Nicholas is a 2 year, 11 month old boy. Nicholas began developmental intervention service in May 2007, 3x a week for 60 minutes each visit. The goals of therapy werer to increase expresive and receptive language skills, demonstrate appropriate social interaction skills, work on behavior strategies and play more independently.

According to an informal assessment using The Birth to 3 Record Form, Nicholas’s current levels are as follows:

Language Comprehension: 25-30 month range (displays some difficulties)
Language Expression: 19-24 month range (displays some difficulties)
Nonverbal Thinking: 31 month range
Social/Personal Behaviours: 13-18 with some scatters to 24 months
Motor Behaviors: Solid at 25 months with scatters to 30 months

In terms of language expression, Nicholas is beginning to identify objects receptively by pointing, touching or reaching for the object or picture. He is also approximating some sounds to identify colors, shapes, animals and animal sounds. Nicholas has strong cognitive skills. he recognizes and approximates names of shapes, colors, numbers and beginning to recognize some letters of the alphabet.

In the area of social/personal behaviors, Nicholas is beginning to greet adults more appropriately and spontaneously. He has begun to show pleasure in new activities and demonstrates some simple social exhanges. Nicholas has good motor skills and shows great interest in gross motor and rough and tumble play. Nicholas exhibits some sensory needs and responds well to deep pressure, water play, tactile activities and oral sensory input.

During DI therapy sessions teacher and parents began a fairly intense positive behavioral system to reduce tantrums and screaming fits. It was determined through these strategies that Nicholas was exhibiting these behaviors due to over stimulation, sensory issues and lack of ability to communicate his wants and needs appropriately. Nicholas made tremendous gains in this area. He now uses more appropriate behaviors to communicate, play, and express his likes and dislikes. The tantrums and screaming episodes have decreased tremendously. Nicholas has been working on increasing language during play activities, social interactions and improving communication skills for everyday functional needs. He enjoys gross motor activities, books, trains, farm animals and interacting with parents.

Nicholas’s play skills are developing. Teacher continues to present strategies to break the rote play and sometimes is successful. His cooperative play skills are developing, he attempts to participate in turn-taking activities however requires some support and modeling. Nicholas’s imaginative play skills have improved since the onset of DI sessions. Nicholas responds appropriately to musical instruments and attempts to participate in singing portions of the songs and act out gestures. Nicholas is beginning to use his language for labeling simple pictures and objects. Nicholas occasionally displays a somewhat inappropriate degree of emotional reactions to situations that are sometimes unrelated to the events surrounding them. Nicholas is sometimes unresponsive to adult and requries physical and verbal cues/prompting to elicit interaction. He benefits from high affect activities and reciprocal play activities to help maintain responsiveness and increase language in social situations.

Nicholas is a very sweet little boy who has difficulties with communication, demonstrates difficulties with behavior and social interaction skills. He has good developing cognitive skills, and is beginning to show more typical use with some toys. He works best when high affect strategies are utilized.

Due to difficulties with social skills, behaviors, communication and language expression, Nicholas would benefit from a language-based program that uses a variety of communication, sensory input strategies, ABA strategies and interactive skills as well as a multisensory approach to learning that represents all the senses (Visual, Auditory, Kinesthetic, tacticle, Vestibular and Proprioceptive).

July 19, 2007
Not so great day, great night
3rd night Epsom Salt Bath

Speech Eval at school – went terribly. Nicholas did not participate.
(I just wanted to update this and add that this was the understatement of the world. Nicholas fought, kicked and screamed the ENTIRE time we were in the speech therapist’s classroom. A room full of toys and all he wanted to do was tug on the door and leave. This was brutal for all of us.)

Joanne (DI) came – he was okay with her. He did not climb on top of me to escape her.

Took him for a haircut – screamed the whole time. No body thrashing like the last time.

Went to boardwalk and beach – tolerated sand for a little while.

IN bath, he was responding to his name 75% of the time.

Many words – head, eyes, nose, ears, mouth – while identifying
said “cup”

3rd night with new bedtime routine. Was easy tonight – he knew what to expect. Bath, dressed, brushed teeth, bed

handed me toothbrush and said “all done”

We got him a little table and chair set – he loves it!