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

Bruce, S., Vargas, C., Davidson, S., Sullivan, M., &Sikarova, R., Boston College

Pivotal Milestones Associated with Symbolic Expression & Representational Thought

ImitationJoint AttentionDiscrimination-

Categorization

Object Permanence

Means-EndSelf-Recognition

Study PhasesPhase I: Literature Review on 6pivotal milestones, systematic instruction, & transdisciplinary teaming

Phase II: Analysis of Commercial Assessment Tools appropriate for children with severe/multiple disabilities& Development of Informal Structured Assessments on each milestone

Phase III: Assessment of 15 children with severe/multiple disabilities (including 6 with visual impairment & 2 who are deafblind) using 2 commercial assessments & 1 informal structured assessment on each selected milestone

Lesson Plans developed by team consensus (teachers & related service professionals)

Phase IV: Instruction 5X weekly per child on each milestone

Data collected each time lesson was taught by teacher and 2 related service professionals (SLP, OT, PT)

Video evidence for baseline + every 4 weeks per child & milestone instructed

Commercial Assessments AnalyzedIdentified Each Item that Measured Each of the 6 Milestones Developmental

Assessment for Individuals with Severe Disabilities (DASH 2)

Developmental Activities Screening Inventory (DASI-II)

INSITE Caller-Azusa-Scale G Oregon Project for

Visually Impaired & Blind Preschool Children

Carolina Curriculum for Infants/Toddlers with Special Needs

Assessment, Evaluation, and Programming for Infants and Children (AEPS)

Early Learning Accomplishments Profile (ELAP)

Vulpe (revised) Hawaii Early Learning

Profile (HELP)

Participant Results Shared TodayNicholas: Means-End

Jamie: Object Permanence

Winston: Discrimination (of objects & different actions on objects)

Leah: Joint Attention & Discrimination(of different actions on objects)

Jack: Means-End

*does not include video analysis

Prompt/Performance Levels

P = physical promptMO = moving object

promptM = model G = gesture promptV = verbal promptI = independentN = no responseR = refusal

H/H: hand over handH/H-C: hand over hand,

continuous (T=teacher initiated, S = student initiated)

H/H-F: hand over hand, frequent

H/H-I: hand over hand, intermittent (PO = point, PU = push, PO&PU= point & push)

NicholasAge at baseline film: 4 years, 11 months

Disability Characteristics: Microcephaly, global developmental delays, failure to thrive, possible autism, (normal vision & hearing, ambulatory)

Assessment Results: Moves around an obstacle, pushes other objects away to get to desired object, inverts containers to get object out (e.g. he exhibits some means-end behaviors)

Lesson: Means-end: #1: Push “red man” to expel car; Lesson #2: Pick up, place and push “red man”

Nicholas: Means-End Push "Red Man"

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April May June July

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H/H-C

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Nicholas: Means-End Behavior#1: Pick up "Red Man"

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April May June JulyOctober

NovemberDecember

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H/H-C

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R/N

Nicholas: Means-End Behavior #2: Place and Push "Red Man"

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May June July October November December

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H/H-C

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R/N

NicholasKey Findings:

Lesson #1: Push “red man” (after adult places): Achieved with modeling in the first month.

Lesson #2, Behavior #1: Pick up “red man:” Started at 0% independence, achieved 69%.independence

Behavior #2, Place & push “red man:”Started at 0% independence, achieved 69%independence

JamieAge at baseline: 5 years, 8 months

Disability Characteristics: Multiple congenital anomalies, microcephaly, developmental delays,visual impairment (20/90), frequent ear infections (6+ this year), urinary tract infections (3+ this year), non-ambulatory

Assessment Results: Can find a partially hidden object IF she sees it hidden

Lesson: Object permanence: Lesson #1: Using differentcovers; Lesson #2: Solving A-B error

Jamie: Object Permanence Locating Object with Sound Cue

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March April May June

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H/H-C

P

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Jamie: Object PermanenceA-B Error with Intermittent Sound Cue

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July September October November December

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Percentage

P

I

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M

JamieKey Findings:

Lesson #1: Locating object with sound cueAble to perform with independence at 39% of opportunities, additional success with just verbal or gestural cue. Moved to Lesson #2: A-not-B Error after 4 months.

Lesson #2: A-not-B error: Achieved independence 72-100%. May have reached satiation.

LeahAge at baseline: 7 years, 0 months

Disability Characteristics:Trisomy 18, congenital cardiac disease, bronchial malacia, seizures, 20/190 vision, moderate-severe hearing loss, hypertonia in extremities, hypotonia

Assessment Results: Very attentive to people, but very seldom to objects. Does same action on all objects-batting/forceful tapping.

Lesson: Joint attention with adult and over object, discrimination of different actions on 3 different objects

Leah: Joint Attention Eye Contact with Adult

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May June July

SeptemberOctober

NovemberDecember

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G/V

V

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Leah: Joint AttentionEye Contact with Object

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May June July

SeptemberOctober

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Percentage

P

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MO

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Leah: DiscriminationAction on Pop Tube

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May June July

SeptemberOctober

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H/H-C/T

H/H-C/S

Leah: DiscriminationAction on Gumball Machine Toy

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May June July

SeptemberOctober

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H/H-C

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Leah: DiscriminationAction on Pop-Up Toy

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May June July

SeptemberOctober

NovemberDecember

Month

Percentage

H/H-C

H/H-I:PO

H/H-I:PU

H/H-I:PO & PU

P

LeahKey Findings:

Behavior #1: Joint Attention - eye contact with adultAchieved 90-100%-maintained existing skill

Behavior #2: Joint attention - visual attention to objectAchieved over 80% independent for 3 months

Behavior #3: Discrimination - action on pop tube-coactiveDecreased need for hand-over-hand/continuous

LeahKey Finding, continued:

Behavior #4: Discrimination - action on gumball machine toyStarted at 0% independence, achieved 50%

Behavior #5: Discrimination - action on pop-up toyReduced need for hand-over-hand/continuous

WinstonAge at Baseline: 8 years, 6 months

Disability Characteristics: Isodicentric 15,mitochondrial disorder, seizures, severe developmental delays, hypotonia (non-ambulatory), vision loss (20/400), hearing loss-inconsistent response to sounds

Assessment Results: Looks toward lighted objects and a few highly reflective surfaces. Immediately opens mouth in feeding (anticipation).

Lesson: Discrimination of objects and actions on actions in a controlled play space

Winston: Discrimination of Objects Measured by Intentional Acts on Objects in a Structured

Play Space

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Cups Ball Red Mylar Red Pompon Green Pompon Slinky

Object

Percentage

Look

Touch withHand

Look &Touch

WinstonKey Findings: Most intentional behavior was on (a) red mylar and (b) green pompom

He located these 2 items even when placed l/3 - 1/2way into play space.

Further analysis of video revealed that hedifferentiated “green pompom” for combination of touch and taste.

JackAge at baseline: 10 years, 11 months

Disability Characteristics: microcephaly, hydrocephalus, global developmental delays, diabetes, seizures, adrenal gland insufficiency, cerebral palsy, mild unilateral hearing loss

Assessment Results: Purposeful reach, will work to access object out of reach or when obstacle is present, doesn’t yet request adult assistance

Lesson: Solving means-end problems-push down and push up on remove control car control

Jack: Means-EndReach Toward Remote Control

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May June July October November December

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H/H

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Jack: Means-EndPush Down

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May June July October November December

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H/H

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Jack: Means-End Push Up

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JackKey Findings:

Behavior #1, Reach toward remote control:Independence reduced from 100% to 59%. Was it novelty effect? Did he decrease after learning that behavior #3 was difficult?

Behavior #2, Means-End-Push down on remote control: Started at 100%, regressed to 68% in 3rd month,improved in 4th-6th, resulting in 100% again in 6th month (teacher reports that he typically exhibits ups anddowns in performance)

JackKey findings, continued

Behavior #3, Means-End-Push up on remote control: Still requires hand-over-hand support, but has learned to request by reaching for adult-after trying to “push down” (see video)

This marks means-end achievement at trial & error level.

*Application: Jack is now enjoying a trial on an electric wheelchair

Dissemination

Bruce, S. & Zayyad, M. (in press). Assessment and instruction of self-recognition. TEACHING Exceptional Children.

In Progress:Bruce, S. & Zayyad, M. (in revision). The development

of object permanence in children with severe disabilities.

Bruce, S., Campbell, C. & Sullivan, M. Supporting children with severe disabilities to achieve means-end.

Bruce & others: Articles on analysis of commercial assessment tools, discrimination-categorization findings, Imitation findings and joint attention (including non-visual JA) findings.

Other Materials at Our Display

Informal Structured Assessments (also in handouts)

Lesson Plans on all 15 children Video sampling of lessons on the 5

featured children (see desktop folders) List of materials used in the lessons

with ordering information