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Case Study Plan 1

Catherine Livingston 12/19/2010 Student ID: 1458877 EDDU 675 Instructor: Sharon Noble Brandman University

Sam: A Comprehensive Education Plan for Autism Based on a Case Study

Introduction-

Sam is a seventh grade student who was diagnosed with Autism at the age of 3. Sam has been receiving intervention and therapy both in school and at home since that time. He has made slow, steady progress over the years. A school-based, multi-disciplinary team consisting of a school psychologist, speech therapist and special education teacher re-assessed Sam at the request of his parents. The team will develop an individualized educational plan, (IEP), based on

Sam’s current levels of performance to ensure he receives an appropriate level of support to remediate the challenges he faces in a middle school setting due to the impact of autism.

Purpose of Evaluation-

The evaluation was conducted to assess Sam’s present levels of performance in academics, cognitive functioning, adaptive skills, visual motor skills, processing, communication and social-emotional functioning. Sam’s parents would also like for the IEP team to consider

Sam’s current level of anxiety, which has recently increased due to the increased social and organizational demands in a middle school setting. They would like for Sam to begin to learn transitional skills so that he can attain independence after high school.

Although Autism is considered to be a neurological/developmental condition, there is no physiologically based medical procedure that is used for diagnosis. The Diagnostic Statistical

Manual of Mental Disorders, (DSM lV), lists a set of criteria for the diagnosis of autism. Marked Case Study Plan 2 impairments in the areas of social interaction, communication, stereotyped, and repetitive behaviors, are a few of the areas that are assessed in the diagnosis of autism.

Whether or not an individual possessed the characteristics of Autism is determined through multiple measures given by a multidisciplinary team. Some members of this team may include: a psychologist, speech therapist, occupational therapist, audiologist, parents, and special education specialists. Some general categories that the assessments fall under are; Audiological,

Autistic behavior scales, Behavioral/Neuropsychiatric, Intelligence and Academic, Occupational,

Sensory Integration, Speech and Language and Histories. An Individual Education Plan (IEP) will be developed to provide adequate support depending upon Sam’s current levels.

Autistic-Like Observed Behaviors-

During the evaluation procedure, observed behaviors in Sam were recorded. Multiple autistic-like behaviors that are listed as part of the DSM-IV diagnostic criteria were noted by the school psychologist, resource specialist and speech therapist as they worked with Sam. Some of the autistic-like behaviors that were identified in the case study are:

 Hand movements or occasional slapping of self.

 Gets “stuck” when an alternate approach to a task is required (both at home and at

school).

 Speaks in monotone voice or with atypical prosody

 Difficulty taking on the perspective of others

 Difficulty repairing communication breakdowns.

 Heightened level of anxiety

 Restricted/limited interests (video games, movies)

 Few friends at school Case Study Plan 3

It is important to remember that autism is a lifelong condition and there is no known “cure” at this time, (Autism Society.org) Individuals with Autism can learn to cope with their condition and attain the maximum level of independence possible by internalizing functional, social skills strategies and adaptive skills. Autism is considered to be a developmental/neurological condition, (Centers for Disease Control).

Present Levels and Areas of Identified Need-

An IEP is most effective when it addresses the needs through targeted skills development and appropriate accommodations and modifications. Goals and objectives are written by the service providers of the IEP team to address areas of specific need. Autism is a developmental, neurological disorder that requires support in all settings and environments.

Cognitive Levels-

Sam’s relative, cognitive strengths and weaknesses on the WISC (Weschler Intelligence

Scale for Children) remained fairly consistent since the previous educational evaluation.

Completion of rote tasks continue to be strength while verbal comprehension and processing speed remain below average. He exhibits some cognitive areas of strength that are typically associated with autism such as the ability to complete rote tasks. His working memory is a relative strength. He scored average in this area indicating that he can hold information in his mind and use it to solve problems.

Sam’s overall intelligence fell within the low average to borderline range. Current research calls into question the validity of standard intelligence assessments for individuals with autism. Michelle Dawson and others conducted research using the Raven’s measure of fluid intelligence and found that students with autism performed significantly higher than expected. Case Study Plan 4

Subjects with autism scored between 30-70 points higher on fluid intelligence matrixes than on the Weschler Scales of Intelligence, (Dawson ET AL, 2008).

Behavioral/Adaptive-

Several behavioral strengths were observed both in the classroom and during the testing sessions. Sam is cooperative and non-disruptive. He responds to verbal praise and asks for clarification when he doesn’t understand something. These behavioral traits indicate that a formal behavioral support plan is not needed at this time for Sam to participate in a general education classroom successfully. An educationally based behavior specialist should be consulted to observe Sam in various classroom settings for self-stimulatory behaviors, withdrawal and increased anxiety levels. The specialist can then recommend classroom accommodations such as increased visual supports, classroom schedules, or a note-taking buddy.

According to Sam’s parents, he is experiencing a heightened level of anxiety at school.

He does not appear to have the skills to identify when he is feeling depressed or anxious. Recent studies suggest that parent reported levels of anxiety in students diagnosed with autism is markedly higher than that reported by parents of typical children, (McPheeters, M & Davis, A,

2010).

Sam’s parents have taken him to a psychiatrist and he is taking selective serotonin reuptake inhibitors (SSRI’s). The purpose of the medication is to reduce Sam’s rigid behaviors.

Recent studies indicate that anti-depressants as a tool to reduce unwanted behaviors in autism are ineffective. These medications may actually do more harm than good in the treatment of autism.

(Williams, Katrina 2009) Whether or not Sam’s parents wish to continue the medication therapy is a personal, family choice. Perhaps if they are informed of recent research, they may be able to Case Study Plan 5 make an informed choice. Behavioral medication effects should be closely monitored to assess their effectiveness.

The case study indicates that Sam has difficulty recognizing and responding to bullying.

The behavioral specialist may recommend socio-emotional goals and objectives so that Sam can learn skills to reduce anxiety and cope with bullying. The resource specialist could monitor

Sam’s progress in these areas and act as a “go to” person for all of the IEP team members. The resource specialist could check in with Sam daily or weekly to monitor the levels of anxiety his and response to bullying by other students.

Sam exhibits some rigidity in adapting to changes in routines. This behavior was noted both in the home and school settings. The rigid behaviors and difficulty in changing strategies when approaching a problem seems to be impacting Sam’s academic and socio-emotional success at this time. Sam had a tendency to “get stuck” and didn’t change strategy when presented with a new situation.

Communication/Social-

Sam has developed some good communication and social skills. He uses appropriate eye contact. This is unusual in students with autism. Sam is able to engage in reciprocal conversation. He seems to enjoy talking with others and responds well to praise. During the assessment, the speech therapist noted that Sam uses previously learned scripts and social language in a rote manner. This indicates that the use of social stories (Carol Gray) has been successful. Sam has interests such as movies and video games and this has enabled him to maintain a friendship at school with a student who shares his enthusiasm for these topics.

Sam appears to be making progress in the weekly social skills group led by the speech therapist. It is recommended that he continue to attend the group with specific goals and targeted Case Study Plan 6 interventions focusing on recognition and response to bullying and pragmatic skills. At the middle and high school levels, speech therapy goals are often based on academic standards. The communication goals can be monitored by the resource specialist since they would be academically based. Direct speech therapy would not be needed at this time but a consult/collaborative model with an emphasis on social skills would benefit Sam at this time.

Academic Strengths and Weaknesses-

The resource specialist and general education report of present academic levels was not included in the case study. It can be assumed that Sam experiences difficulty in reading comprehension and writing due to his difficulties in retelling a story beyond a basic level. At the middle school level, inferential reasoning and knowledge of hidden meanings is heavily emphasized and individuals with autism tend to have difficulty with these skills. Sam’s cognitive and language deficits indicate that higher-level comprehension and writing skills would be difficult for him. Basic math, spelling and the recall of rote facts should be areas of academic strength for Sam due to strong working memory skills. Since fine motor skills is an area of relative deficit, word processing and typing skills would be highly recommended for Sam.

Educational Recommendations Based on Identified Needs and Strengths-

It is recommended that a special education teacher such as a resource specialist monitor

Sam’s case. This person would communicate with all IEP team members about Sam’s progress and current needs. Based on Sam’s current levels and notes from parents and teachers in the case study, special education services and goals and objectives are recommended in the areas of:

Reading Comprehension, Written Expression, Communication, Social Skills, Adaptive Skills and Socio-Emotional functioning. Direct services provided by a resource specialist with consultation and collaboration with a speech therapist at school is recommended. Case Study Plan 7

A further evaluation by an occupational therapist is recommended for fine motor and adaptive skills. Modifications and accommodations may be recommended at an additional IEP meeting. A behavior support professional assessment and observation is also recommended so that suggestions for the prevention and reduction of anxiety can be implemented at school and home.

The resource specialist would be the “go to” person for Sam and all of the members of the IEP team. It is recommended that Sam receive assistance in the classroom from the resource specialist for 45 minutes of specialized academic instructional time per day to remediate language arts and writing deficits.

Some educational programs that are recommended are: The Comprehensive Autism

Planning System (CAPS) (Henry & Myles, 2007), and Social Stories (Gray, graycenter.org).

The CAPS system is recommended because it provides an organizational tracking system that can enable all of the staff that work with Sam to communicate and log his progress. Social

Stories are a format that Sam is familiar with. Evidence that he applies the scripts he has learned was observed during the evaluation by the speech therapist. Use of a laptop computer in the classroom and at home and word processing software would be useful tools to remediate Sam’s fine motor deficits. An electronic personal organizer would be a useful strategy for Sam both in middle school and beyond. Recent studies indicate that electronic personal organizers yield a higher success rate in organization and approach to novel tasks in students with autism.

(Mechling, Linda & Savidge, Erin J, 2010)

Transition goals should be included in the IEP due to Sam’s age. He will be entering high school and should be working towards a greater degree of independence. Research supports that Case Study Plan 8

Students identified as having developmental and learning disabilities that learn self- determination skills in school achieve better outcomes in their lives as adults. They retain jobs and earn higher salaries than those individuals who do not attain these skills. (Wehmeyer and

Schwartz, 1997)

Suggested Goals and Objectives-

Here is a list of possible goals and objectives that may be adapted to the specific educational needs of Sam based on the input from the IEP team at the meeting. These goals are based on Sam’s present areas of deficit and expected progress described in the case study. The members of the IEP team would develop the specific goals and objectives.

Reading Comprehension, (adapted from CARS+ 2008)-

• 7.2.1 Understand and analyze the differences in structure and purpose between various

categories of informational materials (e.g., textbooks, newspapers, instructional manuals,

signs). (Transition) (CAHSEE)

Written Expression, (adapted from CARS+ 2008)-

• 7.1.6 Create documents by using word-processing skills and publishing programs;

develop simple databases and spreadsheets to manage information and prepare reports.

(Transition) (CAHSEE)

Adaptive Skills, (Patricia Schetter MA) -

• Sam will increase his ability to adjust his schedule to accommodate changes or new

activities by accurately updating his monthly/weekly calendar with 80% accuracy as

evaluated by a designated instructor across three consecutive weeks.

Study Skills/Executive Functioning (Patricia Schetter MA)- Case Study Plan 9

• Sam will increase his ability to initiate difficult tasks by transitioning to and completing

the tasks without additional prompts from another person on 80% of the given

opportunities across three consecutive days as measured by instructor evaluation.

Social Emotional/Communication (Patricia Schetter MA)-

• Sam will increase his ability to identify those situations which cause him a great deal of

anxiety or frustration by accurately completing a graphic organizer such as the worksheet

for Evaluating Stress Triggers without prompting from another person, across three

consecutive trails as measured by instructor evaluation.

Communication/Social Skills

• Sam will increase his ability to identify and repair conversations with peers and adults by

asking questions and reciprocal conversation skills as measured by teacher observation

and records.

• Sam will recognize when students are bullying him, respond appropriately (planned

ignoring, assertive response, tell an adult) in 3 out of 4 trials over a period of 2 weeks as

measured by teacher records.

• Sam will identify the meaning of common idioms and slang terms by using context clues

in written passages with 80% accuracy as measured by work samples/records.

Suggested Accommodations and Modifications-

 Allow Sam to type assignments (due to difficulty completing handwritten tasks rapidly)

 Teach Sam to use a personal electronic organizer to keep track of his schedule and

assignments.

 Reduce the number of problems or length of work when possible (slow working memory

and difficulty with concentration) Case Study Plan 10

 Present lessons in visually sequenced manner (steps presented visually)-when possible

 Post daily schedule and preview upcoming changes when possible

 Pick an adult who can be his “go to” person. This adult will check in with him r.e. how he

is coping at school. They will communicate with the members of the IEP team and

parents as needed. This may be the resource specialist or a school counselor.

 Use the CAPS (Comprehensive Autism Planning System) as a tool to monitor and

document Sam’s needs and progress over time.

 Teach social stories at home and school to provide Sam with skills required to identify

and respond to bullying and repair social conversations.

Conclusion-

Sam is making progress in school and able to be mainstreamed for most of the school day even though he has been diagnosed with autism since the age of 3. Sam’s success is no doubt due to all of the interventions and support he has had both at home and at school. A comprehensive home-school plan through the IEP process will most likely ensure that he will attain a maximum level of independence after high school. Case Study Plan 11

References-

Autism Society. Retrieved on December 15, 2010 from:

http://www.autism-society.org/site/PageServer?pagename=life_treat

Dawson, Michelle, Soulieres, Isabel, Gernsbacher, Morton, A & Mottron, L, (2008), Research

Report: The Level and Nature of Autistic Intelligence, Psychological Science.

Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV), published by

The American Psychiatric Association (Washington, DC, 1994)

Centers for Disease Control. Autism Spectrum Disorders (ASD)

Retrieved on December 16, 2010 from:

http://www.cdc.gov/ncbddd/autism/index.html

Gray, Carol. Social Stories. Retrieved on December 15, 2010 from:

http://www.thegraycenter.org/social-stories/how-to-write-social-stories

Henry & Myles, (2007), The Comprehensive Autism Planning System (CAPS)

McPheeters, M.L, Davis, A, ET. Al. (2010), Family Report of ASD Concomitant with

Depression or Anxiety Among US Children. Springer Science + Business Media

Mechling, Linda C., Savage, Erin J. (2010), Using a Personal Digital Assistant to Increase

Completion of Novel Tasks and Independent Transitioning by Students with Autism

Spectrum Disorder. Springer Science+Business Media, LLC 2010

Schetter, Patricia MA. ROPES: Program for Autism. Retrieved on December 14, 2010 from:

http://www.autismandbehavior.com/about.htm

Wehmeyer, M. (1996). Self-determination as an educational outcome: Why is it important go

children, youth and adults with disabilities? In D.J. Sands & M.L. Wehmeyer (Eds.) Self- Case Study Plan 12

determination across the lifespan: Independence and choice for people with disabilities

(pp. 1-14). Baltimore: Paul H. Brookes.

Williams K, Wheeler DM, Silove N, Hazell P. (2009) Selective serotonin reuptake inhibitors

(SSRIs) for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews

2010, Issue 8. Art. No.: CD004677. DOI: 10.1002/14651858.CD004677.pub2.

Wright’s Law, All About IEPs. Retrieved on December 16, 2010 from:

http://www.wrightslaw.com/bks/aaiep/index.htm