This client has exhibited several developmental delays, all varying in categorical age based on the task she is asked to complete. Due to these deviations, her developmental age is currently undetermined. After a completed parental report, it has been recounted that she exhibits distracted behavior very easily and struggles with multi-step directions, two frailties suggested to result from Attention Deficit Disorder. Lisa, the client also displays difficulty hearing with the presence of background noise and has a sensitivity to loud environments. Along with these developmental shortcomings, she has a difficulty reading, oftentimes reverses numbers, words, and letters, and has both a learning disability and speech/language disorder.
Lisa was homeschooled up until the second grade and then began her public school education. She is currently in the fourth grade, attending Ward Highlands Elementary School. Although enrolled in mainstream education for her extracurricular classes, Lisa’s Individualized Education Plan (IEP) has placed her in an Exceptional Student Education (ESE) classroom setting for all of her academic courses. As well as her provided coursework, Lisa also receives speech therapy biweekly. This treatment is being provided through the school in a non-private setting as she is currently on a wait list to receive private speech therapy.
When given specific screening and diagnostic assessments to identify potential auditory processing disorders, Lisa exhibited deficiencies in two out of the three screening tests and two out of the five diagnostic tests. During a Gap Detection test, she failed to detect between two tones over three different times as well as scored 16/40 (below average) on the Competing Words-Free Recall (CWFR) subtest. During her diagnostic tests, Lisa scored in the 5th percentile (borderline) regarding a Competing-Words Directed Ear subtest and scored in the 1st percentile (disordered) on the Competing Sentences subtest.
Long-term Goal:
1. Lisa will be removed from ESE classrooms and enrolled in mainstream education for all academic curriculum.
Short-term Goals
1. Lisa will be able to recall and write down a list of 3 words and 3 numbers (in order) provided to her verbally at a pace of 1 word/number per second with a mild to moderate presence of background noise (low volume music or conversation in the next room). Success will be measured through the accuracy of her recall; 80% accuracy is required to deem successful.
2. Lisa will be able to successfully follow directions (provided verbally and written) for a 3-step process regarding a Lego building activity 80% of the time over a period of 5 sessions/attempts.
3. Lisa will complete a detailed book report for a reading at her current reading ability level that includes 2 main character descriptions, a 5-sentence explanation of the main idea, and three important details that support the author’s purpose. Once accomplished with 80% accuracy, Lisa will be assigned an age-appropriate (fourth grade) leveled book and asked to complete the same task; this must be accomplished with 70% accuracy for a minimum of 3 books in order to move up in reading level.
4. Lisa will be able to read/recite a word and number series with 70% accuracy which will change to 80% as progress is made.
Rationale
With a prevalence rate estimated at 5-8%, Attention Deficit Disorder is the most commonly diagnosed children’s psychiatric disorder (Perold, M., Louw, C., Kleynhans, S. (2010). Defined by two primary problems: inattention and impulsivity, ADD oftentimes plays little to no role in a child’s actual level of intelligence, but rather hinders their ability to apply that intelligence in their educational and daily practices (Perold, 2010). In Lisa’s case, her ability to learn and apply her aptitude in a classroom setting is being limited by her short attention span and difficulty listening in loud environments. By implementing our short-term goal of recalling and writing down a list of verbalized words and numbers in the presence of mild background noise, we are encouraging behavior that is tolerant to a non-quiet environment whilst providing a practice that will benefit the regression of her dyslexic comprehension and poor word recall abilities. This would be considered a combination of two common treatments of choice for Attention Deficit Disorders: behavior modification and educational intervention (Perold, 2010).
The ability to remember and follow through with multi-step directions has remained a challenge for children with Speech Language Impairments (SLIs), such as Lisa (Gill, C., Klecan, J., Roberts, T., Fredenburg, K., 2003). By incorporating the short-term goal of having her follow the directions for a three-step Lego building exercise, we are allowing Lisa the opportunity to practice her language comprehension abilities with both reading and verbal stimuli. The actual use of Lego building blocks will offer various instruction types such as specific color, shape, and or position-specific. According to the findings of a 2003 study led by Dr. Cynthia B. Gill, CCC-SLP, an intervention of three hours or less can provide significant increase in a child’s ability to follow multi-step directions (Gill, 2003). By issuing an expectation of 80% accuracy over a period of five separate sessions, we are allowing for the efficacy of these interventions to further develop, eventually increasing her overall direction-following abilities.
Reading comprehension can often be defined as the combination of two vital skills: the decoding ability and linguistic comprehension (Nation, K., Snowling, M., 1998). Through the assignment of a completed book report as our third short-term goal, we are challenging both of those components in one activity. Through the use of character, main idea, and detail recognition, we are challenging Lisa to go beyond the words in a book and truly comprehend the intention and meaning behind them. By starting at a level that she is comfortable with, we are establishing a methodology that she will then carry on when furthering her reading abilities and eventually achieving a grade-appropriate reading level. In other words, we are establishing good habits in an easier environment prior to providing her multiple challenges at once that could potentially discourage progress altogether.
Children with reading disorders similar to Lisa’s have been seen to exhibit difficulties in the retelling of an accurate, logical sequence (Purvis, K., Tannock, R., 1997). Findings in a 1998 study assisted in the development of an argument that introduced the concept of Dyslexic Compensation: a term that defines the reality that dyslexic individuals, just like Lisa are believed to compensate for their disabilities with orthographic phonological mappings, a concept the explains the process of dividing labor that is more dependent on semantic input rather than phonological structure (Nation, 1998). By incorporating a recall activity with both words and numbers, Lisa will be allotted the practice to better her recall abilities while introducing an act of prevention in regards to her dyslexic tendencies to reverse words, letters, and numbers.
All four short-term objectives are intended to serve as building blocks to Lisa’s long-term goal of being removed from Exceptional Student Education and enrolled into mainstream classes. These measurable goals, when combined with several other resources such as speech therapy, occupational therapy, and supplemental practices, will provide Lisa that potential opportunity to reach her long-term goal.