Week 4- Cognition/Action//Perception/Modulation

When Jonny was referred to our program, he received a comprehensive multi-disciplinary evaluation. A service consultant completed the Battelle Inventory of Basic Skills and found that Jonny had difficulty in areas of pre-math, pre-literacy, and imitation of block designs. Attention was fleeting to most tasks. The speech-language pathologist evaluated Jonnny’s pragmatic language/social communication aspects of language. Jonny had difficulties in volume (he does not use appropriate volume level to direct his speech to the person he is talking to), prosody (intonation too varied, somewhat ‘sing-song quality), voice (pitch can sometimes be too high), rate (at times too rapid). He was unable to answer questions without visual cues, indicating language processing deficits. The psychologist assessed behavioral and social areas using the Vineland Social Emotional Early Childhood Scales and the Social Skills Rating Scales along with observation to asses play with peers. Concerns were many, but in the areas of modulation, Jonny was found to initiate with peers, but due to the inability to modulate his volume and maintain an appropriate proximity to the person he is interacting with, his is not able to maintain interaction with peers. The occupational therapist assessed Jonny’s fine motor skills and gathered information regarding his sensory processing through observation and parent and teacher completion of sensory profiles. Jonny had typical vestibular processing and visual processing with difficulties in touch, oral sensory and auditory processing. An observation was completed in Jonny’s daycare. Jonny has difficulty in sustaining interactions with peers and having his needs met in a classroom setting that has more students and less supports than his specialized preschool environment. The difficulties that inhibit him are more pronounced there and result in inappropriate behaviors such as meltdowns, and arguments with peers.

Jonny uses a variety of sensory strategies that are incorporated into his specialized preschool. He has been taught to ask for a break, request a sensory strategy using a picture board ‘menu’ of strategies to reduce his high arousal state, and has visual strategies to help him monitor his time for each activity. Social stories and role playing and modeling are used to demonstrate and practice appropriate volume, proximity and how to direct his voice to a listener. Jonny is paired for activities with peers that are more likely to be able to maintain the interaction to help make conversation and interactions more successful. These strategies are taught to his daycare staff through consultants, although follow through is inconsistent, partially due to a much higher teacher-child ratio in that setting.