Let Me Introduce Matt
Matt Smith
8 Years Old
Behavior and Developmental Problems
Matt is an attractive stocky, eight year old, with dark eyes, black hair and sallow complexion, who was referred to the observer because of behavior problems in school, and the presence of developmental lags associated previously with emotional and behavioral difficulties. Matt has been tested by neurologists and clinical psychologists, and is currently receiving pharmacological therapy, in order to stabilize his behavior.
Matt has normal-to-high muscle tone, mixed skin tone and full range of motion in all four extremities; his motility, proprioceptive, vestibular and other gross motor behaviors appear to be below age level; his movements lack smoothness ad integration from one sensory mode to another. For example, he reverses directions, runs, hops, bends and stretches one action at a time, but does not simultaneously stand and catch, or rotate his head and hold his hands on his knees
Matt generally exhibits low average coordination He uses lateral, digital and pronated fine motor grasp; he writes, cuts, tears, stacks and draws at slightly below age level, adjusting his head and trunk position awkwardly, tilting toward the surface upon which he is writing or drawing. He uses a "close-in" downward head position, which allows him to scan close range. In the sitting position, Matt is able to catch a ball and let it go, but uses erratic eye movements to search the environment.
Matt spends a lot of energy and time visually checking with observer to see if he is correctly complying with requests. Matt's visual field changes normally at near to middle distances, but he loses accuracy when scanning from near to far distance.
Language Development: Matt smiles easily and often, happily using two and three word phrases (more often than sentences) to tell the observer what he likes and dislikes; his conversations contain some questions, a small vocabulary and few descriptive words, but his communication skills and receptive language denote symbolism and meaning. He uses slang, plurals and other informal oral strategies, and can be readily understood by unfamiliar observers.
Matt's words are telegraphic and abbreviated combination, of letter and words, reminiscent of children four to six years of age. For example, he said, "hair pretty," over generalizing and simplifying. Matt does not give details or specifics. He uses facial expressions to communicate basic emotions with gestures, as well as other forms of nonverbal communications and words. Matt uses syntax and semantic interpretation at a level approximately three years below age level.
Temperament personality: Matt's personality can be characterized by an average to low energy level, average regularity in his eating, sleeping, bowels and bladder habits, an average level of attention to new and novel stimuli (such as the observer's array of objects), a pleasant mood, and a high level of persistence. The intensity of his responses to adult interference, commands and directives is high; he proceeds from a high level of acceptance to complete refusals and demonstrates a high level of distractibility. He is engaging and friendly, but also frequently withdrawn, reflective, and impulsive, according to parent report.
Social and Intellectual strength: Matt demonstrates knowledge of logi-mathematical and reasoning skills at an older six year old level. Matt attempts cursive writing, reading and story-writing with abilities associated with "Level Two" spelling and basal work (later part of first grade and beginning second grade). He likes to read and correctly identified and recognized two new words when shown how to string words to make a sentence, even a nonsense sentence. He counted without losing his place, going from 1 to 40. Matt smiles often and enjoys making words from pictures. He is not oppositional or confrontational by nature, exhibiting a high level of social need fro contact and approval.
Matt's ability to estimate amounts of substances or mass, to visually measure length and width, or perform any conservation tasks, was one-to-two years below age level. His linear abilities are more clearly observable than his insight, perceptual memory or problem solving skills. His sequencing, ordering, naming and recall skills are at a 60-64 month level. Matt's concentration and short-term memory skills are lagging a year behind his chronological age.
Cognitively, Matt manages his academic learning in a classroom with age-mates, but he appears to have difficulty integrating his abilities into his personal-social sense of self. He appears to lag behind in his ability to integrate a social sense of what is expected or what he thinks is appropriate with his ability to reason.
Matt is motivated by the need to "move in" on people, in order to see what their reaction will be, even if it is a risk to him, socially. Matt expresses his needs and want both orally and physically, demanding tactile and vestibular interaction. He also show defensiveness against tactile contact from others. For example, he pushes a child than stares blankly at them when they pus or yell back.
Recommendations: A 90 minute observation does not take the place of repeated observations of Matt in a variety of settings. Because of his birth history and early environmental and genetic experiences, the effects of probable fetal alcohol exposure and subsequent neglect cannot be ignored, but can be put into perspective. matt clearly can benefit from efforts to enable him to learn self-control and to take responsibility for his own behavior. Matt is at an age, when can learn academic skills by a process of acceleration. Matt's success in school depends on strategies that accelerate, rather than slow-down his learning.
We know that children with chronic developmental and behavioral lags are not served well by instruction that stresses the prevailing approach to teaching children with developmental handicaps - repitition and focus on functional skills. Rather, there is considerable evidence that Matt needs to learn to use his natural ability to "reinvent" mental and social images, given instruction that emphasizes a multi-sensory integrated approach. It may be that matt's inability to smoothly integrate visual, auditory, tactile and kinesthetic sensory information is, at least partially, responsible for his inappropriate behavior and developmental lags.
The following suggestions may be helpful to the whole family, and the school as they begin to view Matt's behavior and development in the light of his strengths.
- At school, establish a regular class meeting time, starting with an explanation that the class is working on a plan for everyone, including Matt. There are family rules, specific activities to establish specific steps:
- Step 1 - Because teachers and parents want a more cooperative and normal academic environment, they want to give compliments to children when they catch them being good. Practice showing the children, exactly what that means.
- Step 2 - When someone isn't doing what he or she is supposed to do, no problem, they will need to have "time to think" until they can calm. Practice showing the children exactly what calm is and what it looks like (model it). "Time to Think" but close by is a more intense correction approach than "time out." It has been show to help alter autistic-like and behaviorally-troubled young children.
- Step 3 - Matt needs cueing, prompting, signaling and reminding of what is expected and anticipated. Nothing can be left to "oh, he know exactly what I mean," or "he's done the same thing a thousand times, he's just trying to get attention." While this is true, it is also probably true that every time he does even familiar acts, it seems to him as if he has never done it exactly the same way. This notion that young children naturally reinvent mental images over and over again helps parents and teachers understand children's need for constant prompting and reminding and practicing.
- Step 4 - Make a list with children of activities (not food) that they each like to do in their free tie, and tell the children this list will be kept handy for reward accomplishments when parents and teachers catch them being good.
- Step 5 - parents and teachers need to concentrate on communicating to each child when he or she feels strong and competent. They need to model, the skill of asking permission, rather than raising hands or interrupting.
- A speech and language communication system needs to be started in which Matt gets what he wants only as a result of verbal "asking or telling" - no guessing what he means, no getting him food or other needs, unless words and gestures accompanying words are used. A household-and-schoolwords-scrapbook that stresses classroom and home rules would be an excellent activity, as a means of getting full sentences, details,a nd descriptions from Matt and the other children. Matt is putting all his social and intellectual energy into interactions that are often devoid of specific information.
- Think of rules, board games, and social peer activities normally associated with seven and eight year-olds' play. Drugs may be masking Matt's ability to figure out how to tell what he knows.
- At school, Matt's random outbursts seem intentional, but meaningless (like touching and taking food). Help Matt translate those acts into intentional ones. He is probably getting varied responses to his random acts, which is not a good match, either at home or a t school.
- At school, Matt's extreme behavior needs to be drawn into a more normal range. "Floor time" play, following extreme behavior, is one effective way to accomplish this. Matt needs thinking time to motivate him to cooperate and comply. This means Matt is using the time to think about the situation that has occurred . This gives him time to think and collect himself, without disrupting other children in the classroom. This encouragement strategy works more quickly than "Praise and punishment" techniques to develop Matt's self control. The goal at school is that matt feels strong and competent, not shame-faced and vulnerable.
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