Transcript Document

Applying a
Transdisciplinary Team
Approach to the
Systematic Instruction
of Pivotal Milestones
Bruce, S., Vargas, C., Davidson, S., Sullivan, M., &
Sikarova, R., Boston College
Pivotal Milestones Associated
with Symbolic Expression &
Representational Thought
 Imitation
 Object
 Joint Attention
Permanence
 Means-End
 Self-Recognition
 Discrimination-
Categorization
Study Phases
Phase I: Literature Review on 6
pivotal milestones, systematic
instruction, & transdisciplinary
teaming
Phase II: Analysis of Commercial
Assessment Tools appropriate for
children with severe/multiple disabilities
& Development of Informal Structured
Assessments on each milestone
Phase III: Assessment of 15 children with
severe/multiple disabilities (including 6
with visual impairment & 2 who are
deafblind) using 2 commercial
assessments & 1 informal structured
assessment on each selected milestone
Lesson Plans developed by team
consensus (teachers & related service
professionals)
Phase IV: Instruction
5X weekly per child on each milestone
Data collected each time lesson was
taught by teacher and 2 related
service professionals (SLP, OT, PT)
Video evidence for baseline + every 4
weeks per child & milestone
instructed
Commercial Assessments Analyzed
Identified Each Item that Measured Each of
the 6 Milestones

Developmental
Assessment for
Individuals with Severe
Disabilities (DASH 2)
 Developmental
Activities Screening
Inventory (DASI-II)
 INSITE
 Caller-Azusa-Scale G
 Oregon Project for
Visually Impaired &
Blind Preschool
Children





Carolina Curriculum for
Infants/Toddlers with
Special Needs
Assessment,
Evaluation, and
Programming for Infants
and Children (AEPS)
Early Learning
Accomplishments
Profile (ELAP)
Vulpe (revised)
Hawaii Early Learning
Profile (HELP)
Participant Results Shared Today
Nicholas: Means-End
Jamie: Object Permanence
Winston: Discrimination (of objects &
different actions on objects)
Leah: Joint Attention & Discrimination
(of different actions on objects)
Jack: Means-End
*does not include video analysis
Prompt/Performance Levels
H/H: hand over hand
H/H-C: hand over hand,
continuous (T=teacher
initiated, S = student
initiated)
H/H-F: hand over hand,
frequent
H/H-I: hand over hand,
intermittent (PO = point,
PU = push, PO&PU=
point & push)
P = physical prompt
MO = moving object
prompt
M = model
G = gesture prompt
V = verbal prompt
I = independent
N = no response
R = refusal
Nicholas
Age at baseline film: 4 years, 11 months
Disability Characteristics: Microcephaly, global
developmental delays, failure to thrive, possible
autism, (normal vision & hearing, ambulatory)
Assessment Results: Moves around an obstacle,
pushes other objects away to get to desired object,
inverts containers to get object out (e.g. he exhibits
some means-end behaviors)
Lesson: Means-end: #1: Push “red man” to expel
car; Lesson #2: Pick up, place and push “red man”
Nicholas: Means-End
Push "Red Man"
100
90
80
Percentage
70
H/H-C
M
V
I
60
50
40
30
20
10
0
April
May
June
Month
July
Nicholas: Means-End
Behavior#1: Pick up "Red Man"
100
90
H/H-C
P
M
G
V
I
R/N
70
60
50
40
30
20
10
Month
No
ve
m
be
r
De
ce
m
be
r
ob
er
O
ct
Ju
ly
Ju
ne
M
ay
0
Ap
ril
Percentage
80
Nicholas: Means-End
Behavior #2: Place and Push "Red Man"
100
90
80
Percentage
70
H/H-C
P
G
V
I
R/N
60
50
40
30
20
10
0
May
June
July
October
Month
November December
Nicholas
Key Findings:
Lesson #1: Push “red man” (after adult
places): Achieved with modeling in the first
month.
Lesson #2, Behavior #1: Pick up “red man:”
Started at 0% independence, achieved 69%.
independence
Behavior #2, Place & push “red man:”
Started at 0% independence, achieved 69%
independence
Jamie
Age at baseline: 5 years, 8 months
Disability Characteristics: Multiple congenital
anomalies, microcephaly, developmental delays,
visual impairment (20/90), frequent ear infections
(6+ this year), urinary tract infections (3+ this year),
non-ambulatory
Assessment Results: Can find a partially hidden object
IF she sees it hidden
Lesson: Object permanence: Lesson #1: Using different
covers; Lesson #2: Solving A-B error
Jamie: Object Permanence
Locating Object with Sound Cue
100
90
80
Percentage
70
H/H-C
P
G
V
I
R
60
50
40
30
20
10
0
March
April
May
Month
June
Jamie: Object Permanence
A-B Error with Intermittent Sound Cue
100
90
80
Percentage
70
60
P
I
R
M
50
40
30
20
10
0
July
September
October
Month
November
December
Jamie
Key Findings:
Lesson #1: Locating object with sound cue
Able to perform with independence at 39% of
opportunities, additional success with just verbal or
gestural cue. Moved to Lesson #2: A-not-B Error after
4 months.
Lesson #2: A-not-B error: Achieved independence
72-100%. May have reached satiation.
Leah
Age at baseline: 7 years, 0 months
Disability Characteristics:Trisomy 18, congenital
cardiac disease, bronchial malacia, seizures,
20/190 vision, moderate-severe hearing loss,
hypertonia in extremities, hypotonia
Assessment Results: Very attentive to people,
but very seldom to objects. Does same action on
all objects-batting/forceful tapping.
Lesson: Joint attention with adult and over
object, discrimination of different actions on 3
different objects
Leah: Joint Attention
Eye Contact with Adult
100
90
70
60
G/V
V
I
50
40
30
20
10
Month
De
ce
m
be
r
No
ve
m
be
r
O
ct
ob
er
be
r
Se
pt
em
Ju
ly
Ju
ne
0
M
ay
Percentage
80
Leah: Joint Attention
Eye Contact with Object
100
90
70
P
G
V
MO
I
60
50
40
30
20
10
Month
De
ce
m
be
r
No
ve
m
be
r
O
ct
ob
er
be
r
Se
pt
em
Ju
ly
Ju
ne
0
M
ay
Percentage
80
Leah: Discrimination
Action on Pop Tube
100
90
70
60
H/H-C/T
H/H-C/S
50
40
30
20
10
Month
No
ve
m
be
r
De
ce
m
be
r
O
ct
ob
er
be
r
Se
pt
em
Ju
ly
Ju
ne
0
M
ay
Percentage
80
Leah: Discrimination
Action on Gumball Machine Toy
100
90
H/H-C
H/H-I
P
M
G
V
I
N
70
60
50
40
30
20
10
Month
No
ve
m
be
r
De
ce
m
be
r
O
ct
ob
er
be
r
Se
pt
em
Ju
ly
Ju
ne
0
M
ay
Percentage
80
Leah: Discrimination
Action on Pop-Up Toy
100
90
70
H/H-C
H/H-I:PO
H/H-I:PU
H/H-I:PO & PU
P
60
50
40
30
20
10
No
ve
m
be
r
De
ce
m
be
r
ob
er
O
ct
be
r
Se
pt
em
Ju
ly
Ju
ne
0
M
ay
Percentage
80
Month
Leah
Key Findings:
Behavior #1: Joint Attention - eye contact with
adult
Achieved 90-100%-maintained existing skill
Behavior #2: Joint attention - visual attention to
object
Achieved over 80% independent for 3 months
Behavior #3: Discrimination - action on pop tubecoactive
Decreased need for hand-over-hand/continuous
Leah
Key Finding, continued:
Behavior #4: Discrimination - action on gumball
machine toy
Started at 0% independence, achieved 50%
Behavior #5: Discrimination - action on pop-up toy
Reduced need for hand-over-hand/continuous
Winston
Age at Baseline: 8 years, 6 months
Disability Characteristics: Isodicentric 15,
mitochondrial disorder, seizures, severe developmental
delays, hypotonia (non-ambulatory), vision loss (20/400),
hearing loss-inconsistent response to sounds
Assessment Results: Looks toward lighted objects and
a few highly reflective surfaces. Immediately opens mouth
in feeding (anticipation).
Lesson: Discrimination of objects and actions on
actions in a controlled play space
Winston: Discrimination of Objects
Measured by Intentional Acts on Objects in a Structured
Play Space
100
90
80
Look
Percentage
70
Touch with
Hand
60
50
Look &
Touch
40
30
20
10
0
Cups
Ball
Red Mylar
Red Pompon
Object
Green Pompon
Slinky
Winston
Key Findings: Most intentional behavior was on
(a) red mylar and (b) green pompom
He located these 2 items even when placed l/3 - 1/2
way into play space.
Further analysis of video revealed that he
differentiated “green pompom” for combination of
touch and taste.
Jack
Age at baseline: 10 years, 11 months
Disability Characteristics: microcephaly,
hydrocephalus, global developmental delays,
diabetes, seizures, adrenal gland insufficiency,
cerebral palsy, mild unilateral hearing loss
Assessment Results: Purposeful reach, will work
to access object out of reach or when obstacle is
present, doesn’t yet request adult assistance
Lesson: Solving means-end problems-push
down and push up on remove control car control
Jack: Means-End
Reach Toward Remote Control
100
90
80
Percentage
70
H/H
P
G
V
I
60
50
40
30
20
10
0
May
June
July
October
Month
November
December
Jack: Means-End
Push Down
100
90
80
Percentage
70
H/H
P
G
V
I
60
50
40
30
20
10
0
May
June
July
October
Month
November
December
Jack: Means-End
Push Up
100
90
80
Percentage
70
H/H
P
I
R
60
50
40
30
20
10
0
May
June
July
October
Month
November
December
Jack
Key Findings:
Behavior #1, Reach toward remote control:
Independence reduced from 100% to 59%. Was it
novelty effect? Did he decrease after learning that
behavior #3 was difficult?
Behavior #2, Means-End-Push down on remote
control:
Started at 100%, regressed to 68% in 3rd month,
improved in 4th-6th, resulting in 100% again in 6th
month (teacher reports that he typically exhibits ups and
downs in performance)
Jack
Key findings, continued
Behavior #3, Means-End-Push up on remote
control: Still requires hand-over-hand support,
but has learned to request by reaching for adultafter trying to “push down” (see video)
This marks means-end achievement at trial & error
level.
*Application: Jack is now enjoying a trial on an
electric wheelchair
Dissemination
Bruce, S. & Zayyad, M. (in press). Assessment and
instruction of self-recognition. TEACHING
Exceptional Children.
In Progress:
Bruce, S. & Zayyad, M. (in revision). The development
of object permanence in children with severe
disabilities.
Bruce, S., Campbell, C. & Sullivan, M. Supporting
children with severe disabilities to achieve
means-end.
Bruce & others: Articles on analysis of commercial
assessment tools, discrimination-categorization findings,
Imitation findings and joint attention (including non-visual
JA) findings.
Other Materials at Our Display
Informal Structured Assessments (also
in handouts)
 Lesson Plans on all 15 children
 Video sampling of lessons on the 5
featured children (see desktop folders)
 List of materials used in the lessons
with ordering information
