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

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Applying a Transdisciplinary Team Approach to the
Systematic Instruction of Pivotal Milestones
Bruce, S., Vargas, C., Davidson, S., Sullivan,
M.,
Sikarova, R., Boston College
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Pivotal Milestones Associated with Symbolic
Expression Representational Thought

• Imitation
• Joint Attention
• Discrimination-Categorization

• Object Permanence
• Means-End
• Self-Recognition

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Study Phases
Phase I Literature Review on 6
pivotal milestones, systematic
instruction, transdisciplinary
teaming Phase II Analysis of Commercial Asse
ssment Tools appropriate for
children with severe/multiple disabilities
Development of Informal Structured
Assessments on each milestone
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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 (teache
rs related service professionals)
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Phase IV Instruction 5X weekly per child on eac
h 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
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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)

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Participant Results Shared Today
Nicholas Means-End Jamie Object Permanence
Winston Discrimination (of objects
different actions on objects) Leah Joint Att
ention Discrimination (of different actions on
objects) Jack Means-End does not include v
ideo analysis
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Prompt/Performance Levels

• P physical prompt
• MO moving object prompt
• M model
• G gesture prompt
• V verbal prompt
• I independent
• N no response
• R refusal

• H/H hand over hand
• H/H-C hand over hand, continuous (Tteacher
  initiated, S student initiated)
  
• H/H-F hand over hand, frequent
• H/H-I hand over hand, intermittent (PO point,
  PU push, POPU point push)

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Nicholas
Age 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 d
esired object, inverts containers to get object
out (e.g. he exhibits some means-end behaviors)
Lesson Means-end 1 Push red man to expel c
ar Lesson 2 Pick up, place and push red man

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Nicholas
Key Findings Lesson 1 Push red man (aft
er 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
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Jamie
Age 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 infecti
ons (3 this year), non-ambulatory Assessmen
t Results Can find a partially hidden object
IF she sees it hidden Lesson Object permanence
Lesson 1 Using different covers Lesson 2 S
olving A-B error
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Jamie
Key Findings Lesson 1 Locating object with s
ound cue Able 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.
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Leah
Age at baseline 7 years, 0 months
Disability CharacteristicsTrisomy 18, congenita
l cardiac disease, bronchial malacia, seizures,
20/190 vision, moderate-severe hearing loss,
hypertonia in extremities, hypotonia
Assessment Results Very attentive to people, bu
t very seldom to objects. Does same action on all
objects-batting/forceful tapping.
Lesson Joint attention with adult and over obje
ct, discrimination of different actions on 3
different objects
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Leah
Key Findings Behavior 1 Joint Attention - e
ye contact with adult Achieved 90-100-maintained
existing skill Behavior 2 Joint attention -
visual attention to object Achieved over 80 inde
pendent for 3 months Behavior 3 Discriminatio
n - action on pop tube-coactive
Decreased need for hand-over-hand/continuous
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Leah
Key Finding, continued Behavior 4 Discrimina
tion - action on gumball machine toy Started at
0 independence, achieved 50
Behavior 5 Discrimination - action on pop-up t
oy Reduced need for hand-over-hand/continuous
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Winston
Age at Baseline 8 years, 6 months
Disability Characteristics Isodicentric 15, mi
tochondrial disorder, seizures, severe
developmental delays, hypotonia (non-ambulatory),
vision loss (20/400), hearing loss-inconsistent
response to sounds Assessment Results Looks t
oward lighted objects and a few highly reflective
surfaces. Immediately opens mouth in feeding
(anticipation). Lesson Discrimination of objec
ts and actions on actions in a controlled play
space
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Winston
Key Findings Most intentional behavior was on
(a) red mylar and (b) green pompom
He located these 2 items even when placed l/3 -
1/2 way into play space. Further analysis of v
ideo revealed that he differentiated green pompo
m for combination of touch and taste.
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Jack
Age at baseline 10 years, 11 months
Disability Characteristics microcephaly, hydroc
ephalus, 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, doesnt yet request adult assistance
Lesson Solving means-end problems-push down and
push up on remove control car control
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Jack
Key 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 3r
d month, improved in 4th-6th, resulting in 100 a
gain in 6th month (teacher reports that he typic
ally exhibits ups and downs in performance)
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Jack
Key findings, continued Behavior 3, Means-End-
Push up on remote control Still requires hand-o
ver-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 no
w enjoying a trial on an electric wheelchair
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Dissemination
Bruce, S. Zayyad, M. (in press). Assessment and
instruction of self-recognition. TEACHING Ex
ceptional Children. In Progress Bruce, S. Za
yyad, M. (in revision). The development
of object permanence in children with severe
disabilities. Bruce, S., Campbell, C. Sullivan
, M. Supporting children with severe disabiliti
es to achieve means-end. Bruce others Artic
les on analysis of commercial
assessment tools, discrimination-categorization
findings, Imitation findings and joint attention
(including non-visual JA) findings.
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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