LEELO ROSENBERG:
Summary Progress Report
STUDENT: Leelo
Rosenberg
DATE OF BIRTH: Fall
2000
PARENTS: Squid
and Seymour Rosenberg
DATE
OF REPORT: 6/3/04
PROGRAM
COORDINATOR: Supervisor
M
Leelo is a 3 year 4 month old boy who lives
with his mother, father and five-year-old sister in Deadwood City. He was originally diagnosed, by the Regional
Center in Spring 2003, as having social language delay. At that time, Leelo
also had tubes inserted in his ears. A
March 2004 evaluation at the Stanfford University Medical Center’s
Neuropsychiatry/PDD Clinic indicated a diagnosis of autism spectrum disorder.
An initial educational evaluation for intensive autism services was conducted
in June 2003 by Rainbow Center. Since
August 2003 Leelo has been participating in an intensive Applied Behavior
Analysis (ABA) program designed to facilitate learning in children with
autism. In addition, since April 2003,
he has received language therapy services from Teacher A at AL&L in Deadwood
City. Leelo also receives weekly
occupational therapy services at AL&L.
Leelo’s Applied Behavior Analysis (ABA)
program is comprised of a variety of instructional approaches and components
designed to facilitate learning of new skills and generalized use of skills in
non-training settings. Leelo receives
up to 25 hours of ABA therapy weekly, including Discrete Trial Training (DTT),
incidental methodologies such as Natural Language Paradigm (NLP), and
facilitated play groups. Program
coordination services include training and support for staff and family, data
analysis and program revision, cross-professional communication, and quality
assurance with an outside expert (Supervisor Andil, PhD). In addition, Leelo’s team, including his
mother, therapists, and program coordinator, meets every two to three weeks for
data-based program review, discussion of instructional procedures, and
examination of other issues related to Leelo’s learning.
SUMMARY
OF PROGRESS:
In the past 9 months, Leelo’s ability to
focus on and respond to instruction has increased dramatically. Leelo can now work on up to 15 different
skills in one session, in a variety of locations including at a small table, on
the floor, and outside on the deck and yard.
He attends to structured activities in one-to-one settings for about 8
minutes, with occasional attention to tasks for 15 or more minutes. For some tasks, Leelo has demonstrated some
spontaneous generalization of skills to non-training contexts, and use of novel
language and play ideas not modeled in therapy setting. Leelo’s program includes the following
skills areas: attention, receptive and expressive language, motor and
imitation, self-care, play, and social skills. Leelo uses spontaneous language throughout his session, mostly
to make requests, and occasionally to give descriptions, give directions, and
to greet. He continues to echo modeled
language; therapists respond by modeling the desired response.
Leelo uses some behaviors that can interfere
with instruction. These include hitting
head with hands; running head first into couches and furniture, and adults;
vocalizations, such as singing, non-communicative talking, and whispering. In addition, Leelo is very active, and
frequently runs and jumps around the room.
When Leelo is sick, or has a diaper rash, some behaviors appear to
increase. Data is currently being
collected on these behaviors in order to determine the function and designate
appropriate interventions.
A. Greetings: In discrete
trial setting, therapist says “hi (student’s name)” and student responds “Hi
(therapist’s name)”.
In
generalization context, when seeing therapist, family members, friends, student
initiates “Hi (therapist’s name)”. Leelo is working on initiating
greetings in context, such as when therapists arrive at the door, when seeing
someone at the bottom of the slide, in play group circle times, etc. He consistently says “bye” and “bye (name)”
in response to “bye”, but is less consistent with “hi” and “hi (name)”.
Leelo’s family reports that he sometimes spontaneously greets adult friends and acquaintances. Leelo also occasionally echoes greetings
with “hi Leelo”.
B. Eye Contact: In discrete
trial setting, therapist says “(student’s name)”, and “Look at me”. Student is expected to look up, and to
sustain eye contact for gradually increasing periods. Generalization: Student makes eye contact in real
life context when variety of people call name and say “look at me”. Therapists began task using
edible reinforcer at eye level on each trial.
With systematic fading of this prompt, in a discrete trial setting Leelo
has mastered eye contact in response to “Leelo”, and to “Look at me” for up to
two seconds. He is working on responding to “Leelo” and “look at me” in
context, while playing, and can currently look, while he is running around,
when his parents call his name.
C. One-Step
Directions: In discrete trial setting, therapist gives simple verbal
direction, and student responds accordingly. Generalization: Student follows directions in real
life contexts, with family members, teachers, peers, etc. Leelo has
mastered 17 directions, all of which he is now working on generalization.
D. Two-Step
Directions: In discrete trial setting, therapist gives two-step verbal
direction , and student responds accordingly.
Generalization: Student follows directions in real life contexts, with
family members, peers, etc. These are
difficult, as they require the student to maintain process language, and
maintain 2 pieces of information while performing actions. Leelo has mastered 7 two-step directions.
E. Imitate Actions
with Objects: In discrete trial setting, therapist says “Do this”,
and models an action with a toy/object.
Student imitates model.
Generalization:
Student uses skills in variety of contexts, including during play with peers,
and during small and large group instruction.
Leelo has mastered 18 actions with objects. In addition, he
can do all of these actions when they are stated as a direction- this requires
language comprehension rather than copying from a model. Leelo is working on generalizing
these skills by imitating his peers in play group.
G. Two-Step Gross
Motor Imitation: In discrete trial setting, therapist says “Do this” and
models 2 actions. Student imitates both
steps. Generalization: Student imitates
2-step movements in variety of contexts, with peers. These
are very challenging for Leelo, as they require his attention to the 2-step
model while simultaneously demonstrating control over his body. Leelo has mastered three 2-step
gross motor actions.
H. Receptive Body
Parts: In discrete trial setting, therapist says “Touch (body
part)”. Student touches correct body
part. Generalization: Identification of
body parts in books, on toys and other people.
Leelo has mastered 21 body parts receptively. He is working on identifying body parts in
play group activities.
I. Expressive Body
Parts: In discrete trial setting, therapist says “What’s
this?” and points to body part. Student
correctly labels body part. Generalization: Student labels body parts with
variety of materials, contexts. Leelo
has mastered 21 body parts expressively.
He is working on labeling body parts in play group activities.
J. Saying “All
Done”: Student initiates “all done” when he/she feels
finished working at the table.
Generalization: student initiates “all done” in a variety of settings,
with a variety of people. Leelo
has progressed from running away from the table to spontaneously stating “I’m
all done” when he is finished with something.
He also spontaneously uses “I’m all done” in structured play contexts
with therapists, and with parents in a variety of settings. When frustrated, he needs a prompt to remind
him to say “I’m all done” and to speak clearly when stating “I’m all done”.
K. Saying “My turn”
to access toys: In discrete trial setting, therapist
takes a turn playing with toy/material.
Student spontaneously says “My turn” to access toy. Generalization:
Student spontaneously says “my turn” to access materials with a variety of
people, in a variety of situations. In discrete trial setting, Leelo
says “my turn” to access toys. Leelo also spontaneously says “my turn” in play
group with peers, and responds to peer requests of “my turn” by giving them a
toy.
L. Pretend Play: In discrete
trial setting, therapist says “pretend to ...”. Therapist models pretend behaviors, sounds, and actions with
toys. Student follows direction/model.
Generalization: student pretends in play contexts, student pretends with other children. Leelo has mastered 19 pretend
actions, including at least 8 animals, and as well as pretending to cry, swim
and fly. He will use these skills in a variety
of locations with DTT presentation. In addition, he is beginning to play
spontaneously. However, his play skills are not yet refined and fluid enough to
be functional in a typical play setting.
Leelo also continues to bang toys together and play without apparent
purpose.
M. Pretend Play
Sequences: In discrete trial setting, therapist models 2 or more
related play skills (e.g. feed and hug baby doll). Student imitates 2 or more steps correctly. Leelo has been working on
stringing two or more play actions together.
He recently began combining two and three steps using food and birthday
party toys, as well as blocks, both with a model and spontaneously. On occasion, he has spontaneously used toys
in an abstract fashion; for example, he made a “slide” for a character out of
blocks.
N. Yes/No:
With
object labels: In discrete trial setting, student correctly responds “yes” or
“no” when presented with object and question “Is this a _____?”
With preferences: In discrete trial setting,
student correctly responds “yes” or “no” when presented with object and
question “Do you want _____?” Generalization:
student uses skills correctly in real life settings. Leelo has
mastered yes and no for objects. He
also has mastered yes for preferences in discrete trial.
O. Wet/Dry: Receptive: in
discrete trial setting, student correctly identifies wet and dry materials from
an array. Expressive: In discrete trial
setting, student can label wet and dry materials when presented with an array.
Generalization: Student uses skills correctly in real-life settings. Leelo has mastered wet receptively and
expressively.
P. Dressing/Undressing: In discrete
trial setting, student correctly removes or puts on clothing items when asked
to do so. Leelo has mastered 4 undressing skills:
taking off shoes, socks, shirt and pants.
He is beginning to work on dressing skills.
Q. Toileting:
This
encompasses many skills, including identification of wet and dry, dressing and
undressing, staying dry,requesting/initiating toilet use, correct use of the toilet when necessary, and proper
cleaning. Leelo has mastered pulling off pants, is working on wet
and dry discrimination. Toilet training
began the week of 5/10/04, and is ongoing.
S. Natural Language Paradigm (NLP):
An ABA
procedure used to increase imitation and spontaneous language. Leelo responds well to NLP
techniques, and is currently working on four word imitations. With therapists, he regularly initiates spontaneous
language, and often gives a novel response to a therapist model (e.g.:
Therapist: “Bear is blue” Leelo: “Bear
is green”.) During structured play
groups, Leelo consistently imitates at
least 3 words in NLP with his sister and peers.
T. Making Verbal Requests:
In both
discrete trial and all other settings, student will spontaneously make verbal
requests for things he/she wants. Leelo consistently makes verbal
requests of his parents and therapists.
His requests can be elaborate and varied. Examples include:
·
Open door. I want to go outside.
·
Go down slide, Therapist L
·
I want to sit on bean bag.
·
Give me hat.
·
Let’s go to bed. Daddy bed.
Leelo’s articulation is often unclear when
making requests. In addition, when
frustrated, he requires prompts to remind him to use language to communicate
his needs. He is working on making
requests from peers. Therapists
encourage a variety of requests.
U. Spontaneous
Language: Therapists and families use incidental teaching methods to
provide rich opportunities for spontaneous language. Spontaneous language data
is collected throughout therapy, and during family time. Leelo
generalizes vocabulary and phrases learned and heard during NLP, stories, and
videos. Recently he began spontaneously
using adjectives (e.g. “I want the blue bear”). He occasionally asks “where” questions and gives directions to
his therapists. He also answers yes and
no questions correctly in real contexts.
And, he can give a novel response when a therapist models a statement
(e.g. Therapist: “I have a red car. “ Leelo- “I have a blue car.”).
V. Facilitated Play
Group: Leelo participates in two facilitated
play groups each week. One group
includes his sister and a family friend (both 5 years old) as peers. A second group includes a cousin and a neighbor
(ages 5 and 6) . During the group, the
peers learn how to play with Leelo by getting Leelo’s attention, using NLP,
speaking with Leelo in short phrases, and helping him to imitate play behaviors
and ideas. Leelo’s goals include greeting peers, exchanging materials with peers,
imitating peers, and playing games (pretend and structured) with peers. In
addition, in order to prepare him for future preschool participation, the group provides Leelo with opportunities
to experience circle time activities. Leelo
currently greets his playmates, often spontaneously in response to their
greetings. He regularly takes turns
with and exchanges toys. In NLP
activities, he imitates up to 4 words said by his peers, and occasionally says
novel phrases. He is beginning to
attend to circle time activities; however he generally requires prompts to sit
and participate, and frequent breaks throughout the hour-long play group.
W.
Therapy Circle Time: In
order to accelerate Leelo’s mastery of circle time skills and readiness for preschool, Leelo has
recently begun to participate in circle time during therapy, both in his play
group and with 2 adults (when peers are not available). During circle time, skill emphasis is on
taking turns, imitating others, following directions, and increasing independent
participation in routines.
MASTERED
SKILLS:
Skill Introduced Mastered
A. Greetings:
1
Responds “Hi”
in DTT 8/28/03 9/9/03
2
Responds “Bye”
in DTT 8/28/03 9/9/03
3
Responds “Hi
(name)” in DTT 9/15/03 10/16/03
4
Responds “Bye
(name)” in DTT 9/15/03 10/16/03
5
Responds to
“Hi (name)” in context 9/15/03 11/5/03
6
Responds to
“Bye (name)” in context 9/15/03 11/5/03
B. Eye Contact
1
1 second in
response to “Leelo” 7/31/03 10/7/03
2
1 second in
response to “Look at me” 7/31/03 10/7/03
3
2 seconds in
response to “Leelo” 10/8/03 10/14/03
4
2 seconds in
response to “Look at me” 10/8/03 10/14/03
C. One step directions
1
Hands down 8/1/03 10/6/03
2
Stand up 9/10/03 10/7/03
3
Give me a hug 9/10/03 10/9/03
4
Give me a hi-5 9/10/03 10/7/03
5
Stamp feet 9/24/03 10/8/03
6
Jump 10/2/03 10/28/03
7
Throw this
away 10/16/03 10/28/03
8
Get tissue 10/2/03 11/11/03
9
Clap hands 10/16/03 11/13/03
10
Blow a kiss 11/12/03 11/19/03
11
Shut door 11/12/13 12/4/03
12
Wipe nose 11/19/03 12/4/03
13
Come here 11/19/03 12/30/03
14
Get shoes 1/14/04 1/27/04
15
Get jacket 1/14/04 1/27/04
16
Bring me block 1/28/04 2/2/04
17
Bring me train 1/28/04 2/2/04
D. Two Step Directions
1
Pick up salt,
put on table 2/24/04 2/26/04
2
Blow kiss,
give hug 2/24/04 3/12/04
3
Get tissue,
throw away 3/2/04 3/12/04
4
Stand up,
stomp feet 3/17/04 3/26/04
5
Get shoes,
bring to me 3/27/04 3/26/04
6
Sit down,
hands in lap 3/30/04 4/26/04
7
Get Teletubby,
sit on rug 3/30/04 4/26/04
Introduced Mastered
E. Actions with
objects
1
Put block in
bucket 8/28/03 10/15/03
2
Push toy car 8/28/03 10/9/03
3
Drink from cup 8/28/03 10/15/03
4
Roll playdough 9/9/03 10/9/03
5
Feed doll 9/17/03 10/6/03
6
Put on hat 9/17/03 10/9/03
7
Brush hair 9/24/03 10/6/03
8
Kiss doll 9/24/03 10/6/03
9
Ring Bell 9/24/03 10/16/03
10
Say hello into
phone 10/2/03 10/14/03
11
Bang hammer 10/21/03 10/28/03
12
Write with
crayon 10/16/03 10/28/03
13
Bang drum 11/12/03 11/18/03
14
Put coin in
bank 11/12/03 12/11/03
15
Wipe nose with
tissue 11/20/03 12/8/03
16
Blow horn 11/20/03 12/8/03
17
Put train
track together 1/14/04 1/28/04
18
Push trains on
track 1/14/04 1/28/04
F. Two Step Actions
with Objects
1
Put 3 pieces
of track together 1/29/04 2/3/04
2
Put 2 tracks
together and roll train 2/12/04 2/13/04
3
Roll train and
say choo choo 2/23/04 3/2/04
4
Roll one train
to another and say greeting 3/2/04 3/26/04
5
Build tower
w/3 blocks 3/30/04 4/21/04
G. Two Step Gross
Motor Imitation
1
Clap hands and
touch head 2/13/04 2/19/04
2
Wiggle fingers
and slap thighs 2/13/02 2/19/04
3
Stomp feet and
tap table 3/2/04 3/17/04
H. Expressive and
I. Receptive Body
Parts
Intro Rec Exprs
1
Nose 7/31/03 10/7/03 2/12/04
2
Knees 7/31/03 10/15/03 2/12/04
3
Head 7/31/03 10/13/03 2/12/04
4
Elbow 9/17/03 10/8/03 2/12/04
5
Tummy 9/18/03 10/7/03 2/12/04
6
Feet 9/24/03 10/9/03 3/1/04
7
Eyes 9/24/03 10/13/03 2/12/04
8
Hair 10/2/03 10/23/03 2/12/04
9
Mouth 10/2/03 10/23/03 2/12/04
Intro Rec Expr
10
Legs 10/17/03 11/13/03 3/1/04
11
Arms 10/30/03 11/14/03 2/12/04
12
Ears 12/1/03 12/5/03 2/12/04
13
Face 12/9/03 1/26/04 3/1/04
14
Hands 12/9/03 1/26/04 2/12/04
15
Shoulders 1/28/04 2/5/04 3/1/04
16
Cheeks 1/29/04 2/3/04 3/1/04
17
Chin 2/12/04 2/23/04 3/1/04
18
Thumb 2/12/04 2/23/04 2/23/04
19
Neck 3/2/04 3/10/04 3/17/04
20
Toes 3/2/04 3/10/04 3/17/04
21
Fingers 3/11/03 3/23/04 4/10/04
Introduced Mastered
1
Initiating
“all done” in DTT 8/28/03 9/17/03
K. Saying “My turn”
to access toys:
L. Pretend Play
1
Pretend to be
a lion 9/24/03 10/15/03
2
Pretend to be
a cat 9/24/03 10/15/03
3
Pretend to
sleep 9/24/03 10/14/03
4
Pretend to be
a car 10/29/03 11/14/03
5
Pretend to be
a dog 10/29/03 11/14/03
6
Pretend to be
a cow 1/14/04 2/09/04
7
Pretend to be
a frog 1/14/04 2/09/04
8
Pretend to be
a mouse 1/14/04 2/09/04
9
Pretend to be
a rooster 1/14/04 2/09/04
10
Pretend to be
a pig 1/14/04 2/09/04
11
Pretend to be
a horse 1/14/04 2/09/04
12
Pretend to be
a sheep 1/14/04 2/09/04
13
Pretend to be
an owl 1/14/04 2/09/04
14
Pretend to eat 1/29/04 2/20/04
15
Pretend to cry 3/2/04 3/25/04
16
Pretend to
swim 3/2/04 3/17/04
17
Pretend to fly 3/18/04 3/22/04
18
Pretend to
brush teeth 3/30/04 4/27/04
19
Pretend to be
a train 3/30/04 4/04
M. Pretend Play
Sequences 1/15/04 ongoing
N. Yes/No
1
Yes with
Objects 1/28/04 2/26/04
2
No with
Objects 1/28/04 2/26/04
3
Yes with
Preferences 3/1/04 3/12/04
Introduced Mastered
O. Wet/Dry
1
Wet receptive 3/24/04 4/12/04
2
Wet expressive 3/24/04 4/12/04
P. Dressing/Undressing
1
Take off socks 11/01/03 11/14/03
2
Take off shoes 11/01/03 11/14/03
3
Take off pants 11/15/03 12/30/03
4
Take off shirt 1/13/04 3/12/04
Q. Where is ...? ongoing
1
Imitate two
word phrases 8/1/03 10/2/03
2
Imitate three
word phrases 10/3/03 3/17/04