Pam had finally made it far enough
in her nursing assistant training that she could take the exams necessary to
acquire her license. Because Pam had been busy at school and kept her job at
the diner to earn money, she barely had time to take care of Michelle. Out of
desperation, Pam contacts Brian and asks him if he can take Michelle to and
from school. After the last hearing, Pam and Brian settled their differences
and Brian is now allowed to see Michelle when he pleases. He is still
unaccepting of the fact that Michelle has Down syndrome, but he has matured
since Michelle’s birth and decides it is best to be there for her.
Since Pam refused to accept a
special class placement as initially recommended, Michelle had attended a half
day kindergarten in a general education setting. She received speech therapy
services through 504 accommodations. When Michelle went into first grade the
gaps in her academic and social emotional functioning had grown. Although, she
had demonstrated improvement in kindergarten, the increased academic demands
made Michelle’s deficits even more apparent. Michelle entered first grade being
able to recite the alphabet but unable to consistently identify each letter.
She was able to count to ten consistently but made errors when counting to
twenty. She still lacked one to one correspondence when counting objects such
as blocks or crayons. Her writing was sloppy and she was unable to trace over a
dotted pattern with any accuracy. In North Carolina, the learning standards for
a first grader include skills such as decoding through phonics, and reading
picture books with comprehension. In math, children are expected to read and
write numbers to a 100, know place value, and learn early addition sums to ten.
They also learn the basics of telling time. Michelle struggled with identifying
letters, and lacked the recognition of sounds to letters. She barely counted to
twenty with any consistency and had minimal number concepts.
In addition, her social immaturity became more
pronounced. She would laugh inappropriately or seek to play games that were
suited for younger children. This left her isolated and often ignored or teased
by her peers. As a result, the teacher referred Michelle for re-evaluation for
a special class placement. When Michelle
saw the psychologist at the school during kindergarten, he administered the
WPPSI (Wechsler Pre-school and Primary Scale of Intelligence) which is used for
children 2.6 – 7.7 years of age. It is also used for children who demonstrate
delays. At that time, the psychologist just gave Michelle subtests to determine
a full scale IQ. Upon re-evaluation, a primary index score was obtained.
Primary index scores show intellectual functioning in specific cognitive areas
such as verbal comprehension, visual-spatial, fluid reasoning, working memory
and/or processing speed. This gave a more complete view of Michelle’s
functioning in a variety of areas.
The testing revealed significant deficits in all
areas. Testing reflected the need for an occupational therapy evaluation for
poor visual-spatial skills which impact writing, copying, tracing, coloring
etc. Once the OT evaluation was completed, OT services were recommended. In
addition, a physical therapy evaluation was completed and showed delays in
gross motor skills and PT services were recommended as well. Children with Down
syndrome demonstrate issues with movement, gait and muscle strength. Children
with Down syndrome tend to have hypotonia. PT helps to improve a child’s gait,
strengthen muscles and eliminate compensatory movements which are common in
children with Down syndrome during early physical development.
OT services concentrate on fine motor
development needed for a variety of daily living skills which children with
Down syndrome often have difficulty. Skills such as buttoning and zippering impact
their ability to dress themselves. In school, fine motor deficits affect
writing, cutting, and copying from the board.
Pam had been invited to a meeting to discuss the
results of these evaluations. The evaluations were gone over and the
classification of intellectually deficient was made and a self contained class
was recommended with the related services of speech, OT, and PT. Although Pam was upset, she had seen the
problems Michelle was experiencing at school and knew that it would be a better
program for Michelle. The program would teach academics as they relate to daily
living skills. It would offer Michelle a chance to be with peers like her, and
provide acceptance rather than ridicule and isolation. The class size would be
small and provide for more individualized instruction. The class would be made
up of 7 – 9 year olds in a public school setting with opportunities for
mainstreaming in non academic areas.
Michelle spent her first year in the special
class and was coming home with new behaviors that she copied from others in her
class. Pam was quite upset and called the teacher several times to complain.
Pam was also concerned with the lack of homework and academic work. Pam was
wondering if she had made the right decision. The teacher called in response to Pam’s
complaints. She apologized for Michelle picking up some negative behaviors but
stated that it sometimes happens and she would work on eliminating those
behaviors. She also explained that the academics they do are more functional.
The children learn to identify coins and their value, as well as telling time,
adding, subtracting, along with mathematical concepts such as greater than and
less than. They also learn to read, with an emphasis on functional sight words.
Literature shows that most children with Down syndrome do not progress past the
intellectual capabilities of a normal 6-8 year old. This does not mean that one should assume the
child isn’t capable. The teacher invited
Pam to come in and observe the class to see what goes on. Pam had been too busy
to take time out to see the program but requested that Michelle be placed in an
inclusion class for next year. Studies show that inclusion programs are
beneficial for peer relationships and reducing issues of stigmatization. It
also shows that the teacher must be fully supportive of this model for it to be
successful.
Pam lives in a rural area of North Carolina. Funding
is limited in rural areas. This means limited staff as well as programs. Although
IDEA is a law ensuring services to children with disabilities, the states are
responsible for implementation and must work within their budget to meet governmental
regulations. The availability of special
education programs may be limited in Pam’s school depending on the population,
perceived need, and funds to support the additional staff. Inclusion programs
are not required by law. It only requires that a significant effort be made to
find an inclusive placement.
Michelle returned to her second year in the
special ed. program. The school did not have a full inclusion program for
Michelle, but tried to address Pam’s request by a part time opportunity for
inclusion in a second grade class with an understanding teacher who was open to
the arrangement. Although Michelle was
now 8, and a third grade class would be age appropriate, it was felt that
Michelle’s small stature would enable her to fit in with second graders. The staff decided that Michelle would spend
an hour in the morning when the class worked on reading. The teacher provided
her a buddy who helped her follow along.
The school told Pam that if it worked out they would add time in other
areas. Pam agreed and felt the school was trying to address her request given
that they did not have an inclusion program.
Questions:
1.
What
impact does early intervention and proper care have on children with Down syndrome?
2.
What
benefits did Michelle derive from her experiences in a general education
program?
3.
What
factor did Pam’s age have on her first child being born with Down syndrome?
Decision
Point:
Does Pam move to an urban section of
North Carolina to find better educational opportunities for Michelle?
1) The first years of life are critical for a child's development. All younger children go through rapid and developmentally significant changes during this time, and basic physical, cognitive, language, social, and self-help skills will lay down the foundation for them to succeed in the future. Children who have down syndrome typically will face some delays in certain areas of development, so early intervnetion is highly reccomended. Since development is a continuous process, milestones in the four areas of development (gross and fine motor abilities, language skills, social development, and self-help skills) that serve as prerequuisites for the stages to follow. Due to specific challenges with down syndrome, children will experience delays in development. They will achieve some of the milestones as other children, but on their own time and at a different rate and pace. When dealing with early intervention with a child with down syndrome, it is more useful to look at the sequence of milsteones achieved. rather than the age the milestone was achieved at.
ReplyDelete2) The benefits that Michelle gained from being in the general education program, were in her half day kindergarten class, she receieved speech therapy services through the 504 accomodations. She did demonstrate imporvement in Kindergarten, but in first grade, academic and social gaps were apparent. Through speech pathology, she worked on her language skills, and her language skills greatly increased. Through the general educatin program she was able to learn how to recite the alphabet, but couldn't consistantly identify each letter. She could count to ten, but could not reach 20. Due to her being placed in the general education setting, her teacher was able to recognize her social immaturity and other needs, and referred Michelle for a re-evaluation, which got her moved into a different classroom, which could cater to her needs more. Through her testing, it was found that she had deficits in all areas, and she would need occupational therapy and PT services as well.
ReplyDelete3)Pam's age did not play a significant factor in her daughter having autism, because in 2007, the medical guidelines changed from only offering women 35 years and older for prenatal testing for down syndrome for expectant mothers. However, this does not mean that maternal age is irrelevant when considering prenatal testing. The age of the mother is the only factor that has been shown to increase the risk of having a baby with down syndrome, but Pam, Michelle's mom was only 17 when she gave birth to her. However, younger women are more likely to have babies than older women, 80% of babies with down syndrome are born to women younger than 35 years olf age.
ReplyDeleteDecision Point: Pam does not decide to move to an urban area of North Carolina for better education services, because she can not afford to move, and moving to a more urban area would have higher taxes and she would need to pay out extra expenses for schooling, because the only school in the urban area she was looking in, was a private school. Pam liked the idea of Michelle spending an hour in the morning while the class worked on reading with a buddy who helped her follow along, because it gave her individualized attention. Adding time in other areas for Michelle, would prove great benefit for her.
ReplyDeleteCitations:
Maternal age, the chance for Down syndrome, and prenatal testing. (n.d.). Down Syndrome Prenatal Testing. Retrieved July 2, 2014, from http://www.downsyndromeprenataltesting.com/maternal-age-the-chance-for-down-syndrome-and-prenatal-testing/
Early Intervention. (n.d.). - National Down Syndrome Society. Retrieved July 2, 2014, from http://www.ndss.org/Resources/Therapies-Development/Early-Intervention/
Early intervention with children with Down syndrome - Past and future issues. (n.d.). Early intervention with children with Down syndrome - Past and future issues. Retrieved July 2, 2014, from http://www.down-syndrome.org/reviews/62/