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Joshua HullASP 494Child Case Analysis #2

Name (initials only): TRDOB: 11/25/10Sex: MHearing age: 0Educational placement: noneHealth: Good overall HealthCo-occurring conditions: AutismDescription of hearing loss: SN hearing lossDegree: Severe to ProfoundType: Sensory NeuralConfiguration: flatLaterality: BilateralType of amplification: none

Type of ALD: None

1) This twelve month old client has not seen any professionals previous to theseevaluations concerning his hearing due to family issues and lack of support from theclients mother. The client was diagnosed with Autism yesterday. The clients aunts orlegal guardians have put in a request to pursue cochlear implants within a month. Theclient will be enrolled in Child Hearing Services immediately after the operation hasbeen completed.When TRs aunts brought him to TEIS we first looked at his case history and didsome informal observations of TR. Our observations were consistent with the casehistory which stated that he had a sever to profound SN hearing loss. Also we

observed that TR had lack of communicative intent, poor eye contact with theclinician, inappropriate play with his toys, and he displayed repetitive self-stimulatory movements.

2) Guardian Counseling recommendation: TRs aunts have displayed many signs ofhigh stress levels concerning TRs situation. Less than three months ago they had noidea that they would become TRs guardian and now they just found out he is autisticand almost completely deaf. This situation is a lot to take in for new parents. We arerecommending that the guardians seek a professional psychiatrist to talk about theirfeelings and frustrations. We are also referring them to a local support group forparents with autism. We have also gotten a list of parents here at CHS that are willingto talk to the two aunts about what it was like for them discovering that their childhas a profound hearing loss and what the process has been like for them whiledealing with their own situation to give TRs aunts some perspective about what it isgoing to be like during TRs therapy process.

3) Due to the mothers lack of interest in the well being of TR before the aunts gotguardianship TRs mother never took advantage of and early intervention servicesbefore. His hearing loss and Autism should have been identified a long time ago ifshe had taken TR to the appropriate doctor check ups that children his age should goto. If he had been diagnosed with his hearing loss earlier he would have probably

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gotten hearing aids at first but most likely would have made little difference due tohis type of hearing loss but he would have to wait until he was one year old to get hiscochlear implant. He would have gotten an IFSP that would have included training ofthe parents on how to deal with a child with autism and hearing loss and the would besix months further along at least as far as getting used to therapy sessions and doctorvisits. We are going to recommend a very high intensive schedule for therapy here atour Aural Rehabilitation center as well as intensive training for both his aunts so thatthey can conduct intervention at all times for TR because children with autism needconstant intervention. We are also recommending Speech therapy after the surgerytwo to three times a week.

4) TR is a candidate for a cochlear implant and both of his aunts wish to get him onethis month. He is a candidate because she has a severe to profound SN hearing loss.The Cochlear Implant process is a seven step process. These are the seven steps in theprocess: initial contact, pre-implant counseling, formal evaluation, surgery, fittingand activation, follow-up, and aural rehabilitation.

5) First we will be working on TRs Detection skils: for example does TR respond to

the presence or absence of sound, pay attention to sound, or respond when there is nosound.We will be working to get TR to show us selective attention to sounds anddemonstrate Meaningful Auditory IntegrationThen we will work on Discrimination skills: for example working on having TRshow that he can perceive similarities and differences between two or more speechstimuli/attend to difference and respond differently to different sounds.We would like TR to show that he can discriminate between moderately differentspeech stimuli as well.Then we will work on Identification: Have TR label by repeating, pointing to orwriting the speech stimuli.

We want TR to show identification of common phrases/actions/ songs.Lastly we would work on Comprehension: have TR understand the meaning ofspeech by answering questions, following instructions, paraphrasing, and hopefullyhave conversations.

6) For TR we are going to work on his detection skills first after TR gets his cochlearimplant. After we are done working on his detection skills we will move on to hisdiscrimination skills. We will evaluate his rate of progress carefully and concentrateon one skill at a time intensely before moving on to the next skill. In his condition ifhe shows any engagement or responses at all at this point we will consider thatprogress.

7) Some services available to TR through IDEA are family counseling, speechpathology and audiology, occupational and physical therapy, case management,psychological services, medical services for dx and evaluation, screening andassessment, as well as transportation to and from services. Public schools will alsopay for mapping if TRs parents opt for cochlear implants. Instrumental indeveloping the most effective IEP for TR is the multidisciplinary team. This is madeup of an audiologist, speech pathologist, his teacher, special education teacher,occupational therapist and physical therapist and most importantly TRs aunts. In thecase of his cochlear implant, a surgeon will be included on the team. TRs IEP

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related to his school placement when he is old enough will include: classroomplacement, communication mode, and listening device. He will be assessed using theEarly Speech Perception Test (ESP). When TR is three years old he will have anaudiological diagnostic follow-up every 6 months.

8) At the age of five TR will be assessed using the Early Speech Perception Test as wellas the Auditory Verbal Scales for Listening. TRs rate of progress should besomewhere around three months of progress for every twelve months that pass orless. This is the typical rate for children who are profoundly deaf and autistic. He willhave a very intense schedule of treatment which will probably include auralrehabilitation three times a week or more and speech therapy two times a week ormore. He will need constant intervention all day everyday and that is why his auntswill need intensive training and constant updates from his therapists so that they areworking on his goals at all times.

7) TR is going to have social, emotional and cognitive delays already based on hisautism alone. The hearing impairment is only going to make these delays worse

exponentially. If his therapy with using his cochlear implants goes well and hedevelops some sort of communication it will help his delays but also may not.

8) TR will need to be in intensive intervention programs for most of his life. He willnever get a chance to be in a mainstream school based on his condition of hearingimpaired and autism. There are many local Autistic specific centers that TRs auntswill have to choose from but in TRs case they will need to find one that has someexperience with working with hearing impairments.

9) In TRs case we are going to explore all options of communication. Whatever heresponds to best will determine which path we take but we will start out with English,

sign language or picture cards. The Ipad is beginning to gain popularity as a alternatecommunication device as well and will be explored if needed. We will choosewhatever option best suits TR to help him gain independence.