Special Needs Case Studies

ECED 439 Assignment 3

Christine Grippo

72363096

Oct.5^th/14

1. Discuss what the impact of a hearing impairment can have on other developmental domains. (2)

Since Joshua was born premature with a low birth weight, he was at a higher risk for developmental delay and therefore should have been a priority for screening and early intervention at birth. The impact of a hearing impairment can be moderate to severe on other developmental domains. A hearing impairment can lead to additional disabilities and could compromise communication development. Studies by the Joint Committee on Infant Hearing (JCIH) show that 30-40% of children with a hearing impairment have an additional disability (McLean, Wolery, & Bailey, 2004, p.124).

The main developmental domains that children with hearing impairments, such as Joshua, are at risk of are: communication competency, literacy development, academic attainment, social and emotional well-being, and “overall optimal development and quality of life” (McLean et al, 2004, p.125). A child with a hearing impairment may not be able to develop socially and make friends due to the communication barrier and therefore his/her emotional well-being could be compromised. A hearing impairment can severely impact speech development and oral language. Receptive and expressive speech and language can be impacted by a hearing impairment and affect the developmental domain of communication, further affecting the ability to be included in an otherwise exclusive society.

Early intervention is a crucial factor for contributing to developmental domains that may be affected by the presence of a hearing impairment. Research has proven that children who receive identification and intervention prior to 6 months of age have lower impact on developmental domains of speech and language, and therefore also on personal-social skills development (McLean et al, 2004, p.126). Early intervention from 0-6 months of age is key in mitigating the impact of a hearing impairment on developmental domains. This is true, regardless of the nature of the hearing impairment being moderate or severe (Mclean et al, 2004, p.125).

2. Describe the types of audiological testing conducted by the audiologist under the following headings: diagnostic, monitoring, and evaluative. (3)

Audiological testing responsible for screening and assessment of hearing of infants and toddlers is considered diagnostic. The goals of diagnostic testing are to detect a hearing loss, then diagnose it with a medical evaluation and confirmation, which then would lead to implementation of intervention. It is important to have a timely transition between detection, diagnosis, and intervention in order to have optimal results (McLean et al, 2004, p.132).

The JCIH recommended a “two-stage screening protocol using objective physiological measures for the universal screening of newborns” (McLean et al, 2004, p.132). The most common screening procedure that falls under the diagnostic category is immittance or impedance testing, which is able to rule out conductive hearing loss. The immittance or impedance testing involves an audiologist examining the ear canal with an otoscope in order to detect fluid and/or infections. “Immittance tests evaluate the status of the middle ear system and may include tympanometry, acoustic reflex, and static acoustic testing” (McLean et al, 2004, p.132).

   An approach to hearing assessment that falls under the diagnostic category is the Behavioural Observation Audiometry (BOA) and is typically used on children 5-6 months old, who cannot be assessed using pure-tone measures due to developmental factors or other variables (McLean et al, 2004, p.134). BOA is quick, simple and inexpensive. However, it cannot rule out hearing loss in one ear only, as it tests both ears simultaneously. Other forms of diagnostic testing include Visual Reinforcement Audiometry (VRA) and Tangible Reinforcement Operant Conditioning Audiometry (TROCA) (McLean et al, 2004, p.135).

One type of system that falls under the evaluative heading during audiological testing is the HEAR kit system. The HEAR kit system is implemented by early interventionists who use a variety of calibrated noisemakers, otoacoustic emissions (OAEs) in order to screen hearing of children (McLean et al, 2004, p.132). An OAE does not measure functional hearing, but rather correlates hearing in a “systematic way” in order to predict and determine hearing status (Mclean et al, 2004, p.136). After an OAE has been performed, an auditory brain-stem response (ABR) is performed as an evaluative assessment using technology to define the hearing impairment as permanent bilateral or unilateral. The ABR is implemented if infants fail the OAE test. It is considered the “gold standard” of physiological testing since it measures how the auditory nerve responds to sound, and can be implemented at 27 weeks of age (McLean et al, 2004, p.136). However, ABR screening is expensive, and requires infants to be sedated, which is not ideal (McLean et al, 2004, p.136).

3. Discuss how you would plan a developmental assessment program for the child described in this scenario. (2)

“An accurate and reliable assessment of hearing in young children is best obtained when the procedures selected accommodate the child’s developmental level and response capability” (McLean et al, 2004, p.133). Unfortunately Joshua was not afforded the earliest intervention possible since he was not screened for hearing impairments at birth. However, now that Joshua’s pediatrician has expressed concern about his several ear infections and his parents are noticing his lack of response to regular household items, I would implement an early intervention team to take action immediately. The team would consist of Joshua’s parents, his pediatrician, an audiologist, and any early childhood educators in his life. Since Joshua was found to have severe to profound bilateral sensorineural hearing loss with a conductive component, I would first order an OAE and then ABR in order to define the location and degree of the impairment (McLean et al, 2004, p.132). Because the hearing loss has a conductive component, I would ask the pediatric otolaryngologist if antibiotics and or decongestants would help his hearing, or if he would benefit from insertion of tympanostomy tubes. Because sensorineural hearing loss is generally irreversible, I would ask if Joshua would be a candidate for cochlear implants in 7 months, when he turns one year old. My developmental assessment plan for Joshua would be ongoing monitoring to assess his development of language and speech as well as his social development. Part of my plan would be enabling Joshua by ensuring that his learning environment is designed with his impairment in mind, and structurally arranged for success.

1. Discuss some of the factors that may influence a child’s use of vision. (2)

“The first three months of a child’s life are the most critical to the development of the visual system, even a few days of monocular deprivation during this time can permanently alter the visual system” (McLean et al, 2004, p.140). Factors that influence a child’s use of vision may include the child’s other sensory modalities. There may be cortical visual impairment, fixation deficits, field limitations, convergence insufficiency, nystagmus, and optic atrophy associated with vision impairment (McLean et al, 2004, p.141). Premature birth and severe central nervous system damage are most often associated with vision impairments in infants and toddlers. “A child’s level of acuity and/or extent of visual fields are considered in the diagnosis of a severe visual impairment” (Mclean et al, 2004, p.141).

Different children with the same level of acuity may use their vision differently due to personal or environmental factors. Personal levels include the level of the childs’ neuromotor integrity, cognitive functioning, attention span, and organizational behaviours. All of these personal factors will influence how a child experiences different activities and therefore how and what the child actually sees (McLean et al, 2004, p.142).

The environmental factors that influence how a child uses his or her vision include the entire area of physical space visible to the eye without shifting gaze, and the childs’ peripheral vision, which begins to be responsive as early as 4-6 months of age (McLean et al, 2004, p.146).

2. Describe some of the formal and informal measures used to assess the vision of children with disabilities. (2)

“A visual acuity of 20/20 represents normal vision.” “When a child presents with an acuity of 20/200 or worse in the better eye with the best correction, he is considered to be legally blind” (McLean et al, 2004, p.142).

Parents are often the first to detect a vision concern and are rarely wrong when they think there is a problem. Formal vision screening at birth and before the first 6 months of age is crucial for detection of abnormalities of binocular vision. In the United States, premature infants are evaluated by an ophthalmologist due to their higher risk of retinopathy and other vision impairments associated with prematurity. The Academy of Optometry and the American Academy of Ophthalmology recommend complete formal eye examinations for all infants at 6 months of age, and then a follow up examination at 30 months of age (McLean et al, 2004, p.143).

Photoscreening is a formal technique that is designed particularly for preverbal and nonverbal children, which may include children with disabilities (McLean et al, 2004, p.149). Photoscreening is a method that can be used when other conventional screening methods such as the Teller Acuity Cards are not successful. The lighting of the measure used to assess vision of children, with or without disabilities, is essential. Good lighting is required and the administration of the test should be adjusted to accommodate physical, visual, communicative, and attention needs of the individual child (McLean et al, 2004, p.149).

The New York Flashcards is a formal evaluative assessment that is successful with children who are severely physically limited (McLean et al, 2004, p.149). The Lea SYMBOLS are another system used to assess vision of children with disabilities. The cards are sensitive to blur, and difficult to distinguish. The most useful stimuli for children with disabilities are the Single Symbol book of flash cards, which presents a single symbol at a time (McLean et al, 2004, p.149). The Screening Tests for Young Children and Retardates (STYCAR) is another formal test with creative, practical, motivational tools in which a child with a disability can be examined.

Informal measures that should be taken when assessing vision of children with disabilities are interviewing parents, guardians and caregivers of the child (McLean et al, 2004, p.150). It is important to ask the parents for a description of how the child’s vision impedes his or her mobility, daily life, social interactions and play. Another question for the parents in an informal measure of assessment is for a description of the supports the child needs in order to use his or her vision i.e. what, if any, strategies and materials does the family use to help the child. It is also important to observe the child’s daily activities and attention, as well as the natural environment the child is in on a regular basis (McLean et al, 2004, p.150). It is beneficial to know the distance between the child and the stimulus when the child detects it, such as knowing where the child sits in a classroom, and then how far up to the board the child needs to go in order to see what is on the board clearly.

3. Discuss how you would plan a developmental assessment program for the child described in this scenario. (2)

I would plan a developmental assessment program for Natasha with her parents, doctors and early intervention team. It is important to monitor her babbling noises and have the pediatrician assess in further detail why Natasha babbles when she rolls from her back to her side. I would request regular monitoring by a medical eye-care specialist due to Natasha’s lack of tracking objects and or faces and request the Lea SYMBOLS as well as the STYCAR test to be implemented as soon as possible, as early intervention and implementation is key. As well, I would work with the teacher of the visually impaired to arrange Natasha’s instructional environment to be as supportive as possible for optimal learning.

Due to Natasha’s Cerebral Palsy and the fact that her parents notice she is responsive to voices and sounds by turning her head in the direction of the sound, I would check to see if Natasha consistently ignored items on one side of her body and always turned one way to orient herself towards the direction of sound. “The most important data for a parent, a teacher, other caregivers, and service providers to have is knowledge of what the child can see and predictions of how he may respond to items encountered in different environments” (McLean et al, 2004, p.154).

4. As an early interventionist, how would you determine if Natasha is at risk for a sensory dysfunction? (2)

Natasha may experience a vast array of sensory perception difficulties due to her Cerebral Palsy. I would determine if Natasha was at risk for a sensory dysfunction if she had persistent symptoms that interfered with her adaptive functioning. I would look out for the following identifying characteristics that are often seen in children with regulatory disorders: sleep disorders, extreme difficulties self-consoling significant feeding problems, hyperarousal leading to disorganization, fussiness, and irritability (McLean et al, 2004, p.161). Since Natasha already showcases difficulty self-consoling and is known to be a fussy, easily irritable baby, she is at higher risk of depicting dysfunction in sensory processing. “When an infant or toddler is difficult to console, irritable, and easily disorganized, even in the context of routine and familiarity, early childhood personnel should suspect a regulatory disorder or dysfunctional sensory integration processes” (McLean et al, 2004, p.166). Due to these factors I would determine that Natasha is at risk for a sensory dysfunction.

References

Mclean, M., Wolery, M., & Bailey, D. B. Jr. (2004). Assessing Infants and Preschoolers with Special Needs. Columbia, OH. 3^rd Ed. Pearson Merrill Prentice Hall.