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Chapter 7: Case Study I

Lynn is an 8 year old 1st grade student attending Oakview Elementary School. Very little information is known about her biological mother. It is reported that her mother had a history of substance abuse, and Lynn was possibly exposed to alcohol in utero. It is known that Lynn has a sibling who was born when she was 1 years old. Shortly after her sibling was born, Lynn was placed with a foster family. She was adopted by the Copelands when she was 3 years old.

Lynn was the Copelands’ first child and they were not certain when developmental milestones should be achieved. The Copelands brought Lynn to a pediatrician. They wanted her to have a thorough check-up given her high activity level and their concern with her short stature and low weight. The pediatrician reassured the Copelands that Lynn was adjusting to her new home and that she was “on the charts” with height and weight at the 5th percentile, not to worry.

As the Copelands spent more time with Lynn, they were concerned that she had special needs. They decided to take Lynn to another pediatrician. This pediatrician took note of the limited known history of her biological mother and observed that Lynn had some mild dysmorphia. The pediatrician, familiar with FASD, assessed that Lynn had some behavioral and cognitive features consistent with prenatal alcohol exposure. Lynn was given the diagnosis of Fetal Alcohol Spectrum Disorder.

When Lynn first arrived at the Copelands’, she was quite active; in fact, she was described as rambunctious. She ran from one activity to the next. Although quite verbal, language difficulties became apparent. Lynn had a slight articulation difficulty, but more problematic was her difficulty remembering the names for things and communicating effectively. She was impulsive—always getting into things. The parents describe Lynn as not yet knowing how to tie her shoes, very slow to learn how to do simple chores, and unable to tell her right from her left.

The pediatrician suggested that Lynn attend the Strawberry Preschool when she was 5 years old. The class was small and developmentally oriented. Usually, the children worked in groups of 4 and received a lot of adult attention. The teachers were engaged with the students. The daily routine was consistent. Every day there was music and art. The parents report that their goal for Lynn was to develop her social skills and interact with other children. Lynn did develop a friendship with one girl. She loved going to school.

The following year when Lynn was 6 years old she began kindergarten at a public school. The day was short and the class size was small, although not as small as Strawberry Preschool. Lynn was described as friendly but immature, not interested in pre-academic skills, and had many developmental delays. At the kindergarten teacher’s request, a Student Study Team meeting was held at the end of Lynn’s 1st year in kindergarten. The team decided that Lynn would repeat kindergarten with the hope that an extra year would give her time to catch up with her peers. Lynn’s 2nd year in kindergarten proved to be beneficial in terms of lengthening her attention span, improving her social skills, beginning to learn sound/symbol association, and developing some pre-academic skills.

This year, Lynn’s 1st grade teacher, Ms. Meltzer, is requesting a 2nd student study team to dis- cuss Lynn’s educational and behavioral strengths and concerns. Halfway through 1st grade, Lynn has made many gains. Ms. Meltzer describes Lynn as learning although her learning is at a very slow pace. Lynn is beginning to read CVC and CVCC words. She is able to read some common irregular words (e.g. the, of, come). She works best when reading with 1:1 help or small group work. Lynn loves to listen to the teacher read big picture book stories. She not only looks carefully at the illustrations she even touches them. When asked questions about the story, Lynn remembers pieces of it. She is not able to sequence the events of the story.

Math skills are a weaker area for Lynn. She has difficulty understanding number concepts (i.e., bigger than and smaller than) and remembering the math symbols for addition and subtraction. At the beginning of the school year , Lynn would work on math with the class. Lynn enjoyed working with manipulatives but was not on task. She would build with the blocks or play with the manipulatives; she did not follow the directions given. When paper and pencil tasks were presented in mathematics, Lynn became very frustrated. This led to tearing up math papers and refusing to work. Now , Lynn works 1:1 on math skills with the classroom aide. She also enjoys working on math programs on the computer. Lynn responds to positive reinforcement.

Lynn’s 1st grade teacher reports that poor focus and attention continue to be a hindrance to her learning. She loses her focus quickly. Lynn’s attention span varies depending on the activity. She gets out of her seat and wanders. She visits with other students, is very chatty, and likes to hug them. She also likes to take the pet rabbit and guinea pig out of the cage even when it’s not a “free time.” During “free time,” Lynn darts from one activity to the next.

Due to her small stature, petite frame, and immature behavior , Lynn is regarded as a younger child and is babied by her peers. A few of her classmates want to hold her hand and lead her to the music room or the lunchroom; they want to help her when she’s “stuck” or confused. When Lynn invades her classmates’ space, they become annoyed with her. Some classmates keep their distance from her. Her peers do not include her in recess games unless an adult organizes an activity and encourages everyone to join in. During recess, Lynn usually plays in the sandbox with some of the kindergarten children.

During her 2nd year of kindergarten, Lynn was evaluated by the Speech and Language Specialist. She now receives speech and language assistance 2 times a week for 30 minutes. Even though Lynn is very verbal, her language interferes with her social skills. She is not an effective communicator, as she gets off subject and is unaware of her listener. She often has difficulty finding the word she wants to say, forgetting the names of her classmates. Many of her classmates fill in her words. Her slight articulation difficulties are age appropriate and do not interfere with her communication.

When Lynn enters the classroom, it seems as if it’s a new experience each time. She needs to be reminded to put her lunch pail in the lunch box. Then, she needs to be directed to the coat hooks and take off her coat. Next, Lynn begins a process of wandering or flitting about the classroom unless she is directed to an activity with adult supervision.

During group lessons, Lynn will sit and listen for a short period of time. She can follow a 1- step direction. However, multi-step directions are very difficult for Lynn. She does not seem to remember the 1st part of what was said. She never asks for help. She will focus her attention on something else that interests her even if all the students are working on a class project. Lynn rarely finishes an assignment. When she does work, it takes her a long time to finish a project. When she’s frustrated, she cries.

Safety is a concern. During field trips, it is imperative for Lynn to be paired with an adult the entire time. On her 1st field trip to the zoo, Lynn wandered away from the group. They found her happily talking to an animal trainer and petting a llama. She did not demonstrate an under- standing of why the teacher was upset.

Gross motor skills are a strength for Lynn. Her parents have enrolled her in swim lessons, which she seems to enjoy. She is also starting to skate. Fine motor control is coordinated yet slow. Lynn likes to draw with big magic markers. She does have an awkward pencil grip and seems to tire easily.