At 18 months of age, Terrance didn't meet many of the developmental milestones typically associated with children his age. He was able to talk, but the manner in which his mouth seemed to hang open a bit made articulation difficult. Terrance was a challenge overall and had been since birth. He simply could not sit still and had a very difficult time soothing in general. It was like he could never quite get comfortable in his mother's arms. Terrance didn't walk until 17 months and was still very unsteady on his feet. He would meet his mother's gaze and was able to look at things she looked at, but his language was almost impossible to understand. He did seem to have many words that he was able to attempt to form, and his level of frustration when he couldn't speak in the way he wanted to was evident.
Vasha, for her part, continued to feel incredibly guilty, and she struggled with her depression. Going to AA was helpful for a time, and she was able to befriend Sarah, someone with whom she was able to share her joys and sorrows. Surely their friendship was a welcome bright spot in what otherwise was an ongoing struggle for Vasha. She often thought about giving up, but she really didn't know what that would mean. She loved Terrance, to be sure, but that sense of love was crowded with other feelings of helplessness, hopelessness, grief and sorrow.
* Describe typical developmental milestones for an 18 month old child. Be sure to include physical, cognitive, social and emotional domains.
* How does Vasha go about getting services through Part C of IDEA? Assume that Vasha does not have access to the Internet. What might a IFSP for Terrance include? Propose goals for Terrance. What are Vasha's responsibilities with regard to IDEA Part C?
* Create an M-CHAT for Terrance that might exist at his 18 month pediatric visit. How will diagnosticians be able to distinguish between FASD and Autism Spectrum Disorder?
* Given Terrance's significant challenges, what other services are available in the community for him? Check into PACE at the Community Services Board. What other services are available for Vasha? Check into Medicaid-funded Mental Health Support.
DECISION POINT ::: Does Vasha obtain other services in addition to IDEA Part C? If so, which ones?
* Describe typical developmental milestones for an 18 month old child. Be sure to include physical, cognitive, social and emotional domains.
ReplyDelete1. Typical developmental Milestones for an 18-month-old child in the area of movement and physical skills are as follows:
· “Walks alone
· May walk up steps and run
· Pulls toys while walking
· Can help undress herself
· Drinks from a cup
· Eats with a spoon (CDC, 2011)”
· “Has a closed soft spot on the front of the head (anterior fontanel)
· Is growing at a slower rate and has less of an appetite compared to months before
· Is able to control the muscles used to urinate and have bowel movements (sphincter muscles), but may not be ready to use the toilet
· Runs with a lack of coordination and falls often
· Is able to get onto small chairs without help
· Walks up stairs while holding on with one hand
· Can build a tower of two to four blocks
· Scribbling
· Can turn two or three pages of a book at a time (Mannheim, 2010).”
Typical Developmental milestones for an 18-month-old child in the area of cognitive skills (which include learning, thinking, and problem-solving) are as follows:
· “Knows what ordinary things are for; for example, telephone, brush, spoon
· Points to get the attention of others
· Shows interest in a doll or stuffed animal by pretending to feed
· Identifies one or more parts of the body
· Can follow 1-step verbal commands without any gestures; for example, sits when you say ‘sit down’ (CDC, 2011).”
· “Shows affection
· Listens to a story or looks at pictures
· Can say 10 or more words when asked
· Often imitates
· Begins to feel a sense of ownership, identifying people and objects by saying ‘my’ (Mannheim, 2010)”
Typical Developmental milestones for an 18-month-old child in the area of social and emotional skills are as follows:
· “Likes to hand things to others as play
· May have temper tantrums
· May be afraid of strangers
· Shows affection to familiar people
· Plays simple pretend, such as feeding a doll
· May cling to caregivers in new situations
· Points to show others something interesting
· Explores alone but with parent close by (CDC, 2011)”
Typical Developmental milestones for an 18-month-old child in the area of language and communication skills are as follows:
· “Says several single words
· Says and shakes head “no”
· Points to show someone what he wants (CDC, 2011)”
* How does Vasha go about getting services through Part C of IDEA? Assume that Vasha does not have access to the Internet. What might a IFSP for Terrance include? Propose goals for Terrance. What are Vasha's responsibilities with regard to IDEA Part C?
ReplyDelete2. Under Part C of IDEA, any child who is “suspected of being eligible” for support services can be referred to their local Part C system (Infant & Toddler Connection of Virginia, 2011). Due to Terrance’s condition, he is considered eligible for support services provided by Part C of IDEA. Although Vasha does not have access to the Internet, she was able to contact her family physician to request a referral for Terrance. Part C of IDEA also allows families to receive a “multidisciplinary evaluation and assessment, the development of an Individualized Family Services Plan (IFSP), and service coordination at no cost” (Infant & Toddler Connection of Virginia, 2011). There are many services that are available for an individual’s IFSP. Some of these services include: “assistive technology, audiology, family training/counseling and home visits, health services, medical services (diagnostic and evaluations), nursing services, nutrition services, occupational therapy, physical therapy, psychological services, social work services, special instruction, speech-language pathology, transportation, and vision services” (Infant & Toddler Connection of Virginia, 2011).
Although Terrance does not require all of the services available to him, he could benefit most from family counseling, physical therapy, and speech-language pathology. Although only 18 months old, family counseling would help Terrance in the long run by opening up communication and understanding with his mother, Vasha. Terrance’s IFSP might also include physical therapy because of his difficulty with mobility. Speech-language pathology would also be beneficial to Terrance because of his lack of language and communication skills.
The focus of Part C in IDEA is to “support the family to meet the developmental needs of their child with a delay or disability” (Johnson, 2001). After receiving services through Part C of IDEA, Terrance would have goals of improving his functional mobility, and ability to articulate and communicate at a level that is appropriate for his age. As Terrance’s mother, Vasha is responsible for maintaining his well-being and providing him with the opportunity to receive all the necessary supports and services available. Under Part C of IDEA, Vasha is responsible for being a decision maker and advocate of her child’s needs (Johnson, 2001). Vasha is also responsible for being involved and participating in Terrance’s IFSP process (Johnson, 2001).
* Create an M-CHAT for Terrance that might exist at his 18 month pediatric visit. How will diagnosticians be able to distinguish between FASD and Autism Spectrum Disorder?
ReplyDelete3. This is what an M-CHAT would look like for Terrance that might exist at his 18 month pediatric visit.
1. Does your child enjoy being swung, bounced on your knee, etc.? Yes No
2. Does your child take an interest in other children? Yes No
3. Does your child like climbing on things, such as up stairs? Yes No
4. Does your child enjoy playing peek-a-boo/hide-and-seek? Yes No
5. Does your child ever pretend, for example, to talk on the phone or take
care of dolls, or pretend other things? Yes No
6. Does your child ever use his/her index finger to point, to ask for
something? Yes No
7. Does your child ever use his/her index finger to point, to indicate interest in
something? Yes No
8. Can your child play properly with small toys (e.g. cars or bricks) without
just mouthing, fiddling, or dropping them? Yes No
9. Does your child ever bring objects over to you (parent) to show you
something? Yes No
10. Does your child look you in the eye for more than a second or two? Yes No
11. Does your child ever seem oversensitive to noise? (e.g., plugging ears) Yes No
12. Does your child smile in response to your face or your smile? Yes No
13. Does your child imitate you? (e.g., you make a face-will your child imitate
it?) Yes No
14. Does your child respond to his/her name when you call? Yes No
15. If you point at a toy across the room, does your child look at it? Yes No
16. Does your child walk? Yes No
17. Does your child look at things you are looking at? Yes No
18. Does your child make unusual finger movements near his/her face? Yes No
19. Does your child try to attract your attention to his/her own activity? Yes No
20. Have you ever wondered if your child is deaf? Yes No
21. Does your child understand what people say? Yes No
22. Does your child sometimes stare at nothing or wander with no purpose? Yes No
23. Does your child look at your face to check your reaction when faced with
something unfamiliar? Yes No
We know that Terrance has FASD and has experienced challenges since his birth and will continue to throughout his life. During his M-CHAT testing it is obvious that Terrance is significantly delayed and frustrated in his speech and language and uneasy with touch and interaction. These symptoms are very much comparable to children that have ASD but we know that these behavior and cognition affects are due to FASD. Children with FASD exhibit cognitive deficits, executive functioning deficits, motor functioning delays, including delay in walking, difficulty coordinating hands and gingers, attention problems and social skills. FASD and ASD are part of a broader category of pervasive developmental disorders (PDD), which could be the reason of an overlap of the two diagnoses. (Fetal Alcohol Spectrum and Autism Spectrum Disorders) Physical characteristics may be the obvious factor that a child has FASD. The physical characteristics they may have are abnormal facial features, smooth ridge between the nose and upper lip, thin upper lip and short distance between the inner and outer corners of the eyes, and height weight or bother that are lower than normal. (Centers for Disease Control and Prevention).
Decision Point
ReplyDeleteDecision Point: Vasha continues to receive services for Terrance under IDEA Part C. Additionally she makes connections with other families which help her deal with her feelings of "helplessness, hopelessness, grief and sorrow." Vasha also continues attending AA as well as receiving mental health and substance abuse services through the CSB.