Clinical Field, Case Study Example

Part One: Design and Implement an Intervention

Adam Johnson is a seven-year old boy who was born with autism (ASD). He struggles communicating with his pears and exhibits no desire to socialize with others. He will not respond to his peers when they speak to him, opting to continue playing or remaining deep in his own thoughts. As a result, Adam alienates himself frequently from the rest of the class members, and the others have learned to leave him alone since he has started fights with the other children, which required disciplinary action. Adam never begins conversations with his peers or with his teachers, and he seldom makes eye contact with other people. From time to time, Adam loses his temper and gets quite upset various times while he was at school. Adam is not the only individual in his family who is afflicted by ASD. His older brother, Tommy, exhibits similar signs of autism that his younger presents with such as a lack of desire in socialization and/or interacting with other people. In addition, Tommy engages in repetitive behaviors and other behavioral issues. Although Tommy faces these obstacles and barriers, effective interventions were carried out, which enabled Tommy to effectively integrate into the general education classroom at his school. Adam has been placed in a special education classroom at Sierra Madre Elementary School when school began in September. Mrs. Labinger, Adam’s primary teacher, has hitherto not been able to implement a useful or effective teaching strategy to work with Adam. Adam chooses not to listen to Mrs. Labinger on a quotidian basis, and she experiences many difficulties with the other eight students in his class because of his behavioral disruptions and lack of concentration, which requires Mrs. Labinger to constantly pay attention to him rather than attend to the rest of the class. When Adam is at home, his parents noted that Adam throws tantrums more frequently than at school, especially since they moved to Sierra Madre less than a year before school commenced. The methods that Adam’s parents utilized on his older brother Tommy to alter his aberrant behavior have been ineffective thus far. As such, a reassessment of the strategies and techniques for working with Adam are necessary, which propelled Mrs. Labinger to schedule a team meeting with Adam’s parents in order to figure out how to  design and implement an effective intervention.

After the IEP team meeting, it was decided that the main goal was to assist Adam in learning how to better communicate with others, thereby eschewing an intervention that prioritized one-on-one therapy sessions because of the lack of peer contact. For over a year, Adam’s family tried to communicate with him using sign language, which proved to be a futile strategy as it had as much of an impact on Adam as direct speech did. While Adam exhibited his ability to imitate the signs exhibited by his parents, he never took the initiative to use sign language on his own volition. Even if Adam learned the sign language, Adam’s teachers and parents worried that his peers would not comprehend these signs and might make fun of him. The inefficacy of sign language prompted Adam’s parents and the IEP team to adopt a picture-system approach in Adam’s intervention to enhance his communication and social skills. Such an approach emboldens children to initiate communication. This intervention focuses on a child’s personal interests rather than forcing the student to concentrate on concepts or objects that he lacks interest in. The use of pictures was also enticing for Adam’s parents since they along with Tommy would be able to comprehend what Adam was trying to convey to them. In addition, Adam’s parents were pleased with the design and implementation of this intervention not only for Adam but also because they wanted Adam’s younger brother to be able to communicate with his older brother. This intervention was optimal because it did not require  extensive training prior to implementation. As such, Adam’s parents wanted this intervention to be implemented as soon as possible.

The IEP team decided that the primary goal was to help Tommy learn to communicate better. Over the past year, the Johnsons had tried sign language with Tommy, but this strategy did not seem to be any more effective than teaching him direct speech. Tommy was capable of imitating signs, but never initiated signed speech on his own. The Johnsons were also concerned that even if Tommy did learn signs, his peers would not necessarily understand these signs. Imitation strategies also seemed to be relatively ineffective for Tommy. Although Tommy was capable of repeating language, he never did this consistently. He rarely looked at his trainer’s face and usually could not sit still long enough to focus on language skills. The Johnsons also felt that teaching Tommy to communicate by using imitation would take a very long time. They hoped for an approach that would help Tommy communicate better immediately.

Part Two: Intervention Experience

Adam is a seven year old white boy who lives in a middle-class neighborhood. He has exhibited severe autistic traits, most poignantly his lack of ability to communicate with his peers and socialize. In addition, his periodic tantrums further alienated his classmates from him. As such, it was necessary to choose an intervention that would encourage socialization while also enhancing his communication skills. Because past interventions have attempted to use sign language by Adam’s parents gesticulating to him, Adam failed to initiate communication. Moreover, his peers did not understand what he was trying to convey. As such, the use of pictures through a well-tested intervention was chosen as a the most effective intervention for Adam’s case. As mentioned previously, the primary goal for Adam was for him to commence communication without the need of any external clues, which would allow him to forged better and more healthy relationships with his peers, and that he would not become so frustrated in his quotidian interactions with others. This intervention was to be implemented both within the home setting as well as in the classroom. As such, Adam’s parents agreed that they would undergo PECS training in order for Adam’s parents to be able to work with him some time after he works with a PECS specialist on school grounds. Adam’s parents observed the preliminary training sessions that Adam and the PECS specialists participated in so that they would be more adequately prepared to implement the strategy in their home without needing specialists to be present.

The PECS specialists who began working Adam spent the majority of the first session ascertaining what Adam liked and what he disliked. Prior to the second session, they created images of the objects he desired on velcro squares. During the following sessions, the specialists used the various images on squares through various phases which culminated in Adam’s ability to communicate using the images. It was the hope that he would be able to initiate conversations with others as a result of this picture image intervention that was divided into three different phases.

Adam’s parents were  satisfied with the rapid progress Adam made as a result of the PECS intervention because he found a way he could communicate with others and express his desires or aversion towards things and people. Because the intervention was carried out both in the school and domestic settings, there was a noticed improvement in the communication between Adam and his two brothers, thereby cultivating better relationships among the siblings. The communication book of images was embraced by Adam and his younger brother, and Adam’s peers could understand what he was trying to say because of the visual cues that Adam learned and utilized. Mrs. Labinger also testified that Adam did not throw tantrums as frequently, and he evinced a sense of calmness and serenity throughout the school day. In addition, she noticed that Adam used his communication tools via the book very frequently, suggesting that he had a desire to initiate conversations so as to socialize with others.

As Adam became more comfortable socializing and communicating through the communication book, he slowly began to accompany the images with speech. Now, Mrs. Labinger believes that she has ample time to give all of the students equal because of the efficacy of Adam’s intervention in his communication and socialization skills. Indeed, she no longer had to worry that Adam would throw volatile tantrums that would disrupt group activities and short lectures. Adam still has much work left to do, but he has made great strides in his communication skills and desire to socialize with his peers and with his teachers.

The IEP team, along with Adam’s parents, will continue to collaborate in order to keep track of Adam’s progress both in the home and in educational settings. With the vast improvement of Adam’s social and communication skills, the IEP team and Adam’s parents planned to set new goals for Adam in the future so that by the time he reaches adulthood he will be self-sufficient and able to take care of himself. One such strategy to be used in the future within the classroom settings for Adam and other ASD students is establishing a very structured classroom in which the educator stresses the visual facets of each lesson when working with ASD students who have not fully developed their verbal skills. Collaboration between pedagogue, family, and clinicians will enable Adam to continue developing his communication skills—eventually verbal ones—as well as speech and social skills.