A Case

ED 425
10/06/2015
Demographics:
Name: A J
School/Grade: Preschool at Kidz Corner and Jefferson School District
Date of Birth: 2/10/2012 (Made up by Nevada)
Age: 3 years 7 months
Date of Evaluation: September-October 2015
Phone:
Address:
Family: J (dad), S (mom), B (brother), N (brother), A (sister), J (sister), K (sister), S (sister),
A (brother), A (brother), N (brother), A, C (brother).
Examiners: Brittany Sullivan and C
Report writer: Brittany Sullivan
Know examiners by: Class referral
Referral Made:
The parents were concerned with As delays in communication and understanding dangers. They
also want to have A defend himself and express himself. Mom worries about A not being able to
defend himself when others take things away from him or hurt him. She also is concerned that
his peers wont be able to communicate with him since he is nonverbal right now, and he can
only sign. They want someone to help A to progress and learn more, especially in the areas they
are concerned for A.
Background:
Developmental History:
A is a safe haven baby. This means his mom dropped him off at the hospital to give him away a
few days after he was born with no paper work. The mother only spoke Mandarin and had a
translator with her. She asked the hospital if it (safe haven) was a real law in Nevada. The next
morning A was dropped off at the hospital. The hospital personal think A is from California and
think the birth was normal. They think he was healthy and the mother had a problem feeding
him. They gave A to a foster family. That family had a hard time taking care of him. So the Js
now have him and have since 3 months.
He has reached some milestones of a 3 year old, but most of his development is of an 18 month
old. He is working on gaining muscle strength in his mouth to gain the ability to speak. He goes
to speech three times a week. He also goes to occupational therapy twice a week. His gross
motor skills are mostly of an 18-month-old child. He just learned how to walk and run in the past
few months. His fine motor skills are also coming along. He has a hard time speaking, but is able
to pick things up and use them.
Family History:
A is adopted. Most of his siblings are adopted too. J and S adopted a family with six children and
a family of three children. J and S also have two children of their own. A was adopted with just
him. A is the second youngest of the twelve. The children all like each other and help each other.

A also has a rough time when his siblings leave him to go to school. He will cry when the bus
comes. The family is definitely loving and caring for each other.
Social/Emotional History:
With routines, Mom and Dad like the ones in place. A likes routines, but he has some trouble
transitioning. The hardest transition is when he has to stop playing outside. One of the family
members normally carries him inside. Their basic routines include waking up, family scripture
study, breakfast, getting dressed, brush teeth, bus comes for older children, A goes to school and
comes home, lunch, nap, snack, playing outside with other siblings, dinner, playtime, bath, and
bed time. When this routine is broken, A will scream and cry, because he knows it is not right.
This will sometimes last for an hour. He will try his best to stick to the routine too. If someone is
over and it is bath time, he is going to walk to the bathroom and start the routine with or without
someone. It really varies day to day if the routines will go well for A.
Medical History:
At three months, A was diagnosed with Down s syndrome, visual impairment, a speech
impairment, and mixed receptive and expressive impairment. He also wears glasses. A has a
small airway. This can make it hard to breath. He doesnt have a strong immune system and is
slow to recover. Therefore, he is in the hospital often for not breathing well because of
sicknesses. To prevent him from getting sick, they use a lot of different oils and healing
bracelets. A also has allergies and takes medicine for it. He takes Zyrtec, Singular, and Flonase.
Educational History:
Alex goes to school at Kidz Corner with the HR, on Monday, Wednesday, and Friday. He also
attends the preschool in the Jefferson School District on Tuesday and Thursday. A also attends
speech three times a week, occupational therapy twice a week, and in the public school, he goes
to the gym to participate in physical therapy. His prior testing includes Routine Based
Intervention, Downs Syndrome Assessment, and Preschool Language Scale IV. In Las Vegas,
they were not getting many services for him, which is why they moved to Rigby. They had to
travel 2 hours to get services for A.
Observation:
Cognitive Domain:
A demonstrates his humor and cause and effect skills. During the Battelle Development
Inventory, C asked for a block. A picked up the block, dropped it in the box, while looking at C,
and laughed. A did this 4 times. A also would drop things off of the balcony. He would drop
multiple objects and watched what happened. He also did the same thing with beans from the
sensory table during the RBI. He was pouring beans on the floor and would smile when the
beans scattered onto the carpet. A has demonstrated contact skills by giving hugs, and high fives.
After our second visit, A gave everyone in the room a hug when we were leaving. A will give
high fives out when a person puts a hand up and says high five. Also when A is doing
activities he was engaging in for a few minutes, he had a smile on his face.

Motor Domain:
A shows physical movement skills by running, jumping, climbing, and fine motor skills by
coloring and grabbing beans from his sensory table. A demonstrated climbing when he gets on a
chair by holding to the seat, picking one leg up and putting it on the seat, and then pulls himself
onto the chair. Also A just learned how to run about a month ago. After the Battelle
Developmental Inventory, A decided to race his sister twice. He also demonstrated fine motor by
drawing horizontal lines on paper. During the RBI, A was playing in the sensory table. He had
beans in there. He dumped some on the floor and then picked them up using the fine motor
muscles in his hands.
Communication Domain:
A demonstrates his communication skills by using sign language, noises, and body language. He
will follow directions some of the time. During the Battelle Developmental Inventory, Mom
asked A to stack the rings on the stick. He proceeded by taking the rings off the stick and stacked
them. He then signed all done when he finished stacking the rings. A is very vocal with the
word up. He mostly says up. He was talking on the phone for the Battelle Developmental
Inventory. He acted as if he was talking to Dad. He said, Hi, which was followed by with
many ups.
Adaptive Self Help Domain:
A displays adaptive self-help skills through feeding himself and undressing himself. When we
come over, A is normally eating at the table without any one. He was dipping crackers into the
cheese and eating it. Also during the RBI, As brother mentioned getting a bath. A took off his
shirt and ran to the bathroom. He ran back to us in just a diaper.
Educational Domain:
A demonstrates knowledge of routines at school. A walked into the room. He walked to a chair
that had a boy sitting in it. A started to cry. The teacher walked A to a new chair. The teacher
explained, A this is your new seat. During playtime, A plays with multiple materials. One of
them was water in the sensory table. There were other children around him playing with cups
and people. A poured water out of the cup into the table and got more water. He was smiling. He
repeated it 4 times. He did not interact with others.
Summary of Trial Intervention
For As trail goal, we worked on A raising his hand to say stop. We decided to do that so A can
stand up for himself when a sibling takes his toy or is hurting him. Since he is nonverbal, we
think helping sign stop with his hand will be effective.
The activities we did were pouring water and running. We know he likes water, and was crying
after he was told he cant get a bath just yet. So we got two cups this water and gummies. We
bribed him with gummies throughout the activities. We poured water into a cup and would say
stop and show a stop sign with our hands. We gave him a physical prompt to sign stop, this was
to help teach the sign to stop. A wanted to participate and he helped pour. After the cup was
empty, we would say and sign stop. A would put his hand when we were modeling and sign all
done 5 consecutive times.

Then we went into the running activity. C was modeling running with A, and I was on the
opposite side of the balcony modeling the sign for stop. We both gave verbal prompts when ran
and when we stopped. After A would demonstrate the sign for stop, he would get a gummy. The
second time they ran he put both of his hands up. We did this 7 times. The last 3 times he
consecutively would run to me and put at least one hand up when we signed and said stop. This
shows he is ready to use the sign into action.
Results of Interviews
Routine Based Interview:
This information was obtained 9/30/2015 from mom.
The parents were concerned with As delays in communication and understanding dangers. They
also ultimately want A defend himself and express himself so he doesnt get hurt and can
communicate with his peers, since he is nonverbal right now.
The J family is religious and has varies of church activities. This provides friends for them,
which means help occasionally. They also have community help for resources for a few of their
children. Some services are physical therapy, occupational therapy, speech, and school services.
A wakes up around 6-6:30 along with the other younger children. The rest of the family is
waking up and getting ready for the day. After waking up, the family participates in family
scripture study. Mom explained that the family is normally good about it, and A is the Prayer
Nazi. He makes sure every morning there is a family prayer before scripture study. The family
reads a few verses and then eats breakfast.
During breakfast the family talks and eats. When they are finished, they put their dishes away.
They have to keep an eye out for A, because he will sign that he is done. A few seconds later, he
will smash his food or flip over his bowl or plate on the table, mom explained.
After breakfast everyone brushes their teeth. Older siblings and parents help the younger ones
when needed. Then the older children get everything together to catch the bus to school. Mom
said, After A watches his brothers and sisters get on the bus, he will sometimes grabs his
backpack, because he wants to get on the bus too.
Then around 8:15, HR from Kidz Corner takes A to school. He is in school from 8:15-11:30 on
Monday, Wednesday, and Friday at Kidz Corner. On Tuesday and Thursday, he goes to the
public school. A sits well in class, but gets upset when his seat is changed or if someone else is in
his seat. He also doesnt interact with other peers and is very independent. He also gets physical
therapy, speech, and occupational therapy in school. Mom is at home with a 18 month old boy.
Then when he comes home, he eats lunch. They watch speech videos together. Again, A has to
be watched so he doesnt dump the leftover food he has on the table. Mom, N, C, and A eat
together at the table. Mom and N help clean up afterward. Mom looks through As backpack for
schoolwork

Then they all take a nap. Mom will read them a story. They nap anywhere from 1-3 hours. They
go into separate rooms. Sometimes they wake up early for speech on Monday and Tuesday.
When they wake up, normally the older children are home, and they will eat a snack together.
Then they go outside to play until dinnertime. A and C play a lot together. A normally doesnt
want to leave, so he is carried inside. They play games, jump on the trampoline, swing, and, play
on the teeter-totter. During this time, mom is making dinner.
During dinner time, A will dump his food out of the plate or bowl and then he will smash it.
Sometimes he will eat really fast or really slow depending on when his siblings finish their food.
He didnt eat solid food until he was about 2 years old. At one year, he would eat baby cereal,
and at 18 months, he started eating baby food. Some textures of food he wont eat. His mother
says that the food needs to be simple. He recently has learned how to drink from an open cup.
After dinner time the children in the family will get to play a little longer until bedtime. Around
7 pm it will be time for A to take his bath. He loves his bath time! He is able to turn the water on
without assistance if there was nobody there to supervise him. He likes to dump water out of the
bathtub. He is able to climb out of the bath by himself and grab a towel as well.
After bath time it is story time. He doesnt like when the stories end because that means he has to
go to sleep. He usually gets mad when it is time to sleep. Bedtime is between 7:30 and 8:00pm.
Mom seems very confident with her routine and doesnt have a problem with them. She does
want A to stand up for himself and understand dangers he runs into throughout the day.
Tests Administered:
RBI (Routine Based Intervention)
o This is an interview to evaluate routines. Parents decide if they like the routines
after describing them. If not interventionist and parents work together to make
them better.
Trial Intervention
o This helps determine whether a child is ready to start learning on a goal.
Vineland- II Adaptive Self-Help
o This shows his skills in the developmental domain. It finds the age equivalent and
shows if he is compared to his peers.
BDI-2 (Battelle Developmental Inventory- 2nd Edition)
o The new Battelle Developmental Inventory, Second Edition (BDI-2) can be used
for all sorts of disabilities by using modifications. For ages birth to 8, the BDI-2 is
ultimately used for identification of children with disabilities, evaluation of
groups of children with disabilities in early education programs, assessment of the
typically developing child, screening for school readiness, and program
evaluation for accountability.

Data:
Vineland II

Communication
Receptive
Expressive
Written
Daily living
skills
Personal
Domestic
Community
Socialization
Interpersonal
Relationships
Play and Leisure
Tine
Coping Skills
Motor Skills
Gross
Fine
TOTAL TEST

Date Administered : 9/30/2015, 10/07/2015

90%
Domain
Raw
V-Scaled
Conf. Standard
Score
Score
Interval
Score
7
54
23

2
11
6
1
7
15
3
0
10
8
64

28
20
4
4

8
11
9
28

20

13

10

48
24

11
19
10
9

2
3
2
6
2

68
-

2
8
2
2
5

67
61

Percentile
Rank
0.1

Age
Equivalent

1:0
1:3
1:10

0.5

1:9
1:10
1:6
0:7
1:2
2:1
1:9
2:1

In Receptive, A he will follow instructions with promptings. He struggles with repeating

common words. In Expressive, he can sign help, finished, and more continently. He struggles
with standing up for himself. In Written, A can draw lines. He has difficulty with making letters.
In Personal, A can undress himself. He has difficulty dressing himself. In Domestic, he will get
help when he needs something. He hasnt put away toys consistently. In Community, he will
help others complete tasks when asked. A hasnt gain an understanding of strangers.
In Interpersonal Relationship, A sometimes looks at people who are talking. He hasnt. In Play
and Leisure Time, he will play next to other peers. He has difficulty with playing with peers
other than family. In Coping Skills, he will stop crying if he is distracted. A struggles with selfsoothing.
In Gross A can throw a ball five feet. He hasnt walked down the stair with both feet on each
stair. In Fine, he unwrap small objects such as candy. He struggles with turn paper pages of a
book.

BDI-2

Date Administered: 9/30/2015, 10/07/2015

Raw Score
Scaled Score
34
1
4
2

Adaptive
Self-Care
Personal
Responsibility
Personal-Social
Adult Interaction
Peer Interaction
Self-Concept and
Social Role
Communication
Receptive
Communication
Expressive
Communication
Motor
Gross Motor
Fine Motor
Perceptual Motor
Cognitive
Attention and
Memory
Reasoning and
Academic Skills
Perception and
Concepts
Total

Percentile Rank
0.3
<1
<1

38
12
30

3
2
2

1
1
<1
<1

15

0.1
<1

25

<1

64
29
11
28

4
2
2
1

0.5
2
<1
<1
0.4
<1

12

17

<1

0.1

In the Self-Care section of the test, A without assistance undresses himself and feeds himself. A
has some difficulty with expressing the need to use the toilet, and controlling his bladder. In
Personal Responsibility, A most of the time shows care to small infants and animals when
handling them, and puts away toys. He does struggle with knowing hot is dangerous and indicate
when he is feeling sick.
In Adult Interaction, A asks an adult for help when needed, and responds positively when adults
in authority initiate social contact. He does struggle with following rules and attempting to be
humorous. In Peer Interaction, he responds differently to familiar and unfamiliar children and
plays independently in the company of peers. He does struggle with playing with a peer using the
same materials. In Self-Concept and Social Role, A imitates others and change behavior based
on what others are doing, and expresses enthusiasm for work and play. He struggles with using
personal pronouns and stating his age.
In Receptive Communication, A responds to different tones of a persons voice and turns head
toward a sound. He doesnt attend to peoples conversations for 30 seconds, and doesnt point to
objects across the room when it is named. In Expressive Communication, A communicates back

and forth with sounds, gestures and other nonverbal methods, and spontaneously initiates sounds,
words or gestures that are associated with the object. He has difficulty use 10 or more words, and
using pronouns.
In Gross Motor, A can throw a ball 5 feet and walk down 4 steps with support. He has difficulty
catching a ball from 5 feet away and walking in a straight-line heel-to-toe for four steps. In Fine
Motor, he intentionally throws objects and scribbles linear patterns. He struggles with holding a
paper with one hand while drawing with the other hand and fastening clothing without
assistance. In Perceptual Motor, A stacks two cubes and dumps raisins from bottle. He struggles
with imitating circular markings and stacking 8 blocks vertically.
In Attention and Memory, A finds a hidden toy under one of two cups and attends an activity for
3 or more minutes. He hasnt attended a learning task or story in a small group for 5 minutes or
recited memorized lines from entertainment. In Reasoning and Academic Skills, A nests objects
inside another and reaches around a barrier to obtain a toy. He struggles with identifying the
source of common actions such as flying, sleeps, barks, and gives three objects on request. In
Perception and Concepts, A places a circle and square on a foam board cut out and imitates
simple facial gestures. He struggles with identifying big and little shapes and sorting by size.
Interpretation:
Cognitive:
Alex is in the below average range according to the BDI-2 for the cognitive domain. A
demonstrated cause and effect skills when he poured the beans from the sensory table onto the
carpet. He was seeing how the beans fall and scattered. He tried dropping them on the floor and
pouring them out of a cup. This is typical for his age; children are always exploring the world
around them. During the Battelle Development Inventory, C asked for a block. A picked up the
block, dropped it in the box, while looking at C, and laughed. A did this 4 times. He thought it
was funny and kept doing it. This is also typical for a child his age, especially ones with
siblings. Due to As skills in the cognitive domain, he has a hard time occupying himself for 10
minutes without demanding attention, which means he will need lots of attention throughout the
day and may have a hard time getting that attention in school.
A Doesnt Yet:
Occupies himself for 10 or more minutes without demanding attention
Points to pictures in a book
Recite memorized lines from a book, TV, or songs
A Sometimes:
Occupies himself for 5 minutes
Matches colors
Signs words for colors
A Always:
Reaches for a toy around a barrier
Uncovers hidden toy
Attends to one activity for 3 minutes

Motor:
A is below average in his motor skills according to the Vineland, and below average in the BDI.
A shows motor skills at home by climbing on the chairs to sit on. This is normal for children his
age. A can also walk on a tapeline one foot in front of the other using alternate feet. At school he
attends a PT class and walks on a balance beam sometimes. This is advanced for a child at this
age. I think he obtained this skill through practice at school, which means through application
and practice, A can learn skills and surpass age milestones. During the BDI-2, A used a crayon to
draw horizontal lines on a paper. This is typical for his age. But he cant color in circular motion,
which is typical for a child his age. During the test he didnt want to spend more time coloring
and drawing because he was distracted with the rings on a stick. He wanted to play with them.
Due to As skills in motor development, he might struggle to participate in motor activities with
others easily.
A Doesnt Yet:
Skip
Rides a bike with training wheels
Colors inside the lines
A Sometimes:
Extends a toy to a person and releases it from his grasp
Walks up the stairs without assistance
Walks forward 2 or more steps on a line on the floor with alternating feet.
A Always:
Climbs on furniture and equipment
Run 10 feet without falling
Drop an object intentionally with demonstration
Communication:
A is below average for his age in communication skills according to the BDI, and Vineland.
During trail intervention, A signed all done when we dumped all the water out of the cup.
Even though we were introducing the sign for stop, he was signing his version of it by using his
prior knowledge. I feel like this is typical for a child his age learning a new word. During the
BDI-2, A was pretending to talk to his dad on the phone. He started by saying, hi and the rest
of the conversation was A constantly saying the word up. This is typical for children younger
than A is. Since A is mostly nonverbal, because his fine motor muscles in his mouth are
struggling to get the strength to make sounds. So he is learning words with signs. A only knows
about 30 signs, he has a hard time communicating. Due to As communication skills, he may
have a hard time expressing himself whether it is his need, wants, or standing up for himself.
A Doesnt Yet:
Understands pronouns
3 word phrases
Follow verbal commands
A Sometimes:
Recalls events from stories
Attends to someone speaking to him for 10 seconds
Associates spoken words to familiar objects or actions

A Always:
Says the words up and hi
Understands and uses 30 signs
Responds to tones in a persons voice
Adaptive Self Help:
A is below average according to the Vineland, but below average according to the BDI. A
demonstrated picking up beans from the carpet after spilling them on the floor and mom asked
him to do so. I think he did pick some up, because we all helped him pick up the beans. He had a
model and verbal prompt. This is normal for children, because most children do not like cleaning
up at this age if someone else will let him get away with it. Also during the RBI, As brother
mentioned getting a bath. A took off his shirt and ran to the bathroom. He ran back to us in just a
diaper. It is typical for children to undress themselves at this age. I think he was prompted to do
this because he is a stickler for following routines. He knew it was bath time. Due to As skills in
adaptive self-help, he may have a hard time understanding dangerous things.
A Doesnt Yet:
Uses caution when doing or near dangerous things
Careful around hot objects
Dress himself
A Sometimes:
Describes illness to adults
Distinguishes food from toys
Puts away toys when asked
A Always:
Can undress himself
Feeds himself without assistance
Asks for food or liquid with gestures
Social/Emotional Domain:
A is below average in this domain according to the Vineland and BDI. Mom has told us that
normally play on his own, but if he plays with anyone, it is normally his 18-month-old brother.
This may be happening, because he cant truly communicate with others or imaginary play with
roles. So developmentally, he plays with someone at his own level. A also gives people hugs
when they leave. I think is because he comes from a loving family. A is conditioned to give hugs
often in his big family. This is normal for a child at this age to do with familiar people. Due to
As social/emotional skills, he may struggle with fitting in and having relationships with others,
because of the lack of him playing and connecting with his peers.
A Doesnt Yet:
Trusts familiar adults and accepts their explanations
Shows sympathy or concern
Throws or breaks things on purpose
A Sometimes:
Expresses feelings of anger and frustration appropriately

Recognizes a childs feelings

Changes behavior for different people

A Always:
Follows directions given by an adult for simple games
Shows affection to familiar people
Makes social contact
Reliability/Validity Discrepancies:
These tests do have some errors that give it a range of where the true answer could be. There
could be errors, because of health, environment, administrating, and the test itself. When tests are
given at different times, it can also affect the scores. Also A needed a lot more help to stay
focused on the assessment.
Recommendations:
After the assessments, interviews, and observations, A is eligible for an IEP under cognitive
impairment. In the BDI-2 and the Vineland, A is ranked 3 standard deviations below his peers in
communication, adaptive self-help, motor skills, and personal-social domains. In the BDI-2 he
also was 3 standard deviations below his peers in the cognitive domain. Typically anything 2 or
more standard deviations away from the mean one qualifies for special education. A fits in this
category to have special education and service.
In the communication domain, A has a hard time communicating his wants and needs with words
and signs, but will wave bye and give hugs to people who are leaving. In the adaptive self-help
area, A has a hard time dressing himself, but can undress himself. In motor skills A can run, but
he slides down the stairs rather than walking down them. In his social domain, he will interact
with people he knows, but struggles to play with others. Then in the cognitive domain, A can
identify a few colors with sign language, but has a hard time staying focused in something.
These skills are good for A to obtain. To help A in prove, intervention with specialists can help
the progression of these skills. A can receive speech services, occupational and physical therapy,
and a general developmentalist to help A gain social and adaptive self-help skills (also can help
implement interventions in the home if other services are done through the school).
Since the parents are concerned with As delays in communication, understanding dangers, and
standing up for himself, we will work in those areas. All of those seen to be appropriate and
important.
Recommendations for Professionals:
Continue working on words (speech) and signs
Keep parents involved with school activities and ask them to use the same
activities/procedures/things learned at home
Provide opportunities for A to work and communicate with others
Recommendations for Parents:
Model and practice with A how to say/sign stop
State dangers to A and tell him simply why it is dangerous

 Help A play with others by having him play with you then work on other people
Recommendations for the Classroom:
Have pictures of words for A to communicate with to others
Have group activities and group discussion to help A communicate in different ways with
his peers
Put a picture that represents danger on things that are dangerous
Summary:
A is 3 years old boy. He has a family who cares about him and wants to help him grow. They
want A to understanding dangers, defend himself/express himself, and communicate with peers.
Alex is delayed in cognitive, communication, adaptive self-help, motor skills, and
social/emotional skills. He doesnt know when to use caution with dangers. He doesnt follow
verbal commands. A also struggles with dressing himself, and playing with peers. In the motor
domain, A does run and is making great progress in it. He is also progressing with his signs. A
can feed himself with little spilling, has an attention span long enough to play with a desired toy
for 3 minutes, and walks over to someone who is crying.
Also professionals should continue working on words (speech) and signs, keep parents involved
with school activities and ask them to use the same activities/procedures/things learned at home,
and continue with OT and PT. They should also have their classrooms contain transitions that
require movement in correlation with what A is learning in OT/PT, have group activities and
group discussion to help A communicate in different ways with his peers, and put a picture that
represents danger on things that are dangerous. While the parents should model and practice with
A how to say/sign stop, state dangers to A and tell him simply why it is dangerous, and help A
play with others by having him play with you then work on other people.
Signatures:
______________________________________________________________________________
______________________________________________________________________________
Date: ____________________