Assessment of Young Children with Special Needs

A Context-Based Approach

Susan M. Benner, Joan Grim

• Publisher: Routledge
• Year: 2012
• eBook ISBN: 9781136882074
• Topic: Education
• Subtopic: Early Childhood Education

Assessment of Young Children with Special Needs, Second Edition helps prepare teachers for the task of evaluating the skills of infants, toddlers, and preschool children with developmental delays and those considered at risk to experience developmental delays or difficulties.

A child's environment is a critical consideration when focusing on assessment, and authors Susan Benner and Joan Grim explore the important issues of family resources, health, multidimensional environmental influences, economic deprivation, and domestic violence on infant and child development. This textbook conveys a sense of respect for parents, the powerful influence assessment results can and do have in the lives of young children with special needs, and an understanding of the complexity of child development, progression, and measurement. This book sets the tone for important values and beliefs to honor throughout one's professional life.

This fully revised edition addresses recent legislation, updated versions of assessment, and the newest assessment tools that teachers will come across. The popular full-length case studies of the first edition have been updated, and vignettes of other cases are fully integrated across chapters, bringing the text alive with meaning. Assessment of Young Children with Special Needs, Second Edition now includes expanded discussion on progress monitoring and response to intervention, functional behavioral analysis, pros and cons of norm-referenced testing, web-based gathering tools, ELL students, and screening for autism.

1

MEET THE CHILDREN
Infant and Toddler Cases

INTRODUCTION

A determined 17-year-old mother is faced with raising an infant at-risk for disabilities and her early interventionist discovers her determination is stronger than her parenting skills. Young, professional parents learn that their toddler does not behave like the toddlers in her playgroup or her young cousins and they grapple with recognizing they might need more help to raise her than they planned. A family is jolted into assuming guardianship of their young nephew after a devastating car accident that left his mother dead and father in a coma. These are the stories of the children and families who come to the early intervention system. They look to early intervention providers to give them information and guidance as they face the challenges of raising their children.

These families and their unique set of circumstances reflect the complexity of gaining useful and meaningful information and the limitations of what we can learn from traditional assessments. The families and children depicted in these cases are not real, but their stories illustrate a broad range of issues and concerns associated with situations they face. Early interventionists have the responsibility to help families find answers to questions about their child's development. It is not any easy task. Children's developmental outcomes are influenced by a broad environmental context. Understanding the unique characteristics of each child's experiences is critical if we are to connect their lives with meaningful assessment information.

ERICCA

• Ericca Johns: nine-month-old child
• Julianna Johns: Ericca's mother
• Sarah Brewer: Ericca's grandmother
• Gina Croce: early childhood specialist.

Ericca is 9 months old. She lives with her mother, grandmother, and two uncles in a government-subsidized apartment located on the east side of a large Midwestern city. Ericca was born six weeks premature and stayed in the hospital neonatal intensive care unit for two months following her birth. When the hospital released Ericca, the staff gave her mother information about early intervention services and suggested that she contact a service coordination program in the city for developmental follow-ups.

Juliana, an enthusiastic young mother, immediately followed up on this suggestion. Gina, a member of the staff, made a home visit to Ericca and Juliana. She completed a developmental screen of Ericca, who was then 3.5 months old, using the Early Learning Accomplishment Profile (E-LAP; Glover et al., 1995a). It is common practice to adjust the developmental expectations of a premature baby to that of an infant based on the actual due date rather than the date of birth. Thus, when assessing premature babies, examiners will keep both the chronological age and an adjusted age in mind. Considering how young the child was chronologically, and that she had an adjusted age of only 1.5 months, it was not surprising that Ericca did not initially appear eligible for services as developmentally delayed. Although Juliana reported that she was having some difficulty feeding Ericca, there were not sufficient symptoms or specific motor behaviors to diagnose any motor impairment or brain injury resulting from the premature birth. Well-child checkups were already available to Ericca through the local health department. The service coordinator explained the results of her screening and the meaning of chronological age and adjusted age to Juliana, and indicated that she would like to reevaluate Ericca in six months, when the child would be 9 months old. She also gave Juliana developmental questionnaires from the Ages and Stages Questionnaire-3 (ASQ-3; Squires & Bricker, 2009) for two months and four months and asked her to complete them over the next week and return them to her by mail. She gave her a stamped self-addressed envelope for the return.

Gina, whose background is in early childhood special education, documented her visit to Ericca's home and the results of the developmental screening. She coded the file so she would be prompted to contact the family about the reassessment if she did not hear from them within the designated six months. She was currently carrying a caseload of 57 families, including 27 children who would turn three within the next six months and need transition planning during that time. It would be easy for her to forget Ericca without this reminder, and she was not confident that Juliana would contact her again, even if the child were experiencing some developmental problems.

Juliana was 17 years old and had little knowledge of infant development. Her reading skills were limited and she seemed hesitant when given the developmental questionnaires to complete. Gina was wishing that she had taken the time to go over the questionnaires during the home visit. Although Juliana expressed a fierce determination to take care of Ericca, it seemed that her skills in child care had yet to be developed.

Six months later, when the prompt from Ericca's file appeared, Gina had to review the case before she could clearly recall the child or her mother. She was able to remember Ericca and Juliana, and gave the case high priority for follow-up. When she called the apartment, Juliana was not available. Gina explained to Ericca's grandmother, Sarah, who she was and why she was calling. Sarah said that Juliana and Ericca were still living with her and that she was providing child care for Ericca part time. Sarah explained that two weeks ago, Juliana and Ericca began participating in a family literacy program. In the mornings, Ericca was attending an early childhood education program while Juliana took basic adult education and parenting classes through the program. Gina debated to herself quickly about whether to schedule the appointment for Ericca through Sarah, but decided to ask that Juliana return her call instead. Juliana was the child's mother, even if she had just turned 18, and Gina was afraid that the cost would be high in terms of her relationship with Juliana if she sidestepped her. The grandmother's tone as she took the message was not encouraging, but Gina knew that she had to give Ericca's mother proper courtesy even though the grandmother was probably serving as the mother figure for Ericca in their multi-generational household. As she returned the file to the “needs follow-up” pile on her desk, she realized that she had never received the developmental questionnaires that she had left with Juliana. Now she had to decide how long to wait to hear from Juliana before calling again.

A few days later Gina received a call from Sarah about scheduling an evaluation for Ericca. Sarah explained that she had spoken with Juliana about her follow-up call and her daughter had asked that she make the arrangements since she was in classes or at work all day. Gina had no way to confirm the grandmother's information, but agreed to schedule another evaluation of Ericca. The appointment was arranged for late morning so Juliana could join them for at least some of the visit on her lunch break between the family literacy program and work. By this time, Ericca was 10 months old. Gina began with the ASQ-3 for six and nine months. She went over these checklists with Sarah and realized that Ericca seemed to be well below expected development. Using a context-based, family-directed assessment model, Gina, Sarah, and Juliana planned the assessment of Ericca by identifying Juliana's priorities, and primary areas of concern. Juliana was worried that Ericca was not sitting up and often refused a bottle at meal times. Sarah shared her concern that when Ericca took a bottle, she often spit up afterwards. She tried feeding her sitting upright but Ericca was too unsteady so they gave her the bottle while holding her in their arms. Sarah was concerned that Ericca seemed hungry and cried frequently. Julianna and Sarah both tried to play with her, but she is not able to reach and grasp her toys. The results of this planning are as follows:

The primary questions to be considered in this assessment of Ericca were:

1 How can we get Ericca to eat more and stop spitting up so much?

2 How can we get Ericca to sit up and start playing with toys more?

3 What are Ericca's current developmental levels and what skills are beginning to emerge in all developmental areas?

Sarah and Juliana agreed that Ericca was a happy child who smiled frequently and seemed to enjoy the attention of her young uncles who would play with her after school. Therefore, it was hard for them to believe that anything serious was wrong with her. However, Sarah realized that the infant's inability to gain weight or eat anything but formula was becoming a big problem. She realized that Ericca seemed to be falling behind in her development and was anxious to find out why. She had taken her to the health department for several well-baby checkups. Initially, the health department staff talked about Ericca's prematurity and how they would use her adjusted age to understand her development. They had explained to Sarah and Juliana that the eight weeks that Ericca did not have developing in the womb could be a possible explanation for some of her slowness in development. Recently, they became more concerned since Ericca was still more resistant than typical to eat semisolid foods. Sarah and Juliana were not particularly troubled by this behavior as other children they knew had relied primarily on bottle-feeding well past their first birthdays. However, they were concerned that Ericca was still spitting up and unable to gain weight. They had been told that the spitting up should improve after she began standing, but they were still waiting for her to begin standing. It was beginning to look like this might never happen—she was not even sitting yet.

The service coordinator assured Sarah and Juliana that the feeding issues would be the top priority for the evaluation. Ericca's poor weight gain, spitting up problems, and intolerance of any textured foods all seemed to indicate that she was having significant eating difficulties. She would arrange for a feeding evaluation by a speech pathologist. The service coordinator working with the Johns also wanted them to follow up on the health department recommendation that a neurological examination be completed. Ericca's prematurity, coupled with her eating problems and apparent delays in motor development and play behaviors were reasons for this recommendation.

Gina talked with Sarah and Juliana about how best to answer the other two questions regarding Ericca's development. She explained that the questions could be addressed somewhat through an arena transdisciplinary play-based assessment that would include a physical therapist, an early interventionist, and the same speech pathologist who would conduct the feeding evaluation. The physical therapist might also need to conduct a more thorough individual evaluation of Ericca, using a standardized assessment, such as the Peabody Motor Development Scales, Second Edition (PMDS-2; Folio & Fewell, 2000). However, they would need a doctor's referral before the therapist could provide any therapy recommended as a result of this evaluation. Once again, Gina stressed their need to take Ericca to a neurologist. She also explained that additional standardized testing of her developmental levels would be needed to determine if Ericca was eligible for services due to a developmental delay.

Findings. The feeding evaluation included interviews with Sarah and Juliana and an observation of each of them feeding Ericca. The speech pathologist asked both Sarah and Juliana to describe Ericca's eating patterns and habits. Both essentially indicated the same behaviors during feeding time. Ericca is eager and almost too excited when presented with the bottle. She has difficulty getting started, but is able to suck with some success once she gets going. However, it seems to be exhausting for her so she needs frequent breaks, which extends the time needed for each feeding. After every break, she has to reestablish the sucking process. After feeding, they hold her upright on the shoulder and gently pat her back. They maintain her in this position while they either walk around or remain seated. They report that regardless of how much Ericca has eaten, she typically spits up large amounts of the formula she has just eaten. They described this “spitting up” as forceful, almost violent in nature. The pathologist explained to them that this is known as projectile vomiting. Several months ago, at the urging of health department staff, they tried to get Ericca to eat highly diluted baby cereals. Her resistance to this textured food was far more extreme than Sarah had seen with any other infant. Ericca gagged, seemed to pull away, and her mouth gripped the spoon and she appeared unable to release it. After several other efforts failed, they quit trying to entice her to eat cereal. They have also offered her finger foods, such as crackers and dry cereal, but she does not eat any of these things. Sarah did comment that the feedings seem to go best when the apartment is quiet, when just she and Ericca are at home.

Play as Assessment

A team of experts came together to conduct a Transdisciplinary Play-Based Assessment (TPBA2; Linder, 2008b) with Ericca. The session included Gina, the speech therapist, an early intervention specialist, a physical therapist, Sarah, and Juliana. The early intervention specialist served as the facilitator while others watched and prompted her during the process. Ericca was initially placed on the floor in a prone position. Although she could manage to lift her head, it seemed to take most of her energy to maintain this position. She did not have the freedom to shift her weight to one or the other elbow to free the other hand for reaching and exploring toys that were placed on the floor in front of her. She was able to roll from a prone position to a supine position. While Ericca was prone, the interventionist presented a variety of colorful toys, including some that made noise. Ericca would turn her head to the toys as they were presented. She would smile and laugh along with the interventionist as she reached for the toys. Her arm would fully extend and move in a jerky fashion toward the object. The quality of her reach prevented her from actually retrieving the desired object unless the interventionist placed it in her hand. Then she was not able to maintain a grasp of the toy. It would fall from her hands and Ericca seemed to forget about the toy rather than continuing to pursue it. When Juliana joined Ericca, she was asked to place Ericca in her lap as she sat cross-legged on the floor. Ericca's legs flexed easily over Juliana's crossed legs and her bottom tucked comfortably into a snug fit as she leaned back against her mother's trunk. In this position, the interventionist faced Ericca and played with a ring-stack toy while Ericca watched. Then the interventionist asked Juliana to take over the “playing” while she observed Ericca's interest in and attempts to interact with the toy. Ericca watched and listened to her mother while she placed the rings on the base in the proper order. When she began reaching out to take one of the rings in her own hand, the quality of her arm control was far better than it had been in the prone position. The arm remained partially flexed as her mother assisted her by bringing the ring within easy reach. She held her hand over Ericca's to keep the ring from dropping and used her other hand to bring the base in close so Ericca could “place” the ring on the base. Ericca enjoyed “placing” several of the rings on the base in this fashion with her mother's assistance. Later in the assessment, an infant seat was used for positioning Ericca. In this seat, she was at a gentle angle. However, her arms and legs returned to a more extended posture and she lost some of the control that she had achieved while sitting with her mother in a flexed position.

Ericca's motor delays would interfere with her performance on a standardized developmental assessment of children within her age range, therefore, the play-based assessment was also used as an opportunity to explore her development in other areas. When properly positioned, Ericca established eye contact with the examiner and visually tracked a variety of rattles and small toys. She would turn her head to orient to sounds when they were made outside ...

Table of contents

• Front Cover
• Assessment of Young Children with Special Needs
• Title Page
• copyright
• CONTENTS
• Preface
• 1 Meet the Children: Infant and Toddler Cases
• 2 Meet the Children: Preschool and School Age Cases
• 3 Legal and Theoretical Perspectives
• 4 Assessment Purposes, Stages, and Approaches
• 5 Engaging with Families in the Assessment Process
• 6 Norm-Referenced Standardized Assessment
• 7 Criterion-Referenced and Play-Based Assessment
• 8 Portfolio, Work Sampling, and Goal Attainment Scaling
• 9 Progress Monitoring and Response to Intervention (RTI)
• 10 Child Observations and Functional Behavioral Assessment
• 11 Assessing Young Bilingual Children with Special Needs
• Appendix A
• References
• Index