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Applying a Transdisciplinary Team Approach to the Systematic Instruction of Pivotal Milestones

Applying a Transdisciplinary Team Approach to the Systematic Instruction of Pivotal Milestones. Bruce, S., Vargas, C., Davidson, S., Sullivan, M., & Sikarova, R., Boston College. Imitation Joint Attention Discrimination-Categorization. Object Permanence Means-End Self-Recognition.

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Applying a Transdisciplinary Team Approach to the Systematic Instruction of Pivotal Milestones

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  1. Applying a Transdisciplinary Team Approach to the Systematic Instruction of Pivotal Milestones Bruce, S., Vargas, C., Davidson, S., Sullivan, M., & Sikarova, R., Boston College

  2. Imitation Joint Attention Discrimination-Categorization Object Permanence Means-End Self-Recognition Pivotal Milestones Associated with Symbolic Expression & Representational Thought

  3. Study Phases Phase I: Literature Review on 6 pivotal milestones, systematic instruction, & transdisciplinary teaming Phase II: Analysis of Commercial Assessment Tools appropriate for children with severe/multiple disabilities & Development of Informal Structured Assessments on each milestone

  4. Phase III: Assessment of 15 children with severe/multiple disabilities (including 6 with visual impairment & 2 who are deafblind) using 2 commercial assessments & 1 informal structured assessment on each selected milestone Lesson Plans developed by team consensus (teachers & related service professionals)

  5. Phase IV: Instruction 5X weekly per child on each milestone Data collected each time lesson was taught by teacher and 2 related service professionals (SLP, OT, PT) Video evidence for baseline + every 4 weeks per child & milestone instructed

  6. Developmental Assessment for Individuals with Severe Disabilities (DASH 2) Developmental Activities Screening Inventory (DASI-II) INSITE Caller-Azusa-Scale G Oregon Project for Visually Impaired & Blind Preschool Children Carolina Curriculum for Infants/Toddlers with Special Needs Assessment, Evaluation, and Programming for Infants and Children (AEPS) Early Learning Accomplishments Profile (ELAP) Vulpe (revised) Hawaii Early Learning Profile (HELP) Commercial Assessments AnalyzedIdentified Each Item that Measured Each of the 6 Milestones

  7. Participant Results Shared Today Nicholas: Means-End Jamie: Object Permanence Winston: Discrimination (of objects & different actions on objects) Leah: Joint Attention & Discrimination (of different actions on objects) Jack: Means-End *does not include video analysis

  8. P = physical prompt MO = moving object prompt M = model G = gesture prompt V = verbal prompt I = independent N = no response R = refusal H/H: hand over hand H/H-C: hand over hand, continuous (T=teacher initiated, S = student initiated) H/H-F: hand over hand, frequent H/H-I: hand over hand, intermittent (PO = point, PU = push, PO&PU= point & push) Prompt/Performance Levels

  9. Nicholas Age at baseline film: 4 years, 11 months Disability Characteristics: Microcephaly, global developmental delays, failure to thrive, possible autism, (normal vision & hearing, ambulatory) Assessment Results: Moves around an obstacle, pushes other objects away to get to desired object, inverts containers to get object out (e.g. he exhibits some means-end behaviors) Lesson: Means-end: #1: Push “red man” to expel car; Lesson #2: Pick up, place and push “red man”

  10. Nicholas Key Findings: Lesson #1: Push “red man” (after adult places): Achieved with modeling in the first month. Lesson #2, Behavior #1:Pick up “red man:” Started at 0% independence, achieved 69%. independence Behavior #2, Place & push “red man:” Started at 0% independence, achieved 69% independence

  11. Jamie Age at baseline: 5 years, 8 months Disability Characteristics: Multiple congenital anomalies, microcephaly, developmental delays, visual impairment (20/90), frequent ear infections (6+ this year), urinary tract infections (3+ this year), non-ambulatory Assessment Results: Can find a partially hidden object IF she sees it hidden Lesson:Object permanence: Lesson #1: Using different covers; Lesson #2: Solving A-B error

  12. Jamie Key Findings: Lesson #1: Locating object with sound cue Able to perform with independence at 39% of opportunities, additional success with just verbal or gestural cue. Moved to Lesson #2: A-not-B Error after 4 months. Lesson #2: A-not-B error: Achieved independence 72-100%. May have reached satiation.

  13. Leah Age at baseline: 7 years, 0 months Disability Characteristics:Trisomy 18, congenital cardiac disease, bronchial malacia, seizures, 20/190 vision, moderate-severe hearing loss, hypertonia in extremities, hypotonia Assessment Results: Very attentive to people, but very seldom to objects. Does same action on all objects-batting/forceful tapping. Lesson: Joint attention with adult and over object, discrimination of different actions on 3 different objects

  14. Leah Key Findings: Behavior #1: Joint Attention - eye contact with adult Achieved 90-100%-maintained existing skill Behavior #2: Joint attention - visual attention to object Achieved over 80% independent for 3 months Behavior #3:Discrimination - action on pop tube-coactive Decreased need for hand-over-hand/continuous

  15. Leah Key Finding, continued: Behavior #4: Discrimination - action on gumball machine toy Started at 0% independence, achieved 50% Behavior #5: Discrimination - action on pop-up toy Reduced need for hand-over-hand/continuous

  16. Winston Age at Baseline: 8 years, 6 months Disability Characteristics: Isodicentric 15, mitochondrial disorder, seizures, severe developmental delays, hypotonia (non-ambulatory), vision loss (20/400), hearing loss-inconsistent response to sounds Assessment Results: Looks toward lighted objects and a few highly reflective surfaces. Immediately opens mouth in feeding (anticipation). Lesson: Discrimination of objects and actions on actions in a controlled play space

  17. Winston Key Findings: Most intentional behavior was on (a) red mylar and (b) green pompom He located these 2 items even when placed l/3 - 1/2 way into play space. Further analysis of video revealed that he differentiated “green pompom” for combination of touch and taste.

  18. Jack Age at baseline: 10 years, 11 months Disability Characteristics: microcephaly, hydrocephalus, global developmental delays, diabetes, seizures, adrenal gland insufficiency, cerebral palsy, mild unilateral hearing loss Assessment Results: Purposeful reach, will work to access object out of reach or when obstacle is present, doesn’t yet request adult assistance Lesson: Solving means-end problems-push down and push up on remove control car control

  19. Jack Key Findings: Behavior #1, Reach toward remote control: Independence reduced from 100% to 59%. Was it novelty effect? Did he decrease after learning that behavior #3 was difficult? Behavior #2, Means-End-Push down on remote control: Started at 100%, regressed to 68% in 3rd month, improved in 4th-6th, resulting in 100% again in 6th month (teacher reports that he typically exhibits ups and downs in performance)

  20. Jack Key findings, continued Behavior #3, Means-End-Push up on remote control: Still requires hand-over-hand support, but has learned to request by reaching for adult- after trying to “push down” (see video) This marks means-end achievement at trial & error level. *Application: Jack is now enjoying a trial on an electric wheelchair

  21. Dissemination Bruce, S. & Zayyad, M. (in press). Assessment and instruction of self-recognition. TEACHING Exceptional Children. In Progress: Bruce, S. & Zayyad, M. (in revision). The development of object permanence in children with severe disabilities. Bruce, S., Campbell, C. & Sullivan, M. Supporting children with severe disabilities to achieve means-end. Bruce & others: Articles on analysis of commercial assessment tools, discrimination-categorization findings, Imitation findings and joint attention (including non-visual JA) findings.

  22. Other Materials at Our Display • Informal Structured Assessments (also in handouts) • Lesson Plans on all 15 children • Video sampling of lessons on the 5 featured children (see desktop folders) • List of materials used in the lessons with ordering information

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