Pediatric Services Pediatric Services: An intervention team serving children with developmental delays.

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CASE IN PROGRESS • Last updated May 27, 2017

Jonathan at 2

This is the story of Jonathan. Jonathan is a beautiful little boy with a diagnosis of Down Syndrome. The following is his growth and development from the ages of one to two years. If you would like to learn more about Down Syndrome reference books are listed at the end of this article.

Julie Loe

At Jonathan’s second birthday on January 25th, it was time to look at his final year of early intervention and begin planning his school based services that would begin on his third birthday. At the time of his second birthday he was receiving services from a physical therapist, child education specialist, behavior/parent specialist, and speech/language pathologist.

In the previous six months, Jonathan had developed what we termed, "throwing behaviors." He literally threw anything we presented to work with. These behaviors were interfering with his development in all areas. At this assessment, his parents discovered that he was making much less developmental progress because so much time was spent on these behaviors.

We decided that the behavior/parent specialist would work closely with mom, dad and Jonathan on finding alternative outlets for Jonathan rather than simply throwing everything placed in his hands. The parent specialist introduced the concept of "quiet hands" to the family, and we found a measure of success when Jonathan worked in a small, well-defined area , such as sitting on a blanket, or inside of a basket.

A second area of concern was Jonathan’s short attention to task and resistance to completing activities. We began to work on keeping Jonathan sitting for longer and longer periods of time. Many different types of activities were presented to retain his attention, to the point where the therapist was "the party". As the year went on, it was discovered that Jonathan would work well for longer periods of time if singing and reading specific books was incorporated. We learned to intersperse his favorite activities with less favorite tasks to build his attention to detail and task completion.

Health-wise Jonathan’s third year was notable for the placement of another set of P.E. tubes in his ears to address his ongoing ear infections. Otherwise Jonathan remained quite healthy, with only two colds and no flu or other illnesses. Following his eye surgery Jonathan did not have to wear his glasses anymore

By his third birthday Jonathan was able to walk and run well, and he discovered the joys of climbing, (to his parent’s dismay, at times). His mother and father have found many creative methods of keeping Jonathan from climbing over the baby-gates. When he discovered how to climb out of his crib, his parents found ways to keep him safe while he slept, but allowing him to play in his room at other times during the day. Jonathan learned to be self directed and independent, often preferring to play upstairs in his room rather than in the living room.

Speech therapy began on a weekly basis just following his second birthday. This year a lot of time was spent improving his ability to communicate. Jonathan did learn several signs, such as more, all gone, eat and drink, and this greatly helped him communicate with his family.

In the fall of this third year, a psychologist from the local school district visited the family to assess Jonathan before his Individualized Education Plan (IEP). This particular psychologist used the Developmental Profile II (DPII). The DPII is an assessment where the parents act as informants as to the skills their child possesses in addition to assessments submitted by the early intervention therapists. The DPII looks at all areas of development and is scored by showing a percentage delay. Jonathan’s scores were as follows: Physical (24 months - 29% delay); Self-Help (16 months - 52% delay); Social (20 months - 41% delay); Academic (18 months - 47% delay); and Communication (24 months - 29% delay). These standings were submitted to the school district (both local and county) and were part of the information used to determine the best educational program for Jonathan following his third birthday.

As a child approaches this milestone, it is of great concern to the parents as to where their child would go to school. Many parents have ideas about what they would like, or not. Many parents aren’t able to visualize their small child going to school, possibly without them or even possibly on a school bus. There are many emotional issues tied to a decision about where and when and how much a child should go to school , at the young age of three. Jonathan’s mother and father had all of these concerns and more.

When Jonathan was 28 months old, his parents met with representatives of the local school district, County Office of Education, speech/language preschool, and his current therapists to discuss what would be the most appropriate placement for him. His parents were invited to visit all the preschool programs to see what they were like and if Jonathan would be happy there. His mom and dad liked the COE speech and language program and it’s nurturing atmosphere. They decided that that was where they would like Jonathan to go after he turned three.

As the law requires, Jonathan’s IEP was held just before his third birthday. At that time he was functioning at: 18 month level in fine motor, toileting, and adaptive/cognitive skills; 21 month level in gross motor and personal social skills; skills scattered from 12 - 18 months in communication skills; and 15 - 18 month level in hygiene and dressing skills.

The professionals agreed with Jonathan’s parents that the COE speech and language classroom would be a good choice for Jonathan. It was noted that Jonathan is a happy and very active little boy. His strengths include his love of music and games involving music and his joy in playing outdoors. The IEP team decided to transition him into his school career by having him attend school two days a week, increasing the amount of time at school each day as he is ready. His parents decided to drive him to school, rather than have him take a school bus.

Jonathan had made good developmental progress during his time with Pediatric Services, and his family was delightful to work with. Jonathan began his pre-school career immediately following his third birthday. School has been a big change for Jonathan and his family, but they take each day one at a time, and Jonathan is growing well.

Suggested Readings

Babies with Down Syndrome- A New Parent’s Guide, Edited by Karen Stray Gundersen, Woodbine House
Keys to Parenting a Child with Down Syndrome, by Marlene Targ Brill
Teaching Your Down’s Syndrome Infant: A Guide for Parents and Professionals, by Marci J Hanson
Communication Skills in Children with Down Syndrome: A Guide for Parents, Woodbine House
The Language of Toys, Sue Schwartz, and Joan Heller Miller, Woodbine House
In association with Amazon.com. Available now by at Amazon.com.

 
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Last modified: May 27, 2017