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Understanding and Integrating Developmental Pathway Case Studies Analysis

Case Studies Analysis Project, Part 1
My focus child is a boy named Tom Lee. He is 27 months old. In August 2013,
Tom began attending preschool in the Northern Virginia area. Tom has an intact
nuclear family. He lives with his parents, and they are a close-knit group. The parents
are not only carefully taking care of him, but also working hard. Even though Tom
does not have any siblings, he still has a big family because his family lives with
another family together in the same house. Toms primary language is Spanish even
though he was born in the United States. His parents speak Spanish with him at home,
but he studies English at school.
Tom has a developmental delay, and receives preschool special education services.
His special education eligibility is based on assessments that were conducted through
early intervention services by an early childhood education teacher, speech and
language therapist and occupational therapist in the home. When Tom was 18 months
old, his mother found that he was still babbling and could not speak in single or whole
words to communicate. Moreover, his mother noticed that Tom had a problem with
chewing. It was difficult for him to eat solid food. Therefore, Toms mother applied
for an assessment with the Early Childhood Assessment Team (ECAT). With goals for
assessing speaking, playing, and feeding, three teachers did a test with Tom using a
language game and toys. In addition, they did a hearing test with Tom. Based on the
result of the assessment, they decided that Tom has a delay in communication. Both
parents and the teacher think the chewing problem is evidence of oral muscle
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difficulty that causes communication delay. His hearing test was normal. In order to
help Tom fully benefit from educational experiences in the future, Toms mother
contracted with a professional early-English teacher to work with him at home until
Tom started at the preschool.
Tom has gone to the preschool for more than two months now. According to his
teacher, Tom currently has about 20 words in his vocabulary. He can say more juice,
eat, cracker, milk, up, here, want, and help etc. Tom is a little bit shy.
He seldom verbally communicates with others, but he understands names of familiar
people and objects, follows teachers instruction and responds nonverbally to simple
questions. For example, when the teacher asked him how many pumpkins are there
on the ground?, he answered the question nonverbally by showing his five fingers.
He also knows how to pretend with objects. For instance, he picked up an apple from
the tree and pretended to taste it. Besides that, Tom can hold books right side up and
recognize a favorite book by the cover. He also does random scribbling with chalk.
When he is in the activity room, he enjoys playing with other children. Tom likes to
listen to a story being read, and to select a book and pretend to read it. Sometimes, he
goes to the teacher when he needs help. The teacher in the school uses several specific
teaching strategies, like small group playing, modeling, proximity, and verbal models,
to help Tom develop his communication ability. In addition, the teacher uses AEPSi
and anecdotal notes to monitor his progress. Moreover, an occupational therapist and
a co-teacher collaborate with the teacher in the classroom to take care of Tom.
In Summary, Tom has a learning delay in communication. Even though he seldom
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communicates verbally, he does use various nonverbal communication cues. His
parents are extremely responsible and found his problem early. With professional
assessment and education, Tom is making progress step by step.



















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Case Studies Analysis Project, Part 2
Tom Lee, aged 27 months, is experiencing developmental delays. His mother
found his communication delay at age 18 months, because he could not communicate
with the others in single or whole words. Due to communication and behavior
concerns, Tom had his initial IFSP and team evaluation completed on April 2013
when he was 20 months old. Furthermore, he was referred to a school by the Infant
Toddler Connection (ITC) at age 21 months. Tom underwent ITC testing, which used
appropriate diagnostic instruments and procedures to measure proficiency in four
areas: cognitive development, communication development, social or emotional
development and adaptive development. Having reviewed the evaluation components
and the information gathering from the ELAP, observation, and parent report, Tom
was showing at least a 25% delay in all areas of development, except his gross motor
skills (Fine Motor 11 months, Gross Motor 19 months, Receptive Communication
9 months, Expressive Communication 8-9 months, Cognition 10 months,
Social/Emotional 14 months, and Adaptive 8 months atypical feeding).
According to the test results on the ELAP in April 2013, Tom had an expressive
language age approximation of 8-9 months and a receptive language age
approximation of 9 months. At that time, Tom did not say any words. He often fussed
or cried to communicate. For example, Tom communicated by leading his mom to
what he wants, bringing her a sippy cup if he wants to drink, and lifting his arms to be
picked up. He did not readily imitate sounds or words. Moreover, Tom did not readily
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imitate actions except some simple movements. For instance, he was not able to point
to any pictures in books when his mother asked him. When looking at books, he
typically turned the pages quickly by himself without looking at pictures. In addition,
Tom did not respond to his name being called. Although he occasionally followed
verbal directions, it was unclear how much he understood of what was being asked of
him. Toms delays in expressive language and receptive language not only impact his
ability to communicate his wants and needs clearly, but also affect his ability to follow
directions and complete activities.
According to the conversation with the teacher, Toms mother employed a
professional early-English teacher to teach Tom at home before he went to school.
Currently, Tom has received his special education at the preschool for more than two
months. The teacher reported that Tom has mastered about 20 words in his vocabulary,
such as more juice, eat, cracker, milk, up, here, want, and help etc.
According to my observation, Tom does not frequently verbally speaking, but he can
understand names of familiar people and objects, and participate in activities by
following teachers instruction. For instance, when the teacher asked him do you
want to change this small leaf to a big one?, he put back his leaf and chose a big red
one. In addition, Tom likes reading books. He can find his favorite book by the cover
and pretend to read it. These examples show that Tom has begun to imitate single
words and sounds, and use vocalizations to make a choice between two items or
preferred activities. More importantly, with no more that 3 prompts, Tom follows one
step in-context directions, such as go sit at circle, put on your head.
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The ELAP testing also showed that Tom had a social emotional age
approximation of 14 months and a fine motor age approximation of 11 months with
adaptive at 8 months (feeding atypical). Tom had difficulty chewing foods, evidencing
oral muscle difficulty that causes communication delay. He did not bite off or chew
crackers or cookies, but rather sucked on them until they are soft enough to swallow.
It takes Tom about half an hour to eat. Recently, Tom had surgery for a frenulum clip,
and now he is beginning to take bites of cookies and food. Even though Toms delays
in fine motor skills impact his ability to feed himself independently and eat age
appropriate foods, he currently can imitate horizontal and vertical lines, and utilize a
utensil, rather than his fingers, to bring food to his mouth without spilling.
Tom parents are an intimate and responsible group. They take care of Tom by
themselves, so Tom has a wonderful family. According to his ITC evaluation, when
Tom was at home he showed toys to his mother to share his interest, and enjoyed
playing outside with his dad. Tom is the only child, but he is not lonely because his
family shares the same house with another family. However, access to this big family
seems not to have affected Toms social/emotional development. According to the
parents report, Tom often cries around those who are not his family members, even if
he is familiar with them. Moreover, Tom is reluctant to leave his parents side to
explore. For example, when children visited his home, Tom did not leave his mothers
lap to interact with other children. Toms parents also report that he sometimes bangs
his head on hard surfaces and sometimes hits them with his head. Therefore, Toms
parents avoid taking him out often because he has difficulty with new people and
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places. Toms delays with social skills impact his ability to interact with those around
him and explore his environment independently.
Having reviewed the evaluation components and analysis of Toms language and
communication development, his developmental delay is not primarily a result of
cultural factors, environmental or economic disadvantage, or limited English
proficiency. Although Spanish is the primary language spoken in Toms house,
English is also spoken, giving Tom exposure to both languages. Toms
communication delay is not a result of these factors. In order to address his delays in
communication, fine motor and social development, Tom requires specialized
instruction in a highly structured environment, with a low teacher/student ratio.
Moreover, Tom needs special education services to access and make progress in the
general education curriculum and learn new skills in language and communication.
Due to Toms bilingual background, teachers can foster and facilitate his language
acquisition through classroom organization, language techniques, and classroom
activities (Tabors, 1998). As mentioned above, Toms parents mainly communicate
with him in Spanish at home, while Tom is exposed to English in school. Even though
Tom has a communication delay, he does have the cognitive capacity to acquire two
languages at the same time without ill effects (Hulit, Howard & Fahey, 2011). In the
classroom, teachers can use some nonverbal communication or combine gestures with
talk. Moreover, teachers can keep the message simple and emphasize the important
words in a sentence while encouraging Tom to participate in classroom routines and
activities (Tabors, 1998). This communication style can support Toms ability to
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understand what the teacher says in English. In addition, teachers need to encourage
communication with Toms parents in order to learn how Tom is doing in Spanish at
home, and encourage the parents to continue using Spanish with Tom. Teachers can
ask the parents for some common phrases in Spanish, and invite them to the
classroom to do some activities in English with Tom. All these behaviors can promote
Toms engagement in literacy activities in English and the home language, developing
his cognitive ability.
In my observation at his school, I could see that Tom enjoys playing peek-a-boo
with others. This behavior implies that teachers can foster Toms emergent literacy
through pretend play or make-believe play. As Leong and Bodrova (2012) state,
children with language delays or emotional disorders are thought to benefit from play
interventions. Pretend play gives children the opportunity to represent, repeat and
share stories (Bardige & Segal, 2005), and make-believe play expands childrens
language and develops their social skills (Leong & Bodrova, 2012). These activities
not only support Toms language development, but also help him to make friends.
Therefore, due to Toms difficulty with new people and places, parents and teachers
should provide play scaffolding to encourage him to engage in social play such as
building a block structure or making a pile of sand-cakes with other kids. In addition,
in order to develop Toms social/emotional skills, the parent can encourage him to
participate in a variety of non-structured activities that involve interacting with other
children and sharing materials. This can be facilitated by the parent practicing with
the child through parallel playing with fading adult prompts.
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Like so many other things, language development is a mixture of nature and
nurture. As evidenced by the difficulty of chewing foods, Toms oral muscle
development, in part, causes his communication delay. Although Tom had surgery to
address his oral muscle problem, parent and teachers can provide some educational
interventions to encourage him communicating. Dialogical reading is a powerful
strategy for introducing and enhancing communication skills, because it includes
frequent interactions between adults and children (Bardige & Segal, 2005). These
interactions, such as asking questions and making predictions, can facilitate childrens
language development. According to Dennis and Horn (2011), encouraging
conversations during a book-reading session provides opportunities for all children,
including children with disabilities and those from culturally and linguistically diverse
backgrounds, to participate and feel included. While reading a book for Tom, parents
or teachers can provide multiple opportunities for him to respond but not demand or
require an answer. The book can be used as a scaffold to make conversations with
Tom. These back-and-forth conversations can expand Toms vocabulary and
encourage his expressive language.
In conclusion, Tom is experiencing developmental delays in the areas of:
cognition, communication, social or emotional development, and adaptive
development. After analyzing his language and communication, I have suggested
several strategies, such as pretend play, make-believe play, and dialogical reading for
parents and teachers to use to develop Toms cognitive ability, social/emotional skills
and communication skills. Early intervention is essential, when speech, language, and
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developmental problems exist. More importantly, the connection between parents and
teachers is critical, especially for young toddlers like Tom. Many of the strategies that
teachers implement in the classroom can very easily generalize to the home. Teachers
can emphasize the notion of practice and reinforcement to parents, helping them to
support their childs language development out of classroom (Dennis & Horn, 2011).
Through informed intervention from parents, and special education from teachers,
Tom will make progress step by step.















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Case Studies Analysis Project, Part 3
With the development of science and technology, more and more low and
high-tech equipment is being designed to support childrens early development. In
order to improve Toms language development and communication, three assistive
technologies are recommended below.
The first one is a range-of-light tech display set, named Tab Top Flip Set. It
includes a static core vocabulary along with a flip system of category pages. Each
vocabulary word is presented with an appropriate picture. Symbols are color coded
according to parts of speech, and each page includes a tab that represents its category.
The core vocabulary in the set includes actions, describing words, toys, clothing,
question words, and places. This light tech display set is ideal for supporting children
who are verbal, but have vocabularies that are not sufficiently enriched to fully
participate in reading. The key reason to use this light tech communication set is that
Tom can learn a vocabulary set through looking at pictures. It is important that
children be able to find vocabulary, and know where to look for needed words.
Moreover, a consistent set of vocabulary words should replace the words from
heaven scenario, where words fly down on a choice board, then return to heaven,
never to be seen again. Furthermore, the core vocabulary in the set can be customized
to the child, and additional activity pages can be added for individual needs. For
example, if Toms parents or teachers have BoardMaker, they can make changes to
pages, customizing the set to meet the needs of Tom. This light tech display set is
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inexpensive and readily available to support Toms language and literacy
(Musselwhite, 2011).
The second one is a voice output device. This is an electronic device that speaks
for a child. With the push of a button, or by using an adapted system, the child can
expressively communicate one or more messages. The messages are recorded
specifically for that child, so that they are relevant to the childs needs and
environment. A voice output device benefits children who are verbal but whose
speech is often unintelligible. The key advantage to voice output devices is that the
device provides a means of initiating communication, helping Tom develop his
receptive and expressive language skills. Tom can start by using a single word or
sentence to send one specific message until he understands the meaning of the word
or sentence. In addition, using a voice output device not only develops Toms literacy
by enhancing his language foundations, but also increase his verbal speech through
encouraging him to actively participate in the learning process. This voice output
device offers magnificent help for children with communication delays (Why use a
voice output communication device? 2009).
The last recommended piece of technology is a visual scene display (VSD),
which is an interactive photo. It promotes childrens communication and social
interaction by displaying various objects and scenes. Mostly, these scenes are actual
images of the childs environment. Therefore, it is easier for Tom to begin
communicating within a context he recognizes. There are two types of VSD:
personalized context and generic context. A personalized context uses personalized
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photos of familiar surroundings. Conversely, a generic context is a more abstract
environment, like a classroom with teachers and students, a house with different
rooms, or a workspace with different tools. By using photos and images to help
children communicate, VSD is effective for children with limited or nonverbal
communication capabilities. In addition, VSD can be applied to stimulate
conversation, provide instructions, support play, tell stories, and increase motivation
for learning. This technology reduces cognitive demands, make learning easier and
offer children with limited cognitive and linguistic skills success (Blackstone, 2005).
In conclusion, the development of science and technology provides various
assistances for special children and their parents. By taking advantage of these low
and high-tech equipments, teachers and parents not only effectively facilitate
childrens language development, but also foster childrens independence and
self-sufficiency to a certain extend. More importantly, using these technologies offers
more opportunities for teachers and parents to interact with children, strengthening the
bond between them and children.







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Reference
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Blackstone, S. (2005, January 13
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Dennis, L. R., & Horn, E. (2011, September). Strategies for Supporting Early Literacy
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