Background-Sarah is a 22 month old functioning at a level much below her chronological age. Sarah has been evaluated twice regarding her symptoms, and at the time of the 2nd evaluation, she was too young for a formal diagnosis of Autism Spectrum Disorder (ASD). Sarah does though, present with many of the common symptoms associated with ASD and she is essentially non-verbal. Sarah has a multitude of goals, both short term and long term to increase her level of functional communication. There are three main areas that need to be addressed.
They include improving pragmatic skills, improving receptive anguage and improving expressive language. Strengths- Sarah has many strengths as a 22 month old. She has motor functions within the normal limits. Sarah also has many interests including assembling puzzles, rolling cars, stacking Duplos blocks, flipping through magazines and watching bubbles. These are all activities that attract Sarah’s attention, so they will be used consistently throughout therapy sessions. Weaknesses- Sarah presents with the classical symptoms of ASD. Sarah has multiple deficits and delays that need to be addressed immediately in therapy.
Sarah has speech and language ilestone delays. Sarah presents with deficits in pragmatic skills, expressive language and receptive language. Pragmatically, Sarah does not use communicative gestures when she desires something. Sarah is also unable to respond to joint attention, even when pointing was used simultaneously and she is unable to hold proper eye contact. In expressive language, Sarah cannot communicate her needs effectively. In receptive language, Sarah does not respond to her name, nor does she respond to simple one step directions such as sit down.
Sarah has strengths and weaknesses that were carefully valuated by the clinician. After they were evaluated, three long- term goals were made to target Sarah’s deficits. The short term goals that were created, look to Sarah’s interests and highlight her strengths so she will find success in the short term goals and in the future, the long term goals will be more attainable. Long Term Goal #1- Sarah will pair communicative gestures with eye contact when requesting and protesting in all social settings 80% of the time with minimal assistance. Sarah has deficits in the area of functional communication.
She has very poor eye contact and doesn’t use gestures such as ointing in social situations. Sarah needs to be able to respond to joint attention so that the therapy session can be productive. Sarah needs to obtain these pragmatic skills because they can be detrimental to her ability to thrive in the schooling system, and connect with her teachers. Sarah’s pragmatic skills need to be addressed before her speech skills are. Short Term Goal #1- Sarah will use eye contact when communicating with an adult when verbally cued by the adult 70% of the time.
Activity: The clinician will have stickers of the child’s interests and the child will get to choose two stickers to ut on the clinician’s forehead right above each of her eyes. The child will be verbally prompted to look at the stickers while the clinician and the child are doing a puzzle together. Because the stickers are of the child’s interests, she will be inclined to keep looking at them when the clinician prompts her to. The clinician will give positive reinforcement as well as an extrinsic reinforcer whenever the child maintains the contact for longer than 4 seconds. • According to Vincent J.
Carbone, a Board Certified Behavior Analyst with over 25 years of experience said, “within he studies done, social consequences were not conditioned as reinforcers but instead the eye contact responses were strengthened by “extrinsic” reinforcers in the form of the presentation of tangibles, social praise, or edible items. ” Short Term Goal #2- Sarah will use a functional gesture (pointing) to request her wants in all social settings 70% of the time. o Activity: Clinician will have child’s favorite toys and food items and will place them out of the child’s reach, but the child can see them.
The child must gesture or communicate in some way to get the item. The child must do more then just standing y the item as she currently does. • Once the child gestures or uses another form of communication they will get the item. If food they are permitted to eat it and if a toy they are permitted to play with it for 5 minutes. • Eventually the child will go from standing next to the item, to gesturing, to leading the adult by the item and reaching, to verbally asking for the item Long Term Goal #2- Sarah will improve her receptive language in all social settings with 80% accuracy. Sarah has deficits in the area of receptive language.
Sarah needs to be able to successfully respond to her name as well as follow ne-step commands such as sit-down. These are important life skills to have as Sarah approaches two years old. • Short Term Goal #1- Sarah will respond successfully when prompted with a one-step instruction by the clinician during familiar activities 70% of the time. o Activity: The clinician will take out Duplos blocks. The clinician will imitate how the child is stacking the blocks to make sure the child is comfortable. After a few minutes of this associative play, the clinician will then join the child and watch how she is playing with the blocks.
The clinician will then verbally cue the child to do certain tasks with he blocks such as put one block on top of the other block, or put a block behind that block. The clinician will also use this opportunity to have the child stand up as another one-step instruction. • The mixture of the one-step instructions both with the blocks and the child’s physical being are helpful so that the child does not get used to one particular way of responding • She will then be able to recognize that one-step instructions happen in different contexts and she will be able to relate better
• According to autismspeaks. rg, the clinician should avoid omplex verbal directions, and to keep information brief and to the point. The clinician should also allow for “wait time” to allow the child to process what has been said or asked of them. It is very important to model and shape correct responses to help facilitate understanding (“Supporting Learning,” 2012). •Short Term Goal #2- Sarah will respond to her name with both a verbal and tactile cue during a play activity, 75% of the time. o Activity: The clinician will have a bunch of toy cars for the child to play with. The child and the clinician will take turns rolling the cars back and forth to each other.
The clinician will at random times throughout the activity, say the child’s name and touch the child gently to ensure her attention. The clinician is looking for a response to the child’s name. • Sarah has poor auditory processing skills, but we are unsure just by observing her behavioral skills if she is under-responsive or over-responsive when she is not responding to her name. • Short Term Goal #3- Sarah will appropriately turn pages of a magazine and point to pictures of known items when verbally cued by the clinician 75% of the time. o Activity: The clinician will have magazines favorable to the child.
The child enjoys flipping through magazines so the clinician will use this to her advantage. The child will turn the pages of the magazine and take in the information. The clinician will then ask the child to point to a known object that the child likes, such as bubbles. The clinician will then blow bubbles to reinforce the child’s meaningful gesture. • The clinician will only ask the child about objects that the clinician has so it can be appropriately reinforced when the child uses the communicative gesture. Long Term Goal #3- Sarah will improve her expressive language in all social settings with 85% accuracy.
Sarah is essentially unable to communicate her wants and needs. The clinician will work to provide a means of communication, first non-verbal and then when an appropriate level of understanding of non-verbal communication is met, the clinician will move to verbal communication and work on both simultaneously. Short Term Goal #1- Sarah will be able to use 5 ASL signs applicable to her daily life when modeled and verbally cued by the clinician in therapy 70% of the time. o Activity- The clinician will have the list of the 5 ASL signs applicable to the child’s life. They are MORE, FOOD, STOP, YES, SLEEP.
The clinician will have nd maintain the child’s attention while they practice ASL for 5 minute durations, then the child will get a play break with bubbles. The clinician will say and sign MORE, and the child is expected to imitate her and sign MORE back. The child understands what more means so she will be able to then functionally use the sign MORE as well as the other 4 signs. • The child has expressive language deficits and the clinician is looking to increase vocabulary and communication skills. ASL is an appropriate route that will help the child be able to communicate in a more efficient way.
ASL can also be used as speech develops. The child will hopefully develop a diverse ASL vocabulary and it will then help her to be less frustrated while she is developing speech.. According Sundberg and Partington, “teaching manual signs has been found to benefit children with autism as they can be easily shaped with handover-hand prompting and fading. ” (Sundberg & Partington, 1998) • Sundberg has also found that sometimes as a child has more experience using ASL to request specific needs, wants and desires, which have always been paired with hearing the word, the sign itself might trigger the verbalization “automatically”(Sundberg).
Short Term Goal #2- Sarah will successfully imitate 10 words presented by the clinician when verbally and visually cued 70% of the time. o Activity. The clinician will have a beach ball with 10 different colored sections on the ball. There will be a different picture on each of the sections of the ball. These pictures will be of relevance to the child such as her mother, father, brother, a car, her blanket, etc. The clinician will roll the beach ball to the child and one the child catches it, the clinician will say the name of the picture that the child landed on with the carrier phrase, “Say_ _.
The child will then have to imitate what the clinician says. The child will be positively reinforced when she successfully imitates the clinician. • According to Dr. Brooke Ingersoll, a psychologist from Michigan State University who researches imitation in autism, “working on imitation in a naturalistic way has resulted in improvements in other skills, such as the child’s ability to imitate language and gestures, their pretend play, joint attention skills, and social skills. ” (“Imitation with Children”)
· Dr. Ingersoll said that the more naturalistic way includes the child’s interests as opposed to the behavioral therapy Discrete Trial Training, because it is hard to generalize what is learned in Discrete Trial Training into real-world situations. If the 3 main areas of pragmatic skills, expressive language and receptive language are focused on in therapy sessions with these short term and long term goals as guidelines for the clinician, Sarah will be working towards improved functional communication in all aspects.
