Case Study 1
Area of Intervention: Intervention to further develop on Annie’s speech, communication and social skills.
(i) Intervention
The intervention that I will recommend Annie to further develop on her speech, communication and social skills is music therapy. According to this article by Bower and Shoemark (2009) music therapy has tremendously helped a child who has encountered an Acquired Brain Injury (ABI) and had just emerged from coma and post traumatic amnesia (PTA) to be able to construct some speech. This intervention is carried out within five to six sessions. Through this intervention, it is able to promote basic interpersonal interaction skills, other than just helping the child in his/her speech and language skills. It is important that this intervention helps to further enhance Annie’s speech and language development as Annie has poor social interaction with her peers. By carrying out music therapy, provides Annie with the ability to co-facilitate speech pathology interventions thus allowing her to be successfully engaged in musical interactions. According to the article in Bower and Shoemark (2009), music therapy can also provide her opportunity to show musically appropriate interpersonal interactions which further enhances on her social capacity. As such, she will then be able to respond to the musical elements of early interpersonal or social interactions before she acquired the ability to process language. This intervention offers Annie the opportunity to address the fundamental needs of process language and hence reducing the chance of her being isolated by her peers.
(ii) Effectiveness
The effectiveness of this intervention has been reported to be successful in increasing the vocal range and intonation. Vocal and breathing exercise done during the intervention has been proven to be beneficial as it increases the breath support for prolonged phonation. The use of rhythmic speech cueing has also seen to be improving the rate of speech and speech clarity. The use of music therapy mainly the singing instruction is seen to be potentially a stimulating, fun and reminiscent medium that increase motivation and focus during speech rehabilitation exercises.
As stated as an example in the article by Bower and Shoemark (2009), a boy who has undergone this intervention has benefited tremendously. He is able to develop the proper language to greet and convey his goodbye to his peers. With this positive communication, he is able to better interact with his peers. Apart from that, through this intervention, he was also given the chance to try out rhythmic activities such as free drumming improvisation as it facilitate non-verbal interactions between the boy and the music therapist. Hence, it subsequently increases the awareness of the therapist initiated interpersonal interactions. Throughout the course of co-facilitated music therapy and speech pathology, the boy was able to participate actively and shows interest to what he was doing.
(iii) Personal evaluation how the child will benefit from this intervention
As Annie displays some behavioral and social difficulties, I strongly feel that this intervention will help to reduce her behavioral problems. Personally, I believe that the behavioral problems occurs as she feels frustrated with her own disabilities and finds it hard to be involved with the activities provided in school. Aside from being extremely shy and withdrawn, she also felt tense and frustrated which then resulted in her biting her classmates. Moreover she is teased by her peers because of her facial deformities. With this intervention that is to include the element of music allows Annie to be more involved socially with her peers.
Through this intervention too, it helps Annie to firstly further develop her language skills. With proper speech, Annie is being understood by her peers, and thus allowing her to have better communication skills with everyone around her. Hence, her friends will be able to be more understanding of the difficulties that Annie is going through with her language and social emotional development. Having to go through this intervention process one step at a time, we are able to monitor Annie’s both social emotional and language development just like the example given in Bower and Shoemark (2009) that the boy benefited tremendously having to adopt this music therapy as an intervention.
(iv) Suggestions how adjustments can be made to cater to the needs of the child and to facilitate integration of the child / the intervention activity into the classroom.
I believe that to carry out this intervention efficiently for Annie, the teacher will have to do more research on music therapy thus making improvisations to meet developmental needs. Apart from that, the teacher will have to work closely with Annie’s parents and speech therapist to constantly keep track of her speech and language progression. When the teacher is knowledgeable to Annie’s strengths and weaknesses, the teacher is able to make appropriate improvisations to the intervention. The music therapy intervention mentioned in Bower and Shoemark (2009), it goes through various number of sessions. Each session will have different objectives to be met according to Annie’s improvement and progression made.
As stated in Bower and Shoemark (2009), drum is used to help the boy however, to facilitate integration to the child; the teacher can introduce items for Annie to be involved with according to her interest. The teacher can split this intervention to a few sessions which starts off with a simple music activity to introduce Annie to a song. The song can be a simple song to teach Annie and the other children about greeting one another. This is followed by a simple goodbye song to cue the conclusion of the session. The teacher will then observe Annie’s progression. As Annie is able to make improvements, teacher will then introduce different kinds of songs. With simple greeting songs like that will help Annie with her language as she is able to sing it repeatedly. Through active engagement in the activities, Annie will gradually develop interpersonal interactions as she mingle and work with her peers. Since Annie has difficulty with her speech, teacher can also aid her speech by having picture cards to teach the routines during this therapy. With the picture cards too, it will be easier for Annie to interact with the teacher and her peers.
Reference
Bower, J., & Shoemark, H. (2009, July). Music therapy to promote interpersonal interactions in early paediatric neurorehabilitation. Australian Journal of Music Therapy, 20, 59-75. Retrieved September 5, 2009, from CINAHL Plus with Full Text database.
Wednesday, September 9, 2009
Nur Azlina Subari (Group B)
Case Study 1
(i) the intervention
What is the intervention about?
The intervention is designed to teach peer-group entry skills to kindergartners with social interaction and communication deficits, especially to those who have specific language impairments (SLI). According to the authors of this article, children with SLI use low-risk behaviors to enter peer group such as hovering, waiting and engaging in parallel play. This approach differs from typically developing children who had no trouble interacting with their peers. They use high-risk behaviors to enter peer group such as making a verbal statement or asking a question to initiate play.
Procedures in the intervention
The child (target child) involved in this intervention chose a friend (host child) that she wanted to try to play with. Each intervention sessions lasted for 45 minutes and it was conducted during free play for 4 afternoons per week. The teachers in the classroom helped in the interaction between the target child and the host child. They also used a sequence of pictorial instructions to initiate play called the Mayer-Johnson Symbol. This instruction illustrates pictures of- (1) Walking to your friend, (2) Watch your friend playing, (3) Get a toy similar to your friend, (4) Do the same thing as your friend and (5) Tell your friend your idea of playing with the toy. These sequences were taught to the target child using direct instructions, modeling and prompting.
The target child was given 2 minutes to initiate play with the host child. If she did not manage to do that, the teacher will then have to follow these levels of prompting to help the target child:
Level 1: No prompt
Level 2: Visual Cue
Using the Mayer-Johnson Symbol mentioned above. If it still does not work, the teacher can then move on to the next level.
Level 3: Non-Verbal Prompt
Teacher shows the toy to target child and say to the host child “It looks like (target child) wants to make a cake with you.”
Level 4: Prop and Verbal Prompt
The teacher can say this to the target child “You could use a (toy) to make a cake just like (host child).”
She can continue to say this to the host child “It looks like (target child) wants to make a cake with you.”
Level 5: Prop and Direct Modeling
The teacher tells target child, “I’m using a (toy) to make a cake like you are.”
She then tells the host child “We’re making cakes just like you (host child).”
At the end of the session, the teacher will record down the children’s name and the transcripts of what they said. The target child will be rewarded with stickers or candy after each entry attempt. She will also be rewarded with a treat from a ‘prize box’.
(ii) its effectiveness (as reported in the journal article)
Results, as written in the article, demonstrated increases in (a) high-risk behavior that the child use, (b) the use of toys and verbal statements to enter peer groups, (c) cooperative play, and (d) time spent interacting with peers. Results also indicated that the child’s behaviors in peer group entry closely resembled those of her typically developing peers. Even after the intervention has ended, the child generally maintained these behaviors on her own. In addition to that, the child who used more non-verbal gestures to initiate play showed an increase in using specific words to describe what she was doing. For instance, instead of “Let’s (doing the action of digging)”, the child is able to say “Let’s dig!” This shows that the intervention did not only improve social interaction between the children but also increases the use of language.
Overall, the children have a change in perception of the target child as they interact more. Thus, they were able to accept and respect the target child for the way she is. Furthermore, the article states that the teachers who were involved in this study find the intervention useful as it can also be implemented to other children as well. Thus, the whole class would benefit from this intervention.
(iii) your personal evaluation how the child will benefit from this intervention
From this intervention, Annie would be guided in using appropriate cues or behaviors when interacting with her peers. Overtime, she would know how to enter a play without disrupting any children as she develops interaction skills. This would promote positive social interaction among them. Hence, it will then minimize the chances of biting and being shy or withdrawn when she is around her peers. This intervention, as stated in the article, could be use on all the children in the class. As Annie has more opportunities to develop positive interactions with her peers, it will result in a change of perception on how they view her. Thus, they would accept and respect her for who she is.
(iv) your suggestions how you can make adjustments to cater to the needs of the child and to facilitate integration of the child / the intervention activity into your classroom.
I will have to go through training in order to have the skills and knowledge on carrying out the intervention successfully especially when using the Mayer-Johnson Symbol card. I would also have to communicate with Annie’s parents and speech therapist to exchange information regarding her development. The information obtained from them could be useful in modifying the intervention if necessary. The family could be inform of this intervention and I would allow them to be involved in the process, provided that they attend the training as well. Apart from doing this intervention during play time, I could also implement it to other lessons as well. This will allow Annie to not only play cooperatively with her peers but work well with them too.
In facilitating the integration of the intervention into my classroom, I would introduce it briefly to the whole class. This is to ensure that every child will get an idea about the intervention and how it can benefit all of them. In order to make it successful, I would ensure that the intervention is done consistently so as children will be familiar with the routine and thus not get distracted by it whenever it is conducted during their lessons.
Reference
Beilinson, J., & Olswang, L. (2003, April). Facilitating Peer-Group Entry in Kindergartners With Impairments in Social Communication. Language, Speech, & Hearing Services in Schools, 34(2), 154. Retrieved September 5, 2009, from Education Research Complete database.
(i) the intervention
What is the intervention about?
The intervention is designed to teach peer-group entry skills to kindergartners with social interaction and communication deficits, especially to those who have specific language impairments (SLI). According to the authors of this article, children with SLI use low-risk behaviors to enter peer group such as hovering, waiting and engaging in parallel play. This approach differs from typically developing children who had no trouble interacting with their peers. They use high-risk behaviors to enter peer group such as making a verbal statement or asking a question to initiate play.
Procedures in the intervention
The child (target child) involved in this intervention chose a friend (host child) that she wanted to try to play with. Each intervention sessions lasted for 45 minutes and it was conducted during free play for 4 afternoons per week. The teachers in the classroom helped in the interaction between the target child and the host child. They also used a sequence of pictorial instructions to initiate play called the Mayer-Johnson Symbol. This instruction illustrates pictures of- (1) Walking to your friend, (2) Watch your friend playing, (3) Get a toy similar to your friend, (4) Do the same thing as your friend and (5) Tell your friend your idea of playing with the toy. These sequences were taught to the target child using direct instructions, modeling and prompting.
The target child was given 2 minutes to initiate play with the host child. If she did not manage to do that, the teacher will then have to follow these levels of prompting to help the target child:
Level 1: No prompt
Level 2: Visual Cue
Using the Mayer-Johnson Symbol mentioned above. If it still does not work, the teacher can then move on to the next level.
Level 3: Non-Verbal Prompt
Teacher shows the toy to target child and say to the host child “It looks like (target child) wants to make a cake with you.”
Level 4: Prop and Verbal Prompt
The teacher can say this to the target child “You could use a (toy) to make a cake just like (host child).”
She can continue to say this to the host child “It looks like (target child) wants to make a cake with you.”
Level 5: Prop and Direct Modeling
The teacher tells target child, “I’m using a (toy) to make a cake like you are.”
She then tells the host child “We’re making cakes just like you (host child).”
At the end of the session, the teacher will record down the children’s name and the transcripts of what they said. The target child will be rewarded with stickers or candy after each entry attempt. She will also be rewarded with a treat from a ‘prize box’.
(ii) its effectiveness (as reported in the journal article)
Results, as written in the article, demonstrated increases in (a) high-risk behavior that the child use, (b) the use of toys and verbal statements to enter peer groups, (c) cooperative play, and (d) time spent interacting with peers. Results also indicated that the child’s behaviors in peer group entry closely resembled those of her typically developing peers. Even after the intervention has ended, the child generally maintained these behaviors on her own. In addition to that, the child who used more non-verbal gestures to initiate play showed an increase in using specific words to describe what she was doing. For instance, instead of “Let’s (doing the action of digging)”, the child is able to say “Let’s dig!” This shows that the intervention did not only improve social interaction between the children but also increases the use of language.
Overall, the children have a change in perception of the target child as they interact more. Thus, they were able to accept and respect the target child for the way she is. Furthermore, the article states that the teachers who were involved in this study find the intervention useful as it can also be implemented to other children as well. Thus, the whole class would benefit from this intervention.
(iii) your personal evaluation how the child will benefit from this intervention
From this intervention, Annie would be guided in using appropriate cues or behaviors when interacting with her peers. Overtime, she would know how to enter a play without disrupting any children as she develops interaction skills. This would promote positive social interaction among them. Hence, it will then minimize the chances of biting and being shy or withdrawn when she is around her peers. This intervention, as stated in the article, could be use on all the children in the class. As Annie has more opportunities to develop positive interactions with her peers, it will result in a change of perception on how they view her. Thus, they would accept and respect her for who she is.
(iv) your suggestions how you can make adjustments to cater to the needs of the child and to facilitate integration of the child / the intervention activity into your classroom.
I will have to go through training in order to have the skills and knowledge on carrying out the intervention successfully especially when using the Mayer-Johnson Symbol card. I would also have to communicate with Annie’s parents and speech therapist to exchange information regarding her development. The information obtained from them could be useful in modifying the intervention if necessary. The family could be inform of this intervention and I would allow them to be involved in the process, provided that they attend the training as well. Apart from doing this intervention during play time, I could also implement it to other lessons as well. This will allow Annie to not only play cooperatively with her peers but work well with them too.
In facilitating the integration of the intervention into my classroom, I would introduce it briefly to the whole class. This is to ensure that every child will get an idea about the intervention and how it can benefit all of them. In order to make it successful, I would ensure that the intervention is done consistently so as children will be familiar with the routine and thus not get distracted by it whenever it is conducted during their lessons.
Reference
Beilinson, J., & Olswang, L. (2003, April). Facilitating Peer-Group Entry in Kindergartners With Impairments in Social Communication. Language, Speech, & Hearing Services in Schools, 34(2), 154. Retrieved September 5, 2009, from Education Research Complete database.
Heng Shi Wen Eda, Group A
Case 1: Intervention to promote Annie’s behavioral and social emotional development
The intervention
The intervention is to involve and teach student self-management, self-monitoring and self-instruction. Self-management refocuses and engages student with disruptive and other behavior problems toward independent behavior control. These interventions can assist students in shifting their contingent behavior from external rewards to intrinsic, natural rewards and consequences, and can support student responsibility and self-control. Self-monitoring involves the student's recognizing and recording designated target behavior(s). Often, one's awareness and counting of target behaviors serve as useful interventions by themselves. Self-monitoring procedures comprise two components: self-observation and self-recording. Self-observation involves the student becoming aware of the presence or absence of the target behavior. Self-recording involves the systematic observation and recording of one's own behavior. Self-monitoring strategies have contributed to the long-term stability of appropriate social responses of students who are inept at reading social situations. Self-instruction consists of covert self-statements to help regulate behaviors that interfere with classroom performance and learning outcomes. Self-instruction is effective in helping students to recall the necessary steps to solve a social or academic problem and is intended to teach individuals ways to restructure maladaptive thoughts and beliefs.
Its effectiveness (as reported in the journal article)
Students who have been taught self-management interventions have successfully generalized their behaviors to other situations and settings reduced disruptive behaviors in both general and special education classrooms and increased appropriate social interactions within and outside the school setting. Several studies have shown that self-monitoring improved classroom behavior of students. Self-monitoring is often recommended and used by practitioners to enhance the acquisition and maintenance of specific skills because self-monitoring has been shown to increase appropriate school behaviors. Self-instruction involves teaching students how to monitor and evaluate themselves and has been used successfully in the SPED settings.
My personal evaluation on how Anna will benefit from this intervention
Having self-management, self-monitoring and self-instruction skills, Anna will enhance independence and responsibility when she is able to independently control her behavior. Being more aware on the presence or absence of the target behavior can motivate her display more appropriate behavior. She will be able to regulate her own behaviors and recall the necessary steps solve social. After all these are seen the teacher will see a great behavior improvement and praise her for her effort. Because of the teacher consistently modeling positive behavior towards Anna and praising her in front of everyone might change Anna’s classmates mindset about her and will see her in a different light. These will increase Anna’s self-esteem and might be more willing to socialize with her friends.
Suggestions
Spend more time with Anna in helping her learn the skills needed to control her behavior. Include a corner in class for Anna to be able to vent her anger and frustration by writing, drawing and listening to the music.
Reference:
Fitzpatrick, M., & Earle, K. (2009). Bringing evidence-based self-directed intervention practices to the trenches for students with emotional and behavioral disorders. Preventing School Failure, 53.4, 253(14). Retrieved from Academic OneFile database.
The intervention
The intervention is to involve and teach student self-management, self-monitoring and self-instruction. Self-management refocuses and engages student with disruptive and other behavior problems toward independent behavior control. These interventions can assist students in shifting their contingent behavior from external rewards to intrinsic, natural rewards and consequences, and can support student responsibility and self-control. Self-monitoring involves the student's recognizing and recording designated target behavior(s). Often, one's awareness and counting of target behaviors serve as useful interventions by themselves. Self-monitoring procedures comprise two components: self-observation and self-recording. Self-observation involves the student becoming aware of the presence or absence of the target behavior. Self-recording involves the systematic observation and recording of one's own behavior. Self-monitoring strategies have contributed to the long-term stability of appropriate social responses of students who are inept at reading social situations. Self-instruction consists of covert self-statements to help regulate behaviors that interfere with classroom performance and learning outcomes. Self-instruction is effective in helping students to recall the necessary steps to solve a social or academic problem and is intended to teach individuals ways to restructure maladaptive thoughts and beliefs.
Its effectiveness (as reported in the journal article)
Students who have been taught self-management interventions have successfully generalized their behaviors to other situations and settings reduced disruptive behaviors in both general and special education classrooms and increased appropriate social interactions within and outside the school setting. Several studies have shown that self-monitoring improved classroom behavior of students. Self-monitoring is often recommended and used by practitioners to enhance the acquisition and maintenance of specific skills because self-monitoring has been shown to increase appropriate school behaviors. Self-instruction involves teaching students how to monitor and evaluate themselves and has been used successfully in the SPED settings.
My personal evaluation on how Anna will benefit from this intervention
Having self-management, self-monitoring and self-instruction skills, Anna will enhance independence and responsibility when she is able to independently control her behavior. Being more aware on the presence or absence of the target behavior can motivate her display more appropriate behavior. She will be able to regulate her own behaviors and recall the necessary steps solve social. After all these are seen the teacher will see a great behavior improvement and praise her for her effort. Because of the teacher consistently modeling positive behavior towards Anna and praising her in front of everyone might change Anna’s classmates mindset about her and will see her in a different light. These will increase Anna’s self-esteem and might be more willing to socialize with her friends.
Suggestions
Spend more time with Anna in helping her learn the skills needed to control her behavior. Include a corner in class for Anna to be able to vent her anger and frustration by writing, drawing and listening to the music.
Reference:
Fitzpatrick, M., & Earle, K. (2009). Bringing evidence-based self-directed intervention practices to the trenches for students with emotional and behavioral disorders. Preventing School Failure, 53.4, 253(14). Retrieved from Academic OneFile database.
Siti Nadiah Bte Abdul Gani (Group A)
(a) The intervention addresses: Communication skills that in turn causes social and behavioral difficulties.
The intervention I would use for Annie’s case would be the Picture Exchange Communication System. From the case study, one of the difficulties Annie displayed was communication skills. Her communication may have been a result of her speech impairment in turn causing social and behavioral problem such as biting her classmate. Therefore, addressing her difficulty in communication skills may assist in reducing her behavioral and social problem as she would be able to gradually learn to verbalize or express her needs or feelings. Moreover, Annie’s 2 hours of speech and language therapy services at the local hospital per week may not be adequate and/or may not address Annie’s difficulty she faces in school.
Picture Exchange Communication System as cited in Ganz, Cook, Corbin-Newsome, Bourgeois and Flores (2005),”… is a picture-based augmentative communication program frequently used with individuals with autism spectrum disorders(ASD) and others who are nonverbal(Frost & Bondy, 2002) (p1).
From my understanding of the article that I have read on, PECS requires the child to exchange pictures in accordance to his or her preferred item. In addition, the process goes through six phases. The phases are picture exchange, increasing distance, picture discrimination, sentences, questions and beyond expansion.
(b) Its effectiveness
In the article, the author included and mentioned other articles by author in regards to the result derived from the use of PECS. To name some, an article by Schwartz, Garfinkle, & Bauer (1998), reported that eighteen children with developmental delay in an integrated preschool were trained with the use of PECS. As a result, Forty-four percent of the
Of the children effectively develop speech. Another article researched by Magiati & Howlin
(2003) mentioned in the article, found that the thirty four children that was taught to use PECS, increased their usage of communicating using PECS and improved their overall levels of communication
As for the authors of this article themselves, the findings and research was based on a child name Elise who had characteristics of autism and difficulty with communication. After conducting the study, the authors noted that Elise did show improvement though it was slight and only reached phase 1. Though Elise improvements were minimal, the authors were inspired and took the opportunity to improve and find variations in using PECS with Elise.
(c) Personal Evaluation
Having read from a few resources, I feel that Picture Exchange Communication Exchange will be beneficial for Annie when the strategy is done consistently and is individualized that would adapt to her. From the article that I read up on, it was stated that PECS did work on the child however required more variations and adaptations so as to suit to the child’s needs. I have learned that PECS is an intervention strategy that can be used with children with difficulty in communication, however, bearing in mind that the process of PECS needs to be consistently assessed and observed so as to ensure that it is working effectively. As PECS has phases, it assists in the clarity and understanding for teachers or adults to effectively use it and document improvements.
I feel that PECS would benefit as it is an opportunity for everyone around Annie to be involved. It can help build an understanding and respect among her peers as they would know what exactly Annie needs. Annie would also gradually learned to be able to express her wants and needs. At the same time, it allows Annie to communicate with her peers and adults without the worry of having to verbalize it. PECS does not replace verbal conversation; however, I feel that it is a first step that can be taken to help Annie’s peers to understand her difficulty and to allow Annie to be socially active with her peers. PECS, in a way, provides another medium for communication.
(d) Suggestion for adjustments
It was mentioned in the article that PECS involves trainer and the child itself. A suggestion for adjustment I would take would be to include friends and families to be part of the system so as to avoid Annie from feeling integrated. By including Annie’s peers, it would also greatly assist Annie to feel belonged and in turn for peers to understand Annie’s situation. This would partly address the issue of Annie’s behavioral and social difficulty. Ultimately, PECS would allow Annie to be able to communicate with her peers through a different medium so as to avoid instances where she would withdraw in class. Gradually, with constant support and guidance, Annie would be able to learn to communicate her needs and feelings through conversations and interactions.
Reference:
Ganz, J. B., Cook, K. E., Corbin-Newsome, J., Bourgeois, B. & Flores, M. (2005) Variations on the Use of a Pictorial Alternative Communication System with a Child with Autism and Developmental Delays. Retrieved on September 8, 2009, from
http://web.ebscohost.com.libwww3.np.edu.sg/ehost/pdf?vid=6&hid=3&sid=7dabdce3-aa84-4670-8894-a0e7aaea2fae%40sessionmgr110
The intervention I would use for Annie’s case would be the Picture Exchange Communication System. From the case study, one of the difficulties Annie displayed was communication skills. Her communication may have been a result of her speech impairment in turn causing social and behavioral problem such as biting her classmate. Therefore, addressing her difficulty in communication skills may assist in reducing her behavioral and social problem as she would be able to gradually learn to verbalize or express her needs or feelings. Moreover, Annie’s 2 hours of speech and language therapy services at the local hospital per week may not be adequate and/or may not address Annie’s difficulty she faces in school.
Picture Exchange Communication System as cited in Ganz, Cook, Corbin-Newsome, Bourgeois and Flores (2005),”… is a picture-based augmentative communication program frequently used with individuals with autism spectrum disorders(ASD) and others who are nonverbal(Frost & Bondy, 2002) (p1).
From my understanding of the article that I have read on, PECS requires the child to exchange pictures in accordance to his or her preferred item. In addition, the process goes through six phases. The phases are picture exchange, increasing distance, picture discrimination, sentences, questions and beyond expansion.
(b) Its effectiveness
In the article, the author included and mentioned other articles by author in regards to the result derived from the use of PECS. To name some, an article by Schwartz, Garfinkle, & Bauer (1998), reported that eighteen children with developmental delay in an integrated preschool were trained with the use of PECS. As a result, Forty-four percent of the
Of the children effectively develop speech. Another article researched by Magiati & Howlin
(2003) mentioned in the article, found that the thirty four children that was taught to use PECS, increased their usage of communicating using PECS and improved their overall levels of communication
As for the authors of this article themselves, the findings and research was based on a child name Elise who had characteristics of autism and difficulty with communication. After conducting the study, the authors noted that Elise did show improvement though it was slight and only reached phase 1. Though Elise improvements were minimal, the authors were inspired and took the opportunity to improve and find variations in using PECS with Elise.
(c) Personal Evaluation
Having read from a few resources, I feel that Picture Exchange Communication Exchange will be beneficial for Annie when the strategy is done consistently and is individualized that would adapt to her. From the article that I read up on, it was stated that PECS did work on the child however required more variations and adaptations so as to suit to the child’s needs. I have learned that PECS is an intervention strategy that can be used with children with difficulty in communication, however, bearing in mind that the process of PECS needs to be consistently assessed and observed so as to ensure that it is working effectively. As PECS has phases, it assists in the clarity and understanding for teachers or adults to effectively use it and document improvements.
I feel that PECS would benefit as it is an opportunity for everyone around Annie to be involved. It can help build an understanding and respect among her peers as they would know what exactly Annie needs. Annie would also gradually learned to be able to express her wants and needs. At the same time, it allows Annie to communicate with her peers and adults without the worry of having to verbalize it. PECS does not replace verbal conversation; however, I feel that it is a first step that can be taken to help Annie’s peers to understand her difficulty and to allow Annie to be socially active with her peers. PECS, in a way, provides another medium for communication.
(d) Suggestion for adjustments
It was mentioned in the article that PECS involves trainer and the child itself. A suggestion for adjustment I would take would be to include friends and families to be part of the system so as to avoid Annie from feeling integrated. By including Annie’s peers, it would also greatly assist Annie to feel belonged and in turn for peers to understand Annie’s situation. This would partly address the issue of Annie’s behavioral and social difficulty. Ultimately, PECS would allow Annie to be able to communicate with her peers through a different medium so as to avoid instances where she would withdraw in class. Gradually, with constant support and guidance, Annie would be able to learn to communicate her needs and feelings through conversations and interactions.
Reference:
Ganz, J. B., Cook, K. E., Corbin-Newsome, J., Bourgeois, B. & Flores, M. (2005) Variations on the Use of a Pictorial Alternative Communication System with a Child with Autism and Developmental Delays. Retrieved on September 8, 2009, from
http://web.ebscohost.com.libwww3.np.edu.sg/ehost/pdf?vid=6&hid=3&sid=7dabdce3-aa84-4670-8894-a0e7aaea2fae%40sessionmgr110
Ery Rosa Indah , Group A
Case 2
The reason why I chose this case study is because I want to find out if ABA approach is suitable to improve on Kim’s social skills.(i) The intervention
The intervention suitable for Kim to improve on her social skills is Applied Behavioral Analysis (ABA). According to Reed, Osborne and Corness (2007) as cited in Link (2008), Applied Behavioral Analysis (ABA) is “based on the behaviorist approach of altering behaviors through systematic, extrinsically reinforced behavior modification and training”. ABA approach is developed and greatly influenced by the philosophies and theories of B.F Skinner who believes in the rewarding and reinforcement system. This intervention approach was considered to be founded by Lovaas, and the approach consists of one-to-one teaching, discrete-trial reinforcement-based method, and an intensive regime of about 40 hours per week, and the intervention can go on for 3 years. ABA is used mostly for children with autism, but it is also widely used to improve on the behavior of children with intellectual disabilities.
For the first year, Link (2008) stated that the intervention mainly focuses on the “reduction of self stimulatory and aggressive behaviors, increasing imitation responses, generating appropriate toy play, and extending treatment into the family”. During the second year, language skills are enhanced, and the appropriate way of communicating and socializing with her peers are also taught. For the third year, the expression of appropriate emotional skills are being taught, and pre-academic tasks such as reading, math, and observing peers engaging in academic tasks (learning through observation) is being taught as well. Additionally, according to Link (2008), the cost of intervention is an estimated $60,000 per year.
(ii) Its effectiveness (as reported in the journal article)
Eldevik, Eikeseth, Jahr and Smith (2006) did a study to find out if low-intensity behavioral treatment or eclectic treatment works better for children with autism and mental retardation. The education team consisting of the supervisor and therapists, and parents, worked closely together in this program, and it is stated that “parental participation was a central part of the program”. For the program, the therapists offered one to one teaching and also served as one to one aides in the unit or classroom. Additionally, they implemented specific low-intensity behavioral interventions, such as teaching peer interaction skills and self-help skills.
The result is, according to the journal, “After 2 years of treatment the behavioral group made significantly larger gains on measures of intellectual functioning, receptive and expressive language, communication skills and behavior pathology.” In addition, there is significant improvement in the degree of mental retardation as stated in the ICD-10 classification criteria, more often in the behavioral group than in the eclectic group.
This shows that the behavioral treatment which was based exclusively on ABA approach, is effective for children with mental retardation. Also considering that Kim has mild mental retardation and that this study is on low-intensity behavioral treatment, it is most possible that the both low-intensity and intensive ABA intervention works for Kim, because also stated in Lovaas (1987) as cited in Eldevik, Eikeseth, Jahr and Smith (2006), “Other studies have reported that almost half of the children receiving intensive behavioral treatment achieved normal intellectual functioning”.
(iii) Your personal evaluation how the child will benefit from this intervention
The ABA approach has a teaching method based on discrete trial discrimination learning and the use of simple commands. When commands are broken down and simplified, Kim will be able to understand better what is needed of her. This encourages Furthermore, negative and undesired behaviors are ignored, while the positive ones are being rewarded and reinforced. Therefore, if Kim continues to shout out loud and throw things around, the behavior will not be acknowledged. However, when Kim displays a positive attitude and complies with simple commands, she will be rewarded and reinforced. This encourages positive behavior that will be able to help her in her social skills.
This intervention will enhance Kim holistically. According to Eldevik, Eikeseth, Jahr and Smith (2006), the intervention may improve the cognitive, language and adaptive functioning of the children. Kim will also be taught on self-help skills and also appropriate peer-interaction. However, Kim will need to go through lots of intensive training and consistent reinforcements to see progress in her development. Slowly, Kim will learn to socialize and communicate positively with her peers, and she will understand that when she has done a good job, she will be rewarded so as to encourage her to display more appropriate behaviors.
(iv) Your suggestions how you can make adjustments to cater to the needs of the
child and to facilitate integration of the child / the intervention activity into
your classroom.
I would start with small things such as simplifying the way I communicate with her. Since it is quite difficult for Kim to understand long commands like “Please go to the toilet and wash your hands”, I would simplify it by saying “Toilet. Wash hands”. I would have to break down the commands so that it is easier for her to understand.
Since the ABA approach is mainly about reinforcements, I would praise her for her positive behavior and actions. I should be consistent with the praises so as to prevent from discouraging her from displaying desired behaviors. For instance, when she speaks to her friends nicely or helps her friends, I would say “Good Job!” or “That’s very nice!”
Also, for the lessons, I would take into consideration her interests as well. Since she is also easily distracted, lessons that interest her will engage her and hold her focus longer. For instance, if she likes music, I would integrate musical elements into the lessons to make the lesson more interesting. However, since she is easily tired because of her medication, the duration of the lessons should be suitable for her so as not to tire her out too much.
Lastly, I would take into account her the attitudes and behaviors of the other classmates towards her. Since she is also learning peer-interaction interaction skills, the way her peers respond to her should not affect her development negatively. Therefore, I feel that the buddy system would be a great idea. Both Kim and her friend can learn more about each other, and her friend can guide her in her learning too. Through this buddy system, her language, communication and social skills will be enhanced through constant communication and interaction with her friends.
References:
Eldevik, S., Eikeseth, S., Jahr, E., & Smith, T. (2006, April). Effects of Low-Intensity Behavioral Treatment for Children with Autism and Mental Retardation. Journal of Autism & Developmental Disorders, 36(2), 211-224. Retrieved September 9, 2009, doi:10.1007/s10803-005-0058-x
Link, S. (2008, June). Applied Behavioral Analysis. Applied Behavioral Analysis -- Research Starters Education, Retrieved September 9, 2009, from Research Starters - Education database.
Nurazura Bte Mohamed Amran (Group A)
CASE STUDY 2:
Area of intervention:
Communication and social skills: To enhance Kim’s communication and social skills so as to minimise disruptive behaviour in class.
(i)The intervention: Music in cooperative learning
Children with mild intellectual disability have difficulties in reading social cues, in exhibiting appropriate turn-taking during conversations, or in engaging reciprocal interactions (Lim & Quah, 2004, p. 329). As a result of not being able to understand others, Kim displays inappropriate/ disruptive behaviours in class as mentioned in the case study.
A study was conducted by Duffy & Fuller (2000) to enhance the communication and social skills of children with mild intellectual disability through the use of music in cooperative learning.
There were five social skills targeted for the intervention: turn-taking, imitation, vocalization, initiation and eye contact.
1. Turn-Taking: This refers to an event involving a sequence of turns to play alternating between the child and the therapist (using jumping frog game).
2. Imitation: This refers to the state where the child spontaneously tries to follow the manner, style, or character of the therapist’s playing, or what the therapist does while engaged in interaction (using the basic OXO magnet board)
3. Vocalization: This refers to an event where the child spontaneously initiates interaction with the therapist, or initiates a change and expects the therapist to follow (through reading a picture book)
4. Initiation of Interaction: This refers to the child’s behaviour in response to the therapist’s initiation of interaction.
5. Eye Contact: This refers to an event where a child looks at the therapist while playing, manipulating, holding, touching toys / instruments, or being engaged with the therapist in any way.
(ii) its effectiveness
According to Duffy and Fuller (2000), “music therapy has been reported to be beneficial in the development of communication and social skills of children with mild intellectual disability (Bunt 1978; Humpal 1991)”. They found that the use of music in the area of intellectual disability is successful to:
· teach self-help skills, recreation skills and social
· increase the capacity of the person with intellectual disability to interact with peers and/or staff.
The article also mentioned that results of music intervention increase the “development of imitation skills, increasing anticipation and providing enjoyment” (Duffy & Fuller, 2000, p.9). It was seen that children with mild intellectual disability begins to turn taking during conversation and relate better to social cues. As a result, there is a decrease in displaying inappropriate / disruptive behaviours by children with mild intellectual disability. Besides, the article mentioned that the programme was equally effective with children who had been returned from special classes to mainstream placement and those who had never attended special classes.
(iii) your personal evaluation how the child will benefit from this intervention
I feel that Kim will benefit from this programme as it develops on her social skills towards her peers. Kim can learn how to communicate and interact with her peers through a fun and enjoying lessons – through music. Besides social skills, music also helps to enhance and facilitate Kim’s speech and language development. Moreover, the activities done in the intervention are seen as a hands-on experience where Kim can explore with her senses. Lastly, research has shown that music programme do significantly help to increase in academic performance as well as promote friendship between students with and without disabilities.
(iv) your suggestions how you can make adjustments to cater to the needs of the child and to facilitate integration of the child / the intervention activity into your classroom.
I feel that music element is a must when planning lessons plans. One suggestion I would like to make is to have music integrated into the curriculum. As Kim is 7 years old, she would be in primary one and as we know that primary school usually focus on academic teaching. Thus, it would be a great improvement if teachers can add music as part of their teaching methods in lessons. Thus, incorporating music in daily lesson can be beneficial to all children and cooperative between peers can also be encouraged. Also, whenever Kim displayed tiredness and signs of distraction, I can use music to help her refocus and redirect her back to the lesson. I can also pair her up with peers to explore music together. In this way, she can learn and imitate social cues from her friends as well.
Reference:
Duffy, B., & Fuller, R. (2000). The role of music therapy in social skills development in children with moderate intellectual disability. Retrieved August 28, 2009, from http://web.ebscohost.com.libwww3.np.edu.sg/ehost/pdf?vid=10&hid=104&sid=2547d404-cc75-4653-8043-0259a7b5974a%40sessionmgr111
Lim, L., & Quah, M. M. (2004). Educating learners with diverse abilities (1st ed.). Singapore: McGraw-Hill Education.
Other reading:
Jackson, R. (2007). Music activities initiated by staff within services for people with intellectual disability. Retrieved, September 2, 2009, from http://web.ebscohost.com.libwww3.np.edu.sg/ehost/pdf?vid=7&hid=3&sid=87a92fef-d9c9-435b-ab11-dcc43556ba6b%40sessionmgr111
Area of intervention:
Communication and social skills: To enhance Kim’s communication and social skills so as to minimise disruptive behaviour in class.
(i)The intervention: Music in cooperative learning
Children with mild intellectual disability have difficulties in reading social cues, in exhibiting appropriate turn-taking during conversations, or in engaging reciprocal interactions (Lim & Quah, 2004, p. 329). As a result of not being able to understand others, Kim displays inappropriate/ disruptive behaviours in class as mentioned in the case study.
A study was conducted by Duffy & Fuller (2000) to enhance the communication and social skills of children with mild intellectual disability through the use of music in cooperative learning.
There were five social skills targeted for the intervention: turn-taking, imitation, vocalization, initiation and eye contact.
1. Turn-Taking: This refers to an event involving a sequence of turns to play alternating between the child and the therapist (using jumping frog game).
2. Imitation: This refers to the state where the child spontaneously tries to follow the manner, style, or character of the therapist’s playing, or what the therapist does while engaged in interaction (using the basic OXO magnet board)
3. Vocalization: This refers to an event where the child spontaneously initiates interaction with the therapist, or initiates a change and expects the therapist to follow (through reading a picture book)
4. Initiation of Interaction: This refers to the child’s behaviour in response to the therapist’s initiation of interaction.
5. Eye Contact: This refers to an event where a child looks at the therapist while playing, manipulating, holding, touching toys / instruments, or being engaged with the therapist in any way.
(ii) its effectiveness
According to Duffy and Fuller (2000), “music therapy has been reported to be beneficial in the development of communication and social skills of children with mild intellectual disability (Bunt 1978; Humpal 1991)”. They found that the use of music in the area of intellectual disability is successful to:
· teach self-help skills, recreation skills and social
· increase the capacity of the person with intellectual disability to interact with peers and/or staff.
The article also mentioned that results of music intervention increase the “development of imitation skills, increasing anticipation and providing enjoyment” (Duffy & Fuller, 2000, p.9). It was seen that children with mild intellectual disability begins to turn taking during conversation and relate better to social cues. As a result, there is a decrease in displaying inappropriate / disruptive behaviours by children with mild intellectual disability. Besides, the article mentioned that the programme was equally effective with children who had been returned from special classes to mainstream placement and those who had never attended special classes.
(iii) your personal evaluation how the child will benefit from this intervention
I feel that Kim will benefit from this programme as it develops on her social skills towards her peers. Kim can learn how to communicate and interact with her peers through a fun and enjoying lessons – through music. Besides social skills, music also helps to enhance and facilitate Kim’s speech and language development. Moreover, the activities done in the intervention are seen as a hands-on experience where Kim can explore with her senses. Lastly, research has shown that music programme do significantly help to increase in academic performance as well as promote friendship between students with and without disabilities.
(iv) your suggestions how you can make adjustments to cater to the needs of the child and to facilitate integration of the child / the intervention activity into your classroom.
I feel that music element is a must when planning lessons plans. One suggestion I would like to make is to have music integrated into the curriculum. As Kim is 7 years old, she would be in primary one and as we know that primary school usually focus on academic teaching. Thus, it would be a great improvement if teachers can add music as part of their teaching methods in lessons. Thus, incorporating music in daily lesson can be beneficial to all children and cooperative between peers can also be encouraged. Also, whenever Kim displayed tiredness and signs of distraction, I can use music to help her refocus and redirect her back to the lesson. I can also pair her up with peers to explore music together. In this way, she can learn and imitate social cues from her friends as well.
Reference:
Duffy, B., & Fuller, R. (2000). The role of music therapy in social skills development in children with moderate intellectual disability. Retrieved August 28, 2009, from http://web.ebscohost.com.libwww3.np.edu.sg/ehost/pdf?vid=10&hid=104&sid=2547d404-cc75-4653-8043-0259a7b5974a%40sessionmgr111
Lim, L., & Quah, M. M. (2004). Educating learners with diverse abilities (1st ed.). Singapore: McGraw-Hill Education.
Other reading:
Jackson, R. (2007). Music activities initiated by staff within services for people with intellectual disability. Retrieved, September 2, 2009, from http://web.ebscohost.com.libwww3.np.edu.sg/ehost/pdf?vid=7&hid=3&sid=87a92fef-d9c9-435b-ab11-dcc43556ba6b%40sessionmgr111
Nur Tahirah Bte Abdul Latiff, Group A
Case 1 - Annie, 6 years old
Area of intervention - Problem Behavior
(i) the intervention
Problem behavior or challenging behavior is defined as "any repeated pattern or behavior, or perception of behavior, that interferes with or is at risk of interfering with optimal learning or engagement in prosocial interactions with peers of adults" (Smith & Fox as cited in Jollivete, Gallagher, & Morrier, 2008, p. 78).
Young children like Annie, "may have primary behavior problems or behavior problems as a secondary condition of a disability" (Jollivate et. al., 2008, p. 78). This may lead to peer rejection by her friends or even viewed as a "problematic child" by her teachers.
To intervene such behaviors from recurring, Jollivate et. al. (2008) recommend two intervention strategies:
1. positive behavior support, and
2. choice-making
Positive behavior support focuses on the child's positive bevaviors. This includes a behavioral chart which functions like a reward system. When positive behaviors are displayed, rewards are given to encourage the desired behaviors.
Providing choice-making offers predictability in the child's schedule. Choice-making opportunities can be embedded into the child's daily routines. This helps them to experience and have a better understanding on the natural consequences of their actions.
(ii) it’s effectiveness
Several studies conducted on the effects of positive behavior support found "highest levels of engagement and lowest levels of problem behaviors during the intervention phases" (Duda, Dunlap, Fox, Lentini & Clarke as cited in Jollivate et. al., 2008, p. 83).
Also, "the results indicated that the referral rates due to problem behaviors decreased, children adjusted to classroom routines better, and children adhered to the rules" (Fox, Jack & Broyles as cited in Jollivate et al., 2008, p. 83).
In addition, Fox et al. (as cited in Jollivate et. al., 2008) reported "improved center climate, were able to discontinue the use of time-out, and improved the delivery and use of other interventions and strategies" (p. 83).
"Providing young children who display problem behavior with opportunities to make choices... is a strategy that has been proven to decrease problematic behavior." (Peck, Wacker, Berg, Cooper, Brown & Richman as cited in Jollivate et. al., 2008, p. 84).
According to Jollivate et. al. (2008), the effects of choice-making results in eight postive outcomes from the child (p. 84):
1. promotes independence
2. self-monitoring of appropriate behaviors
3. improved sense of control over the environment
4. active participation in the environment
5. improved performance
6. increased sense of well-being
7. connections between natural consequences and responsibility are made, and
8. decrease in inappropriate behaviors.
(iii) your personal evaluation on how the child will benefit from this intervention
I believe choice-making will help Annie to develop a sense of control and independance over the environment. However, I believe due to the facial deformities that Annie has, she is more likely to feel insecure and thus seeks high attention from her teachers and peers. Hence, when rewarded for her positive behaviors, I believe it will boost Annie's morale and sense of worth.
To aim for higher attention, Annie may repeat the positive behavior. As Annie gain higher attention from her teachers and peers, I believe her confidence will increase. Eventually, she will seek to understand that positive behaviors equates to higher attention. Therefore, I believe Annie benefit more from positive behavior support as compared to choice-making.
(iv) your suggestions how you can make adjustments to cater to the needs of the child and to facilitate integration of the child / the intervention activity into your classroom.
Though Annie displayed inappropriate behaviors such as biting, I believe her peers too are equally displaying inappropriate behaviors. I believe they are responsible for Annie's inappropriate behavior as they were teasing her of her facial deformities. Hence, the positive behavior support or behavioral chart can also be used on Annie's peers.
To facilitate integration of Annie and the intervention activity into the classroom, I can create a "Our positive behavioral chart" for all children in the class. The chart can be mounted on the classroom board or wall for the entire class to practice positive behaviors.
References
Jolivette, K., Gallagher, P. A., Morrier, M. J., Lambert, R. (2008). Preventing problem behaviors in young children with disabilities. Exceptionality, 16(2), 78-92. DOI:10.1080/09362830801981195
Area of intervention - Problem Behavior
(i) the intervention
Problem behavior or challenging behavior is defined as "any repeated pattern or behavior, or perception of behavior, that interferes with or is at risk of interfering with optimal learning or engagement in prosocial interactions with peers of adults" (Smith & Fox as cited in Jollivete, Gallagher, & Morrier, 2008, p. 78).
Young children like Annie, "may have primary behavior problems or behavior problems as a secondary condition of a disability" (Jollivate et. al., 2008, p. 78). This may lead to peer rejection by her friends or even viewed as a "problematic child" by her teachers.
To intervene such behaviors from recurring, Jollivate et. al. (2008) recommend two intervention strategies:
1. positive behavior support, and
2. choice-making
Positive behavior support focuses on the child's positive bevaviors. This includes a behavioral chart which functions like a reward system. When positive behaviors are displayed, rewards are given to encourage the desired behaviors.
Providing choice-making offers predictability in the child's schedule. Choice-making opportunities can be embedded into the child's daily routines. This helps them to experience and have a better understanding on the natural consequences of their actions.
(ii) it’s effectiveness
Several studies conducted on the effects of positive behavior support found "highest levels of engagement and lowest levels of problem behaviors during the intervention phases" (Duda, Dunlap, Fox, Lentini & Clarke as cited in Jollivate et. al., 2008, p. 83).
Also, "the results indicated that the referral rates due to problem behaviors decreased, children adjusted to classroom routines better, and children adhered to the rules" (Fox, Jack & Broyles as cited in Jollivate et al., 2008, p. 83).
In addition, Fox et al. (as cited in Jollivate et. al., 2008) reported "improved center climate, were able to discontinue the use of time-out, and improved the delivery and use of other interventions and strategies" (p. 83).
"Providing young children who display problem behavior with opportunities to make choices... is a strategy that has been proven to decrease problematic behavior." (Peck, Wacker, Berg, Cooper, Brown & Richman as cited in Jollivate et. al., 2008, p. 84).
According to Jollivate et. al. (2008), the effects of choice-making results in eight postive outcomes from the child (p. 84):
1. promotes independence
2. self-monitoring of appropriate behaviors
3. improved sense of control over the environment
4. active participation in the environment
5. improved performance
6. increased sense of well-being
7. connections between natural consequences and responsibility are made, and
8. decrease in inappropriate behaviors.
(iii) your personal evaluation on how the child will benefit from this intervention
I believe choice-making will help Annie to develop a sense of control and independance over the environment. However, I believe due to the facial deformities that Annie has, she is more likely to feel insecure and thus seeks high attention from her teachers and peers. Hence, when rewarded for her positive behaviors, I believe it will boost Annie's morale and sense of worth.
To aim for higher attention, Annie may repeat the positive behavior. As Annie gain higher attention from her teachers and peers, I believe her confidence will increase. Eventually, she will seek to understand that positive behaviors equates to higher attention. Therefore, I believe Annie benefit more from positive behavior support as compared to choice-making.
(iv) your suggestions how you can make adjustments to cater to the needs of the child and to facilitate integration of the child / the intervention activity into your classroom.
Though Annie displayed inappropriate behaviors such as biting, I believe her peers too are equally displaying inappropriate behaviors. I believe they are responsible for Annie's inappropriate behavior as they were teasing her of her facial deformities. Hence, the positive behavior support or behavioral chart can also be used on Annie's peers.
To facilitate integration of Annie and the intervention activity into the classroom, I can create a "Our positive behavioral chart" for all children in the class. The chart can be mounted on the classroom board or wall for the entire class to practice positive behaviors.
References
Jolivette, K., Gallagher, P. A., Morrier, M. J., Lambert, R. (2008). Preventing problem behaviors in young children with disabilities. Exceptionality, 16(2), 78-92. DOI:10.1080/09362830801981195
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