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Jessica’s Case Study

Name: Omolara Akinpelu

Student #: 3421006

Athabasca University

Course: Autism Spectrum Disorder

Instructor: Wanda Christensen

Date: May 28, 2020

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INTRODUCTION

Jessica is a 13-year old girl, diagnosed with autism at age 2 with significant delayed

communication and developmental skills. She has attended a preschool program for preschoolers

with significant disabilities for two years. She started kindergarten at age five with a support

from an EA. She currently attends a rural school and she is in her third year of an inclusive grade

six class. Jessica has poor communication and social interaction skills. She also exhibits some

restricted and repetitive behaviors with some sensory issues, which significantly impact her

relationships with peers and other people in her environment. Furthermore, her limited

communication and social interaction skills impact on her academic, behavior, social, and daily

living functioning. Jessica is however organized. She keeps track of her personal belongings and

enjoys outings within her community and traveling with her family. She also likes swimming

and enjoys other water activities.

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Abstract

Jessica has deficits in social communication and social interaction which is defined by

deficits in social-emotional reciprocity, deficit in non-verbal communicative behaviors (joint

attention, eye-contact, poor motivation, short attention span) and deficits in developing and

maintaining relationships (APA, 2013 & Boutot, 2013). She also exhibits some restricted,

repetitive patterns of behavior, interests, and activities. These manifest in several stereotyped and

self-stimulatory behaviors when frustrated like throwing tantrum, finger rubbing, lip pulling till it

sometimes becomes bloody, excessive rigidity, insistence on sameness, restricted interest, hyper-

or hypo-reactivity to sensory stimuli and self-isolation from peers.

Jessica at age 2 was diagnosed with autism based on communication skills and overall

developmental delays. She has since been undergoing some interventions. She is 13 years now

and has limited communication skills, deficit in social interaction and sensory abnormalities

which affect her behavior, academic, social, and daily living functioning.

This paper looks at understanding Jessica’s diagnosis, ASD. It looks into features of ASD

and how it impacts different aspects of individual functioning in living a meaningful independent

life. This includes impacts on family members and gives an overview on strategies to support

families and in service delivery. This paper also presents various evidenced-based strategies

(ABA) intervention plans for supporting individuals with cases like Jessica’s to improve daily

functioning, independence, and overall well-being.

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Overview

Do you think Jessica has Autism? What characteristics would lead you to this conclusion?

Yes, Jessica has ASD

What characteristics would lead to you to this conclusion?

Jessica’s profile shows she has deficits in social communication and social interaction

which is defined by deficits in social-emotional reciprocity, deficit in non-verbal communicative

behaviors and deficits in developing and maintaining relationships (American Psychiatric

Association, 2013; Boutot, 2017). Jessica also exhibits restricted and repetitive patterns of

behavior, interests, and activities such as excessive rigidity, resistance to change, and hyper-or

hypo-activity to sensory stimuli. In addition, based on Jessica’s profile, these symptoms have

been present from childhood and they impair her everyday functioning (American Psychiatric

Association, 2013).

Discuss the Assessment Process to determine if Jessica has ASD. What tools could be used?

Autism is diagnosed clinically based on detailed historical data from physical evaluation

and observation of specific behavior characteristics in a naturalistic environment. Jessica’s

assessment process would begin with the following process: step one is the review of past

medical records (hearing, vision, speech language, psychological and functional behavior

assessment reports) and interviewing her parents about their concerns. This will be followed by

detailed developmental history and booking an appointment for direct observation and

assessment of Jessica in a naturalistic environment. Step two involves staging a semi-structured

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interview with parents, family members or other caregivers. The essence of this is to facilitate

structured communication between Jessica’s Parents and I, identify the parents concerns,

increase their awareness of Jessica’s development, and increase their own awareness as well and

to understand the family functioning, strengths, routines and resources. The next step is most

crucial which is interacting with Jessica in naturalistic environment (home and school) to assess

core features of ASD; social interaction and communication skills, patterns of behaviors (look

for presence of any stereotypic and repetitive behavior), adaptive functioning (Boutot, 2017)

cognitive and motor functioning (American Psychiatric Association, 2013). Step four involves

physical examination and additional information on whether there are medical causes or

associations with Jessica’s condition. Step five would involve considering differential diagnoses

and co-occurring conditions like language disorder and social (pragmatic) communication

disorder, and attention-deficit/hyperactivity disorder (American Psychiatric Association, 2013;

Banterger et al., 2017). Step six would involve collating data together and make ASD diagnosis.

Step seven is a very sensitive stage as it involves communicating diagnosis to both Parents and

child (if appropriate) in a sensitive, supportive manner the diagnostic findings (Bangerter et al.,

2017)

Various assessment tools that can be used include ages and Stages Questionnaire (ASQ),

Screening Tools for Autism in Toddlers and Young Children (STAT), Autism Diagnostic

Observation Schedule -Generic (ADOS-G) (Boutot, 2017) and Gilliam Autism Rating Scale

(GARS-2). Adaptive behavior Assessment System (Harrison & Oakland, 2003) could be used to

assess Jessica’s adaptive functioning. Likewise, Wechsler Intelligent Scales for Children- fourth

edition (WISC-IV; Wechsler, 2004) could be sued to assess Jessica’s cognitive functioning.

Working with Families

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How do you think Jessica’s parents and siblings are affected?

Based on Jessica’s profile, the family has made lots of accommodation for her which

could have with many compromises, stressful for other family members. For instance, Jessica is

unable to start off activities without support, and would need support to continue. Boyd (2002)

posits that mothers of children with autism are most stressed parental group. Jessica’s siblings

might also be stressed having to provide support to their sister even when they do not feel like.

This could have some negative impacts like feeling of less nurturance and intimacy and less

interaction which could culminate into poor relationship with parents (Boutot, 2017) because of

perceived diverted attention toward Jessica. Lastly, since dealing with ASD could be a lifetime

hurdle, the family might be prone to persistent/chronic stress which could lead to depression.

What stressors are they experiencing?

Fear of public scrutiny, from both strangers, families and friends (Boutot, 2017). Jessica’s

limited diet could be another stressor for mum and her maladaptive behavior and poor personal

hygiene might be a concern to everyone in the family. This can even prevent them from

attending family functions together and can impact their social lives. Also, lack of adequate

support (financial, respite, emotional and adequate resources in dealing with and understanding

Jessica’s disorder) can be stressful

How is the family functioning differently if Jessica did not have ASD?

If Jessica did not have ASD, the family would probably live a more quality life free from

the present stressors and concerns they are currently facing.

What strategies could be employed to support Jessica’s parents and siblings?

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The first thing in supporting Jessica’s family is to be receptive of the uniqueness of their

issues and be open minded (acceptance). Conducting Family Needs Assessment to highlight the

family crucial needs and the support they would be next. Family needs assessment is beneficial

because it highlights the family strengths and that of Jessica’s and weaknesses. It also highlights

their concerns and help family prioritize their needs. When these needs have been established, it

would be easier to provide information on state and community resources that can help meet the

family needs (financial and emotional support, respite care and resources in understanding and

dealing with Jessica’s behavior and sensory issues (Boutot, 2017).

How could practitioners engage families in service delivery?

Parents of children with ASD are considered as primary care coordinators for their

children, and they go through many challenges of navigating the service delivery system.

Practitioners can engage families in service delivery by collaborating with them to deliver

services in a family-centred approach that promotes the active engagement of parents/caregivers.

Practitioners develop individualized plan for each family with the aim of meeting their goals,

needs and work in line with their priorities. Specialized services rendered include but not limited

to support services from Speech and Language Pathologist, occupational Therapist, Psychologist,

Physiotherapist, based on the child’s main areas of disability/delay.

Environmental Measures

Discuss Jessica’s problematic behaviors.

Jessica engages in several stereotypical and self-stimulatory behaviours when stressed,

bored, or frustrated such as finger rubbing, lip pulling till it sometimes becomes bloody. She also

has fascination for barbie dolls and long hair. She insists on sameness and like consistent
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environment. Jessica exhibits rigidness towards transitioning and toward foods. She would

become agitated when activities or schedules are changed without warning. Jessica also has

deficits in communication and social-emotional reciprocity.

How would you conduct a functional behavioral assessment on Jessica? What tools would

you use?

Functional assessment process is an evidenced-based practice for determining the

purpose of a behavior in order to develop a behavior support plan (Boutot, 2017). Conducting a

FBA for Jessica would involve various processes. Stage one is the establishment of a team that

comprises of teachers, related service provider such as speech-language pathologists,

occupational therapists, behavior specialist, school psychologist and parents/caregivers. I will

also involve Jessica if the parents consent to it and if she is also willing participate in the

assessment process. Stage two involves identifying and defining behaviors to be assessed. Also,

prioritizing behaviors that are highly disruptive to self and others over those that are minimally

disruptive. Stage three would involve data gathering, and analysis through indirect and direct

data sources. Indirect sources of data will include interviews (functional assessment interview),

review records of past interventions. Behavior rating scale (Behavior rating scale for children – 2

Reynolds & kamphaus, 2004) will be used to quantitatively measure the intensity, frequency, or

duration of the identified behaviors. Stage four involves finding out the reason behind Jessica’s

maladaptive behaviors by conducting direct observation in a variety of contexts to obtain

anecdotal data. Once this information is gotten, I would proceed to implement the scatterplot

data and antecedent-behavior-consequence (ABC data). Although, the scatterplot data may not

result in interventions that could mitigate the contextually inappropriate behavior it can guide

into ABC data collection (Boutot, 2017). Stage five is development and testing of hypotheses.
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This is followed by development of intervention plans and lastly is plan monitoring and

evaluation. information gotten from these assessments would then be used in developing a

comprehensive behavior support plan that renders inappropriate behavior irrelevant, inefficient,

and ineffective (Boutot, 2017).

Hypothesis regarding the function of Jessica’s behavior derived from FBA

Jessica’s frustration was most seen during play time. She was highly irritated and would

not want her anyone to come close to her let alone her toys. She had an outburst when a peer

accidentally bumped into her and crashed her Lego blocks. Despite pleads from her peers and

teacher she would not calm down. She would not want anyone come close to her to sooth her.

This behavior is more likely to occur when Jessica is transitioning from a preferred activity to a

non-preferred activity.

Factors maintaining Jessica’s problematic behaviors

Factors maintaining Jessica’s problematic behaviors include distorted sensory perception,

poor social communication and interaction skills, unstimulating environment (busy environment,

insensitivity and inpatient of people in her environment). Jessica’s hearing may be hyper-acute

and because she is visually sensitive, she might find her classroom setting too busy. This could

make her feel overloaded with so many stimuli her brain cannot filter at the same time. Thus,

making it almost impossible to focus and would compensate with tunnel vision making it seem

she is in her own world.

What antecedent-based interventions would be effective to address the identified behavior

above and why?

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Antecedent-based interventions that would be most beneficial to Jessica include creating

embedded demands into reinforcing activities, increase predictability of the environment,

modifying features of instruction (Boutot, 2017).

Jessica would benefit most from these interventions because they are behavior analytic

interventions that focus on changing the environment to increase interest and make escape

irrelevant, modify behavior and increase outcomes (Boutot, 2017).

Implementation of Increase Predictability of Environment

Environmental predictability is enhanced by providing information. about upcoming

activities by prompting with visual schedules of activities and expectations (Rao & Gagie, 2006).

Jessica’s visual schedules would include interspersed preferred activities with less preferred,

which would be accompanied with verbal communication of upcoming activities. Information

that would be included and location of the schedule, would be based on Jessica’s needs. Timers

and reminders could also be used alongside with the visual schedule as a reminder of an

upcoming change in activity. To a very large extent, there should be consistency in Jessica’s

class routine, activities, and procedures to what would be on her visual schedule (Zirpoli, 2012).

Applied Behavior Analysis

What ABA techniques would be effective to teach Jessica new skills and why?

Discrete trial training (DTT), Modelling and Pivotal Response Training (PRT) are most

effective in teaching Jessica social skills.

DTT is a teaching strategy based on the principles of ABA that focuses on complex skills

acquisition and behaviors through multiple practice opportunities (Boutot, 2017). Jessica would
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benefit from DTT because it breaks down skills into small “discrete” components and can be

customized to match the difficulty of the task and her current skill level (Boutot, 2017)

Furthermore, DTT instructional key rules to reduce variables that can negatively impact learning

“ensure motivation to learn, establish instructional control, use natural cues when possible, clear

the field between trials, keep the ABC separate, reinforce immediately and use errorless learning

for new skills” (Boutot, 2017, p. 84) makes it a very effective ABA strategy for Jessica.

Modelling on the other hand, is an imitation learning. It clearly demonstrates a behavior

to imitate. Researchers suggest that live model is most effective as it allows for pausing, while

allowing teacher to ask the student to observe a behavior and interpret their thoughts (Leblanc et

al., 2003) Jessica should benefit from the video-modeling because she likes using I-Phone and

computers to watch movies, play games. She might find teaching through these media very

motivating.

Jessica should benefit from PRT because it is a play-based child-initiated strategy with

the goals of developing communication and language skills, increase in positive social behavior

and provide relief from disruptive self-stimulatory behavior (Boutot, 2017)

What Verbal behavior Instruction would be most relevant?

Jessica would most benefit from “Mand verbal prompting”

How could ABA be used to address Jessica’s problematic behavior?

The goal of every ABA strategy is help individual learn skills that will help them become

more independent and successful in the short term as well as in the future. Using DTT the first

step to begin treatment is identifying a goal behavior. In order, to understand a goal behavior, it

is important to understand the antecedents, the response behavior, and the consequences. A
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thoughtful consideration into A-B-Cs of DTT treatment would help understand the “why” behind

Jessica’s problematic behaviors and how different consequences could lead to a behavior change.

Behavior Plan to Support Jessica’s target Behavior - (“Tantrum”)

(Antecedent) Teacher: It is time to put away your story books everyone

(Response Behavior): Jessica ignores her teacher and continue reading her story book

Consequence: The teacher walks up to Jessica’s table and asked her to put away her story book.

Jessica began to cry and started her usual tantrum.

ABA strategy

Antecedent (Teacher): It is time to put away your story books everyone

Response Behavior: The teacher tells Jessica she could ask for 5 minutes more time.

Jessica: more 5 minutes?

Consequence (Teacher): (teacher walks up to Jessica and says,) Yes Jessica, more 5 minutes.

Jessica is excited she could be granted 5 minutes more to round up her reading. This would

prepare her for the next class activity, which she does not like. A continuous practice of learning

to make request will eventually lead to a positive behavior change (Boutot, 2017).

Communication Skills

What is Jessica’s Communication Profile?

Jessica has limited communication skills. She speaks many phrases to express her needs

which is mostly understood by everyone around her. However, she has difficulties in answering
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open-ended question but can answer a yes/no question. Jessica displays no form of joint

attention. Sometimes, chooses not to ask for help even when she can. She does not make eye

contact neither does she initiate contacts with peers and staffs. She would ignore any initiation or

comment from peers because she does not know what to say.

What is the role of joint attention in her communication, social interaction and play?

The two types of joint attention; response to joint attention (RJA) and initiating joint

attention (IJA) would provide Jessica the opportunities to develop variety of language and social

skills such as vocabulary building, receptive language development, pragmatic skills, emotional

regulation and pretend play (Toth et al., 2006). It would help her understand communication as a

reciprocal interaction. Also, effective engagement in joint attention would help Jessica

understand her attention could be directed by others and eventually would begin to understand d

communicative intents of others. Thus, making it possible for her to engage in communication,

social interaction and play (Boutot, 2017)

What would be some important communication goals for Jessica?

Jessica’s most important communication goal would be to develop her pragmatics, which

is crucial in developing her expressive and receptive language (Adams, 2002). Other

communication goals would be to improve her syntax and semantics language skills (Boutot,

2017).

What intervention strategies would be most appropriate for Jessica to promote her

language development?

Intervention strategies most appropriate for Jessica will include video modelling, pivotal

response training (PRT) and would like to review the use of PECS with her (Boutot, 2017).
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Social Skills

What are the key areas of social difficulties that Jessica experiences?

Key areas of Jessica’s social difficulties are limited communication and social interaction

skills, and poor joint attention.

What features of her social emotional development compromise her ability to relate?

Jessica’s impulsivity, poor social reciprocity, limited pretend play and mind blindness

(i.e. her inability to understand others’ thoughts, feelings and beliefs are different from her own

(Whitman, 2004) and proprioceptive sensitivity deficit compromise her ability to relate.

What strategies could be used to teach Jessica appropriate behavior?

Skill acquisition strategies such as social stories, video modeling and video self-modeling

and pivotal training response can be used

How would you implement the identified strategies?

Social Story: The first step in implementing Jessica’s social story would be Identification of

goals. This would be done by referring to the Jessica’s IEP goals. The goals would be discussed

with IEP team and Jessica’s parents. There after, a selection would be made of social behavior

for a change. The second step involves defining a quantifiable and measurable target behavior or

skill. Step three involves gathering all necessary baseline data on the target behavior or skill

across settings and involving other people in the process (e.g., asking a parent to collect data at

home, or another teacher/practitioner to collect data in a different settings). Step four would be

writing the Social Narrative in a language appropriate for Jessica’s age and comprehension and

based on Jessica’s characteristics of the learning and step five is choosing the appropriate length
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of story. Step six is introducing visuals that are age appropriate, within Jessica’s cognitive ability

and preference. Step seven is the social narrative implementation stage. The social story would

be part of Jessica’s daily schedule. This would be followed by progress monitoring. It involves

data collection across settings to measure Jessica’s progress and as well, the effectiveness of the

social narrative. Step nine is data reviewing to form instructional decisions and modification of

the Narrative if Necessary. Lastly is to promote generalization of learned skills (Boutot, 2017).

If Jessica begins to show signs of returning to target baseline levels, the social narrative is

reintroduced.

PTR

Implementing Pivotal Training Response begins in a fun and engaging naturalistic

environment with the purpose of targeting pivotal behavior, related to initiation and responding

to environmental cues. Four pivoted areas that would be targeted are Jessica’s responsivity to

multiple cues, initiation, motivation, and self-management. Intervention plans would teach

Jessica how to select cues relevant in a given context, give Jessica a choice in activity, using

natural reinforcers, reinforcing good attempts at interacting to instill motivation. Lastly, self-

management intervention would teach Jessica to be more independent and less reliant on

promptings from others in the environment (Boutot, 2017).

Video Modelling and Video Self-Modeling

Video modeling process involves the use of active video presentation of the desired

behavior to learn. The video modeling and video self- modeling integrates visually cued

instructions with models which makes the strategy very effective. Also, video modelling allow

removal of irrelevant stimuli that could be distracting to Jessica and might not be goal oriented
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through editing (Boutot, 2017). This would allow much focus on essential aspects of targeted

skills.

Daily Living Skills

What needs does Jessica have with regards to her daily living skills?

Jessica’s profile shows she has difficulties with asking for help. She also finds reading

social cues very challenging as well as adjusting her behavior to fit into a social context. Jessica

also has some proprioceptive needs like adjusting to inclines, steps, curbs, walking downhill and

uneven surfaces. She is also very sensitive to touch and sometimes find it irritating. This has led

to poor personal grooming, and poor social interaction.

What barriers are limiting her independence?

Barriers limiting Jessica’s independence include deficits in functional communication,

restrictive, repetitive behaviors including sensory abnormality (proprioceptive dysfunction) and

prompt dependence (Boutot, 2017).

What are the instructional strategies beneficial to Jessica to increase her independence?

Jessica would benefit from methodologies of Applied Behavior Analysis (ABA) such as

task analysis, prompting, video modeling (Boutot, 2017).

How would you promote generalization of Jessica’s skills?

Generalization of learnt skills can be promoted by using prompt fading. This involves

varying instructions, materials used, and ensuring Jessica responds adequately to different people

to reduce dependency. Jessica would be encouraged to apply the acquired skills in different
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instructional contexts even if the material is manipulated. It reinforces her knowledge base on the

learnt skill and increases her independence and encourage flexibility

Academic Skills

Key Academic expectations challenging for Jessica:

The key academic expectations challenge for Jessica is the CCSS guidelines. The

guidelines state that Jessica should be able to “independently read complex literary and

information text with grade level proficiency and demonstrate comprehension with those texts in

subjects like mathematics, English language Art which include literature, information texts,

social study, science and technical subjects” (Boutot, 2017, p. 158). These expectations are

beyond Jessica’s present cognitive functioning in most core subjects. Jessica presently in

reading, struggles with articulating words demonstrate comprehension. In math, Jessica is unable

to reason mathematically to express understanding in solving problems and equations. Also, her

pervasive maths difficulty in telling time would impact elapsed time problem solving integral.

Jessica would also face challenging expectations in writing because of her difficulty to write as

she finds it difficult to come up with her own words and stay in the lines.

What strategies could be used to promote her performance in these areas?

Phonemic awareness instruction, phonics, fluency, vocabulary and reading

comprehension are strategies that can be used to promote Jessica’s performance in reading.

Writing skills intervention using self-regulated strategy development (SRSD) can be used to

promote performance in Jessica’s writing. Lastly, use of picture books and shared story

experience can be used to connect literacy experiences to mathematical concepts. Thereby,

promoting Jessica’s mathematics performance (Boutot, 2017).

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How to modify and adapt a lesson Jessica is having difficulty with?

Theoretical framework of universal design for learning (UDL) to differentiate teaching

and deliver intervention can be used to modify and adapt a lesson Jessica is found challenging.

UDL delineated key elements to factor into instructional planning to facilitate improved student

learning. The first component is goal setting, this would help Jessica become active learner,

achieve learning outcomes for specific academic purpose. The second principle is adopting

differentiation of methods such as integration of technology, adaptation of the environment and

other processes that make lesson comprehensible. The third component is integration of tools

such as contents enhancement tools, media, and technology to provide background information,

and clearly present content to facilitate learning (Rose & Meyer, 2000). The last component is

assessment: This involves application of various assessment for the purpose of collecting data to

inform instruction. However, it would be based on Jessica’s needs (Rose & Meyer, 2000).

Address how you would ensure she would still have meaningful access to the content while

meeting her unique needs as a learner

Using differentiated instruction and materials via principles of UDL can foster grade-

level curriculum access and momentum towards the attainment of Jessica’s individualized

education plan. Thereby, enhancing Jessica’s achievement and promote meaningful learning

(Landrum & Mcduffie, 2010).

TECHNOLOGY

Who should be on the technology team and why?

IEP and IFSP team members should be on the technology team. The IEP is a team of

professionals including Jessica’s parents that have provided vital information and collaboratively
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planned Jessica’s IEP (Boutot, 2017). The IFSP team involves parents, family members and

other advocate of services the family needs to facilitate Jessica’s development. These groups of

people are working with Jennifer and they should know Jessica well enough to make informed

decisions on the most appropriate AT for Jessica

Is there further assessment information that needs to be collected before a decision on

technology?

Jessica’s needs would be re-assessed, to understand clearly what her present needs and

strengths are, and to determine suitability for different assistive technologies. Also, AT features,

characteristics, demands and suitability are assessed to know the ones that best serve Jessica’s

needs (office of special education programs, [OSEP], 2000). Lastly, based on recommendation

on the importance of cultural contexts, Jessica’s cultural context would be assessed before

making AT recommendation.

What technologies would you use for Jessica and why?

Aided augmentative and alternative communication (AAC) such as computer, video

modeling Apple iPad, and Proloquo 2Go would be used to assist Jessica in learning functional

skills. Furthermore, the use of her visual schedule will continue because she likes using it in

school and would seek to incorporating it a home.

I have chosen these devices because of her preference for them. She should be motivated to use

them to learn. Thus, making them suitable and convenient for her to use.

References
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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC: Publisher.

Bangerter, A., Ness, S., Aman, M. G., Esbensen, A. J., Goodwin, M. S., Dawson, G., Hendren,

R., Leventhal, B., Khan, A., Opler, M., Harris, A., & Pandina, G. (2017). Autism Behavior

Inventory: A Novel Tool for Assessing Core and Associated Symptoms of Autism Spectrum

Disorder. Journal of child and adolescent psychopharmacology, 27(9), 814–822.

https://doi.org/10.1089/cap.2017.00183

Boutot, A. E. (2017). Autism Spectrum Disorders: Foundations, characteristics, and effective

strategies (2nd ed.). Boston: Pearson Education, Inc.