneesha Bales
How you know or acquire the examinee: Class Referral

Referral

Mark was referred for a case study through Brigham Young University-Idaho Strategies class. He has not been in this service
previously; so this is a new experience for him and his family. Mark’s parents are concerned about Mark being developmentally
delayed in walking and also his language skills. They are also concerned about self help skills of eating. Since mom is pregnant, she
wanted Mark to be able to bottle-feed himself before the baby got there. They are seeking help in these areas before Mark gets too
behind.

Background
Developmental History

Mark’s mother had a normal pregnancy with no complications. However, She was tested for Down syndrome while she was
pregnant. As a result, they found out that Mark did indeed have Down syndrome before he was born. Mark has a close family and
lives at home with his mother Liz while his father Dave works during the day. Mark has two older siblings named Bailey who is
five and Emmett who is six and half. They love him and play with him daily. Liz is also expecting in March.
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Social/Emotional History

Mark is generally a happy and content child. He is very easy going and is flexible with daily routines. He goes to bed easily and
bath time is smooth. Mark does however; need to be bottle-fed every night. Mark plays well with his siblings and has a healthy
attachment with his parents. He goes to strangers easily and is friendly with extended family.

Medical History

Mark was diagnosed with Down syndrome before he was born. He also developed a clubfoot and had casts on his foot at 2
months old. Following that he has been wearing braces, even though he doesn’t like them. Mark also has had his tonsils removed
and tubes in his ears.
Educational History

Mark receives occupational therapy services in the home in which they are working on walking and holding a bottle on his own.
Mark does not attend any other schooling or early intervention facilities. However, Liz does both preschool and piano lessons in
her home, and Mark gets some social interaction and music during those times.
Summary of Goals
Goal 1:
Mark will crawl five steps independently.
B1. During the observations and assessments that we completed for Mark we found that he was not able to crawl on his hands
and knees. Mark was able to army crawl to get from place to place. According to the developmental checklist, babies should
begin crawling between 7-10 months. This helped us determine that this was an appropriate goal for Mark because he is 15
months old. Furthermore, crawling helps a baby work on core strength and coordination for walking and standing. Since that
will be Mark’s next step in his physical development, we felt that this was an appropriate goal for him.
B2. Some activities that we engaged Mark with were music and any noise makers. Mark loves to make music and practice
cause effect with sound. For example, when Mark was struggling, we would place him on the piano bench and it would help
soothe him. Mark also loved to be cuddled and held. This was a great reward and motivation for him to crawl to us. We would
also use his favorite toys such as blocks to play with. We used these activities to give Mark a goal to crawl to. Though Mark
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was motivated to crawl around on his own, it helped to have a destination for Mark so that he would move far enough to
practice crawling on his hands and knees.
B3/B4. The first strategy that we tried was the crawling box. The idea of the crawling box, is that its too narrow for the child to
put their elbows down in an army crawl and that they have to stay up on their arms in order to move forward. Mark was so
small however, that we had to stuff the sides with pillows and blankets in order for the box to small enough. Mark did not
enjoy the crawling box. He would cry when he was in there and even though it was stuffed, he still managed to get down on his
elbows and attempt to army crawl. We then attempted to use a blanket for a different intervention. We would place a blanket
underneath his belly and hold it up around him. The idea behind this goal was that when a child knows that you’re holding
them, they may cling and just want you to hold them. This way, Mark could still be supported without actually holding him.
This intervention went alright and was beneficial after we had done our task analysis. Mark needed to work on the hands and
knees motion and keep them underneath his body. Using full physical prompting, we would move his hands and legs in the
way of crawling to help him make those mental connections. Lastly, we began just using a hand underneath his belly to help
him crawl. This strategy was fairly simple but the most effective. Mark responded well as he was able to crawl independently
using this intervention strategy.
B5. When interventions first started working with Mark, he was army crawling and was unable to sit in a crawling position or
move his arms and knees forward. Today Mark can crawl on his hands and knees independently without any support.
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B6. It is recommended that Mark continue to practice crawling by partial physical prompting or gesturing. Mark can practice
core and arm strength on the stairs to keep him progressing and help him crawl easier.
Goal 2:
Mark will sign the words ‘more,’ ‘eat,’ and ‘drink’ independently with verbal or modeling prompts.
B1. During the observations and assessments on Mark, we discovered that Mark did not communicate using either verbal or
sign language. Mark was able to say ‘mama’ and babbled. According to the developmental checklist, babies should begin first
words and communication around a year. This helped us determine that the goal was approporiate for Mark because he’s 15
months old and was delayed in his speech. We decided that we would work with communication on a sign language level
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because that is a great introduction to verbal communication. Furthermore, Mark had a speech therapist who was also
working on sign language so our goals aligned with other interventionists.
B2. For Mark’s language goal, we were able to imbed this in most of our activities. We used it during play with the blocks. We
would also practice this goal during lunchtime. Food and drink were great ways to engage Mark and help him self motivate to
sign for what he wanted and needed. We would model and self talk throughout the intervention as well in order to add
language to all of our activities.
B3/B4. The strategies that we implemented were to first engage Mark by playing or getting him interested in our activity. We
would then take the toys and place them just out of reach. We would then prompt him, beginning at a full physical level to help
him sign the word more. After the correct response no matter what level of prompting we would hand him a couple of toys
back. For the word drink, we were able to do this during feeding time. Mark loved to drink his juice so we would allow him to
drink for a while. Then when he would place the cup back on the tray we would take it and place it on the table. That way Mark
could request it by signing drink. We decided that it was easiest to generalize drink instead of using a different one for juice,
water, and milk. We would manipulate the environment to promote communication and encourage Mark to sign. We practiced
on all prompting levels beginning and full physical and backing off to less intrusive forms as he began making those mental
connections.
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Signing
0.6

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0.4

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0.2 Signing

0.1

B5. At the beginning of the semester Mark was unable to communicate using either verbal or sign language. Mark can
successfully sign eat, drink, and more using modeling or verbal prompts. He was even successful on an independent level for
those words.
B6. I would recommend that Mark continue to be prompted in signing these words throughout the day, especially at feeding
time. I would also encourage parents to verbalize the words he is signing so that he begin practicing verbal communication as
well
Goal 3
Mark will be able to drink from a cup independently. He will also spoon feed himself independently.
B1. During our observations and assessment, Mark was unable to hold a bottle and drink on his own without full physical
assistance. He was also not using any utensils to feed himself. According to the developmental checklist, a child should be able
to hold a bottle and drink from a cup independently by 9-12 months. Based off of this, we knew that this would be an
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appropriate goal for Mark. Furthermore, Liz really wanted this self help skill to be developed because she is having a baby
next spring.
B2. For Mark’s goal of drinking from a cup, we were able to engage and motivate him simply because Mark loves juice. We also
engaged him with noisemakers in the bottle. He loved to shake it around and cause the sound when we placed beans inside the
bottle. We were able to begin at a full physical prompting level and move to an independent level through partial physical and
gesture prompting. With spoon feeding, Mark was mostly self motivated because he was hungry during feeding time. We also
engaged him by having him practice fine motor skills through painting and drawing activities.
B3/B4/ The strategies that we initially used were to place Mark at different levels and angles when feeding. We began with
him laying his head down in my lap. After that, we gradually raised him up throughout a few interventions. During our last
intervention, we were able to watch Mark sit up on his own, lift up his cup, and drink independently. This worked very
effectively for Mark; he was able to practice lifting up his hands and raising his head back at different levels. The other strategy
that we did was to help Mark practice raising his arms up and lifting the cup. We placed beans inside the cup so Mark could
hear the sound and it would encourage him to shake the bottle. This worked well because it helped him practice that gross
motor skill of lifting his cup. Mark was engaged in this activitiy because he loves sound and cause and effect. For spoon-
feeding, we let him paint with water and color with crayons to help him practice fine motor skills of grasping the utensil. This
activitiy worked well for our task analysis of him practicing his grip.
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Self-Help Skills
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1.5 Self-Help Skills
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B5. At the beginning of the semester Mark was unable to lift up his cup and drink. He also didn’t use utensils during feeding.
Mark can now successfully drink from his cup independently sitting up. He also has successfully spoon-fed himself food.
B6. I would recommend that Mark continue to be encouraged to drink out of a cup. He should also practice using a cup without
handles. I would also encourage Liz to place spoons and forks on his tray for Mark to practice with and manipulate during
feeding times.
C. In summary its been an exciting and educational experience working with this family. I have learned that when working
with a child, you are also working with an entire family. I loved this family and it was incredibly rewarding experience for
Mark to be successful in all of his goals. It was a blessing to see the differences I can make not only a child but an entire family.
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