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   Jan van Dijk, PhD, Catherine Nelson, PhD - APH For use at AER Conference March 2012 1

      Developmental Skills using tools such as INSITE, HELP, Callier Qualitative Aspects (biobehavioral states, sensory channels) Vision (Functional Vision Assessment, CVI Range) Communication Matrix Write a case story about the child Progress on IFSP/IEP goals 2

8 observation areas to conduct assessment: 1.

Behavioral state 2.

Orienting response Learning channels 4.

Approach – Withdrawal Memory Social Interactions Communication Problem Solving 3

Prior to Assessment: interview Beginning the Assessment: respect/adapt environment, emotions, interests and respond to behaviors.

Establish a Routine – turn-taking conversation and anticipation Modifying Routine- add dilemma, delay your response, observe arousal patterns, create learning experiences.

7 Y.O., HIGH MYOPIA, CVI AND UNDETERMINED HEARING LOSS. VOCALIZES, NO WORDS, WOLF HIRSCHHORN SYNDROME 25 MONTHS WITH ZELLWEGER (DEGENERATIVE), LP, VERY TIRED, DID HAVE WORDS.

   Controlled by internal needs and external environment Children with impairments of the CNS have difficulty moving smoothly between states and controlling/maintaining their states These children may become easily over stimulated and agitated if there with too much stimuli or move into a sleep state to protect themselves.

    Ensure the child is mostly in either a quiet awake or active awake – optimal learning Gather info about the variety of states, sleep patterns, wake patterns.

Watch the child for signs of overstimulation (examples?).

CRIB – Carolina Record of Individual Behavior 8

a.m.

7:30 8:00 8:30 9:00 9:30 10:00 10:30 11:00 11:30 p.m.

12:00 12:30 1:00 1:30 2:00 2:30 3:00 3:30 4:00 4:30 p.m.

Comments Sunday Monday Tuesday Wed Thursday Friday Saturday Sunday Monday Tuesday Wed Thursday Friday Saturday Directions: Mark the state the child was predominantly in at the end of each half hour interval. Refer to the attached handout for a description of the states and examples of comments.

0 - Seizure 1 - Deep Sleep 2 – Intermediate Sleep 3 – Active Sleep 4 – Drowsiness 5 - Quiet Awake 6 - Active Awake 7 – Fussy Awake 8 – Mild Agitation 9 – Uncontrollable Agitation Adapted from the Carolina Record of Individual Behavior (CRIB) Rune J. Simeonson 10

  What behavioral state is Hannah in during clips 1 and 2?

In what states do you see Brian? How does he control his state and protect himself?



Repetition soothes, variety awakens calming stimuli (slow, rhythmic, firm, warm) vs. arousing (fast, irregular, bright, cool, irregular rhythm an varied vocal patterns)

  Crucial to information gathering and learning (Als et al., 1976, Richards and Richards, 1997, Van Dijk, 1997) Determine by our internal state  Too much? Too little?

 Consider:  Type of stimuli that gathers attention     Intensity or strength that attract Sensory channels used to gather info Sensory channels to show that he is orienting The child’s behavioral state

Hannah – 1 and 6, Brian 5 and 9 worksheet review

    Bring the child’s state up to an awake level Present stimuli in a way they can perceive – limit to one stimulus to start.

Highlight and draw attention for them Incrementally add more stimuli, watching for overload 14

   • Observe child’s orienting responses carefully to see which sensory stimuli attract attention.

Ask others for a list of what they have seen the child respond to Watch for responses to: 

Vision, Sound, Touch, Vibration, Movement

Do they use more than one sense at a time?

Engaging vs. disengaging?

Routine vs. novel

  Which learning channels does Hannah use in this video clip and what sensory channels does she use to respond. How does she respond when the tie goes from side to side rather than up and down?

How does Brian respond to the voice of the assessor and then how does he respond to the voice of his mom? Which learning channels does he us and which does he use to exhibit responses?

  Build on sensory strengths and plan learning around those.

Pair weaker sense with a stronger one.

 Likes = Approaches – Starting points for building routines  vs. Dislikes = Withdraws 18

 Filtering out what is meaningful and what doesn’t need attention.  Info must be processed and compared to what we have previously learned   Neutral stimuli – change attention to something more important if stimulus is familiar or neutral Minimally aware of the habituated one unless it changes (child’s cat) – dehabituation.

  Does the child turn their attention from an oriented stimulus to another?

How long (how many times) does the stimulus need to be presented?

  Does the child attend again if features change?

Does the child have different reactions to different stimuli?

 Hannah   Why did she turn away?

How long before she habituated?

  Did she return attention or dishabituate with the singing?

What would you suggest for intervention?

Clip 7 - What techniques is Dr. van Dijk using to help her develop object permanence?

 Brian

Clip 4 -What happens when mom begins to talk?

Clip 11 – to which of the stimuli is Brian attending?

Clips 10 & 11 – what does Brian do when the balloon is no longer within reach of his hands?

    Provide increased time Highlighting the important features and pointing them out = generalization and discrimination Information presented in context – within complete schemes and not fragments Eliminate extraneous stimuli (auditory or visual, i.e.) as needed.

     Cry brings mom Phone ringing may interrupt this Unpredictable environment but mom still exists even if out of sight Crying bring her back.

Mom’s footsteps = goood  Phone ringing = opposite  Child learns communication through the intentional use of crying 25

  Infant may not see or hear mom coming = difficulty learning object permanence.

Doesn’t hear the phone and doesn’t see his mother walk away, cries failed=unpredictable, scary environment :O( 26

    

ROUTINES -

key is the establishment of predictable and interest ones Pause – let the child communicate a desire for routine to continue Mismatch or surprise added to see how well routine was learned Discontinue –assesses memory of the routine and then come back.

**Memory Observation Checklist**

 Hannah –      clip 5 What stimulus does H initially use to follow the routine of the tie moving?

As the routine continues, what does she use?

At the end, how does Hannah demonstrate anticipation?

How does she react to the mismatch of tie on head?

What does this indicate about Hannah’s functional use of objects?

 Establish consistent and understandable chains or routines which are based on child’s interest.

 Begins with imitating what the child does and expand.

 At each step, the child should be given opportunities to demonstrate anticipation – slowly Daily activities = important context for learning routines.

Routines = complete activities which include preparation, the activity, clean up, and transition (i.e., calendar boxes or schedules).

 Secure attachment can be threatened by:  Time in the NICU      Health problems lower interactions If arousal is low and awake states low, no time Too high of arousal and they are overstimulated Unusual or difficult to read communications Limited ability for the child to read caregiver cues.

   Interest in human faces and voices Examine attachment (separation) Ability to engage in turn-taking interactions.

   What do you think about Hannah’s attachment with her mother?

(clip 8) Why is it important that she reaches out and touches Dr. VanDijk?

(clip 3) Does Hannah take her turn , if so, what does she do when it is her turn?(clip 4)   How does Brian take his turn? (clip7) Does Brian initiate new actions?

   Should involve caregivers – the need assistance as they learn to read their child’s unusual social and communicative cues and then adjust their behavior according to the child’s cues. Learning the nuances of the child’s behavior and emotions is increased as proximity to the child increases (van Dijk, Carlin & Hewitt, 1991).

Caregiver should follow each of the child’s movements and the pause to allow the child to take a turn. Read the child for engagement and disengagement.

When disengagement occurs, caregiver should give him a break to avoid overstimulation 33

Look at Early Communication

http://www.designtolearn.com/pages/m atrix.html

Project PLAI By Deborah Chen Video and Manual on Developing Early Communication with Infants and Toddlers who are Deafblind Assessing Communication and Learning in Young Children who are Deafblind or Who Have Multiples Disabilities Design to Learn 39

       Choices Enjoyable , motivating Intent behind all Look at behavior before and after Wait time Need Start-stop technique 40

  Respond to all attempts – if not reinforced, they will fade away or be replaced by unwanted communication Take time, carefully observe and try to understand communicative meanings behind a child’s behaviors (Durand and Crimmins, 1998) 41

 Warm communicative environment – communication partners are sensitive to each other and pause to allow the partner to take his turn - child with MD may take longer to process    Routines facilitate communication – they give the partners a shared subject/topic – calendars, not just for transition.

Nonsymbolic as well as symbolic – should continue after symbolic comm is established Communication is NEVER separate from other developmental areas.

 Previous skills are also used in problem solving.     Must be alert and aware Maintain attention Integrate previously learned info into schemes Cause and effect 43

     Begin a routine and then stop to create a need for a child to begin it again.

After they are comfy, add a dilemma.

Provide enough time See how long the child persists and what techniques they use to solve.

Problem Solving Worksheet Hannah – clip 6  does she attempt to solve the problem of tie on head?

 does she persist?

Brian – clip 5   what leads you think that Brian understand cause and effect?

which of the techniques that Brian uses demonstrates a beginning concept of means-end?

    Be sure there is a need to practice skills They could acquire the “good fairy syndrome” when things are brought and taken easily away.

These children could become very passive.

As they are actively involved this syndrome can be cured easily if they are involved in ALL stages of activities.

Child:

Position #1 Supine #2 Prone #3 Sidelying #4 Sitting State Initial Changes Main Initial Changes Main Initial Changes Main Initial Changes

Main

Leg Mouth

Date: Adapted from Every Move Counts Observer:

Eye Ear Cheek Chin Neck Head

Location:

Arm Shoulder Hand Foot Other IFSP/IEP Summary Activities for this Position Staff State Observations Position Supine Prone Side Sitting Voluntary/Intentional Movements Possible in this Position

     Discuss child’s medical conditions and treatment, results, prognosis.

Discuss interventions, team involved, how often seen and by whom.

Share family’s story and impressions. How would child be different without EI? How would family life be different without EI?

Discuss what child was like in the beginning, how he/she changed, what doing now; the progress.

Discuss child strengths, concerns, etc.