Possible Middle School Placement Observations

This week on Wednesday, I went to observe the middle school program for children with "Emotional and Behavioral concerns", which is one of the possible placements for Honeybunches next year. I went in the morning, when school first began. Here are some things I observed on some handy dandy observation sheets I made up myself:

Thursday, I went to observe the program for children who have "Intellectual Disabilities". Honestly, I did not use the sheets I made up for this observation visit, because it turned into a Question and Answer plus the teacher letting me know about herself and her theories instead! I can tell now that this classroom will be a much better fit for Honeybunches.  The teacher does a lot of work on emotions and feelings (Facial expressions, validating feelings, helping children understand facial expressions plus how others might feel, "I see your face looks sad because you are frowning and your eyes are like this...", "Look at how ____ is _____... How can we help him/her feel better"?). She said honestly at times she scraps the academics and works on life skills and feelings. Her class is very structured.  They use Con Academy Math, which I'll have to look up more about.  The work she gives the children is very individualized. They go with the flow. Sometimes she'll use games as learning lessons, through which the children learn about taking turns and other skills. She doesn't really use a lot of "Rewards" because she wants to get children ready for the real world.  With the majority of the children in her class liking Uno, sometimes she'll use that as a reward. She said the children in her class don't integrate. She does a lot of work regarding life skills. She's very flexible and has clear expectations (Which are on a sheet on the wall, but in the past she's had some students who need them taped to their desks).  I asked what the differences were between her class and the ILC.  She told me that children in the ILC get integrated and can do okay in some regular classes, while intellectually her children would be lost.  She does a lot of work with other members of the school administration on building relationships between them and the students, so in case she's not there because she is out sick, the students will have other "Safe people" to go to. Her personality, theories and ways of teaching seem like a very good fit for Honeybunches.  She used to work at a RTC, so she's experienced with children who have mental illness as well as Autism and intellectual disabilities. She said in the past she's been restraint trained, but tries to use everything else possible before having to utilize it especially with this age group of children. It sounds like she'd be opened to doing the training though.

If I could pick a classroom based off of what I've seen in the past two days, it would be the one I seen today.

My main concern is that neither program has staff that's restraint trained.  The adjustment counselor who stayed to observe with me and answered my questions told me that there are staff in the building who are restraint trained and could come if needed.  Knowing Honeybunches, do you have any idea how much ruckus he could cause by the time they get there?  UGH! That alone makes me question if the school as a whole could meet his needs.  He's needed to be restrained already this year.  Next year he'll be testing new staff for sure to see what he can get away with in his new environment.  Once he finds out that they can't restrain him, he'll likely test them even more and be more aggressive.  "Things that make you go hmmmm!"

I am going to request the BRIDGE program I observed today, but stipulate the teacher needs restraint training. 

Developmental Behavioral Pediatrics Evaluation Part 2

Honeybunches had his 2nd visit with the Developmental Behavioral Pediatrician down at the big hospital on July 14th.  Today (July 19th) I got the evaluation report in the mail.  I was impressed with how quickly it came and how thorough the report is. :)

Here are some of the highlights:

"Methods of Assessment:
Clinical Observation
Parent Report
Review of Medical Records
Review of School Records
Achenback System of Empirically Based Assessment (ASEBA)
Autism Diagnostic Observation Scale"

The report then goes into his history from birth through now including issues during his birth, health history, his developmental issues, previous diagnostic history, hospitalization history, medication history and all that fun stuff.

She went into detail about issues he has with his fine motor, sensory, gross motor, language and communication, cognitive, personal-social, self care, feeding/growth/nutrition, sleep, emotional-behavioral and relationships with adults and siblings in the family.

She clearly wrote under "Educational History" that "--is identified as a child with: Autism Spectrum Disorder".

I like how under "Current Developmental Status" she wrote:
"His mother has advocated strongly for good special educational services and he has made nice progress in recent years..." :) She also wrote in there how "He reports being bullied, but did not want to discuss it." I plan on going into that further with the school at his IEP meeting in September, requesting something be put into his IEP in regards to a bullying safety plan if that's something that exists or at least ways to protect him from bullying. I know as he gets older, that becomes more prominent.

Under "Behavioral Observations" she wrote how "-- answered my questions nicely at the beginning of the interview, but then became so focused on leaving in order to eat that he had difficulty answering questions. -- turned his body away from me while talking on several occasions and had poor eye contact. He seemed to understand that he has behavior problems but had little insight into how they affected others. The prosody of his speech was fairly flat limited affect.... He brightened when we talked about his interest in money and promptly showed me both his money and the signatures on his money.  -- indicated that he liked to do worksheets both at school and at home.  He also indicated that he loved riding his bike and scooter..."

Regarding the ADOS-2, Module 3 she wrote:
"The ADOS-2 is a semi-structured, standardizes assessment to evaluate language and communication skills, reciprocal social interaction, play, stereotyped behaviors and restricted interests. It includes a number of activities such as make believe play and cartoons. Module 3 is used for children and adolescents who use fluent speech to communicate..."
"-- used fluent speech to communicate. The child's speech patterns were fairy typical, but he used little variation in pitch or tone. -- directed vocalizations to me, but often did not look at me. He did not echo other's speech. -- used language that tended to be more formal than that of children at a similar developmental level with some occasional idiosyncratic utterances. -- occasionally offered information about his or her own thoughts and experiences, but was not able to share much information about his feelings. He had difficulty describing his emotional experience.  His conversational speech included some spontaneous elaboration of his own responses for the my benefit and provided some leads to follow, but this was less in amount than would be expected for his expressive language level and limited in flexibility. He took my leads in conversation if they were on a topic that was of interest to him. If I gave a conversational lead that was either not dramatic or not related to his interests, he would simply say "Yep" and change the topic. -- used some spontaneous use of descriptive gestures in the demonstration task and the description of a cartoon. However, he had a very difficult time integrating eye contact, verbalization and gesture..."

Reciprocal Social Interaction:
"--- was pleasant to work with throughout the assessment. But, midway through the assessment he noticed a tiny spider web and spider in the corner of the room. He stared at it throughout the rest of the assessment, and then discussed insects at a much higher rate. He was difficult to engage in a play scenario with super heroes.  He wanted to use the tools to remove the leg of one of the heroes and focused on this throughout the play scenario... -- showed poorly modulated eye contact to initiate, terminate and regulate social interaction..."

She went into his speech-communication issues that she noticed in detail.

He told her that "Friends are people you met and did not seem to have insight into give and take relationships... He expressed that he wanted to be a banker or a cop and live in a bank when he grows up."

Conclusion:
"The ADOS-2 can be considered a reasonable estimate of --'s behaviors and skills in social communication.  On the ADOS-2, --'s scores were consistent with the diagnosis of Autism Spectrum Disorder...
ADOS Classification and Concern Level: Autism Spectrum Disorder, Moderate."

Then she went into why he meets the criteria, what criteria he met, etc which I previously wrote about in a recent post entitled Dev. Beh. Pedi eval part 1.

She gave recommendations for the school including:
"He requires a very individualized instruction and a functionally informed positive behavioral support plan in the classroom and home environments. I believe he would benefit from a highly structured curriculum like SRA connecting math concepts and reading mastery. If -- states he does not want to attend a crowded assembly or a similar situation, his request should be accommodated. It is much better that he asks for this in advance rather than having an aggressive episode. The behavior analyst should make sure that frequent preference assessments are conducted so that effective reinforcers can be used in his behavioral plan.  -- often asks perseverative questions.  If he asks a question once, answer it. If he asks the same question again within a relatively short period of time, have him write the answer down. Then you can respond to future repetitive questions by pointing to the written answer. He may benefit from the use of a Time Timer at home and school. --may benefit from teachers systematically creating schedule changes and rewarding him for tolerating these changes..."

She recommended "Color coding his schedule to indicate whether an item is a definitely scheduled item or if something is just a possibility. -- has improved over the years and although his aggression has decreased, it is more complicated when he is aggressive now due to his strength and size... "

"-- needs to work on skills that will lead to independence in his living environment, community and in a vocational setting.  The Assessment of Functional Living Skills is an assessment skills tracking system encouraged on the guide for the development of skills that will help individuals with disabilities be as independent as possible. The AFLS could be used to guide a portion of --'s school educational program." (She then went into many more details about the AFLS.)

Again, I am impressed with this evaluation report and the previous intake report she sent! Now, time to write a letter to send to the school requesting this AFLS evaluation be part of his three-year IEP eval and also write some new accommodations I want added to his IEP based on this report... 

Another School Year Over... Progress Updates

Today was the last day of school for Honeybunches.  That means it's also report card and progress report time again.  It's confirmed in writing that his placement next year with be with Mr. M again. :)

Some highlights from his Progress Reports:

Honeybunches has:
(Counseling goal report) "Greatly improved his ability to verbalize his feeling associated with frustration, anxiety and stress.  He continues to struggle with using these strategies, however overall has made significant gains this year.... -- Continues to work on identifying and verbalizing his feelings.  He continues to struggle with the comprehension of his feelings, which in turn hindered successful peer interactions.  Continued work in this area would be beneficial... -- Continues to struggle in the larger group setting and often removes himself from the classroom's social skills lesson.  Continued work in this area for -- to remain in class and participate would be beneficial..."

(Behavioral) "During group lesson, -- may protest at times and want to do his independent work right away, but he will stay and participate in the classroom/group activity 100% of the time due in a large part to his desire to earn stars." (Sensory activities are a big part of his behavioral goals, but he refuses to do his sensory activities most of the time although he takes other breaks which are scheduled throughout his day...)

(Sensory Motor) "-- continues to participate in weekly therapy sessions in a small group setting. He is pleasant and cooperative. He will offer assistance when needed, suggest particular activities and state when he needs help.  It has been a pleasure working with -- again this school year and observing his significant progress in all areas of his sensory motor development."

(Occupational Therapy) "-- Has acheived his benchmarks and has improved his readability of hand written text through the use of a spacer. He is now working on correcting a few letter forms that further impact readability. When he works to monitor written output, speed of copying can vary. -- is always happy, polite and cooperative... The team should consider decreasing services if his progress continues next marking period..."

(Speech and Language) "I have enjoyed working with -- this year.  He continues to put forth good effort during language sessions on most days.  -- continues to benefit from multiple choice tasks when providing synonyms or antonyms for words and when identifying the main idea for short paragraph level material.  His ability to define multiple meaning words by using them in sentences has increased from 20%-100% for familiar words...."

(Reading) He is 60% accurate in the skill of "Given a written passage, written directions and a verbal prompt, -- will be able to identifying important details in writing". His goal was 80%. He can determine the meaning of words with 50% accuracy.  Goal for that skill was 60%. He had a goal to read 80 wpm with no more than 3 errors on 4 out of 5 trials.  He did not meet that goal, but did make progress (Which is what I look at the most) going from 55 wpm in November to 61 wpm in June on the DIBELS assessment.  The teacher did note that his "Ability to read fluently varies a lot from day to day and this assessment was done first thing in the morning when it is usually done in the afternoon..." The teacher also commented how he's "Put forth great effort on the Read Naturally Program.  At his request we were able to obtain some 5th grade materials... as he'd gone through most of the 4th grade..."

(Math) He is meeting most of his goals regarding place values, addition with three digits and regrouping, written subtraction with three digits (However the teacher wrote how he needs to be reminded to regroup before he gets going) as well as multiplication and division. He is not meeting his division goal as he's only 40% accurate on #s 100-200 although he's 90% accurate with the smaller numbers. The teacher says that multiplication is a strong skill for him.

(Written Language) "He is doing very well with writing paragraphs, but needs 1:1 help expanding his writing to 2-3 paragraphs.  -- will rewrite his sentences, but will need to get verbal prompts to be able to do this."

His report card does not go by A, B, C, D or F like most children's do.  His goes by
1: Developing grade level skills.  Not yet able to produce required grade level work.
2: Progressing toward grade level.  Producing required grade level work with direction and assistance.
3: Meeting grade level skill.  Producing quality work.
4: Exceeding grade level skills.  Producing highest quality work consistently.

In English Language Arts he got mostly 2's. He did get 3s this trimester in "Understands and utilizes new vocabulary" as well as "Reads with accuracy, fluency and expression". He got 1 in "Edits work" and "Writes an organized piece with purpose, clarity and details" but got a 4 for "Effort".

The narrative for this trimester says "--works very hard in reading.  He did a lot of Scholastic Reading Counts books and Read Naturally stories this trimester and has been improving significantly from his cold to hot reads."

Spelling he got 2 in "Learns spelling words for weekly tests" as well as "Applies correct spelling" but got another 4 for "Effort". :) That narrative says how "We don't do weekly spelling words as we try to focus more on reading and writing.  However, with the Word of the Day we do focus on proper spelling as well as with his written work."

In Math he got mostly 2s again, but got 4 in "Effort", 1 in "Communicates mathematics thinking using correct vocabulary, orally and in writing" and 3 in "Computes accurately". That narrative says " -- loves doing math and always wants to get to his worksheets.  We have been working with him to focus more on accuracy and less on speed."


Social Studies he got 2 in "Demonstrates understanding of concepts...", 2 in "Interprets and constructs data from maps, charts and tables", 1 in "Communicating understanding..."but again a 4 for "Effort".

Science his teacher says "Participates in Science lessons, although they are not his favorite.  He enjoyed our concluding field trip to the Aquarium..." ht moved up from 1 to 2 in "Communicates scientific thinking...", got a 4 for "Effort" and 2s in understanding, making skillful predictions, and draws appropriate conclusions.

In Work Habits he got a 4 for his overall grade; 2s in handwriting and communicates effectively in oral presentations and class discussions, presents neat and careful work; 4s in follows rules, uses time efficiently, accurately completes and returns homework on time, interacts and works cooperatively with peers and adults and follows oral and/or written directions; 3s in organizes work space and uses appropriate study skills. The teacher wrote "Has strong work habits and is one of the hardest workers I have ever had the pleasure to teach.  He has made some progress in making his work neater and more legible. He is very polite and interacts well with peers and adults alike.  He will have Mr. M next year as his teacher...."

Art and Music gave him a simple 3 while in Physical Education he got a 4.  They are not broken down like the other subjects are.

I am very pleased with the progress he's made this year.  He's been sitting hear timing himself doing "Read Naturally" that came home with him for over an hour.  He did it for quite a while this afternoon too. Three weeks until tutoring begins, which is our town's elementary school version of ESY.

Developmental Behavioral Pedi 2014 Part 1

Today Honeybunches had the appointment with the Developmental Behavioral Pediatrician down at the big hospital we've been on the waiting list for since October. This was the intake appointment.  Then they'll do two more appointments: One for the ADOS and another to go over results/reports.

Today's was very beneficial. She told me that many parents have been having a hard time with the school districts regarding the new DSM-5 and whether or not children still have Autism (Although they are technically just supposed to be given the new Autism Spectrum Disorder diagnosis).

She observed him, asked him some questions, me some questions, had him fill out a questionnaire and went over some paperwork previously sent in.  She said even from our appointment today, just going over certain questions and mostly through observing/talking with him she can tell he meets ALL the new criteria for Autism Spectrum Disorder. 

"Diagnostic Criteria for 299.00 Autism Spectrum Disorder

1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
   1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. She said he met this one clearly.
   2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. She said he met this one too.
   3. Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. She said although he's developing some new friendships, he still meets this category too.

Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

2. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):She said he clearly meets all four, although to be diagnosed he only needed to meet two...
   1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
   2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
   3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
   4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior. She did not go over his severity in detail as of yet...

3. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
5. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be beloiw that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder."

She said although she could have confidently diagnosed him today, some school districts have been giving parents issues if they don't have a ADOS report to go along with the new DSM-5 diagnosis.  She said there is a new ADOS to go along with the new DSM. She said that doing the ADOS (Although not necessary) will help prevent any school questions in the future. So we go back in exactly four weeks for the ADOS appointment, then we'll have a follow up appointment just to go over the results. She clearly seen him persevering about wanting to eat lunch lol.  I told her how he smells everything.  She said while many children with different diagnoses have sensory issues in different ways, it's the smelling everything is Autism related.  I found that interesting. She also found it interesting how his intense interest area is money.  I mentioned to her how he can go to the store and bank 5+ times per day to change his money.  For example he can have a $10, go change it for two $5s. Come back and go change it for 5 $2s.  Then ten $1s... Etc. He knows the serial numbers, secretary and treasurers.  I told her his other favorite area of intense interest is trains.  She began asking him a couple questions about his favorite train.  He said Netfork Southern lol. 

She mentioned that she can see an underlying anxiety disorder.  I mentioned how he was previously diagnosed by a Developmental Behavioral Pedi at Tufts with Generalized Anxiety Disorder, but a more recent eval by a child psychiatrist at the hospital she is affiliated with said it was part of his Autism and Bipolar.  She said that while what was previously diagnosed as ADHD was part of it (She did not see the hyperness that goes along with that diagnosis), the anxiety disorder she believes is separate.  She said she'd want to be careful about labeling him as ADHD because then doctor's would be likely to try stimulants, which are often a disaster for "Children like him".  I then mentioned how his first med was Ritalin at age three which was a disaster. She gave me a questionnaire regarding anxiety to fill out for our next appointment.  She suggests getting him a Cognitive Eval (Which they also do in her office) when he is between 15-16 to help get adult services into place.  She said that at that age I will be "Concerned about his cognition and memory". ;) That's the age when differences with IQ become more prominent.

Another thing the doc mentioned was that she does not understand why they gave him the diagnosis of PDD-NOS instead of Classic Autism to begin with.  From observing him, she said it's very appearant. He previously scored "Severely Autistic" on the CARS rating scale back in 2009. I mentioned to her that the doc who diagnosed him said that the only reason she did not give him that diagnosis was because he could speak (Although he has Receptive-Expressive Language delays) and he also made limited eye contact (Which he did not do with this doctor today). I can see her evaluation being very helpful with Honeybunches three year IEP eval coming up in September.

Honeybunches Spring 2014 Report Card and Progress

Report cards and progress reports came today. :) Overall, I am happy with his progress.  That's something that not everyone would understand as you can see from these:

Although he got mostly "2"s, I am proud.  It means he is making progress. He moved up to "3"s in a few areas.  That's what I focus on. I am glad that his teacher only gave him 1s on "Writes an organized piece with purpose, clarity and details" because that should help us keep him in OT for another year.  At his last yearly review, they were talking about possibly cancelling him from OT services when they do his three-year eval this upcoming October. I was going to fight that anyways, but now I have more ammunition! Some things on his report card with "1"s are because of his diagnoses.  For example, I believe that "Comprehends inferential meaning (Implied, not stated), "Applies problem solving skills" and "Communicates mathematics/scientific thinking/social studies using correct vocabulary..."might always be areas he struggles with. Him having issues with communicating will help me keep him in speech 2x week. As you can see, he put in a lot of effort as he got "Exceeding grade level skills" in every area!!! He is trying and making progress.  I love reading the teacher comments, such as how he increased his reading fluency by 16 words since the beginning of the year. As long as he is progressing, I am happy.  He might not ever make honor roll, but as long as he is trying his best, this Momma will be supporting him and proud of him.  Maybe I am even more proud than those Momma's whose children do get all A's, because I know how much harder it is for him.  I feel like creating a sticker that says "My child progressed this year" or "My child got 4s for effort".  Hmmm, maybe I can get Shut Up About Your Perfect Kid to make a badge for me lol...

His progress reports also came home.  Here are some comments from them....

Counseling:
"--- has improved his ability to verbalize his feelings associated with frustration, anxiety and stress.  He continues to struggle with consistently using these strategies, however overall has made significant gains this year... He continues to work on identifying and appropriately verbalizing his feelings. He continues to struggle with comprehension of his feelings, which in turn hindered successful peer interactions. Continued work in this area would be beneficial... --- continues to struggle in the larger group setting and often removes himself from the classroom's social skills lesson.  Continued work in this area for --- to remain in the class and participate would be beneficial."

Behavior:
Mostly this one talks about his goals, most of which are sensory related and how he "Engages in sensory activities 25% of the time" instead of 8:10. There is another sensory related goal also, which states how he chooses to take breaks which get him up and moving instead. On a good note, there is a goal that states in 8:10 trials when he is in a classroom setting, with verbal directions and verbal prompt he will participate positively in group activities in 8:10 trials.  He is currently doing this 100%, although he might protest at times and want to do his work independently, but will stay and participate in the classroom group activities 100% of the time.  (Remember, his class is only him and two other boys with the teacher and two class aides so it's still a small group setting.)

Sensory Motor (PT):
He achieved two of his objectives, but continues to work on another in regards to trunk/upper body strength. (If only his forceful hugs counted lol...)

Visual Motor (OT):
He met three of his objectives out of five. They are still working on getting him to write within the assigned spaces and his copying skills. He increased his printing speed, is using both hands for typing tasks and can produce, edit, save, print a draft.

In Speech and Language, he is still progressing towards all 4 of his goals.

Reading: He is working towards his goals of being able to identify important details in writing with 80% accuracy (At 60%); using context cues to identify the meaning of a words with 60% (At 50%); "Given a written passage at a 4th grade reading level, written directions and verbal directions, along with a verbal prompt, he will read 80 wpm with no more than 3-4 errors on 4:5 trials" (He can read 71 wpm with 0 errors which was significantly improved from his September assessment of 55 wpm AND they got him 5th grade Read Naturally work from the other school at HIS request). I am proud that he advocated for himself in getting it! :) :) :)

Math: He's meeting all his objectives!

Written Language: This explains how he needs 1:1 help expanding his writing to 2-3 paragraphs and needs verbal prompts on other areas, but is progressing.

Yup, this report makes a Momma proud as he is progressing!!!

Baby steps are the most important.  As Miley Cyrus says "It doesn't matter how fast we get there... It's the climb..."