Infants and Toddlers with Special Needs Assignment

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Individualizing in Early Childhood: The What, Why, and How of Differentiated Approaches

JoniL. Baldwin and Patty Sorrell

Infants and Toddlers

Intervention in an Early Childhood Setting: Woody's Story

Photos courtesy of the authors, except where noted

Terminology and Acronyms

■ ASD - Autism Spectrum Disorder ■ El - Early Intervention; Early

Interventionist

■ IDEA - Individuals with Disabilities Education Act

■ IEP - Individualized Education Program

■ IFSP - Individual Family Service Plan ■ PartCServices-for children age

0-3 (component of IDEA)

T 8 WEEKS OF AGE, WOODY WAS ENROLLED AT THE Bombeck Family Learning Center, a university- supported early care and education setting. His teachers recorded his growth and development

vRl with narrative and photographic documenta­ tion, as they do with all the children at the center. At 18 months, Woody spoke three-word phrases, used and displayed under­ standing of a strong vocabulary, and followed simple classroom routines and instructions. He pointed to items in his favorite books and kicked a ball at a target. Completion of the “Ages and Stages Questionnaires” (www.easterseals.com/site/Page Navigator/ntlclO_mffc_homepageasq.html) showed that Woody was developing on track for his age. He had a captivat­ ing smile, shining eyes, and a wonderful belly laugh.

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Achange in Woody Adults in Woody’s life started noticing changes during the summer Woody turned 2. Woody stayed home for a month during his father’s (Chris) summer recess from teaching.

When he returned to the center in September, his teach­ ers noticed some definite changes. Woody’s speech was disappearing—down from over 100 words and phrases to about 20 individual words spoken with intent. He stopped socializing with familiar people and engaged in repetitive and nonfunctional behavior. One such activity was repeat­ edly throwing action figure dolls up in the air. Woody wandered the room, not engaging with peers, staff, or toys. When adults or peers tried to interact with him, his eye contact was limited. Woody’s teacher, Lois, who had been with Woody since he entered the Bombeck Center, was concerned.

Collaborative identification strategies Lois spoke with the center director and together they re­ viewed Woody’s current level of development compared to his previous skills. They decided a conference with Woody’s parents was needed. Lois describes that first call to the parents as “the hardest phone call I’ve ever had to make in my life,” but realized she had to discuss her concerns with them. Something was different, and Woody needed help. Woody’s mother (Patty) describes that meeting:

I’d like to comment on the grace exhibited by Woody’s teacher during this very scary time. I can only imag­ ine how difficult it must be to sit down with a par­ ent to discuss a child’s developmental stall. Woody’s teacher was empathetic, supportive, and factual. She gave me good information and data that I could take to our pediatrician. She didn’t make judgments about what might be happening with Woody, but encour­ aged me to see our pediatrician to ask questions. The Bombeck Center’s staff suspected Woody might

have autism. Woody’s teachers, with parental permission,

asked for observations from Dr. Baldwin, an early child­ hood special education faculty member at the University of Dayton, and Dr. Kinsel, a child psychologist provid­ ing support at the center. They observed Woody in the classroom and playing outside to help the teachers learn more about his behaviors and how to address his needs in the classroom. Dr. Kinsel gave Patty and Chris examples and terminology that they could take to their pediatrician, including his concerns about Woody’s lack of eye contact, minimal to no joint attention evident (shared focus on an object or activity through verbal or nonverbal communica­ tion), limited meaningful play, and stereotypical behaviors commonly associated with autism (staring at the ceiling lights, hand flapping, wandering the room instead of play­ ing, and ignoring adults and children in the room).

The classroom teachers provided documentation they had kept while Woody was enrolled, which was essential in demonstrating his loss of previously evident skills. Dr. Baldwin served as a sounding board and educator for the parents as they began attending doctor and therapy ap­ pointments. Dr. Baldwin and Woody’s parents discussed IDEA (Individuals with Disabilities Education Act), Part C services. IDEA is a federal law that provides educational and therapeutic intervention to children identified with exceptionalities. They also talked about how best to accom­ modate Woody’s needs at the Bombeck Center in meetings with the teachers and center director, as well as to keep everyone up-to-date on the diagnostic process. By October,

Lois describes that first call to the parents as “the hardest phone call I’ve ever had to make in my life,” but realized she had to discuss her concerns with them. Something was different, and Woody needed help. the developmental pediatrician and developmental psy­ chologist at Dayton Children’s Hospital identified Woody as having pervasive development disorder-not otherwise specified (PDD-NOS), one of the autism spectrum disor­ ders (ASD). (See “Autism Spectrum Disorder,” page 46.)

Intervention through collaboration: Ages 2 to 3 Intervention occurred in stages as Woody’s treatment plan was being developed by his parents, Bombeck Center staff,

About the Authors Joni L. Baldwin, EdD, is an associate professor at the Univer­ sity of Dayton in Dayton, Ohio. She has several years of experi­ ence working with children with autism, including evaluation, programming, teaching, and advocacy, [email protected]

May 2013 Young Children

Patty Sorrell, APR (PRSA Accredited in Public Relations), is the mother of Woody Sorrell, the child featured in this article. Patty is the director of Innovative Environment and Culture at ACCO Brands in Dayton, Ohio. Patty's professional background includes communications, public relations, and editorial management. [email protected]

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professionals at the children’s hospital, and Dr. Baldwin and Dr. Kinsel. The local children’s hospital completed a referral for the county’s Birth-to-Three program (IDEA, Part C).

Early interven­ tionists (Els) from the Birth-to-Three program met with Woody’s parents at the early child­ hood center so Lois and Dr. Baldwin

could also be present. This began the collaborative process between early interventionists (a teacher and a speech pathologist) and early learning professionals working with Woody (child care professionals) (Wesley & Buysse 2004). Lois shared with the group how the classroom functioned and noted times that would be good for Woody’s individual therapy or group work. The team (Patty and Chris, Lois, Els, and Dr. Baldwin) developed Woody’s Individual Fam­ ily Service Plan (IFSP) with goals to help him regain some of his lost communication and socialization skills. (See “Woody’s IFSP Goals.”)

The Els came to the center to work with Woody both individually and in the classroom. They modeled strategies to increase Woody’s functional communication (giving him only a little milk so he would need to ask for more), purpose­ ful interactions with others (placing items that Woody would want high on a shelf so he had to gain attention from someone to get them down), and introductory play with peers (helping Woody and another child build a tower with blocks). These goals were embedded in key parts of his daily routine (mini-

Woody's IFSP Goals

A n IFSP (Individualized Family Service Plan) is devel­ oped by the team working with the child, including the parents and other interested caregivers. It is similar to an IEP, but the family resources and concerns,

preferred model of therapy, and writing of the goals is more family focused.

1. Communicate with words, signs, or pictures

2. Engage in simple play with peers and adults

3. Respond to one- and two-step directions

4. Identify body parts

5. Make simple choices

6. Identify familiar people spontaneously

circle, snack/lunch, gross motor/playtime) to make activities more meaningful to l^im (Woods & Wetherby 2003).

Patty and Chris were very involved in obtaining services for Woody, including the El specialists and additional speech

Early interventionists from the Birth- to-Three program met with Woody’s parents at the early childhood center so Lois and Dr. Baldwin could also be present. This began the collaborative process between early intervention­ ists and early learning professionals working with Woody. and occupational therapy through the children’s hospital. Patty decided a written weekly schedule would be helpful for the center staff, as Woody arrived and left the center at differ­ ent times based on his appointments for that week.

Autism Spectrum Disorder

A utism Spectrum Disorder is the umbrella term for a group of disorders that affect language, behavior, cognition, and sometimes motor skills. This includes autistic disorder, Asperger's syndrome, and pervasive developmental disorder-not

otherwise specified.

Diagnosis

■ Impaired social interactions and failure to develop social relations ■ Impaired and disordered language and communication ■ Restricted and repetitive behaviors (APA 2000) ■ Severity of the symptoms/behaviors is considered when confirming

diagnosis of children with ASD

Statistics ■ Boys are affected five times more often than girls (CDC 2012)

■ Approximately 50% of individuals with ASD also have intellectual disorders (Volkmar et al. 2004); 50% do not

■ It does not appear to be disproportionately represented among ethnic or racial groups

■ Prevalence in 2008 in the United States was reported to be 1 in 88 (CDC 2012)

Early warning signs in the child's behavior

■ Difficulties with communicating ■ Minimal to no joint attention (sharing comments and thoughts

related to the same item or event through verbal or nonverbal com­ munication)

■ Decreased social interactions ■ Restricted and repetitive behavior ■ Limited visual attention or fixation on nonsocial stimuli (Boyd et al. 2010)

46 Young Children May 2013

The Els who worked weekly with Woody wrote notes to Woody’s parents and shared them with his teachers to document what skills they had worked on each day in the individual sessions. They suggested ways the skills could be incorporated into the classroom and home environ­ ments. By staying in his natural environment (the Bombeck Center, where he had been cared for since he was 8 weeks old), Woody could continue to follow examples of his peers throughout the day.

Woody’s teachers and the rest of the staff at the Bom­ beck Center willingly learned what they needed to do to help Woody succeed in his natural environment (Vakil et al. 2009). Woody went to occupational and speech therapy at the local children’s hospital. Chris and Patty were able to bring the strategies and techniques used in therapy back to the center, including key vocabulary words to work on with Woody, linked to the teachers’ lesson plans for the week. They shared methods to encourage Woody’s play with classmates, and strategies to help Woody gain an adult’s attention to satisfy a want (for example, to go to the gym or outside). The teachers integrated these suggestions into the daily routine, particularly during snack, lunch, circle, and play times.

It quickly became clear to Woody’s teachers that he needed more one-to-one attention throughout the day to encourage interactions than his teachers could provide while also addressing the needs of other children. Dr. Bald­ win recruited volunteers from her college students study­ ing early childhood education, with an endorsement in preschool special needs. The team identified key periods of the day (8:00-11:00 a.m., when all the children in the class

Advice to TeacherS From a Parent ■ Understand the symptoms of autism: Teachers and

other early childhood professionals are often the first to notice that something is changing with a child. If you no­ tice a developmental stall, determine the appropriate next steps with the center's director regarding documentation and approaching the family.

■ Learn: Be an informed advocate for children with autism. There are local, state, and national organizations and resources dedicated to autism advocacy and research.

■ Listen: Pay close attention to parents and siblings of chil­ dren living with autism. The family experiences emotional highs and lows regularly. Sometimes they need a friend to listen and understand.

■ Encourage: Smile and acknowledge a child with autism. Tell his family that you are supportive.

■ Be flexible: With the program director, determine what support your facility may be able to provide for a child with autism. Most families are open to and want to work with their child's program to respect the needs of the other children and meet the needs of their own child.

■ Advocate: Vote in favor of causes, levies, and elected officials who support funding for autism treatment and research.

May 2013 Young Children

were present, and 3:00-6:00 p.m., after lunch and nap) as Woody’s individual intervention times. A college student was assigned to Woody during these hours, with the pri­ mary responsibility of playing with him, while addressing daily goals of increasing communication and attention.

Students volunteering to work with Woody attended two training sessions facilitated by Dr. Kinsel and Dr. Baldwin. The first was held in January with a follow-up in March, both scheduled after the center had closed for the day. Woody’s parents provided pizza and soft drinks for the participants, and many teachers from the center also stayed after work to learn more about ASD and how to work with children identified as being on the autism spectrum.

Woody’s parents and Dr. Kinsel decided Woody’s intervention program at the early childhood center would focus on interactions during play, following the P.L.A.Y. (Play and Language for Autistic Youngsters) Project ap­ proach (www.playproject.org). The P.L.A.Y. Project was developed at the Ann Arbor Center for Developmental and Behavioral Pediatrics by Dr. Richard Solomon. The program is designed to increase communication and interactions between children identified with autism and

Woody’s teachers and the rest of the staff at the Bombeck Center willingly learned what they needed to do to help Woody succeed in his natural environment.

their families. Therapists work with the family to increase interactions with their child through daily routines—for example, bath time, lunch, or bedtime. The team consid­ ered this approach appropriate to use in Woody’s child care setting, which was a “home” for Woody for most of his waking weekday hours.

The volunteers worked with Woody for short periods of time (20 minutes), engaging and expanding on his play, while setting up opportunities for him to purposefully communicate. The student volunteer would start where Woody appeared comfortable (for example, swinging) and then begin to interrupt his play to gain attention and language (for example, stopping the swing and asking Woody what he wanted; if no response, giving verbal and physical cues [signing and saying more], if no response, physically helping Woody “say” more through signing and then pushing the swing again). This continued for 5 to 15 minutes, depending on Woody’s interest. Woody’s parents and teachers decided to follow this same model for other activities Woody liked, including playing with bubbles, playing “chase,” and ball play.

Patty and Dr. Baldwin developed data sheets to commu­ nicate between volunteers, center staff, and Woody’s par­ ents. The teachers designated an accessible spot in the room

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for a clipboard containing all the data sheets the volunteer or therapist would use when working with Woody one-on- one. Woody’s parents could then look at the clipboard as they picked him up to see what had happened during the day. A graduate assistant developed a picture schedule that included the key parts of Woody’s day (Banda, Grimmett, & Hart 2009; Hodgdon 2011). This helped Woody make smoother transitions as he was moved from his classroom to go to the gym or outside and then back to the room.

Woody’s parents and the Bombeck Center staff dis­ cussed the option of having Woody attend a center-based program for 2-year-olds run by the county developmental disabilities program. The program included occupational therapy, speech/language therapy, and a teacher on a half­ day, four-day-a week schedule. It was a difficult schedule for Woody’s parents to manage while working full-time, but everyone agreed that the additional intervention would be beneficial, so the center staff developed a workable plan. Woody’s parents brought him to the early childhood program at the typical time each morning. One £f the center staff walked Woody to the nearby corner to be picked up by the school bus. Woody loved the bus, so this was easy for everyone. At lunchtime, Patty or Chris picked Woody up at the end of the session and drove him back to the Bombeck Center. They chose to do this to be able to talk with the special needs staff daily, and to avoid Woody falling asleep on the bus on the way back to the center.

Under the direction of a licensed physician, Woody’s parents placed him on a gluten-free/dairy-free diet. The center director, the food preparation staff, and Woody’s teachers agreed to help implement this diet and met to de­ termine how to manage this new change for Woody. They developed a list of foods that were usually served at the center that Woody could eat with the other children. The staff also identified items to be eliminated from Woody’s diet, with his parents providing substitutes for snacks and lunches as needed.

Monitoring food in the classroom was relatively simple, because the staff sit with the children for snack and lunch. Woody quickly learned what was “his food” and most of the time did not protest having different snacks from his peers. Woody’s mother credits the center with help and support in putting the new diet in place:

We introduced the diet by meeting with the kitchen staff, teachers, and the center director to discuss Woody’s diet restrictions. Again, the team came through and has helped every step of the way. Chris and I provide substitutes for lunches, snacks, and spe­ cial occasions, but we really couldn’t do this without the support of the entire early childhood center team! Woody’s parents have kept the families of the other

children in the classroom informed during the intervention process. His mother wrote a letter to the families, sharing the story of Woody’s loss of skills and the diagnosis process.

She explained what happens with volunteers and therapists in the room, and that Woody was on a special diet. In addi­ tion, Patty spoke to all center families and staff at a parent association meeting. She described the signs of autism and responded to questions. Her candor and openness resulted in other families becoming more familiar with ASD, and offering support to Woody and his parents.

Progress Through this intervention, Woody has made progress in his developmental skills.' Communication is stressed in all aspects of his day, including snack and lunch, when he receives a small amount of food and then must indicate in some fashion that he wants more. Woody’s teachers and volunteers learned basic sign language to help him com­ municate nonverbally (“more,” “cracker,” “juice,” “swing,” “ball”). They work to maintain his attention during play

What Families Can Do to Facilitate Identification and Intervention

■ Obtain releases for everyone to talk to everyone else in­ volved. As confidentiality has become more of a concern, professionals may not talk to one another about a specific child unless there is a release form. They can only discuss their information, not something they heard or received from another therapist. The El staff need a permission form to talk with the center staff, and another to talk with the doctor. Yet another form is necessary for the staff and doctor to talk with the El staff. This is critical for open communication.

■ Coordinate scheduling of therapies and doctor appoint­ ments.

■ Share openly with program staff, volunteers, and other families.

■ Provide dinner or snacks for training sessions.

■ Provide snacks and lunch when scheduled food is not on the child's allowed list.

■ Bring in experts to train staff and volunteers.

What Educators Can Do to Facilitate Identification and

Intervention ■ Keep anecdotal records of developmental skills

■ Monitor the child closely for safety issues

■ Talk to families and therapists

■ Serve as liaison between families and therapists as needed

■ Ask questions

■ Attend trainings

■ Encourage the child's language use and interaction with peers and adults

■ Adapt food offerings at snack and lunch

■ Help with bus duty

Young Children May 2013

Vakil, S., E. Welton, B. O’Connor, & L.S. Kline. 2009. “Inclusion Means Everyonc^The Role of the Early Childhood Educator When Includ­ ing Young Children With Autism in the Classroom.” Early Childhood Education Journal 36 (4): 321-26.

Volkmar, F.R., C. Lord, A. Bailey, R.T. Schultz, & A. Klin. 2004. “Autism and Pervasive Developmental Disorders.” Journal of Child Psychology and Psychiatry 4 (1): 135-70.

Wesley, P.W., & V. Buysse. 2004. “Consultation as a Framework for Pro­ ductive Collaboration in Early Intervention.” Journal of Educational and Psychological Consultation 15 (2): 127-50.

Woods, J. J., & A.M. Wetherby. 2003. “Early Identification of and Intervention for Infants and Toddlers Who Are At Risk for Autism Spectrum Disorder.” Language, Speech and Plearing Services in Schools 34 (3): 180-93.

APA (American Psychological Association). 2000. Diagnostic and Statis­ tical Manual of Mental Disorders. 4th ed. Washington, DC: APA.

Banda, D.R., E. Grimmett, & S.L. Hart. 2009. “Activity Schedules: Help­ ing Students With Autism Spectrum Disorders in General Education Classrooms Manage Transition Issues." Teaching Exceptional Chil­ dren 41 (4): 16-21.

Boyd, B.A., S.L. Odom, B.P. Humphreys, & A.M. Sam. 2010. “Infants and Toddlers With Autism Spectrum Disorder: Early Identification and Early Intervention.” Journal of Early Intervention 32 (2): 75-98.

activities. These little things allow Woody to continue to work on his skills while remaining a member of his peer group.

Center staff hold monthly meet­ ings with Woody’s parents to assist everyone involved with understand­ ing Woody’s needs and his program. Together we celebrate small successes, and problem solve difficulties. Woody has slowly regained some of his verbal communication and interacts with a few of his peers on a limited basis. While autism remains an obvious part of Woody, his unique personality has begun to re-emerge.

Through the care, compassion, and flexibility of the early care staff and teachers, Woody was able to remain in his natural environment, his parents were able to continue to work, and the staff and volunteers learned strategies to work with children under the age of 3 who are diagnosed on the autism spectrum. The intervention has been a successful collaboration that continues as Woody turns 3 and transitions to school-age services. The public school staff came to the Bombeck Center for his transition meeting so Lois, Dr. Baldwin, and Woody’s parents could share information. Woody’s Individu­ alized Education Program continues the strategies and goals that have proven successful in the early care and education setting.

References

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www.adventurouschild.com

CDC (Centers for Disease Control and Prevention). 2012. “Prevalence of Autism Spectrum Disorders—Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008.” Morbidity and Mortality Weekly Report, www.cdc.gov/mmwr/preview/mmwrhtml/ ss6103al.htm.

Hodgdon, L.A. 2011. Visual Strategies for Improving Communication: Practical Supports for Autism Spectrum Disorders. Rev. ed. Troy, MI: QuirkRoberts.

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