Home » Chapter 7: Case Study I » Reason for Referral

Reason for Referral

Lynn is a 1st grade student in Ms. Meltzer ’s class. She was adopted by the Copelands when she was 3 years old. She was diagnosed with Fetal Alcohol Spectrum Disorder when she was 5 years old. A Student Study team meeting was held in kindergarten of 2005. The concerns at that time were Lynn’s lack of interest in pre-academic skills. She seemed young/immature socially and behaviorally. It was suggested that Lynn attend a 2nd year of kindergarten to help get “caught up.” Due to poor language communication including word retrieval difficulties, the team suggested Lynn be evaluated by the Speech and Language Specialist. Lynn qualified for Speech and Language assistance and receives help 2 times a week for 30 minutes.

Lynn’s kindergarten teacher notes that the 2nd year of kindergarten was beneficial. Lynn seemed to feel more comfortable having the same teacher again. She developed some pre-academic skills; she made gains in sound/symbol identification. Her attention span improved slightly.

A second Student Study team was held January 19, 2007. Ms. Meltzer reported Lynn demands a great deal of attention to keep her on task. Her assignments must be modified, and she needs to be taught on a 1:1 basis or in small group instruction. Ms. Meltzer also was not certain of Lynn’s ability as she performs in an inconsistent manner. Lynn seems to know something one day, and then the next day is unable to remember it. Lynn was referred for a Psychoeducational assessment to help determine her ability, achievement, learning strengths, and learning difficulties. The Student Study team also was concerned with Lynn tiring quickly when given a writing assignment and her need for sensory stimulation. An Occupational Therapy assessment was recommended. The team expressed concern whether her current 1st grade class is an appropriate placement for her.

The Speech and Language Specialist Reports:

Lynn has been coming to the Speech and Language Center twice a week for 40 minutes for the past 1 year. Lynn is chatty, yet her communication is ineffective. Lynn’s language is disorganized, and she is unaware of her listener. She often uses circumlocution because she cannot “find” a word. For instance, Lynn refers to Ms. Grey, the 1st grade aide who Lynn works 1:1 with daily, as “the math lady.” She has made significant progress on her articulation. Her speech is intelligible. Lynn’s speech and language goals are targeted to increase her metapragmatic abilities to help her with more effective social communication including word retrieval. Lynn enjoys the vocabulary and word association games we play, as well as the role playing of social situations.

The Psychologist and the Resource Specialist Report:

Testing on the WISC V indicates that Lynn had a wide scatter profile on her subtests. Her Performance IQ was significantly higher than her Verbal IQ. Performance scores require less abstract reasoning and less short-term memory. Verbal memory was particularly weak. She had an overall IQ score in the average range. Testing indicated auditory processing deficits, memory impairments, and attention issues.

Educational testing revealed Lynn is at grade level in reading. She is at the mid-kindergarten level in written language and mathematics. These scores are based on grade; Lynn is an older 1st grade student. During testing, Lynn’s attention and focus varied with the subtests. She demonstrated a low frustration level when the assessment became challenging.

The Occupational Therapist Reports:

Lynn demonstrates good gross motor skills. She demonstrates some weakness in fine motor skills that require strength and control. She uses a quadrapod (4-fingered) grasp for writing and exerts a lot of pressure when writing. She has trouble fastening buttons, zippers, and snaps. Lynn needs to work on strengthening her fine motor skills.

The Sensory Profile and clinical observations indicate Lynn has sensory seeking behaviors. She enjoys riding on a scooter board and playing catch with a large ball. Lynn needs some additional sensory strategies to keep her organized and on task.

Lynn is eligible for Occupational Therapist (OT) services twice a week for 30 minutes. In addition to the goals Lynn will work on with the OT, resources will be made available to Lynn’s classroom teacher.

IEP Goals:

Area: Focus and Attention

Lynn’s classroom attention varies, depending on the subject or activity. When the class is expected to sit quietly and listen to a lesson, Lynn is often restless and distracted easily. She calls out, gets out of her seat, and disturbs other students.

Effective Strategies:

Lynn is focused for some activities: when a story is being read, when music is an integral part of the lesson, and when she is actively engaged in the learning process by multi-sensory presentations.

Lynn’s attention is increased when the lesson is structured and academic tasks are broken in small “chunks.” Lynn stays on task longer when she is seated in close proximity to her teacher. She also responds positively to eye contact with her teacher .

See Occupational Therapist’s report regarding suggestion of inflatable stimulating seat.

Long Term Goal: Lynn will increase her focus and attention.

Short Term Goals:

1. Given a group lesson, Lynn will stay on task for 10 minutes longer as noted by the teacher.
2. Given a group lesson, Lynn will raise her hand if she has a question.
3. Given a group lesson, Lynn will initiate using a squeeze ball instead of getting out of her seat 25% of the time.

Strategies and Resources:

1. Praise and encouragement
2. Modeling and praise
3. Squeeze ball

Area: Improve Study Habits

Lynn does not start assignments independently. A teacher needs to help Lynn organize so she will begin the assignment. Written language and mathematics assignments require small group or 1:1 assistance. She does complete reading assignments although quite slowly. Assignments in mathematics and written language get completed 10% of the time.

Effective Strategies:

Lynn benefits from having directions independently explained to her. In order to get organized Lynn “thinks aloud” with a teacher what tools she will need to complete her assignment without outside help 25% of the time. She reluctantly begins an assignment when a teacher stands by her. These strategies work for Lynn in helpings her begin her work and sustain it: direct eye contact by the teacher, a reinforcement to remind her to work, a study carrel, positive reinforcement, and a lot of “stickers”.

Lynn may complete a modified math assignment that is enlarged and shortened. The fewer distractions on a page, the better. Language arts assignments are more easily completed when Lynn uses the computer.

Long Term Goal: Lynn will become a more independent worker.

Short Term Goals:

1. When an assignment is given, Lynn will begin on the assignment without teacher help 25% of the time.
2. Given a reinforcement or prop to aid with her work, Lynn will work on 2 problems
3. Given an assignment, Lynn will self- advocate by asking for repetition, saying directions another way, or asking the teacher to slow down 50% of the time.
4. Given an assignment, Lynn will “self talk” and help get organized 25% of the time.
5. When work is completed, Lynn will put work in the work-basket 3 out of 4 times.

Strategies and Resources:

1. Reinforcement prop or aid on desk
2. Eye contact, verbal reinforcement
3. Modeling, role playing
4. “First I get my pencil. Then…”
5. Work-basket clearly labeled for COMPLETED WORK

Area: Following Directions

Following more than 1 step in a direction is confusing for Lynn. She usually can repeat back part of a direction, but it doesn’t necessarily mean that she understands it. Testing indicates difficulty with auditory processing.

Effective Strategies:

Please see the Speech and Language Specialist’s report. She will be working on this within the context of her speech and language program. In the classroom, Lynn’s ability to follow directions is improved when visual cues are given. Repetition also helps. Lynn benefits from the teacher asking other students to explain the directions. Having a “study buddy” next to Lynn has sometimes been helpful as the student can re-explain and show Lynn how to get started. Lynn, however, usually relies on her teacher to individually explain and demonstrate directions to Lynn.

Long Term Goal: Lynn will improve her ability to follow 2-step directions.

Short Term Goals:

1. Given a group lesson, Lynn will demonstrate understanding of a 2- step direction 50% of the time with teacher assistance.
2. Given a group lesson, Lynn will demonstrate understanding of a 2- step direction with visuals and repetitions 50% of the time.

Strategies and Resources:

1. Teacher will explain directions 1:1. Lynn will explain directions back to their teacher. Teacher ensures understanding.
2. Teacher will use visuals to explain a 2- step direction. Two or 3 students will be asked to re-explain the directions to the class.

Area: Mathematics

Current Performance: Lynn is currently performing at a mid-kindergarten level in mathematics. She requires 1:1 assistance in mathematics. She depends on manipulatives to assist her. She prefers relying on her fingers for counting. Money and time are particularly difficult for Lynn. Mathematical knowledge is inconsistent.
Lynn is working on temporal concepts (yesterday, tomorrow, etc.) with the Speech and Language Specialist. Please refer to her goals.

Lynn is able to:

  • Count to 30
  • Count by 10’s to 100
  • Use manipulatives 1:1 with the teacher to determine addition and subtraction problems for 2 numbers that are less than 10 each.
  • She is able to identify a penny and a quarter

Lynn is unable to:

  • Demonstrate an understanding of the concept of addition or subtraction
  • Demonstrate understanding the value of a number; 5, 50, and 500 are all the same
  • Identify a nickel and a dime
  • Demonstrate an understanding of the value of coins
  • Identify time to the nearest hour or demonstrate understanding the concept of time: morning, afternoon, yesterday, tomorrow, before, after

Long Term Goal: Lynn will achieve a mid-1st grade level in mathematics by 3/2007.

Short Term Goals:

Lynn will:

1. Identify time to the nearest hour of everyday events on 3 out of 5 trials.
2. Given 2 sets of objects (up to 10 objects in each group), identify which set is equal to, more than, or less than the other with 75% accuracy.
3. Demonstrate the meaning of simple addition and subtraction problems in 3 out of 5 trials.
4. Compare and order whole numbers to 30 with 80% accuracy.
5. Identify a nickel and dime with 100% accuracy.
6. Show different combination of coins that equal the same value up to $.50 with 25% accuracy.

Strategies and Resources:

1. Linear clock with visuals of everyday events
2. Manipulatives
3. Concrete objects or manipulatives
4. Manipulatives, number line
5. Nickels, dimes
6. Quarters, dimes, nickels, pennies

Area: Written Language

Lynn’s written language skills are at a beginning 1st grade level. Lynn is able to write simple words or phrases; she does not write sentences. Fine motor skills are weak. Spacing between letters and words are uneven as is letter size. Lynn tires easily when performing written language tasks. (Please see Occupational Therapist’s goals).

Long Term Goal: Lynn will achieve beginning-2nd grade level writing skills by 3/2007.

Short Term Goals:

1. Given a topic with a picture as a cue, Lynn will write one brief sentence 3 out of 4 times.
2. Given a topic with a picture as a cue, Lynn will write one descriptive sentence 3 out of 4 times.
3. Given a topic with a picture as a cue, Lynn will independently write 2 sentences 50% of the time.
4. Given a white board and marker, Lynn will practice letter size, shape and spacing as noted by the teacher.

Strategies and Resources:

1. Pictures and topics of interest
2. Visualizing/verbalizing method Pictures and topics of interest
3. Visualizing/verbalizing method Tape recorder/Teacher transcribes Word processor
4. White board and marker Occupational Therapist

Area: Social Skills

Lynn is older than her classmates by 1 – 2 years. Yet, her behavior is very young. She has difficulties with boundaries and often gets too close to the other students. She often will hug her classmates; sometimes she stares at them. When she does play, she often plays by herself or with the younger children at the school. Her classmates tend to treat her like a younger child. They try to help her or they give her a wide berth. (Please see the school counselor’s observations).

Long Term Goal: Lynn will strengthen her relationship with peers in her grade.

Short Term Goals:

1. Lynn will develop appropriate ways to get attention with her peers as noted by her teacher.
2. Lynn will learn how to play grade appropriate games with her peers as noted by the teacher and P.E. instructor.
3. Lynn will learn personal boundaries as noted by her teacher.

Strategies and Resources:

1, 2, 3. Role play/modeling Social Skills Group, School Psychologist School Counselor, P.E. Instructor, Teach positive self-talk

Team Recommendations:

The team agrees that Lynn’s academic needs cannot be met in a regular classroom at this point in time. The Least Restrictive Environment for Lynn is a Special Day Class. This small group setting will address Lynn’s needs for individualized and small group instruction. She will also attend pull-out classes for Speech and Language, as well as Occupational Therapy.