Case Study:Sammy Sensory

Lynn W. MiskielM.A., CCC SLP/A, LSLS Cert AVEd

My name is Lynn Miskiel and I’m presenting a case study. I work for the University of Miami. I have no relevant financial or nonfinancial relationships to disclose. I am the President of AG Bell, FL and Vice President for Option Schools, Inc.

Sammy Sensory• Male, bilingual, middle SES household• 14 months - dx with profound hearing loss• 15 months - fit with hearing aids• 19 months - Debbie School A-O program• 23 months - first cochlear implant• 26 months - second cochlear implant

Educational Choice

Parents focused on providing auditory access and having Sammy learn to listen and talk.

Debbie SchoolAuditory-Oral Education Program

• Full day educational program for children who are deaf/hard of hearing

• Focus on listening and spoken language• Inclusive PreKg classrooms/Self-contained

Primary classroom• Standard curriculum

Three Perspectives:Home behaviorSchool behaviorCommunity therapy behavior

With Sammy in PreKg , how do these perspectives impact placement and outcomes?

Home

• Challenges with Sammy accommodating to the family routine. Frequently “acted up” if activities were not his preference.

• Parents expressed “Sammy being Sammy”.

School

• Prior to CI, teacher observed isolated play patterns not consistent with his age.

• Post CI some improvement but solitary play continued including repetitive and self-stimulation behaviors.

• Off-task behavior during group activities such as laying down.

• Difficulty engaging in social content.

Community

• Non-compliant during language therapy with mom in the room.

• Demonstrated aggressive behavior toward mom, hitting and biting.

• Therapist recommended PCIT but family did not choose to follow up.

• Parents chose to stop receiving services from this provider.

PreKg Concerns/Goals

• Receptive/Expressive Language delays.– Followed familiar verbal directions in context.– Had communicative intent but eye contact poor.– Vocalizations and a few words.

• Behavior– Impulsive– Poor attention/distractible

Overall Concern

Is there something else going on? A co-morbid condition that was masked by the hearing loss and subsequent language delay?

What to do?

• Heading to kindergarten with minimal expressive language and delayed expressive language.

• Academic skills delayed.• Episodes of oppositional behavior at home, at

school, and during language therapy sessions.• Very concerned that A-O approach not

appropriate and that his needs were not being met.

Assessment

• Classroom observation• Wechsler Nonverbal Scale of Ability• Sensory Profile (Teacher and Caregiver)• Autism Spectrum Rating Scales• Gilliam Autism Rating Scale (Teacher and

Caregiver)• Behavior Assessment System for Children

(Teacher and Caregiver)

Results• Classroom observation: Concerns• Nonverbal IQ-WNL• Sensory Profile:

• Parents-WNL;• Teacher-Concerns

• Autism Spectrum Rating Scales-WNL• Gilliam Autism Rating Scale-Possible• Behavior Assessment System for Children-

At Risk

Strategies Implemented in School/Therapy

• Redirection• Positive behavior management with specific

and frequent reinforcement.• Sensory input with weighted vest/lap pad.• Sensory breaks using a bean bag chair.• Sensory balls during transitions.

As perceived by the professionals:

– Parents were in denial, not accepting that Sammy’s behavior is not consistent with the hearing loss, that more seemed to be going on.

– Parents not putting in the time needed to change CA’s outcomes.

– Parents seem to not recognize challenges the teachers have nor to acknowledge the hard work they are putting in.

But then…they came to us

• He had swimming lessons over the summerand this impacted his behavior dramatically.

• It seemed to open the parent’s eyes to hissensory needs.

• They initiated additional sensory activities andtherapy.

Home Skill Practice Increased!

• Language experience books with pictures.• Use of compression clothing.• Communication with school increased.• Father available to come by school when

behavior extreme.

Outcomes

• While still delayed, Sammy’s skills in all areas increased at a faster rate.

• Sammy was able to stay in an auditory-oral education program with the sensory accommodations.

• Strength in receptive language and reading skills.

Outcomes

• Social skills continued to be targeted but he improved in his interactions with his peers and with adults.

• Parents happy with social interactions at home.

• Reading skills less than half a school year behind.

• Math skills one school year behind.

Key Concepts

• Keep experimenting and exploring options.• Consult with other professionals.• Don’t assume family is not on board.

Parents support their child’s progress in their own way and in their own time.

• Be open to the direction this might take.