Case Study NURS1024 – Mrs Irene Thompson As a nursing
David is a 7-year-old boy diagnosed with autism spectrum disorders (ASD). He attends a private day school for children with ASD and receives 45 minutes of speech and language intervention a day and 30 minutes of occupational therapy. Despite the intensity of speech therapy, David has not acquired any vocalizations. His intellectual abilities are significantly impaired, and he is unable to imitate any motor or vocal responses. Overall, David makes few attempts to communicate with others, and his social interactions are limited. In his special education class, the only skills he has been able to acquire include following simple one-step directions and matching pictures. Because David’s cousin, who also has a diagnosis of ASD, had great success learning sign language, David’s parents requested that he be taught sign language. David’s school district does not have any policy or programs in support of PECS or sign language. The speech language pathologist and occupational therapist believe that David is a candidate for an assistive technology device that would involve David touching a button that produces a voice output. In order for David to learn to use the device, it would be necessary to first teach him how to point to pictures of the things he wants. Steps 1-3: External Evidence. Both PECS and sign language have adequate support with a few outcome benefits of using sign language (e.g, increased vocalizations). Adequate motor imitation skills appear to be prerequisite to successful acquisition of sign language. Step 4: Consider Student and Family Factors. When considering David’s case, it is important to recognize that he has significantly impaired intellectual abilities and is unable to imitate any motor or vocal responses. His ability to follow simple one-step directions and to match pictures should be weighed. Other important student-related factors include his limited social engagement with others and his history of slow skill acquisition. David’s parents have requested that he be taught sign language—a significant family factor. Step 5: Consider Teacher and School Factors. Specifically for David, it would be important to consider that the speech-language pathologist and occupational therapist believe that he is a candidate for an assistive technology device and that the school district does not appear to advocate the use of one type of one system over another. Step 6: Integrate the Evidence. Because David is unable to imitate motor movements or sounds and rarely engages others socially, it is less likely that he will be successful with sign language. The family would like the staff to teach him sign language, yet the school personnel believe that a picture-based system would yield more communication for David. In a case such as this, when families and school personnel disagree on the path, school personnel should educate the family on the available research and outline the reasons to support their clinical opinion. Nevertheless, if the family maintains their position, the school personnel should, under most circumstances, comply with the family’s desires. Unless the family’s requests are inappropriate or potentially detrimental to the child, student/family factors generally outweigh teacher/school factors (Gillam & Gillam, 2006). Although David’s teachers and therapists agreed to teach sign language according to his parents’ wishes, they made one request. They asked that if after three months of teaching sign language sufficient progress was not made, they could reconsider the option of teaching PECS or adding PECS to his communication training. Step 7: Monitor the Outcome. At the three-month marker, David required a great deal of manual prompting them to form the signs for candy and cookies. No progress was noted in regards to social engagement or vocalizations. Because of David’s limited progress, the staff and family met to discuss the next step. Together they decided that adequate progress had not been made and to try PECS for a three-month trial period. Daily progress monitoring will allow the team to evaluate the relative effectiveness of the selected communication training and to make continual decisions about what is most appropriate for David. What suggestions would you give his teacher to create opportunities in the classroom to practice the language?
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