Child-guided Strategies - The Van Dijk Approach to Assessment

Child-guided Strategies - The Van Dijk Approach to Assessment

For Understanding Children and Youth with Sensory Impairments and Multiple Disabilities

Catherine Nelson, PhD
Jan Van Dijk, PhD
Teresa Oster, Med
Andrea McDonnell, PhD

American Printing House for the Blind, Inc.
AMERICAN PRINTING HOUSE FOR THE BLIND, INC.

Child-guided Strategies - The Van Dijk Approach to Assessment: For Understanding Children and Youth with Sensory Impairments and Multiple Disabilities/Catherine Nelson, Jan van Dijk, Teresa Oster, Andrea McDonnell

Copyright © 2009, American Printing House for the Blind, Inc. Louisville, KY 40206-0085

All rights reserved.

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In keeping with our philosophy to provide access to information for people who are blind or visually impaired, the American Printing House for the Blind provides an electronic version of this book.

Catalog Number 7-31001-00

Acknowledgements

Authors

Catherine Nelson, PhD

Photo of Dr. Nelson

Dr. Nelson is an assistant professor of Special Education at the University of Utah. She teaches in the areas of deafblindness, severe disabilities, and early childhood special education. Her research interests include assessment of children with multiple disabilities including deafblindness, education of children who are deafblind, reduction of stress in children with severe multiple disabilities, and the use of visual supports with young children with autism. She consults nationally and internationally in the area of deafblindness and has provided long-term technical assistance to programs serving children with sensory impairments and multiple disabilities in Russia and Armenia. In addition, she has presented in the Netherlands, Australia, Spain, Portugal, Slovakia, and Italy. Her work has been translated into Spanish, Russian, and Dutch.

Jan van Dijk
Dr. van Dijk, actively retired, dedicated his 50 year career to helping children who have multiple disabilities in addition to deafblindness. His child-guided methodologies are recognized and used throughout the world. Dr. van Dijk continues to speak and present upon request.

Teresa M. Oster
Teresa Oster is an early childhood special education doctoral student at the University of Utah. Her research interests include assessment, emergent literacy, and language acquisition of children 0-5 years. She currently works as an Infant and Toddler Specialist for the Office of Head Start.

Andrea McDonnell, PhD
Dr. McDonnell is Chair of the Department of Special Education at the University of Utah and a Professor of Early Childhood Special Education. Her research interests include emergent literacy and embedded instruction.

Professional Reviewers

Diane Haynes
State Coordinator
University of Kentucky-Deaf-Blind Project
Lexington, KY

Nancy Steele
Technical Assistance Specialist
National Consortium on Deaf-Blindness
Knoxville, TN

Field Testers

Sanja Angeli, New Jersey
Anonymous, New York
Nancy Gieseke, Kansas
Jane Herder, Missouri
Kate Dilworth, Oregon
Cinda Rapp, California
Mirella Timms, North Carolina

American Printing House for the Blind

Tristan G. Pierce, Project Leader
Monica Vaught-Compton, Research Assistant
Darlene Donhoff, Manufacturing Specialist
Frank Hayden, Technical Research Division Manager
Terri Gilmore, Art Director
[BIG], Design and Layout

Introduction

Photo of Dr. van Dijk

In the early 1960s, Dr. Jan van Dijk of the Netherlands was asked to assess children with sensory impairments and multiple disabilities. He found that existing tests and developmental schemes were not useful because they assumed that the child had been exposed to typical experiences; and he felt that children with sensory impairments and multiple disabilities, due to the very nature of their impairments, had not had the opportunity to experience the world in a typical manner.

Therefore, the assessments of these children were invalid since they did not take into account the significant impact of sensory loss on development. In particular, Dr. van Dijk found that the huge impact of sensory loss on incidental learning was often overlooked. As he developed an authentic framework for assessing the children, he tried to bring areas of the child's strengths to the surface, an aspect that traditional assessments left unexplored. In doing so, he discovered that the children often had unique ways of learning. For instance, they responded to small cues that came in the form of textures, vibrations, or smells.

Dr. van Dijk found that children with sensory impairments and multiple disabilities often were not interested or fully engaged in the "outside" world. In order to help these children demonstrate their learning and skills, Van Dijk needed to go "inside" their world. He began the assessment by following the movements, emotions, and interests of a given child at that particular moment. By establishing turn-taking routines that began with imitating the child's movements, Van Dijk helped the child to gradually notice the outside world and learn to interact with people and items in that new world. In this way, Van Dijk gained insight into the learning processes the child used. He also observed the child's arousal and ability to orient, anticipate, learn routines, and remember. Over time, Van Dijk's assessment framework evolved from a purely cognitive model to one that included different models of explaining behavior including the theories of the neurobiological model, the social learning model, the transactional model, and the attachment model. Using these models, he looked at the child's interactions and play with the primary caregiver, the child's ability to achieve joint attention with others, and how the child used social communication (Nelson, Van Dijk, McDonnell, & Thompson, 2002; Silberman, Bruce, & Nelson, 2004; Van Dijk, Nelson, Postma, & Van Dijk, In Press).

The child-guided manner of assessing children that Van Dijk developed uses no standardized protocol or materials. Each assessment is truly unique as it follows the lead of the individual child. Critical to this process is the recognition that assessment and intervention must always occur "hand in glove" and that meaningful assessment guides intervention. This book contains the guiding principles and guidelines to conduct an assessment that follows the Van Dijk approach. It is organized into eight Observation Areas.

  1. Behavioral State 
  2. Orienting Response 
  3. Learning Channels 
  4. Approach-Withdrawal 
  5. Memory 
  6. Social Interactions 
  7. Communication 
  8. Problem Solving 

Catherine Nelson, PhD

General Guidelines

Prior to the Assessment

Beginning the Assessment

Establishing a Routine

Modifying a Routine After it is Established

Overview of Framework

To understand how this very fluid assessment is conducted, it is useful to watch Dr. van Dijk assessing children. In order to watch this process, you should use the flash drive that accompanies this manual. The flash drive shows Dr. van Dijk assessing two children, Hannah and Brian.

 

Introduction Activity:
Meet Hannah and Brian

 

Hannah

Photo of Hannah

Hannah has Wolf-Hirschhorn syndrome and was 7 years old at the time of the assessment. She has high myopia, or nearsightedness, cortical visual impairment, and an undetermined hearing loss. She vocalizes frequently but does not say words.

Brian

Photo of Brian

Brian is a 25-month-old boy who has Zellweger syndrome. Visually, he has some light perception but is otherwise blind. He has a metabolic disturbance with swelling of his liver and is often very tired. Zellweger syndrome is degenerative; and although he is currently not talking, at one point in his life, he did have words. Hearing appears to be an area of strength for him.

As you begin, look over the guiding principles of the assessment that are presented, then open the flash drive on your computer. Watch Hannah video 1, Hannah video 2, Hannah video 3, Brian video 12, and Brian video 13. As you watch the video clips, notice how Dr. van Dijk incorporates the guiding principles into the assessment. Check the ones that you see used in these short clips. We will review the principles and examine each of the learning areas in which children are assessed. As you go through each section of the manual, you will have the opportunity to watch more of the assessments of Hannah and Brian and then view a full assessment of an 18-year-old youth who is assessed by his mother.

Assessment Framework

Photo of baby's hand grasping an adult finger

Learning: From the moment an infant is born, he is bombarded with sensory information. Voices, lights, faces, movement, smells, and even the taste of mother's milk or formula must be experienced and processed (Kellman & Arterberry, 2000; Restak, 1984). In order for new information to be understood, the infant must first be alert enough to take in the stimuli. Then he must orient to each piece of information and compare the information to what he already understands (existing schemes); and since he cannot pay attention to everything at once, he must "tune out" or habituate to what he has already noticed and that which doesn't need immediate attention (McCall, 1994). As a certain stimulus occurs repeatedly within a certain event or routine activity, it becomes part of a chain of information and complete networks are built in the brain that help the infant make sense of all that is happening. At first, incoming information is stored as scattered fragments; but when integrated with other sensory information that makes up a whole experience, the fragments become meaningful. This combination of stimuli is then "hardwired" in the brain (Kellman & Arterberry, 2000; Luria, 1966; Van Dijk, Klomberg, & Nelson, 1997). For example, when a baby is first touched, he may initially be startled; but he quickly integrates the feeling of being touched with the soft sound of his mother's voice and the taste and smell of her nourishing milk. Connections are formed between the stimuli and the experience. From this integration of information, the groundwork for sociability is laid. The infant also begins to learn to anticipate the chain of information and gradually learns that he can influence or alter unfolding events of the chain.

The described process is the foundation of learning and forms the backbone of the Van Dijk Assessment. Behavioral state or alertness, orienting responses, learning channels, approach-withdrawal, memory processes, communication, problem solving, and social interaction are all examined throughout the holistic assessment in an attempt to discover not just what a child knows, but how he learns, and how future learning might be better facilitated.

Information Processing in Infants

Figure 1: Chart has photo of baby looking at ball. Descriptive text flows around the photo in a clockwise pattern, emulating the information processing of infants. The text reads: Incoming Stimuli (Sight, Sound, Smell, Touch, Taste); Orient to Stimuli (Notice and Focus on Stimuli); Compare Stimuli to Existing Schemes (Built From Prior Experiences); Habituate to Stimuli (Stop Responding to Non-Essential Stimuli); Integrate Stimuli (Connect Stimuli to Develop Meaning); Remember Stimuli (Stimuli is Processed Into Memory)

Chart caption: The infant sees the blurred colors of the ball. He touches the ball and focuses on the faint crackling noise and moving textured bumps whenever he squeezes the ribs. He learns to associate the texture, sound, and color with the ball. He attaches meaning to the ball when it is presented to him each day during playtime.

Observation Area 1: Behavioral State

The first step in an infant's learning is to be alert enough to take in the stimulation that the environment has to offer. Behavioral states are simply the states of arousal or alertness. The Carolina Record of Individual Behavior (CRIB) defines nine levels of such arousal or behavioral states (Simeonsson, Huntington, Short, & Ware, 1988).

These states are controlled by the internal needs of the child and the external environment (Barnard & Kelly, 1990). For example, if hungry, the child's state will likely be active awake or fussy awake. If the child is very hungry, uncontrolled agitation or crying may result. These states are controlled by the child's internal needs. If the environment is dark, warm, and quiet, the sleep states will often result. When it becomes light and there are noises and activity, the awake states will likely be seen.

However, children who have impairments of the central nervous system often have difficulty moving smoothly between states and controlling their states (Guess et al., 1988; Siegel-Causey & Bashinski, 1997). They may swing widely from state to state or remain in a drowsy or sleep state for very long periods of time (Als, Tronick, Adamson, & Brazelton, 1976; Richards & Richards, 1997). Children who have difficulty controlling or modulating their level of arousal may become easily over stimulated and agitated if there is a lot going on around them or move into a sleep state to protect themselves from overload (Richards & Richards, 1997; Spangler & Grossman, 1993).

Techniques for Assessing Behavioral State

 

Activity 1:
Observing Behavioral State

 

Hannah

Watch Hannah video 1 and Hannah video 2.

Question: What behavioral state do you think Hannah is in during these two video clips?

Answer: If you said "quiet awake," you are correct. She is very attentive; her face and eyes are bright; and her body activity is minimal when she attends to Dr. van Dijk. This is her optimal state for taking in information.

Brian

Watch Brian video 7 and Brian video 8.

Questions: In what states do you see Brian? How does Brian control his state and protect himself from over stimulation?

Answers: Brian's primary state in video clip 7 is "quiet awake." His face is bright and shiny; he becomes still as he listens; and his respirations are regular. Sometimes he is "active awake" but becomes quiet when taking in information. At one point, he became a little fussy when over stimulated. In order to lower his state and protect himself, he puts his hands over his eyes.

Intervention Strategies

In general, when designing interventions for behavioral states, think repetition soothes and variety awakens (Barnard, 1979). If you want to calm a child and lower the behavioral state, use calming stimuli such as slow rhythmic rocking, firm pressure, warmth, quiet regular rhythms, dim lights, cool colors, and a soft steady voice. If you want to awaken or arouse a child, use fast irregular movements, bright lights and colors, cool temperature, irregular rhythms, and varied vocal patterns (Langley, 1994). You also want to help children develop strategies to calm themselves such as the one you saw Brian using. Be sure to respect and respond to all attempts to either self-calm or self-arouse.

Observation Area 2: Orienting Response

After an individual becomes aware of a stimulus, he must orient to it. This orienting response is the direction of attention which allows maximum gathering of information—think of a dog perking up his ears and becoming still in order to maximally hear a sound. In humans, the response can be seen in the focusing of the eyes, eye widening, turning toward the stimulus, becoming still, touching, or even turning the nose in the direction of a scent. The orienting response is crucial to information gathering and learning (Als et al., 1976; Richards & Richards, 1997; Van Dijk et al., 1997). The stimulus to which we choose to orient can be determined by our internal state. For example, if hungry, we will be more likely to smell and look at food. If we have just eaten and are sleepy, food will be less likely to attract our attention. A child who is in a lowered state much of the time may orient to things or people in his environment infrequently. Outside stimuli may not be strong enough to be perceived by a child with sensory impairments. For instance, small objects that are not close at hand may not elicit a response from the child with a visual impairment. On the other hand, some children with multiple disabilities have a response that is too intense and in order to cope, they withdraw or sleep (Richards & Richards, 1997). If the outside world is seen as too stimulating or is not stimulating enough, the child is likely to turn his attention to his own body and actions, which can result in self-stimulatory or stereotypic behaviors (Van Dijk et al.,1997). He might also end up focusing his attention on things that may not be important but do attract attention, such as bright and shiny objects.

Techniques for Assessing Orienting Response

The goal of assessing the orienting response is to learn how a child gathers information from the outside world. In order to do this, it is important to consider the following:

 

Activity 2:
Observing the Orienting Response

 

Hannah

Watch Hannah video 1 and Hannah video 6.

Questions: To what type of stimuli does she orient and how strong is it? What sensory channels does she use to take in the stimuli and which sensory channels does she use to exhibit it? What is her behavioral state during the clips?

Answers: In video clip 1, Hannah is attracted first to the sound of Dr. van Dijk's voice as he sings her name quite loudly. She becomes still as she listens and her eyes widen. She then turns toward him and watches him very intently. She is in a quiet awake state. In video clip 6, Hannah's attention is attracted by the tie on Dr. van Dijk's head. This time it is a visual stimulus that attracts her attention, and she shows the response through eye widening and intent gaze. The tie on his head was unexpected (a surprise or mismatch) and more likely to get an orienting response. This is a good technique to use, especially as the assessment process proceeds and the child may become bored, tired, or distracted. In video clip 6, Hannah alternated between the quiet awake and active awake states.

Brian

Watch Brian video 5 and Brian video 9.

Questions: To what types of stimuli does Brian orient? How does he show that he is orienting?

Answers: In video clip 5, Brian oriented to the vibrator on his foot by becoming still as he felt it vibrate. When it was taken away, he listened, again shown by becoming still, and reached for it with his foot. When it was turned on again, he smiled. Brian also oriented to Dr. van Dijk's saying loudly the word "on." This orientation to sound could be differentiated from the response to the vibrator because he opened his mouth each time the word was said. Brian alternates between quiet awake and active awake states during this clip. In video clip 9 of the vibrating ball with simultaneous music, we initially see Brian in an active awake state in which he is very sensitive to stimuli. When presented with both the ball and the music, he turns away and becomes a little fussy because he is overwhelmed. The music is turned off, and Brian orients to the ball by reaching out to it and smiling. He also pulls the ball to his face, a very sensitive tactile area, to get even more information about it. As he interacts with the ball, he is very awake, both quiet and active.

Intervention Strategies

Orientation is essential for learning. Therefore, it is very important that stimuli be given to children that they can perceive. For example, we see that Brian has very little vision; and sound, touch, and vibration attract his orientation. Hannah likes sound and music, so she orients to them first. Her vision is more limited, and stimuli must be presented at close range and in an interesting manner. If too much sensory stimulation is presented at one time, as you saw with Brian, the child could turn away rather than orient. To avoid this, initially limit sensory presentation to one stimulus. Then, incrementally add more stimuli, watching for overload as you proceed. Some children have difficulty in knowing what they should attend to, and it is important to help them orient to what we think is important by highlighting and drawing their attention to it. If interactions are increased and physical cues are used to let a child know what is about to happen, higher levels of both arousal and orientation result (Richards & Richards, 1997). Finally, it is important to bring a child's state up to an awake level before expecting the child to orient successfully.

Observation Area 3: Learning Channels

This area builds on the information that you gathered about the orienting response. You should examine the sensory avenues children use as they take in information and learn.

Techniques for Assessing Learning Channels

 

Activity 3:
Observing Learning Channels

 

Hannah

For this activity, watch Hannah video 5.

Questions: Which learning channels does Hannah use in this video clip and what sensory channels does she use to respond? How does she respond when the tie goes from side to side rather than up and down?

Answers: As she follows the tie, we see Hannah responding to vision, visual movement, and the sound of Dr. van Dijk's voice as he says "up" and "down" and raises and lowers the pitch of his voice. Hannah exhibits her response by vocalizing and moving her body up and down. At first, it seems to be in response to the visual stimulus; but then we also see her move to his voice before the tie moves. Hannah has difficulty following the movement of the tie when it is moved from side to side. Dr. van Dijk had noticed that this might be a problem, and he hypothesized that she would respond better to vertical rather than horizontal movements. It is important to note that he tested out his hypothesis and after it was confirmed, he moved quickly back to her strength of following vertical movements.

Brian

To observe Brian's learning channels, watch Brian video 3, Brian video 4, and Brian video 10. In videos 3 and 4, Brian is being assessed by the woman on the right. His mother is on the left.

Questions: How does Brian respond to the voice of the assessor and then how does he respond to the voice of his mother? Which learning channels does Brian use in this clip and which channels does he use to exhibit his responses?

Answers: Brian orients to the sound of the assessor's voice but has a stronger response to his mother's voice as seen by his stilling of movements and listening posture. From this, we can tell that Brian's auditory channel is relatively strong; he orients to voices; and he can also distinguish among them. In video clip 10, Brian initially responds to Dr. van Dijk's voice as he sings. He shows the response by becoming still as he listens and then, smiles. Next, he responds to the feel of the balloon. We know this because he reaches out to the balloon when it is put in his hand and then brings it to his face. Finally, we see Brian respond to the vibration of the voice spoken into the balloon by smiling, laughing, and holding on to the balloon. Although Brian has almost no vision, he uses auditory, touch (or tactile), and vibration to take in information.

Intervention Strategies

The key to intervention in this area is to build on sensory strengths; you should plan learning activities around those identified strengths. Hannah had difficulty with horizontal movements, so you might want to make a calendar or schedule system in a vertical rather than the typical horizontal format. You can also support a child's use of a weaker sense by pairing it with a stronger one. For example, Hannah's auditory channel is stronger than her visual one; but she uses vision more when it is paired with interesting sounds. Brian's use of audition and sound would be further enhanced through the use of activities that utilize vibration.

Observation Area 4: Approach-Withdrawal

In order for a child-guided assessment to be successful, it is important to learn what a child likes, and therefore approaches, versus what she doesn't like and from which she withdraws. This will help you as you build enjoyable routines within the assessment and also as you design intervention. Favored activities will encourage the child to perform and learn. It is useful to involve the caregivers and primary educators before the assessment so that you have this information before you begin. You will also continue to gather knowledge of child preferences as you follow the child's lead.

Hannah: Hannah's mother said that Hannah enjoyed music and having her father lift her up in the air. She also said that Hannah seemed to know her name. In the video clips of Hannah, Dr. van Dijk used this information as he began the assessment by singing Hannah's name. In clip 8, he uses what he knows about what Hannah likes and lifts her into the air. In designing intervention, her preferences for music and vestibular activities would be starting points for building learning routines.

Brian: Brian demonstrated in the assessment that he likes to take the lead in activities. He also enjoys voices and rhythm. As you can observe in video clips 9 through 12, he likes (approaches) vibratory stimulation. As in Hannah's assessment, these preferences are used to build enjoyable and motivating routines throughout the assessment and will later be used to design intervention based on the parents' request that Brian's quality of life be enhanced.

Observation Area 5: Memory

Now that the child is aware of and has oriented to a stimulus, he or she must encode into the brain and use it for learning. The major components of these learning and memory processes involve habituation, and anticipation and routine learning. These processes and techniques for the assessment are described in the next sections.

Habituation

We are constantly bombarded with a multitude of sensory information. It would be impossible to attend to all of this information at once, so we must be able to filter out what is meaningful at a given time and what doesn't need attention. In order to accomplish this filtering, the information must be processed and compared to what we have previously learned to determine if it needs our continued attention. We attend to stimuli that are novel or attention eliciting, signal an upcoming event, or that are reinforcing (Colombo & Mitchell, 1990; Malcutt, Bastien, & Pomerleau, 1996). If, when compared to existing experiences or schemes, the stimulus is found to be familiar or neutral in terms of the above criteria, we are free to decrease our orienting response and turn our attention to other stimuli (Sokolov, 1963). This process is habituation or habit learning. Without habituation, a child would be unable to tune out extraneous environmental information and focus on what is important (Colombo & Mitchell, 1990; Malcutt et al., 1996; McCall, 1994; Van Dijk et al., 1997). For example, a child might not be able to turn his attention away from the buzz of a fluorescent light bulb in order to attend to what a teacher is saying.

Although attention has shifted to another stimulus, we are at least minimally aware of the habituated one. If something about it changes, we must bring our attention back and "dishabituate." An example of habituation and dishabituation can be seen when a child sees his pet cat walking by him. He processes the information and determines that it is just his cat that he sees every day and that there are more interesting things going on. However, if he steps on the cat's tail and the cat bristles up and hisses, attention to the cat or dishabituation is needed once again as the cat is now signaling a possible upcoming event of scratching (Figure 2).

Figure 2: Illustration of a happy cat and an angry cat as if seen by an individual with 20/20 vision

Photo caption: The child sees and hears the difference between a happy cat and an angered cat.

The ability to habituate and dishabituate demonstrates that an individual is able to perceive differences among stimuli, form concepts about them, and determine a course of action based upon the concepts (Cicchetti & Wagner, 1990). Normally this process occurs rapidly and seamlessly. Children with sensory impairments may have difficulty with these processes because they may not be adequately able to perceive differences among stimuli, or it may take a long time to process the stimuli because of the need to piece together information that has missing components. Think again about our example of the cat: A typically developing child easily sees that the cat has taken on a new and larger form and hears the cat hissing. The child who is deafblind may see the "unbristled" cat as blur that is not distinguishable from the bristled one. When scratched, the child who is deafblind, is therefore unable to connect the signaling events with the negative outcome and sees his world as unpredictable and uncontrollable. He may become "hyper-alert" and tense or give up completely and withdraw into his own world that he can control (Figure 3).

Figure 3: Illustration of a happy cat and an angry cat as if seen (blurry) by an individual with who has a visual impairment

Photo caption: The child with deafblindness may not hear the warning sounds or visually distinguish between the two blurs.

Another important component of the process is the ability of the child to discriminate between familiar and unfamiliar persons. Such discrimination can only occur if the child has a very solid scheme for those who are familiar. The development of secure attachment and socialization will be threatened if a child is unable to make these discriminations.

Techniques for Assessing the Memory Process of Habituation and Dishabituation

As you assess these processes, observe the child throughout the assessment and answer the following questions:

 

Activity 5:
Observing Habituation

 

Hannah

For this activity, first watch Hannah video 1.

Question: Why do you think Hannah turned away after orientation to the sound of her name being sung by a new person?

Answer: This answer has two parts. First, she needed time to process the new stimuli. Second, she was now able to stop orienting to this experience and turn her attention to the audience watching her.

Question: How long was it before Hannah habituated?

Answer: A little more than 10 seconds

Question: Did Hannah return attention or dishabituate when Dr. van Dijk began singing again?

Answer: She oriented again by turning toward him.

Question: Do you think that Hannah recognized that this was a new person and why do you think this?

Answer: Yes, the intensity of her orienting reaction and length of time to habituation showed that she recognized the difference.

Question: What would you suggest for intervention in this area?

Answer: Allow additional time for processing of information.

Next, watch Hannah video 7.

Question: Does Hannah search for the tie when it drops out of her visual field?

Answer: No. Once the tie is out of sight, Hannah does not appear to seek it out. In this sequence, she does not demonstrate object permanence.

Question: What technique do you see Dr. van Dijk using to help her develop object permanence or the realization that something exists even though it is not in view?

Answer: He encourages her to hold on to the tie and feel it even though it is not in sight.

Brian

Again, watch Brian video 4. In this clip, you see Brian orient by reaching out to the assessor's face and listening as she says "ja."

Question: What happens when his mother begins to talk?

Answer: He habituates and turns his attention to his mother's voice.

Now watch Brian video 11.

In this clip, you see at least two stimuli coming to Brian simultaneously. The drum is vibrating against his feet, and a balloon is presented to his hands.

Question: To which of the stimuli is Brian attending?

Answer: The balloon. He has apparently ceased his response to the drum; and the balloon is a novel, interesting new stimulus. He is likely still aware of the drum and might attend again if the drum vibration were to stop.

Finally, watch Brian video 10 and Brian video 11.

Question: What does Brian do when the balloon is no longer within reach of his hands?

Answer: He reaches out and attempts to search for it, demonstrating he understands the concept of object permanence.

Intervention Strategies

If a child takes a long time to habituate to a stimulus, it is an indication that he needs increased time to process information and act upon it accordingly. One of the most important intervention techniques is to allow for increased processing time before moving on. The process of habituation depends upon the individual's ability to categorize his various schemes and therefore requires discrimination and generalization based upon the important features of the information (Xu, Carey, & Welch, 1999; Younger & Fearing, 1999). Highlighting the important features and pointing them out to the child can facilitate this process. It is also important to make sure that the information is presented in a context that is understandable and meaningful to the child. Information should be presented within complete schemes rather than as isolated fragments and should be repeated several times (Van Dijk et al., 1997). If a child has persistent difficulty "tuning out" extraneous stimuli, environment modifications such as reducing interfering noises or the amount of visual clutter might be necessary.

Anticipation and Routine Learning

The next step in assessing memory and learning is to look at the child's ability to anticipate next steps and learn and remember routines. In Figure 4, you see a mother coming to her infant in response to her cries. The infant sees and hears her mother as she approaches and becomes excited and happy. Unfortunately, her approach is interrupted when the phone rings. Faced with this unexpected turn of events, the infant cries and the mother hangs up the phone and comes to her. See Figure 4.

When faced with this scenario in the future, the infant knows just what to do to get her mother to hang up the phone and come to her: cry. In this short sequence of events, the infant has learned that she can communicate by crying and thus control her environment (Morse, 1992; Van Dijk et al., 1997). She has learned that the phone ringing may signal that mother will not come as anticipated. As the infant copes with this event, she demonstrates that she has some idea that even though her mother is out of sight, she exists (object permanence) and crying will bring her back into sight. She knows that her mother's footsteps and approach signal something good and the phone ringing means the opposite. The child demonstrates an ability to solve the problem through the intentional use of the communication of crying. Now consider the impact of sensory impairments on this simple routine. The infant who is deafblind may not see or hear his mother coming and therefore has difficulty learning object permanence (Van Dijk et al., 1997). He doesn't hear the phone ring and doesn't see his mother walk away and pick up the phone. He only knows that his cries failed to bring his mother and therefore, must not be very useful or powerful. He learns that his environment is unpredictable and governed by chance as sometimes mother comes and sometimes she doesn't.

Figure 4: Illustration of mother, infant, telephone ringing, and infant crying

Photo caption: Mom approaches, Infant is happy, Phone rings; Mom stops, Infant cries

The ability to anticipate the next steps in routines indicates that a child can learn and remember a chain of events and predict what will happen next based on the preceding steps. The learning of routines gives the child a reason to communicate his desire for the next step and react and problem-solve when faced with a mismatch of expectations. Routines also facilitate the learning of object permanence as the child learns to hold an image in memory over time. Such mental images will be important to the development of symbolic language because the child has a need to symbolize that which he cannot point to or reach (Kellman & Arterberry, 2000; Van Dijk et al., 1997). Finally, the ability to learn routines and anticipate helps the child have control over his environment and gives it predictability and order.

Techniques for Assessing Anticipation and Routine Learning

 

Activity A/R:
Observing Anticipation and Routine Learning

 

Hannah

For this activity, watch Hannah video 5.

Question: What stimulus does Hannah initially use to follow the routine of the tie moving?

Answer: The movement of the tie

Question: As the routine continues, what does she use?

Answer: His voice moving up and down and possibly, the words "up" and "down"

Question: At the end of the clip, how does Hannah demonstrate that she anticipates the steps of the game of the tie moving up and down?

Answer: She moves up and down before the tie or the voice intonation.

Now watch Hannah video 6.

Question: How does Hannah react to the mismatch of seeing a tie on the head instead of around the neck as she sees on her father daily?

Answer: She becomes still, appears to look at the tie, moves her hands in excitement, and then reaches for the tie. Initially she touches his glasses, but then touches the tie and glasses together on the second try. At this point, she becomes interested in his glasses alone and tries to take them off.

Question: What does this indicate about Hannah's functional use of objects?

Answer: This is an area that needs more exploration. It is possible, given that her father wears a tie on a daily basis, that Hannah has some understanding that ties are usually worn around the neck, not on top of the head. However, she does not seem to have an understanding of the function of glasses even though she is also wearing them. Having her compare her glasses with his glasses and having a conversation about where glasses are worn might be interesting.

Brian

For this activity, watch Brian video 13.

Question: How does Brian demonstrate that he has learned the routine and anticipates the next steps?

Answer: Brian demonstrates through alternating his hand and foot drumming that he knows Dr. van Dijk will either tap the board next to Brian's feet with the drumstick or using his knuckles, Dr. van Dijk will tap the board next to Brian's hands. Brian pauses to allow Dr. van Dijk to take his turn in the conversation, thus indicating his knowledge of the turn-taking nature of the routine.

Intervention Strategies

The first step in intervention is to establish consistent and understandable chains or routines that are based on the child's interests. These can begin with imitating what the child does. Dr. van Dijk imitated both Hannah and Brian and then expanded on their actions as he built the routines used in the assessments. The same routines can be important tools in intervention. At each step in the routine, the child should be given opportunities to demonstrate anticipation. New steps should be added slowly, allowing for adequate processing time. Clear and consistent signals help the child anticipate each part of the routine. Daily activities are important contexts for the learning of routines but must be carried out in a consistent manner to allow the child to understand the routine and anticipate the next steps. Routines should be thought of as complete activities and as such, include preparation, the activity itself, clean up, and transition to the next activity (Brown, Evans, Weed, & Owen, 1987). Children should be actively involved in each of these activity phases. Calendar boxes or schedule systems that use objects or otherwise graphically represent daily activities will help provide order to the lives of children with sensory impairments, including deafblindness, and help them anticipate what is going to happen (Blaha, 1997; MacFarland, 1995; Van Dijk & Nelson, 1998). This is especially important for children with sensory impairments because they may not see or hear the signals that tell children who are typically developing what is going to happen. Many challenging behaviors can be eliminated if children have a way to predict what is going to happen in their lives and are given time to process this information and prepare themselves for the transition.

To help children learn the function of common objects, model their proper use, but also let the children explore their use in other ways. Make the objects part of an entire enjoyable experience so they have the opportunity to see how the object fits into a whole scheme. Avoid the use of fragmented instruction when teaching the use of functional objects and don't insist that the child use an object in only one manner.

Observation Area 6: Social Interactions

By necessity, infants are naturally social beings. They typically orient to the faces of people because this is how their needs are met. As they look at the faces of their caregivers and their caregivers look at theirs, the seeds of attachment are sown. Secure attachment to caregivers is the base from which children are able to explore their environment (Shore, 1997). Children with secure attachment see their caregivers as available and responsive, and they view themselves as both loveable and worthy (Bowlby, 1973). Through interactions with their caregivers, children learn about themselves and begin to understand their relationship with other people and their environment; this learning leads to the development of their self-concept (Ainsworth, Blehar, Waters, & Walls, 1978; Bretherton, 1992, 1995).

Secure attachments are built through reciprocal interactions between children and caregivers (Ainsworth et al., 1978; Beckwith, 1990). They require that caregivers be sensitive and responsive to all of the child's communications and that the child respond to the caregiver in turn-taking fashion. Infants and young children learn the rules of turn-taking interactions through feedback received from their communication partners (Barnard & Kelly, 1990). The turn-taking interactions between infant and caregiver become an intricate dance in which each partner carefully reads the cues of the other and adjusts his or her behavior, including engaging and disengaging from the routine, accordingly. Unfortunately, for children with multiple disabilities including sensory impairments, the development of secure attachment may be threatened by many factors, including (a) long periods of time spent in newborn intensive care units in which they are separated from their parents; (b) severe health problems that can limit both quality and quantity of physical contact with caregivers; (c) if arousal is low and time in awake states is limited, there may not be enough time to allow for attachment to occur; (d) if the child has very high levels of arousal, he may be too easily over stimulated and unable to cope with much interaction; (e) the child might have unusual and difficult-to-read communications; and (f) the child's visual, hearing, and other impairments might limit the child's ability to read caregiver cues (Van Dijk, 1999).

Assessment of Social Interaction

First, when assessing social interactions, it is important to look at the child's orientation to and interest in human faces and voices. This interest might be visual, tactual, or auditory depending on the child's sensory abilities. Second, examine the attachment between child and caregiver. The reaction of the child after a short separation from the caregiver can be an indication of the security of attachment. Securely attached children usually greet the caregiver positively upon his or her return. Children who do not have such secure attachment might seem angry, resistive, or passive when the caregiver returns (Ainsworth & Bell, 1970; Ainsworth et al., 1978; Bretherton, 1992). Finally, the assessment of social interactions should look at the ability to engage in turn-taking interactions.

Techniques for Assessing Social Interactions

 

Activity 6:
Observing Social Interactions

 

Hannah

For this activity, watch Hannah video 8.

Question: What do you think about Hannah's attachment with her mother and what led you to this conclusion?

Answer: Hannah appears to have very secure attachment with her mother. She checks in with her mother to make sure it is alright if she goes to Dr. van Dijk and also appears to want to share this exciting experience with her mother. It is clear that her mother is her secure base from which she explores her environment.

Watch Hannah video 3.

Question: Why do you think it is important that Hannah reaches out and touches Dr. van Dijk?

Answer: She is telling him that she has built up a level of trust in him and he may now touch her. He does not touch her until she gives this signal, and even then, it is always with warning and her permission.

Next watch Hannah video 4.

Question: Does Hannah take her turn in this interaction, and if so, what does she do when it is her turn?

Answer: In the sequence with the shoe, Hannah lifts up her foot as Dr. van Dijk approaches it with his clapping hand. In the following sequence, whenever he pauses in his singing, she signals by bobbing her head and then touching her chest that she wants the routine to continue.

Brian

For this activity, watch Brian video 7.

Question: How does Brian take his turn during this clip?

Answer: He smiles, laughs, lifts his foot to signal he wants the vibrator, and moves his mouth. He waves his hands in anticipation of the vibrator touching them.

Question: Does Brian initiate new actions in the interaction?

Answer: Yes, in addition to the above actions, he moves his foot in a circular motion. Through this motion, Brian invites Dr. van Dijk to join him.

Intervention Strategies

Any intervention surrounding social interaction should involve caregivers. Unfortunately, children with sensory impairment and multiple disabilities do not come with an instruction manual. Caregivers often need assistance as they learn to read their child's unusual social and communicative cues and then adjust their behavior according to the child's cues. Learning to read the nuances of the child's behaviors and emotions is increased as proximity to the child increases (Van Dijk, Carlin, & Hewitt, 1991).

As the conversation or dance between partners develops, it is helpful for the partner to move with the child, following each of his or her movements, and then pause to allow the child to take a turn. As the interaction proceeds, be sure to "read" carefully the child's cues for engagement and disengagement (Figure 5).

Fig. 5

Engagement Cues
 
Disengagement Cues
 
Looking at caregiver's face
Movement of arms toward caregiver
Turning head toward caregiver
Smiling
Smooth movement of arms and legs
Feeding sounds
Raising head
Wide and bright eyes
Bright face
Hunger posture (hands together at high midline)
Feeding posture (hands relaxing downward)
 
Looking away
Fast breathing
Yawning
Wrinkled forehead
Dull looking face/eyes
Frowning
Increased sucking noises
Hand to mouth
Facial/lip grimaces
Hand behind head, hand to ear
Back arching
Turning away
Kicking, squirming
Halt hand (hand turned out, blocking face)
Pulling away
Cry face
Crying
Coughing, choking
 
 

Caption: Typically Developing Infant Engagement and Disengagement Cues (Barnard, 1979)

When the child signals a need for disengagement, the caregiver should give him a short break. Thus, over stimulation will be avoided and the child will be able to stay in the interaction for a longer period of time. Return to the interaction when the child provides engagement cues. Social interaction leads naturally to the area of communication; and in fact, it is difficult to separate the two.

Observation Area 7: Communication

Communication is simply the exchange of information between two or more persons. It arises from social interactions and therefore, has both receptive and expressive components. Receptive communication is the understanding of communication (e.g., following spoken directions or responding to questions), whereas expressive communication is its actual usage (e.g., shaking head to indicate refusal, or waving bye-bye). Figure 6 contains a description of the progression of expressive communication development. Communication may be nonsymbolic or symbolic. The earliest nonsymbolic communications are engagement and disengagement cues. These early communications begin as reflexive actions; but once the child learns that her behaviors resulted in something she wanted, they become intentional and the child learns the power of communication. Nonsymbolic communications include facial expressions, gestures, postures, body movements, acting on and with objects, assuming positions, going places, pantomimed actions, withdrawal, and aggressive and self-injurious behavior (Siegel-Causey & Bashinski, 1997; Siegel-Causey & Guess, 1989). Symbolic communications include words, spoken language, sign language, print, and braille. Conventional gestures such as shaking the head "no," nodding "yes," and waving are early, emerging symbolic communications. Nonsymbolic communications may precede symbolic communication, but they continue to play an important part in interactions that are also symbolic. Think of the importance of body language and facial expressions in our everyday conversations and the difficulties that arise in communications such as e-mail that are missing the nonsymbolic component. Whether nonsymbolic or symbolic, communications should be reciprocal and include turn-taking, joint focus, mutual orientation, and motivation on the part of at least one partner to convey a message (Siegel-Causey & Guess, 1989; Van Dijk & Nelson, 1998).

Fig. 6

Communication Level
 
Examples
 
Use of reflexive, preintentional communications
 
Cries when hurt or hungry, makes feeding sounds when hungry
 
Use of intentional, nonsymbolic communications or signals
 
Cries to get attention, tugs at mother's clothing to get her attention, pushes cup away when finished drinking
 
Use of conventional gestures
 
Nods head to say yes, points to draw another's attention to something, holds up hands to ask to be picked up, waves bye-bye
 
Use of iconic or concrete symbols
 
Uses pre-made line drawings or real objects to request, uses ASL sign for ball, says "woof woof" for dog
 
Use of abstract symbols
 
Signs or speaks words such as "play" or "cracker" that do not look or sound like their referent
 
Use of two word utterances
 
Vocalizes or signs "want down," "help me," or "play ball"
 
Use of short sentences with idiosyncratic structure
 
Says sentences such as "me want cookie"
 
Formal language usage with full sentences following grammatical rules
 
Says "I want to play with my ball now"
 
 

Caption: Expressive Communication Levels

Techniques for Assessing Communication

 

Activity 7:
Observing Communication

 

Hannah

For this activity, watch Hannah video 2 and Hannah video 3

Question: What communicative forms does Hannah use to signal that she wants the activity to continue?

Answer: She puts her hands together, shrugs her head and shoulders, and moves her hands up and down.

Next watch Hannah video 8 and Hannah video 9.

Question: How does Dr. van Dijk tell Hannah that he is going to lift her?

Answer: He uses words, the conventional gesture of holding out his arms, and the touch cue of touching her under her arms.

Question: During the course of the activity, do you think Hannah understands the gestures? What makes you think so?

Answer: Yes, she begins to make the gesture on her own to tell him she wants to be lifted.

Question: For what level of communication do you think Hannah is ready?

Answer: Emerging conventional gestures

Brian

For this activity, watch Brian video 5.

Question: What does Brian do in response to hearing the word "on"?

Answer: He opens his mouth as if he is also saying "on" and holds out his foot to feel the vibrator.

Question: Do you think that receptively Brian understands the word "on"?

Answer: Although it is difficult to say with certainty, the consistency with which Brian holds up his foot and the accuracy of his mouthing movements would indicate he does understand "on."

Question: Do you think Brian's actions have communicative intent?

Answer: Yes, very much so.

Question: For what level of communication do you think Brian is ready?

Answer: Brian appears ready for some conventional gestures such as shaking his head to say "no" or holding up his arms to be picked up. Because it appears possible that he is trying to say "on," it is important to continue to use and emphasize target words such as you see Dr. van Dijk doing with the word "on." Consistently respond to all of Brian's attempts to use such words.

Intervention Strategies

One of the most important things you can do to encourage communication is to respond to all communication attempts. If communications are not reinforced, they will fade away and may be replaced with communications that are stronger and less desirable. However, responding to communication attempts is sometimes difficult because young children with multiple disabilities often have unique and very difficult to read communications. Take your time, carefully observe, and try to understand communicative meanings behind a child's behaviors (Durand & Crimmins, 1988).

Establishing a warm, communicative environment is another essential component of communication intervention (Siegel-Causey & Guess, 1989). A proper communication environment is one in which communication partners are sensitive to each other and always pause to allow the partner to take his turn. Remember that the child with sensory impairments and multiple disabilities may require more time in order to process information and formulate responses. Communication should be enjoyable and should include a range of communicative functions such as making choices, requesting, establishing joint attention to an activity or object, sharing information, and rejecting. Predictable routines allow children to take turns within the routines and express surprise when the routine changes.

Communications are most effective when both partners know the subject of the conversation. Calendars or schedule systems can be used to establish a mutual topic or joint focus (Van Dijk et al., 1997; Van Dijk & Nelson, 1998). Such topics are of particular interest because people are generally most interested in what they have done in the past, what they are currently doing, and what they are going to do in the future. Calendar systems should be thought of as opportunities for conversation not simply tools for transition.

Remember that conversations can be nonsymbolic as well as symbolic. Your communications with the child should be one level above where you think the child is, so as not to overwhelm but still provide a model for the next step in communication. The importance of nonsymbolic communications should not be forgotten once a child gains symbolic communications. Nonsymbolic communications should continue to be emphasized and encouraged (Siegel-Causey & Guess, 1989). These will help the child most effectively convey meaning and will aid in the attainment of social skills. For example, if the learner looks in the direction of his/her communication partner it tells the partner that the learner is trying to communicate with him/ her. If the learner smiles it tells the partner that the learner enjoys the interaction. If an appropriate amount of "personal space" is maintained, it can help the learner feel more comfortable.

Finally, communication development is never separate from other developmental areas; and it is important to take all development into consideration when making decisions about communication systems (Bates, Benigni, Bretherton, Camaioni, & Volterra, 1979; Kennedy, Sheridan, Radlinski, & Beeghly, 1991; Nelson, 1993).

Observation Area 8: Problem Solving

Many of the skills that have been previously outlined in the assessment are also used in problem solving. In order to solve problems, individuals must first be alert and aware that there is a problem; they then must maintain this attention and persist until the problem is solved. As they work to solve a problem, they must integrate previously received information into coherent schemes and then activate the schemes (Kellman & Arterberry, 2000). Early problem solving is seen when children attempt to get something they want or try to make interesting events recur. Cause and effect begins to be understood when the desired results are achieved. Examples of cause and effect are seen when a child cries to get his mother to come or drops keys repeatedly on the floor to get an adult to pick them up. The developmental milestone of means-end occurs when children learn that tools (including the use of adults as tools) may be used to achieve goals. Examples of means-end are standing on a chair to reach something, leading an adult over to the sink in order to get a glass of water, and using symbolic language to acquire something. As children work to solve problems using these skills, they learn the relationship between people and objects and the parts of objects to their whole (Linder, 1993).

Techniques for Assessing Problem Solving

 

Activity 8:
Observing Problem Solving

 

Hannah

For this activity, watch Hannah video 6.

Question: Does Hannah attempt to solve the problem of the tie on the head?

Answer: Yes, she reaches for the tie.

Question: Does Hannah persist in trying to get the tie off?

Answer: No, she becomes distracted by the glasses when she isn't met with immediate success.

Brian

For this activity, watch Brian video 5 again.

Question: What might lead you to think that Brian understands cause and effect?

Answer: He seems to understand that when he lifts his foot to the vibrator it will be turned on. He also vocalizes to get the vibrator turned on.

Question: Of the techniques that Brian uses to get the vibrator on, which do you think demonstrates a beginning concept of means-end?

Answer: He mouths the word "on," which is an intermediate step.

Intervention Strategies

Critically important to assisting children to learn to solve problems is to make sure they have a need, as well as multiple opportunities, to practice the skills involved in problem solving. It is unfortunate that many children with multiple disabilities spend very little time engaged in problem-solving activities. They may acquire the "good fairy syndrome" when adults or others in their environment automatically bring them things and then just as easily take the things away. Children with sensory impairments may not see things coming until they arrive and then do not see where they went after they seemingly disappeared (Van Dijk et al., 1991). For all the children know, the "good fairy" took them away. In addition to becoming very passive, skill acquisition of object permanence, cause and effect, means-end, and communication are severely limited. The "good fairy" syndrome is one syndrome that can be easily "cured" and children's independence fostered if you make sure they are actively involved in all stages of activities from getting materials out to putting them away after the activity.

Writing the Assessment Summary

The final step in the assessment process is to write a summary of your findings with suggestions for intervention. The summary form has three components. The first part looks at the child's strengths in each of the assessed areas. Strengths are emphasized because effective intervention is designed from points of strength rather than weakness. These strengths can be taken directly from the worksheets you have completed. The second area is what the child is ready for in each of the assessed areas. This section should give your impressions of what the next intervention steps should be. Finally, the third section is for recommendations in each area. This should begin the process of bridging assessment and intervention.

The summary forms for the assessments of Brian and Hannah are provided on the following pages. Before reading the forms, it would be useful to view the video clips of each of the children in numerical order.

Summary Form — Hannah

Observation Area  Strengths in Observed Area  What the Individual Is Ready for in Observed Area  Suggestions or Recommendations 
Behavioral State  Hannah is able to maintain an alert state and is able to modulate or regulate her own arousal by turning away or taking brief breaks.

Her mother reports that she sleeps well at night. 
Hannah's current skills are appropriate in this area.  Each person who interacts with Hannah should understand her disengagement cues and allow her to take brief breaks as necessary. 
Orienting Response  Hannah orients to visual, auditory, and movement-based information but often orients to auditory information first.

She orients by stilling, turning her body and head, and widening her eyes. 
Increase orientations to visual information.

Extend on orientation response and understand the meaning of stimuli.  
Pair visual stimuli with auditory component.

Present stimuli in context of activities to help her understand their meaning.

Model and encourage functional use of objects. 
Learning Channels  Hannah followed vertical movements better than horizontal ones.

She enjoyed vestibular activities.

She used auditory sense to listen to rhythmic music and her name.

She uses vision when stimuli are close and moving. 
Increase use of vision as a learning channel.

Use vision and audition together.  
Alternate sitting activities with vestibular activities such as walking or swinging.

Present visual information at close range and in vertical format.

Pair visual information with auditory information.

Add movement to visual information. 
Approach-Withdrawal  Hannah enjoyed and therefore approached rhythmical and musical activities.

Hannah liked having control of activities. 
Increased control  To give Hannah more control, respond to all of her actions as having communicative intent and allow her to control the course of many of her daily activities.

Provide opportunities for choice making.

Utilize singing in daily routines.

Utilize rhythm in turn-taking activities. 
Memory  Hannah habituates appropriately to familiar objects, people, and events.

She is able to differentiate between familiar and unfamiliar individuals.

She is able to learn routines if sufficient repetition is provided. She anticipates what should come next in routines and recognizes when there is a mismatch to her expectations.

It is possible that she has a very early emerging ability to recognize the function of some common objects as seen by the possibility that she recognizes that ties do not go on the head. She does not seem to recognize the function of the glasses, however.

Object permanence is emerging. 
Increase memory for routines

Achieve object permanence

Increase functional use of objects 
Build short, functional routines that are repeated often and used daily. Encourage active, partial participation to help her understand how common objects are utilized.

Give her time to process and demonstrate learning of each step before asking her to move on to another.

Gradually increase the time intervals between learned routines.

At times, continue to throw in a mismatch or surprise.

Hannah should be actively involved in getting materials out and putting them away to increase object permanence.

Whenever possible, have her feel objects as they leave her visual field. 
Social Interactions  Hannah is very interested in people and orients to them.

She appears to have excellent attachment with important individuals in her life.

She engages in turn-taking interactions when others begin the interactions and add information to the interactions.

She attempts to imitate the actions of others. 
Increase length and complexity of turn-taking interactions.

Increase initiation of social interaction. 
Reinforce Hannah's initiation attempts by responding to all of them as communications and continuing the interaction.

Provide frequent opportunities for turn-taking interactions.

Gradually, using one sensory modality at a time, add new steps to interactions.

Reinforce imitation attempts by imitating them back in turn-taking fashion.

Increase opportunities to interact with peers.

Help peers understand her communications.  
Communication  Hannah's interactions demonstrate clear communicative intent.

Hannah has multiple communication forms for events.

She has emerging use of conventional gestures. 
Increased use of conventional gestures

Increased use of differentiated communications 
Select two or three conventional gestures that would be motivating/useful to Hannah. Provide multiple opportunities for her to see their use within activities.

Selected gestures should be ones that Hannah can physically make.

Whenever possible, adapt the gesture to use vertical rather than horizontal movements.

Provide other communications such as words and touch cues to help her understand the gestures.

Pause after presentation to allow Hannah time to process meaning of the gesture.

When appropriate, pause to see if Hannah will initiate the gesture on her own.

Encourage communication within turn-taking games/routines.  
Problem Solving  Hannah has a good idea of cause and effect.

She understands that when she makes a communicative signal, she can influence the actions of others.

She persists for several seconds to solve a problem but is easily distracted.

She will try different approaches to solve a problem. 
Understand means-end

Persist longer in problem solving

Increase strategies to solve problems  
Provide many opportunities to continue practice of cause and effect in a variety of situations.

Respond to all signals as communications.

Increase opportunities for problem solving and give her ample time to work on a problem before intervening.

Model new strategy and then give her time to process and attempt strategy on her own.

Model use of intermediate steps to solve problems and provide opportunities for her to practice their use.

When she has completed a task, give her time to process what she has done. 

Summary Form — Brian

Observation Area  Strengths in Observed Area  What the Individual Is Ready for in Observed Area  Suggestions or Recommendations 
Behavioral State  Brian is able to maintain an alert state but becomes tired easily. He is able to give himself short rests and then come back to an alert state.  Brian's skills in this area are appropriate given his medical condition.  People in Brian's environment should respect Brian's need for short breaks.

They should read his cues for a need to disengage and then return to activities when he again gives engagement signals.

His medical condition should be carefully monitored each day and stimulation planned accordingly. 
Orienting Response  Brian has some light perception.

He orients to visual, auditory, and vibratory stimuli. He orients to his mother's voice.

He orients to stimuli that are novel but turns away if they are too intense. 
Brian's orienting responses are appropriate to his sensory abilities.   Vary objects that are presented to Brian to allow for novelty.

Utilize toys and other materials that have a vibratory component. Be careful not to present stimuli that are too intense. Let him listen to vibratory objects before touching him and let him reach out and touch them before he is touched by them. Give him time to explore all objects including taking them up to his mouth. 
Learning Channels  Brian is eager to take in sensory information by using all of the sensory channels that are open to him. He takes in information through the auditory and tactile channels. He is able to use both the auditory and tactile sense simultaneously. He uses his tactual and motor abilities to explore.

Vibration is a good learning channel for him.

He appears to be able to discriminate among voices using his hearing and understand spoken words. 
Continued practice listening to and responding to spoken words

Continued learning through auditory, tactual, and vibratory means 
Vibration is a strong motivator to Brian and whenever possible, should be incorporated in learning and recreational activities.

A variety of sensory channels should be used but should be built into activities one at a time.

Allow time and opportunity for him to explore objects tactually.

Provide many opportunities for him to listen to voices including speaking and singing. Both should be done close to his ears to increase his ability to hear them. 
Approach-Withdrawal  Brian listens carefully when his mother is speaking.

He appears to enjoy singing and rhythm.

He likes vibration.

He enjoyed being on the resonance or vibration board. His motor activity increased when on it.

He is overwhelmed if stimuli are too strong or if too much sensory information is presented at one time.

He likes to influence the behavior of his conversation partners and environment. 
Increased opportunities to learn through audition and vibration

Have increased control over his environment 
Brian would likely enjoy hearing his mother and other caregivers sing to him.

Use a resonance or vibration board.

Read his signals that he is overwhelmed and, as appropriate, decrease the amount of stimulation and increase his time to explore. 
Memory  Brian habituates to familiar objects and events rapidly. He habituates to voices but rapidly comes back to attention if he hears his mother's voice. Brian seems to have object permanence.

He is able to learn a routine and remembers a sequence of activities. He is able to anticipate what will come next in a routine with which he is familiar.

He responds to some words and imitates them. 
Increase ability to learn and remember routines

Have increased feelings of mastery of his environment

Increase number of words responded to and imitated 
Repeat routines frequently so that Brian can remember and master them. Continue building upon his object permanence by helping him feel where objects are coming from and where they are going.

Use favorite input channels of hearing, vibration, and touch.

Pair words with the matching object and reinforce his imitations of the words.

Give him verbal and tactual information about upcoming activities and routines. Pause and let him demonstrate that he understands what will come next in a routine. Use the mismatch technique to encourage his communication about knowledge of the changed event. 
Social Interactions  Brian appears to have strong attachment to his mother and seeks her out.

He enjoys social interactions.

He engages in turn-taking activities and at times, will initiate such activities. He adds more to the interaction and imitates what other people do. 
Brian is ready to increase the number of interactions.

Have a third person involved in conversations. 
Have both his mother and father involved in interactions— they might take turns with him in singing routines.

Always give Brian time to process information and take a turn.

Because of Brian's health, interactions can be frequent but should be short in duration and of high quality. 
Communication  Brian communicates to partner with intentionality. He enjoys interaction with communication partner.

He communicates non-symbolically through smiles, body movements, and vocalizations.

He may still understand some symbolic verbal communication. 
Begin to establish joint topics of conversation with communication partner and become more aware of the role of the partner in interaction

Increase and refine non-symbolic communication forms 
Using hand-under-hand techniques, explore items of interest with Brian.

Share experiences by doing them with Brian.

Share and communicate about emotions.

Accept and respond to all of Brian's communication attempts. 
Problem Solving  Brian has object permanence and cause and effect. He demonstrated some means-end when he mouthed the word "on."

Brian likes to explore objects and brings them to his mouth to further understand their properties. He maintains attention to a problem and persists in trying to solve it. He uses alternate solutions to solve a problem. 
Brian is ready to learn where objects come from and where they are going.

He is ready to continue to learn about means-end and the use of an intermediate step to solve a problem.

He is ready to have increased opportunities to practice cause and effect. 
Avoid the "good fairy syndrome" by involving Brian in all phases of activities as fully as possible. Brian enjoys being in control and should be given multiple opportunities to lead an activity.

The use of an easily activated switch would give Brian more environmental control and enhance his learning of means-end.

Continue to watch and respond to Brian's attempt to understand and use words.

Make sure that Brian has many opportunities to be successful. 

Michael's Assessment

Photo of Michael

Michael is an 18-year-old youth with multiple disabilities. The assessment you see on the flash drive was facilitated by his mother. As you watch the assessment, fill out the observation worksheets for each of the areas; and then when you are finished, use the summary forms to summarize your assessment and plan future intervention. You can then compare your observations and findings with those of this manual's authors that follow on the next pages. Remember, there may be more than one correct observation! As you watch the assessment, it is also important to observe the wonderful, child-guided facilitation techniques that Michael's mother uses to elicit skills from him.

Note: Michael's video is approximately 30 minutes long.

Behavioral State Observation Worksheet

  1. What is the individual's current behavioral state?
    a. Quiet awake __x__
    b. Active awake __x__
    c. Drowsy ____
    d. Quiet sleep ____
    e. Active sleep ____
    f. Fussy ____
    g. Crying ____
     
  2. Is the individual able to control or modulate his/her state?
    Yes
     
  3. Is the individual's state able to be modulated externally?
    Yes
     
  4. How much time does the individual spend in an alert state during the day time?
    He was alert throughout assessment.
     
  5. What variables affect the individual's state (e.g., temperature, rocking, light)?
    Interaction, having needs met, change of play items, demands of activity
     

Orienting Response Observation Worksheet

  1. What factors elicit an orienting response (e.g., hearing name, bright light)?
    Interaction with tapping game, touch with finger game, mother's voice, musical toys, seeing play objects
     
  2. How does the individual exhibit an orienting response (e.g., eyes widen, becomes still, turns toward stimulus)?
    Looks toward, turns head toward, eyes widen, becomes still, reaches, points, closes hand around his mother's
     
  3. What kind of sensory information triggers the response?
    Auditory (rhythm, mother's voice, music)
    Vision
    Touch
    Proprioceptive (tapping)
     
  4. What senses does the individual use when orienting?
    Vision, auditory, touch
     

Learning Channels Observation Worksheet

  1. What learning channels does the individual use to take in information?
    a. Auditory __x__
    b. Visual __x__
    c. Kinesethetic or touch __x__
    d. Vestibular ____
    e. Proprioceptive __x__
     
  2. How does the individual react to sound?
    Orients, turns toward, tries to get sound by turning on toys, pressing keys
     
  3. How does the individual react to visual stimuli?
    Looks at different toys, points to visual stimuli
     
  4. How does the individual react to being touched or touching things?
    Touches hands, closes his hand around mother's, snuggles up to mother when she rubs his neck, touches key board
     
  5. Does the individual use more than one sense at a time?
    Yes
     
  6. Does the individual exhibit engagement cues in response to particular stimuli?
    Yes
    If so, to which stimuli and what are the cues?
    Touch of mother's hands - continued touching game, curled his hands around hers, repeated actions to get more music
     
  7. Does the individual exhibit disengagement cues in response to particular stimuli?
    Yes
    If so, to which stimuli and what are the cues?

    Reacted negatively (whined and turned away) when presented with problems or tasks requiring too many motor responses, appeared to whine when physically uncomfortable
     

Approach-Withdrawal Observation Worksheet

  1. What are the individual's engagement cues (e.g., smile, turning towards something or someone, reaching)?
    Smiles, turns toward, points, vocalizes, becomes still, reaches for object, snuggles
     
  2. What are the individual's disengagement cues (e.g., frown, turning away)?
    Turns away, vocalizes, pushes objects away, twists body away, points to something else, waves hand
     
  3. What appears to motivate the individual?
    Interaction-tapping and finger games
    Keyboard toys
    Rhythm
    Watching what mother does
     
  4. What does the individual seem to turn away from?
    Being left alone
    Difficult toys with many motor demands
     

Memory Observation Worksheet

  1. Does the individual habituate to familiar stimuli?
    Yes
    List examples for why you answered yes or no.

    Musical toys, tapping game, finger game
     
  2. How long or how many presentations of stimuli are necessary before there is habituation?
    10 seconds of musical toys
     
  3. Does the individual attend again if the features of the stimulus change?
    Yes
    List examples.

    Orients to changes in rhythm of tapping game, orients when new musical toy is presented, or music changes

    Did have difficulty selecting "on" switch when many switches were present
     
  4. Are reactions differentiated?
    Yes
     
  5. Does the individual react differently to familiar and unfamiliar people?
    No, not seen in this assessment
    List examples.

     
  6. Does the individual appear to have object permanence (understands that something exists even if it is not currently visible)?
    Yes
    List examples observed.
    Looked for desired toys, appeared to understand mother was coming back
     
  7. Does the individual appear to anticipate an upcoming event?
    Yes
    If yes, list examples observed.

    • Anticipated tapping game, finger game 
    • Anticipated music when tapping keyboard or turning on switches 
    • Pointed at what he wanted and waited to get them 
     
  8. Does the individual react when there is a mismatch with expectations?
    Yes
    List examples observed.
    Reacted if mother did not tap back right away or if rhythm changed
     
  9. Does the individual demonstrate functional use of objects?
    Yes
    If yes, list examples observed.

    • Musical toys 
    • Stacking blocks 
    • Bag to put toys in 
     
  10. Is the individual able to learn a simple routine?
    Yes
    If yes, list examples observed.
    Tapping game, finger game, stacking blocks, turning on keyboards
     
  11. Is the individual able to remember the routine that he/she learned?
    Yes
    If yes, list examples observed.
    Tapping game, finger game, keyboards
     

Social Interactions Observation Worksheet

  1. Does the individual orient to a person?
    Yes
    If yes, list examples observed.
    Orients to mother, looks toward her when she enters room, watches what she does
     
  2. Does the individual exhibit secure attachment with important individuals in his/her life?
    Yes
     
  3. Does the individual engage in turn-taking when he/she begins the interaction?
    Yes
    If yes, list examples.
    Tapping game, finger game
     
  4. Does the individual engage in turn-taking when a partner begins the interaction?
    Yes, but limited
    If yes, list examples.
    Stacking blocks, putting blocks back in bag
     
  5. How many turns are taken before disengagement?
    10+
     
  6. In response to a partner's interaction, does the individual add more to the turn-taking interaction?
    Yes
    If yes, list examples observed.
    Changes rhythm of knocking game, added more blocks
     

Communication Observation Worksheet

  1. List signals or other communication the individual uses and tally frequency of use: (e.g., looks away when facilitator tries to make eye contact lll, Smiles when touched gently llll)

    • Taps to get mother to tap    lllll   lllll 
    • Vocalize to get something and to indicate refusal    lll 
    • Turn away from something    lllll   lll 
    • Takes mother's hands    lll 
    • Points to what he wants    llll 
    • Music sign or gesture    lllll   lll 
    • Yes sign approximation    lll 
    • Finger in ears or head when thinking lllll   l 
     
  2. Does the individual demonstrate intent to purposefully communicate with others? (Circle all that apply.)
    a.  through signals (e.g., eye gaze, averting gaze) 
    b.  through vocalizations 
    c.  through gestures 
    d.  through other communication (e.g., sign or word approximation,
    symbol on communication board) 
     
  3. Does the individual demonstrate differentiated communications (different communications for different meanings)?
    Yes
    If yes, list these communications, their probable meaning, and probable purpose below:
    Communication Form  Probable Meaning  Probable Purpose 
    Points
    Tap object
    Whine (vocalization)
    AHH (vocalization)
    Wave hand
    Wave hand horizontally
    Flip hand over other hand
     
    I want that
    Now you tap
    I am frustrated
    Want something else
    Yes
    Finished
    Music
     
    Get what he wants
    Begin interaction
    Help me
    Get new toy
    Get what he wants
    End play with toy
    Get music on
     
     
  4. Does the individual make choices when given options? (Circle one.)
    Yes   No   Inconsistent
    1. If yes or inconsistent how are choices indicated?
      Points, takes selected toy
       
    2. What is the context of the choices (e.g., number of choice options, type of choices)?

      • Three choices offered 
      • Many toys stacked together 
       
     
  5. Does the child demonstrate use of conventional gestures (e.g., pointing, shaking head no, lifting up arms to be picked up)?
    Yes
    If yes, list observed conventional gestures.
    Points
     
  6. Does the individual use one item or symbol to represent an activity or object?
    Yes
    List symbols used and the reason for their use.

    • Approximation of finished sign 
    • Approximation of music sign 
    • Waves hand to say yes 
     
  7. Does the individual demonstrate an understanding of communication symbols?
    Yes
    If yes, list observed examples.
    Appears to understand yes or no questions posed by mother, appears to understand when mother asks if he wants music or if he is finished
     
  8. Does the individual use symbolic communication (e.g., spoken or signed words, object/picture/symbol communication boards or systems)?
    Yes, but limited
    List examples observed.
    Yes, Music, Finished
     

Problem-solving Observation Worksheet

  1. Does the individual demonstrate cause and effect?
    Yes
    If yes, provide examples.

    Tapping game, finger game, keyboard to get music 
  2. Does the individual demonstrate an understanding of means/end or use of an intermediate step to solve a problem?
    Yes
    If yes, provide examples.

    • Uses mother to help turn on music 
    • Musical toys-switch activates keyboard 
     
  3. Does the individual demonstrate an understanding of the function of common objects?
    Yes
    If yes, provide examples.
    Switches on musical toys
    Blocks
    Bag to put blocks in
     
  4. When faced with a problem, what does the individual do?
    Tried briefly to put blocks in bags, asks for help turning on switches and stacking blocks
     
  5. When presented with a problem, does the individual maintain attention and persist?
    Yes
     

Summary Form — Michael

Observation Area  Strengths in Observed Area  What the Individual Is Ready for in Observed Area  Suggestions or Recommendations 
Behavioral State  Michael maintained an alert state throughout the assessment. Mother reports that sleep-wake cycles are normal. He does turn away when overwhelmed to modulate his own state.     Train others in his environment to recognize when he is overwhelmed and allow him to take breaks as needed. 
Orienting Response  Michael orients to auditory (music, rhythm, voice), visual, proprioceptive, and tactile stimuli. He uses vision, touch, and audition to orient.  Not a problem at this time  N/A 
Learning Channels  Michael learns through auditory, visual, tactile, and proprioceptive channels. He is able to use touch and sound and vision together as well as sound and touch but appears to become overwhelmed with too much stimulation.  Ready to process more simultaneous stimulation without becoming overwhelmed and needing to turn away  Continue to pair favored channels such as listening to music with visual stimuli. Try presenting only two stimuli at a time and then very gradually add more. 
Approach-Withdrawal  Michael engages by turning head, touching, pointing, vocalizing, becoming still, and reaching. He disengages by turning away, vocalizing, pushing away, twisting body away, waving hand, and pointing to something else. He likes interaction, rhythm, and music.  Ready to produce more consistent conventional signs for wanting to disengage  Continue to reinforce hand waving, but also model finished sign that is more of a pushing away gesture.

Try a simple picture symbol such as a stop sign he can point to in order to say he is finished. Sign can also be mounted on an AAC switch so that he gets auditory feedback as well. 
Memory  Michael habituates fairly rapidly to familiar stimuli and attends again when features change. He does have difficulty picking "on" switch from many switches. He demonstrates object permanence, and shows functional use of some objects. He is able to anticipate a routine and learn and remember routines.  Ready to select important "on" switch when others are also present

Increase number of schemes used together in routines. 
Highlight "on" switch by putting bright color or texture on it.

When Michael adds to a routine, incorporate his change into the routine so that it alternates with his old one(e.g., he taps twice several times then changes to one tap, try to alternate the two tapping rhythms and get him to follow). Add a new stimulus such as a drum to the tapping game to increase schemes and functional use of objects.

Allow for increased processing time. 
Social Interactions  Michael orients to mother and demonstrates attachment. Mother says he also orients to new people. He engages by taking many turns when he begins a routine, but limited when others begin one. He does add more information.  Engage in more turn-taking routines that are initiated by others  Partner initiate favorite tapping and finger games and then when he is in the habit of following his favorite games, initiate a new one and encourage him to follow.

Try to initiate routines that use motor responses that are easy for Michael to perform. Allow time for him to process. 
Communication  Michael communicates using nonsymbolic signals such as reaching for objects, pushing objects away, and reaching for his mother's hand. He also uses vocalizations, a few conventional gestures such as pointing, and sign approximations for music, finished, and yes. Receptively, Michael responds to directions such as "hand me the music."  Refine signs so that the ones he uses are more easily recognizable.

May be ready to start using a couple of salient and simple picture symbols that he can select through either pointing or pushing a switch

Make more choices 
Communication partners should pair the signs that he is using with their words. Make finished sign into more of an actual push away and help him to form music sign over his other arm. Reinforce what he does do, and then assist him to very gradually refine it.

Present simple picture symbols either alone or on switches that represent routines and toys that he really likes (e.g., black and white keyboard picture to represent keyboard toys). Make sure he understands one symbol before adding any more.

Present two choices of toys—one that you know he might want and one that is not favored. Alter their position so he learns to visually scan his choices. Pair picture symbols with the actual objects and then fade the objects. 
Problem Solving  Michael demonstrates cause and effect and means-end. He has an understanding of many common objects. He tries briefly to solve a problem, but does not maintain attention and persist in attempting to solve it. He does not appear to try alternate approaches other than seeking help from his mother.  Ready to persist longer in trying to solve problems and trying alternative approaches  Allow wait time before offering him assistance. Model approach to solving the problem and then assist him to do it by prompting from the wrist or elbow.

Continue to reinforce his asking for help, but then assist and encourage him to do the same thing if it is motorically possible for him. Try not having as many alternative toys available. If one is too difficult, he tends to just move to another. 

Appendices

Appendix A:

Parent Interview Questions
For use prior to assessment during initial parent/care giver interview.

Appendix B:

Observation Worksheets (for each of the areas)
For use during assessment.

Appendix C:

Summary Form

Note: The Appendices pages can be photocopied on 11" × 17" paper. The Appendices are also available electronically on the accompanying flash drive. The electronic version can be printed on 8 1/2" × 11" paper.

Appendix A: Parent Interview Questions

  1. What do you see as your child's strengths? 
  2. What do you see as your child's needs? 
  3. Describe your child's skills in each of the following areas:

    1. Sleep patterns including nighttime sleep and daytime sleep-wake patterns 
    2. Receptive communication (understanding what others are saying) 
    3. Expressive communication (communicating to others). This can be such communications as facial expressions, vocalizations, gestures, objects, words, or signs 
     
  4. Does your child seem to enjoy interacting with others? 
  5. How does your child act with both familiar and unfamiliar people in his/her life? 
  6. Describe your child's activity level. 
  7. Does your child seem to have very strong preferences or dislikes? 
  8. What types of stimulation (activities, games, toys, etc.) does your child seem to like? 
  9. From what types of stimulation does your child turn away or not like? 
  10. How does your child adapt to change, new things, or new events in his/her life? 
  11. How does your child respond to the following:

    1. Visual stimulation 
    2. Auditory stimulation 
    3. Touch 
    4. Movement 
    5. Vibration 
    6. Smell 
     
  12. Does your child seem to get overstimulated when there is too much ambient activity? 
  13. How does your child tell you when he/she likes something? 
  14. How does your child tell you that he/she does not like something? 
  15. Do you think your child understands the function of some common items used in daily activities? Describe: 
  16. Do you have any particular concerns about your child at this time? 
  17. What would you like to learn from this assessment? 
  18. Is there anything else that we have not talked about that you feel is important? 

Appendix B: Observation Worksheets

Behavioral State Observation Worksheet

  1. What is the individual's current behavioral state?

    1. Quiet awake ____ 
    2. Active awake ____  
    3. Drowsy ____  
    4. Quiet sleep ____  
    5. Active sleep ____  
    6. Fussy ____  
    7. Crying ____ 
     
  2. Is the individual able to control or modulate his/her state? 
  3. Is the individual's state able to be modulated externally? 
  4. How much time does the individual spend in an alert state during the day time? 
  5. What variables affect the individual's state (e.g., temperature, rocking, light)? 

Orienting Response Observation Worksheet

  1. What factors elicit an orienting response (e.g., hearing name, bright light)? 
  2. How does the individual exhibit an orienting response (e.g., eyes widen, becomes still, turns toward stimulus)? 
  3. What kind of sensory information triggers the response? 
  4. What senses does the individual use when orienting? 

Learning Channels Observation Worksheet

  1. What learning channels does the individual use to take in information?

    1. Auditory _____ 
    2. Visual _____ 
    3. Kinesethetic or touch _____ 
    4. Vestibular _____ 
    5. Proprioceptive _____ 
     
  2. How does the individual react to sound? 
  3. How does the individual react to visual stimuli? 
  4. How does the individual react to being touched or touching things? 
  5. Does the individual use more than one sense at a time? 
  6. Does the individual exhibit engagement cues in response to particular stimuli?
    If yes, to which stimuli and what are the cues?
     
  7. Does the individual exhibit disengagement cues in response to particular stimuli?
    If yes, to which stimuli and what are the cues?
     

Approach-Withdrawal Observation Worksheet

  1. What are the individual's engagement cues (e.g., smile, turning towards something or someone, reaching)? 
  2. What are the individual's disengagement cues (e.g., frown, turning away)? 
  3. What appears to motivate the individual? 
  4. From what does the individual seem to turn away? 

Memory Observation Worksheet

  1. Does the individual habituate to familiar stimuli?
    List examples for why you answered yes or no.
     
  2. How long or how many presentations of stimuli are necessary before there is habituation? 
  3. Does the individual attend again if the features of the stimulus change?
    If yes, list examples observed.
     
  4. Are reactions differentiated? 
  5. Does the individual react differently to familiar and unfamiliar people?
    If yes, list examples observed.
     
  6. Does the individual appear to have object permanence (understands that something exists even if it is not currently visible)?
    If yes, list examples observed.
     
  7. Does the individual appear to anticipate an upcoming event?
    If yes, list examples observed.
     
  8. Does the individual react when there is a mismatch with expectations?
    If yes, list examples observed.
     
  9. Does the individual demonstrate functional use of objects?
    If yes, list examples observed.
     
  10. Is the individual able to learn a simple routine?
    If yes, list examples observed.
     
  11. Is the individual able to remember the routine that he/ she learned?
    If yes, list examples observed.
     

Social Interactions Observation Worksheet

  1. Does the individual orient to a person?
    If yes, list examples observed.
     
  2. Does the individual exhibit secure attachment with important individuals in his/her life? 
  3. Does the individual engage in turn-taking when he/she begins the interaction?
    If yes, list examples.
     
  4. Does the individual engage in turn-taking when a partner begins the interaction?
    If yes, list examples.
     
  5. How many turns are taken before disengagement? 
  6. In response to a partner's interaction, does the individual add more to the turn-taking interaction?
    If yes, list examples observed.
     

Communication Observation Worksheet

  1. List signals or other communications the individual uses and tally frequency of use: (e.g., looks away when facilitator tries to make eye contact lll, Smiles when touched gently llll) 
  2. Does the individual demonstrate intent to purposefully communicate with others? (circle all that apply)
    1. through signals (e.g., eye gaze, averting gaze) 
    2. through vocalizations 
    3. through gestures 
    4. through other communication (e.g., sign or word approximation, symbol on communication board) 
     
  3. Does the individual demonstrate differentiated communications (different communications for different meanings)?
    If yes, list these communications, their probable meaning, and probable purpose below:
    Communication Form  Probable Meaning  Probable Purpose 
            
     
  4. Does the individual make choices when given options? (Circle one.)
    Yes   No   Inconsistent
    1. If yes or inconsistent, how are choices indicated? 
    2. What is the context of the choices (e.g., number of choice options, type of choices)? 
     
  5. Does the child demonstrate use of conventional gestures (e.g., pointing, shaking head no, lifting up arms to be picked up)?
    If yes, list observed conventional gestures.
     
  6. Does the individual use one item or symbol to represent an activity or object?
    List symbols used and the reason for their use.
     
  7. Does the individual demonstrate an understanding of communication symbols?
    If yes, list observed examples.
     
  8. Does the individual use symbolic communication (e.g., spoken or signed words, object/picture/symbol communication boards or systems)?
    List examples observed.
     

Problem-solving Observation Worksheet

  1. Does the individual demonstrate cause and effect? If yes, provide examples. 
  2. Does the individual demonstrate an understanding of means/end or use of an intermediate step to solve a problem?
    If yes, provide examples.
     
  3. Does the individual demonstrate an understanding of the function of common objects?
    If yes, provide examples.
     
  4. When faced with a problem, what does the individual do? 
  5. When presented with a problem, does the individual maintain attention and persist? 

Appendix C: Summary Form

Observation Area  Strengths in Observed Area  What the Individual Is Ready for in Observed Area  Suggestions or Recommendations 
Behavioral State          
Orienting Response          
Learning Channels          
Approach-Withdrawal          
Memory          
Social Interactions          
Communication          
Problem Solving          

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