Hi loyal readers,
Going to spend this week quoting liberally, but not authoritatively, from Dar’s ABA (Applied Behavior Analysis) Provider’s report that we were given this month. If you’re one of those glass-half-full people, you can see this report as helpfully making sure that Dar continues to receive services, or perhaps you can see this as “WHEW! Glad my kid doesn’t get judged like this.” If you’re one of those glass-half-empty people, you can see this report as a whole lot of uggggggggggggghhhhhhh.
But hey, we’ve got visual aids! (Not necessarily corresponding to their adjacent paragraphs.)
Current Developmental Assessment Results
For each of these specific areas Dar’s score is rated high, above average, average, below average, or low. Dar’s abilities in the Communication domain were below average for Hearing and Understanding, low for Talking, and low for Reading and Writing. In the Daily Living domain, Dar’s abilities in the Caring for Self subdomain were low, in Caring for Home they were low, and in Living in the Community they were low. Dar’s abilities in the Social Skills and Relationships domain were low for Relating to Others, low for Playing and Using Leisure Time, and low for Adapting. The Vineland-II also measures problem behaviors, which are defined as behaviors that are considered undesirable. These behaviors are defined as nonsignificant, intermediate, or significant. Dar’s level on the index that assesses minor problem behaviors was intermediate.
This skill domain was targeted during the current authorization with an emphasis on manding with an alternative and augmentative communication (AAC) device, primarily due to his variability in independent responses when both AAC & vocal mands were being taught. Dar continues to use an iPad and Proloquo2Go system to request various items. During the previous authorization, Dar transitioned to a larger grid, template system. Since the change to the format, he has made progress on this goal.
Currently, Dar independently requests various food items and to go outside and usually uses the carrier phrase “I want.” He also has demonstrated independence with requesting various toys, but does continue to require some support. For any mands he masters, the team is increasing the number of step selections required to request the item (e.g., if he is able to request “Outside” when the BT navigates to the “Places” folder for him, he will then be required to independently navigate to “Places” to select “Outside”). The goal and mastery criterion have been modified to reflect this.
Dar has mastered 13 different instructions, including but not limited to the following: carry your iPad, clean up, get your snack cup, and throw away. He is currently working on 2 2-step instructions, as well as “turn on the light,” “clean/pick up,” and “put it back.” Goal will be continued.
Dar has demonstrated independence with manding for attention using physical touch with the behavior technician; this skill should continue to be targeted with an emphasis on generalization across individuals. Due to an increase in aggression and concurrent decrease in accuracy for this target that occurred around the beginning of April, it is suggested that this goal continue.
Dar has demonstrated increased independence with gesturing or pointing to a desired item when a choice is presented. Some prompts have been provided during sessions with behavior technician, but Dar’s independent responses currently outnumber prompted responses. He does not currently point to out of reach items, though he will sometimes wave his hand in their direction.
(Yes/No) This goal was mastered during a previous authorization, but was reintroduced due to a lack of maintenance. Dar has since mastered responding to “Do you want ____?” with “yes” and “no” using a vocal approximation. He has not mastered “Is this ____?” using a vocal approximation, but has made some progress, especially with “yes” questions. He has not yet demonstrated generalization of this response to his AAC device.
Dar is currently working on answering basic social questions. He has mastered all personal information questions that were introduced using a single selection on his AAC device. We are currently working on him answering these questions from the home screen of his AAC device.
This goal is currently on hold due to a lack of progress. It is recommended that this goal be reintroduced during a future authorization with a variety of simple activities. Independent play tasks are currently being taught independent of the play schedule for future inclusion in the play schedule activity.
Dar is currently making progress with pulling up socks/putting on shoes and pulling up his pants. He continues to have some difficulty with putting on his own socks, partially due to his fine motor deficits in his hand.
Summary & Recommendations
Dar was introduced to a new AAC layout during the previous authorization and has continued to respond well to it by generalizing many communicative responses to the new organization. He is able to independently request for food and drink items and to go outside, as well as some other multi-step mands (e.g. “I want head tickles”). He also has made progress with navigating between different folders on the AAC and opening the AAC to start using it. Dar has demonstrated maintenance of previously taught intraverbal fill-in skills. During the current authorization, Dar has demonstrated independence with responding to various questions related to both new and previously mastered fill-in statements using his AAC device. Dar has made progress with responding to instructions commonly used in the home; this skill will continue to be targeted with an emphasis on functional multi-step instructions and instructions provided by parents. Dar continues to use vocal approximations for “yes” and “no,” but further emphasis has been placed on him using his AAC device as his primary method of communication.
It is the recommendation of STE Consultants that Dar receive medically necessary services utilizing the methodologies of Applied Behavior Analysis to address skill deficits outlined in this report. The program will consist of implementation and generalization of the aforementioned listed programs in addition to parent training. Team meetings including the Clinical Director/Behavior Analyst, therapists, and Dar’s family will be held at least monthly to track Darwin’s progress, review teaching procedures, synthesize data, and proactively address any issues. Successful implementation of this program will require the following hours of service.
Therapy is recommended at 30 hours per week of direct service (H2019) per week during summer (6/19-8/28) and during school holidays to ensure maintenance of skills acquired. When school is in session, it is recommended that Dar participate in 15 hours per week of direct service.