Amy lives with her mother and younger brother. Her father has not seen her since shortly after her birth, and has no role in her upbringing. Amy has been diagnosed with Pervasive Developmental Disorder Not Otherwise Specified (VOODOOS which Is an autism spectrum disorder. Meaning that symptoms can range from mild to severe. She also has a fluency disorder, which affects her language development. Amy was diagnosed with PDP just recently at age 6, after her mother expressed concern to her pediatrician that she was not engaging with other children during “play dates”, that she had extreme difficulty transitioning between activities, and had what her mother felt was an excessive amount of tantrums that she did not seem to “outgrow.
Furthermore, Mays mother reports that her previous private daycare/gladdener setting was concerned that Amy was lagging behind her peers in terms of language development and reading skills, such as phonics, letter sounds, and vocabulary development. Amoy’s pediatrician referred her to a psychologist for evaluation. This evaluation exulted in the diagnosis of PODS_ Autism spectrum disorders, Including PODS, are characterized by a degree of Impairment In communication skills, social Interactions, and cognitive development.
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Children with PODS may display any combination of the following characteristics: Deficiencies in Social Behavior (eye contact, apathy, lack of interest or lack of attachment behaviors), Nonverbal Communication Impairments (absence of gestures, lack of imitation, failure to understand body language), Speech Impairments (failure to understand humor or sarcasm, lack of understanding of spoken words, calceolaria, pronunciation problems),
Unusual Behavior Patterns (struggles with changes in routines and transitions, compulsive behaviors, sensory Issues Movement Disturbances (walking on tiptoes, rocking, flapping), Cognitive Shortfalls ( abstract thoughts, applying rules, using information In a new way, Imitation). Some students with PODS also have cognitive delays, although Amy has a tested IQ of 81, which is in the low average PODS Is often a mystery; It is hard to define statistics on how common range. He disorder is, because it is a spectrum disorder, and it is hard to identify. There is no known cause of PODS, but researchers agree that children are born with the crosier or born with the potential to develop it. There is no credible link too genetic or environmental factor for PODS. A child with PODS will not respond well to disruptions In a dally routine such as field trips, assemblies, etc. Many classroom activities will not interest a child with PODS and they may become delays and abilities.
Common treatments for PODS include Positive Behavioral Supports, an Appropriate Educational Environment (which may or may not include inclusion), medications to reduce some symptoms, and ongoing counseling and evaluation. Less traditional methods of treatment may include a variety of other therapies. In addition to the PODS diagnosis, Amy has a Fluency Disorder of Language. Fluency is comprised of several factors: speech moving at an appropriate rate, easy rhythm, smoothness, effortless, and automatic. Dissidence occurs when there is a disruption in any of these elements.
Fluency also takes into account disturbances in social communication. Fluency disorders have core features of repetitions, prolongations, and blocks. Secondary features of Fluency Disorders include eye blinks, head Jerks, pauses, filters, and / or negative attitude towards speaking. A Fluency Disorder can be developmental or acquired as a result of illness or trauma. A typically developing 7 year old second grader will enjoy telling others how much they know. They also will enjoy asking many questions about things they don’t know.
They begin to use increasingly complex strategies at home and school to solve problems. They should be able to master the consonant sounds of t, s, z, r, chi, who, and soft g. They should also be able to understand opposite relationships such as hot/cold, boy/girl. They should be able to understand terms such as alike, different, beginning, end, etc. They should be able to read simple sentences and write the alphabet legibly. They should also be able to read and retell familiar stories and be developing reading strategies such as predicting, rereading, using visuals, reading aloud, pointing, and writing.
A typical seven year old will display language skills that reflect the increasing impact of language and literacy instruction. Literacy activities enhance children’s recognition of language’s dimensions such as sounds, patterns, meanings, and uses. Seven year olds should be able to demonstrate their understanding of reading material by discussing, writing, and traumatizing. Because Amy has a Fluency Disorder, her language skills are delayed. She is not able to apply reading comprehension strategies as the disorder slows down her ability to comprehend and learn comprehension.
At the present time, Amy is a second grade student at Amity Elementary with a diagnosis of PODS and a related fluency disorder. She has a tested IQ of 85, which places her in the low average range. Amoy’s area of academic strength is in math calculation. However, she remains about one grade level behind her peers, primarily due to her lack of ability to think and relate abstractly. When given a page of grade level appropriate basic math calculations or tat facts, Amy can calculate with above 80% accuracy. However, she struggles with word problems, a common characteristic of children with PODS.
Due to Amoy’s language issues, she struggles in Reading. Currently, she is working on phonemic awareness but continues to have difficulty with middle vowels and ending consonants. Her handwriting is tight and tiny when compared to her peers. In any classroom, Amy enjoys and prefers hands-on activities, but she requires much redirection as she is easily distracted. Socially, Amy is withdrawn. At recess she plays alone or wanders by herself. She struggles with transitions, and if the daily routine is disrupted or different, she will often throw a tantrum.
In Ohio, students with the diagnosis of PODS can qualify for special education services under the disability category of autism. Therefore, Amy will be eligible to receive specially designed instruction to best meet her needs. Amy will be in an inclusion classroom, but will receive specialized instruction in the areas of reading, math, communication, and behavioral supports. Amy will be in a second grade classroom which is co-taught by a general education teacher and an intervention specialist. The intervention specialist will be able to modify the general classroom instruction too level that is more suited to Amy.
This classroom will be well- structured and have many routines and schedules. Amy will receive pull-out speech therapy one hour per week, where she will be placed in a group of 3 to 4 similar students. Speech therapy sessions will allow Amy to practice social communication skills in a positive, nurturing environment To assist with behavior management and transitions, Amy will have a visual and written schedule on her desk for every day. During morning meeting, teachers will go over the schedule for he day with all students, noting any changes from the normal routine.
The intervention specialist will adjust Amoy’s individual schedules on her desk so that Amy is able to refer to her schedule as often as she likes. A teacher will individually give Amy a “warning” of an impending transition, and prompt her with the appropriate steps necessary to transition without a tantrum. If necessary, a reward program can be implemented where Amy can earn “points” towards a reward of her choosing each time she successfully transitions. Amoy’s classroom will be arranged as a learning community, using the principles of Conscious Discipline.
In Conscious Discipline, every moment is a teaching moment, and all interactions are positive. Conscious Discipline teaches students that they are responsible for their own feelings, responses, and reactions. In a classroom such as this, Amy will have many opportunities for social interaction. Teachers will serve as “coaches”, reminding students before each activity of appropriate behaviors and social responses for the activity, rehearsing social skills and behaviors, and practicing social skills. Behavioral expectations will be clearly explained before each activity.
Amy will have written and usual reminders on her desk to help “cue” her as to appropriate behaviors. The classroom has a “safe place” where students can go if they need a sensory break or time away. Academic instruction for Amy will incorporate multi-sensory strategies in all content areas. Visual representations will be incorporated as well as written words and verbal instruction. Amy will have the opportunity to work with an intervention specialist or aide to review daily lessons and for repeated skill instruction.
Amy will be given assignments in small “chunks” so that she is not overwhelmed, and she will be permitted extra time on assessments. Amy will also be permitted to take tests by herself in a secluded location away from distraction. At any time, Amy will have the option to choose to go to a “quiet place” to work. Academic materials will be provided at Amoy’s current level, while still allowing for grade level content. Parent Request After consulting with Amoy’s psychologist and researching on the internet, Amoy’s mother has decided that she wants Amy to participate in an alternative therapy for known as the Loaves Method.
The Loaves Model is a treatment that utilizes Applied Behavior Analysis (ABA). ABA is considered by many to be the best-known ND best researched treatment for autism spectrum disorders. ABA teaches skills through a reward system. The Loaves Model of Applied Behavior Analysis is a behavioral treatment model typically started with children between the ages of two and eight. The method states that children should receive two years of training, 4 to 6 hours a day, 5 to 7 days a week. As children progress, they transition to different services, and Loaves method is generally not used past the age of twelve.
The overall goal of the Loaves Method is to break down skills into manageable pieces and then lid upon those skills so that the child learns how to learn in a natural environment. The Loaves Method helps a child master the healthy emotional milestones that were missed in his early development, thereby helping children overcome their symptoms. It is designed to cultivate a child’s strengths and interests, and develop appropriate structures that promote a child’s independent work skills while fostering communication, social, and leisure outlets.
Treatment begins by establishing Positive Interactions with the child through favorite activities, and motivation through he use of familiar materials and re-enforcers. Success is achieved through positive reinforcement and the fading of prompts. Parental involvement in the process is crucial, as parent’s need to create a home environment where treatment is provided during most of the child’s waking hours, across all settings – home, school, and neighborhood. Facilitated play is an integral part of treatment, as is learning to talk and imitate language. A typical Loaves therapy session is two to three hours at a time.
Short periods of structured time devoted to a task (3-5 minutes _ followed by an equal amount of free play. At the end of each hour is a 10 minute break. Free play and breaks are used for incidental teaching or practicing skills in new settings. Therapists get on the floor with the child and interact and play, these interactions promote the child’s growth by following his lead, persistently engaging his attention, and tuning in to his interests and desires in interactions. The therapy environment is created with clear, concrete, visual schedules, routines, and organizational strategies.
Loaves intervention is usually 35 to 40 hours per week. In a school setting, support would necessitate a 1:1 aide. Ongoing research has indicated behavioral treatment is an effective intervention for children even in later years. While the intervention retains many of the characteristics applied to young children, some modifications are appropriate for older, school-aged children. For example, collaboration with educators and other professionals at school and in the community continues to increase. Treatment may include time for community outings so that skills can be taught or generalized in the setting in which they are meant to be used.
Structured time may be increased to thirty-minute periods, similar to the amount of ark time required at school. Treatment gains are often generalized to school through the use of a trained 1:1 aide, and the treatment itself may even be carried out at the school itself. Goals for older children often revolve around improving their quality of life. Important skills include: self help, independent leisure time, functional communication, inclusion at school, participation in family life, community skills, and peer interactions.
Over 500 articles have been published showing the the effectiveness of the method appear to arise around specific claims of recovery from autism, based on the intervention. The Lavas technique was developed based on research performed by IVR Lavas and his assistants. This research reported that 47% of those children who had received the Lavas treatment protocol of an average of 40 hours of intensive therapy, were mainstreamed into regular classrooms, and were classified as “indistinguishable” from their peers in follow-up studies.
Although subsequent studies have shown that intensive behavioral therapy clearly benefited children with autism, it has been claimed that Lava’s original claims of effectiveness were overstated. A 2005 California study found that early intensive behavioral intervention (BIB), the Lavas technique used for very young children, was substantially more effective for preschool children with autism than the mixture of methods provided in many programs. However, this study did not use random assignment or a uniform assessment protocol, and provided limited information about the intervention, making it difficult to replicate.
Smith et al. (2002) performed a preliminary study of nine high-functioning autistic children, all of whom were previous recipients of early intensive behavioral intervention (BIB), of ages five to seven in free play settings. The purpose was to assess the effects of BIB on solitary activities, ritualistic behaviors, and social activity when exposed to the two experimental groups. Each child participated in four, one hour sessions consisting of 15 minute periods of play with either a typically developing peer or a lower functioning autistic child with major deficits in pragmatic communication, social interaction and self-care.
The children had never met prior to these experimental sessions. The period of play began with 15 minutes of play with either the typically developed (AD) peer or the developmentally disabled (AD) peer, and alternated accordingly in one of two variations: AD-AD-AD-AD or AD-AD-AD-AD. Observers rated play on five criteria: interactive toy play, interactive speech, solitary toy play, solitary speech, and self-stimulation. Data showed the high-functioning children displayed significantly more instances of interactive play and interactive speech when paired with the typically developed peer.
The Lavas technique is best generalized when paired with natural settings, and the implementation is clearly structured. A good sense of direction is needed when planning for intervention. Although this is one approach, many children with autism spectrum disorder learn differently and this needs to be taken into account to ensure the Lavas approach is effective for all. For some children it is shown that typical peer interaction can increase an autistic child’s chances of leading a normal life. However, it is a very costly treatment because of the individual support needed.
Mediation Amoy’s mother is not satisfied with the school’s plan for Amy. She thinks that the Loaves Method will be the best treatment for her daughter, and she is insistent that the school must implement whatever treatment the parent requests. Amoy’s mother has filed a request for a Due Process Hearing. The school has offered to hold a mediation hearing in an attempt to reach some sort of agreement with Amoy’s mother and prevent a costly and time-consuming Due Process. PEP mediation is the first hearing in that its goal is to assist both parent’s and school in reaching a compromise.
The state of Ohio appoints a mediator who is a neutral party and is not an employee of the school district. The mediator does not have any authority to force a parent or school to settle a case, but rather their function is to assist both parties in understanding each other and working together for the best interests of all involved. Mediation has no cost to the parent, and attorneys should not be present. Anything discussed in mediation is not admissible in a due process hearing, should there be one at a later time.
PEP mediation has several benefits. It gives parent’s the opportunity to understand the school district’s reasoning and point of view, and the school a chance to hear a parent’s viewpoint without being in an adversarial environment. Mediation allows the district some measure of flexibility in their talent as they will usually seek to avoid further costs associated with a due process hearing… Most schools want to avoid due process. Mediation also attempts to preserve a positive relationship between the parent and the school.
Both parties must agree to any proposed solutions in a mediation hearing. The key here is compromise. In a due process hearing, a hearing officer makes a decision that is legally binding by both the school and parent. In mediation, the goal is a compromise. Often, parent’s may gain more from mediation than from a due process hearing. Furthermore, mediation does not involve attorneys’ so costs are a minimum. Due process can get very expensive for both parties. Mediation must be held at a time and location that is convenient to the parent.
It is a lengthy meeting, often at least one full day. The school will usually have the special education director and intervention specialist who knows the child present. Parent’s are allowed to bring an outside specialist or evaluator if necessary, as long as they are not an attorney. Mediation begins with the parent presenting their case, including their “wish list” of services. Parent’s should be aware that they will usually not receive everything they sky for, so they should be prepared to prioritize their wishes and needs. Ideation can result in the following outcomes: 1) Full settlement of all issues – both parties are happy with everything 2) Partial settlement – parties agree on some things and disagree on others 3) No settlement but parties agree to return and try again 4) No settlement and no further attempts at mediation, parties have decided to go to due process If a settlement is reached, both school and parent must agree and sign papers stating their agreement, and then both parties are bound by that agreement. The agreement is made binding by a court of law.
Amoy’s mother came to the mediation with her request that the school implement the Loaves Method, and also that they provide for home-based services to help her implement the method at home. Amoy’s mother believes that the school must provide APE, and that this method is appropriate for her daughter, so the school is obligated to implement it. Amoy’s mother is not concerned with her child being in an inclusion classroom, rather, she wants Amy to be instructed using the Loaves method in a 1:1 setting, with breaks during the day which would allow her to have interactions with typical peers in a structured setting.
Amoy’s mother presents her case to the school and the mediator. She brings supporting documentation from Amoy’s psychologist, who supports this treatment. The school presents its point of view, which centers communication skills from being in a supported environment with typical peers, while also receiving individualized instruction in her targeted areas. The school also points out that implementing the Loaves method would be impractical and impossible in a traditional school setting.
The school further points out that, given Amoy’s age, Amy is not a strong candidate for success with this method, as it was signed to be started when the child was much younger. After hours of debate, a recess was taken. Both parties returned, and Amoy’s mother stood firm in her request that the Loaves method be implemented at school. The school stood firm in their view that it was not feasible nor in the best interest of the child to implement this method.
The school offered the parent information about alternative choices in Ohio for parent’s of children with special needs. Amoy’s mother was not aware that Amoy’s diagnosis of PODS qualifies her for a $20,000 per year scholarship where he parent can take her to any approved provider of their choice for an alternative education or therapy. The school suggested that if Amoy’s mother wanted her to focus on Loaves method, maybe this would be a better option.
Mediation ended with no settlement being reached, but Amoy’s mother indicating that she was going to utilize the Ohio Autism Scholarship and seek an independent provider who would implement the Loaves method. In a year’s time, Amoy’s mother agreed to report back to the school about her progress with this method, at which time the school would reevaluate what Amoy’s needs were at that time. Current Classroom Intervention Plan With the result of the mediation, Amoy’s mother received the Ohio Autism Scholarship, and she took Amy to an approved independent provider.
This provider is offering home based and center-based interventions and the Loaves Method of ABA therapy. Amy will have a 5 day per week schedule of Loaves therapy, provided by an in-home worker, with weekly social and play therapy sessions at the learning center.