na
ey
c
1,
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Individualizing
in Early
Childhood:
The What,
Why, and
How of
Differentiated
Approaches
JoniL. Baldwin
and Patty Sorrell
Infants and
Toddlers
Intervention in an Early Childhood
Setting: Woody’s Story
Photos courtesy of the
authors, except where
noted
Terminology and Acronyms
■ ASD – Autism Spectrum Dis
■ El – Early Intervention; Early
Interventionist
■ IDEA – Individuals with Disabilities
Education Act
■ IEP – Individualized Education
Program
■ IFSP – Individual Family Service Plan
■ PartCServices-for children age
0-3 (component of IDEA)
T 8 WEEKS OF AGE, WOODY WAS ENROLLED AT THE
Bombeck Family Learning Center, a university-
supported early care and education setting. His
teachers recorded his growth and development
vRl with narrative and photographic documenta
tion, as they do with all the children at the center. At 18 months,
Woody spoke three-word phrases, used and displayed under
standing of a strong vocabulary, and followed simple classroom
routines and instructions. He pointed to items in his favorite
books and kicked a ball at a target. Completion of the “Ages and
Stages Questionnaires” (www.easterseals.com/site/Page
Navigator/ntlclO_mffc_homepageasq.html) showed that
Woody was developing on track for his age. He had a captivat
ing smile, shining eyes, and a wonderful belly laugh.
44 Young Children May 2013 I
http://www.easterseals.com/site/Page
Achange in
Woody
Adults in
Woody’s life
started noticing
changes during
the summer
Woody turned
2. Woody stayed
home for a
month during his
father’s (Chris)
summer recess
from teaching.
When he returned to the center in September, his teach
ers noticed some definite changes. Woody’s speech was
disappearing—down from over 100 words and phrases to
about 20 individual words spoken with intent. He stopped
socializing with familiar people and engaged in repetitive
and nonfunctional behavior. One such activity was repeat
edly throwing action figure dolls up in the air. Woody
wandered the room, not engaging with peers, staff, or toys.
When adults or peers tried to interact with him, his eye
contact was limited. Woody’s teacher, Lois, who had been
with Woody since he entered the Bombeck Center, was
concerned.
Collaborative identification strategies
Lois spoke with the center director and together they re
viewed Woody’s current level of development compared to
his previous skills. They decided a conference with Woody’s
parents was needed. Lois describes that first call to the
parents as “the hardest phone call I’ve ever had to make in
my life,” but realized she had to discuss her concerns with
them. Something was different, and Woody needed help.
Woody’s mother (Patty) describes that meeting:
I’d like to comment on the grace exhibited by Woody’s
teacher during this very scary time. I can only imag
ine how difficult it must be to sit down with a par
ent to discuss a child’s developmental stall. Woody’s
teacher was empathetic, supportive, and factual. She
gave me good information and data that I could take
to our pediatrician. She didn’t make judgments about
what might be happening with Woody, but encour
aged me to see our pediatrician to ask questions.
The Bombeck Center’s staff suspected Woody might
have autism. Woody’s teachers, with parental permission,
asked for observations from Dr. Baldwin, an early child
hood special education faculty member at the University
of Dayton, and Dr. Kinsel, a child psychologist provid
ing support at the center. They observed Woody in the
classroom and playing outside to help the teachers learn
more about his behaviors and how to address his needs in
the classroom. Dr. Kinsel gave Patty and Chris examples
and terminology that they could take to their pediatrician,
including his concerns about Woody’s lack of eye contact,
minimal to no joint attention evident (shared focus on an
object or activity through verbal or nonverbal communica
tion), limited meaningful play, and stereotypical behaviors
commonly associated with autism (staring at the ceiling
lights, hand flapping, wandering the room instead of play
ing, and ignoring adults and children in the room).
The classroom teachers provided documentation they
had kept while Woody was enrolled, which was essential
in demonstrating his loss of previously evident skills. Dr.
Baldwin served as a sounding board and educator for the
parents as they began attending doctor and therapy ap
pointments. Dr. Baldwin and Woody’s parents discussed
IDEA (Individuals with Disabilities Education Act), Part
C services. IDEA is a federal law that provides educational
and therapeutic intervention to children identified with
exceptionalities. They also talked about how best to accom
modate Woody’s needs at the Bombeck Center in meetings
with the teachers and center director, as well as to keep
everyone up-to-date on the diagnostic process. By October,
Lois describes that first call to the
parents as “the hardest phone call
I’ve ever had to make in my life,”
but realized she had to discuss her
concerns with them. Something was
different, and Woody needed help.
the developmental pediatrician and developmental psy
chologist at Dayton Children’s Hospital identified Woody
as having pervasive development dis -not otherwise
specified (PDD-NOS), one of the autism spectrum disor
ders (ASD). (See “Autism Spectrum Dis ,” page 46.)
Intervention through collaboration:
Ages 2 to 3
Intervention occurred in stages as Woody’s treatment plan
was being developed by his parents, Bombeck Center staff,
About the Authors
Joni L. Baldwin, EdD, is an associate professor at the Univer
sity of Dayton in Dayton, Ohio. She has several years of experi
ence working with children with autism, including evaluation,
programming, teaching, and advocacy, [email protected]
May 2013 Young Children
Patty Sorrell, APR (PRSA Accredited in Public Relations), is the
mother of Woody Sorrell, the child featured in this article. Patty
is the director of Innovative Environment and Culture at ACCO
Brands in Dayton, Ohio. Patty’s professional background includes
communications, public relations, and editorial management.
[email protected]
45
mailto:[email protected]
mailto:[email protected]
professionals at the
children’s hospital,
and Dr. Baldwin and
Dr. Kinsel. The local
children’s hospital
completed a referral
for the county’s
Birth-to-Three
program (IDEA,
Part C).
Early interven
tionists (Els) from
the Birth-to-Three
program met with
Woody’s parents
at the early child
hood center so Lois
and Dr. Baldwin
could also be present. This began the collaborative process
between early interventionists (a teacher and a speech
pathologist) and early learning professionals working with
Woody (child care professionals) (Wesley & sse 2004).
Lois shared with the group how the classroom functioned
and noted times that would be good for Woody’s individual
therapy or group work. The team (Patty and Chris, Lois,
Els, and Dr. Baldwin) developed Woody’s Individual Fam
ily Service Plan (IFSP) with goals to help him regain some
of his lost communication and socialization skills. (See
“Woody’s IFSP Goals.”)
The Els came to the center to work with Woody both
individually and in the classroom. They modeled strategies
to increase Woody’s functional communication (giving him
only a little milk so he would need to ask for more), purpose
ful interactions with others (placing items that Woody would
want high on a shelf so he had to gain attention from someone
to get them down), and introductory play with peers (helping
Woody and another child build a tower with blocks). These
goals were embedded in key parts of his daily routine (mini-
Woody’s IFSP Goals
A
n IFSP (Individualized Family Service Plan) is devel
oped by the team working with the child, including
the parents and other interested caregivers. It is
similar to an IEP, but the family resources and concerns,
preferred model of therapy, and writing of the goals is more
family focused.
1. Communicate with words, signs, or pictures
2. Engage in simple play with peers and adults
3. Respond to one- and two-step directions
4. Identify body parts
5. Make simple choices
6. Identify familiar people spontaneously
circle, snack/lunch, gross motor/playtime) to make activities
more meaningful to l^im (Woods & Wetherby 2003).
Patty and Chris were very involved in obtaining services
for Woody, including the El specialists and additional speech
Early interventionists from the Birth-
to-Three program met with Woody’s
parents at the early childhood center
so Lois and Dr. Baldwin could also be
present. This began the collaborative
process between early intervention
ists and early learning professionals
working with Woody.
and occupational therapy through the children’s hospital.
Patty decided a written weekly schedule would be helpful for
the center staff, as Woody arrived and left the center at differ
ent times based on his appointments for that week.
Autism Spectrum Dis
A
utism Spectrum Dis is the umbrella term for a group
of dis s that affect language, behavior, cognition, and
sometimes motor skills. This includes autistic dis ,
Asperger’s syndrome, and pervasive developmental dis -not
otherwise specified.
Diagnosis
■ Impaired social interactions and failure to develop social relations
■ Impaired and dis ed language and communication
■ Restricted and repetitive behaviors (APA 2000)
■ Severity of the symptoms/behaviors is considered when confirming
diagnosis of children with ASD
Statistics
■ Boys are affected five times more often than girls (CDC 2012)
■ Approximately 50% of individuals with ASD also have intellectual
dis s (Volkmar et al. 2004); 50% do not
■ It does not appear to be disproportionately represented among
ethnic or racial groups
■ Prevalence in 2008 in the United States was reported to be 1 in 88
(CDC 2012)
Early warning signs in the child’s behavior
■ Difficulties with communicating
■ Minimal to no joint attention (sharing comments and thoughts
related to the same item or event through verbal or nonverbal com
munication)
■ Decreased social interactions
■ Restricted and repetitive behavior
■ Limited visual attention or fixation on nonsocial stimuli (Boyd et al. 2010)
46 Young Children May 2013
The Els who worked weekly with Woody wrote notes
to Woody’s parents and shared them with his teachers to
document what skills they had worked on each day in the
individual sessions. They suggested ways the skills could
be incorporated into the classroom and home environ
ments. By staying in his natural environment (the Bombeck
Center, where he had been cared for since he was 8 weeks
old), Woody could continue to follow examples of his peers
throughout the day.
Woody’s teachers and the rest of the staff at the Bom
beck Center willingly learned what they needed to do to
help Woody succeed in his natural environment (Vakil et
al. 2009). Woody went to occupational and speech therapy
at the local children’s hospital. Chris and Patty were able to
bring the strategies and techniques used in therapy back to
the center, including key vocabulary words to work on with
Woody, linked to the teachers’ lesson plans for the week.
They shared methods to encourage Woody’s play with
classmates, and strategies to help Woody gain an adult’s
attention to satisfy a want (for example, to go to the gym or
outside). The teachers integrated these suggestions into the
daily routine, particularly during snack, lunch, circle, and
play times.
It quickly became clear to Woody’s teachers that he
needed more one-to-one attention throughout the day to
encourage interactions than his teachers could provide
while also addressing the needs of other children. Dr. Bald
win recruited volunteers from her college students study
ing early childhood education, with an endorsement in
preschool special needs. The team identified key periods of
the day (8:00-11:00 a.m., when all the children in the class
Advice to TeacherS From a Parent
■ Understand the symptoms of autism: Teachers and
other early childhood professionals are often the first to
notice that something is changing with a child. If you no
tice a developmental stall, determine the appropriate next
steps with the center’s director regarding documentation
and approaching the family.
■ Learn: Be an informed advocate for children with autism.
There are local, state, and national organizations and
resources dedicated to autism advocacy and research.
■ Listen: Pay close attention to parents and siblings of chil
dren living with autism. The family experiences emotional
highs and lows regularly. Sometimes they need a friend to
listen and understand.
■ Encourage: Smile and acknowledge a child with autism.
Tell his family that you are supportive.
■ Be flexible: With the program director, determine what
support your facility may be able to provide for a child
with autism. Most families are open to and want to work
with their child’s program to respect the needs of the
other children and meet the needs of their own child.
■ Advocate: Vote in favor of causes, levies, and elected
officials who support funding for autism treatment and
research.
May 2013 Young Children
were present, and 3:00-6:00 p.m., after lunch and nap) as
Woody’s individual intervention times. A college student
was assigned to Woody during these hours, with the pri
mary responsibility of playing with him, while addressing
daily goals of increasing communication and attention.
Students volunteering to work with Woody attended
two training sessions facilitated by Dr. Kinsel and Dr.
Baldwin. The first was held in January with a follow-up in
March, both scheduled after the center had closed for the
day. Woody’s parents provided pizza and soft drinks for the
participants, and many teachers from the center also stayed
after work to learn more about ASD and how to work with
children identified as being on the autism spectrum.
Woody’s parents and Dr. Kinsel decided Woody’s
intervention program at the early childhood center would
focus on interactions during play, following the P.L.A.Y.
(Play and Language for Autistic Youngsters) Project ap
proach (www.playproject.org). The P.L.A.Y. Project was
developed at the Ann Arbor Center for Developmental
and Behavioral Pediatrics by Dr. Richard Solomon. The
program is designed to increase communication and
interactions between children identified with autism and
Woody’s teachers and the rest of the
staff at the Bombeck Center willingly
learned what they needed to do to
help Woody succeed in his natural
environment.
their families. Therapists work with the family to increase
interactions with their child through daily routines—for
example, bath time, lunch, or bedtime. The team consid
ered this approach appropriate to use in Woody’s child
care setting, which was a “home” for Woody for most of
his waking weekday hours.
The volunteers worked with Woody for short periods
of time (20 minutes), engaging and expanding on his play,
while setting up opportunities for him to purposefully
communicate. The student volunteer would start where
Woody appeared comfortable (for example, swinging)
and then begin to interrupt his play to gain attention and
language (for example, stopping the swing and asking
Woody what he wanted; if no response, giving verbal and
physical cues [signing and saying more], if no response,
physically helping Woody “say” more through signing and
then pushing the swing again). This continued for 5 to 15
minutes, depending on Woody’s interest. Woody’s parents
and teachers decided to follow this same model for other
activities Woody liked, including playing with bubbles,
playing “chase,” and ball play.
Patty and Dr. Baldwin developed data sheets to commu
nicate between volunteers, center staff, and Woody’s par
ents. The teachers designated an accessible spot in the room
47
48
for a clipboard containing all the data sheets the volunteer
or therapist would use when working with Woody one-on-
one. Woody’s parents could then look at the clipboard as
they picked him up to see what had happened during the
day. A graduate assistant developed a picture schedule that
included the key parts of Woody’s day (Banda, Grimmett,
& Hart 2009; Hodgdon 2011). This helped Woody make
smoother transitions as he was moved from his classroom
to go to the gym or outside and then back to the room.
Woody’s parents and the Bombeck Center staff dis
cussed the option of having Woody attend a center-based
program for 2-year-olds run by the county developmental
disabilities program. The program included occupational
therapy, speech/language therapy, and a teacher on a half
day, four-day-a week schedule. It was a difficult schedule
for Woody’s parents to manage while working full-time,
but everyone agreed that the additional intervention would
be beneficial, so the center staff developed a workable
plan. Woody’s parents brought him to the early childhood
program at the typical time each morning. One £f the center
staff walked Woody to the nearby corner to be picked up by
the school bus. Woody loved the bus, so this was easy for
everyone. At lunchtime, Patty or Chris picked Woody up at
the end of the session and drove him back to the Bombeck
Center. They chose to do this to be able to talk with the
special needs staff daily, and to avoid Woody falling asleep
on the bus on the way back to the center.
Under the direction of a licensed physician, Woody’s
parents placed him on a gluten-free/dairy-free diet. The
center director, the food preparation staff, and Woody’s
teachers agreed to help implement this diet and met to de
termine how to manage this new change for Woody. They
developed a list of foods that were usually served at the
center that Woody could eat with the other children. The
staff also identified items to be eliminated from Woody’s
diet, with his parents providing substitutes for snacks and
lunches as needed.
Monitoring food in the classroom was relatively simple,
because the staff sit with the children for snack and lunch.
Woody quickly learned what was “his food” and most of the
time did not protest having different snacks from his peers.
Woody’s mother credits the center with help and support in
putting the new diet in place:
We introduced the diet by meeting with the kitchen
staff, teachers, and the center director to discuss
Woody’s diet restrictions. Again, the team came
through and has helped every step of the way. Chris
and I provide substitutes for lunches, snacks, and spe
cial occasions, but we really couldn’t do this without
the support of the entire early childhood center team!
Woody’s parents have kept the families of the other
children in the classroom informed during the intervention
process. His mother wrote a letter to the families, sharing
the story of Woody’s loss of skills and the diagnosis process.
She explained what happens with volunteers and therapists
in the room, and that Woody was on a special diet. In addi
tion, Patty spoke to all center families and staff at a parent
association meeting. She described the signs of autism and
responded to questions. Her candor and openness resulted
in other families becoming more familiar with ASD, and
offering support to Woody and his parents.
Progress
Through this intervention, Woody has made progress in
his developmental skills.’ Communication is stressed in
all aspects of his day, including snack and lunch, when he
receives a small amount of food and then must indicate in
some fashion that he wants more. Woody’s teachers and
volunteers learned basic sign language to help him com
municate nonverbally (“more,” “cracker,” “juice,” “swing,”
“ball”). They work to maintain his attention during play
What Families Can Do to Facilitate
Identification and Intervention
■ Obtain releases for everyone to talk to everyone else in
volved. As confidentiality has become more of a concern,
professionals may not talk to one another about a specific
child unless there is a release form. They can only discuss
their information, not something they heard or received
from another therapist. The El staff need a permission
form to talk with the center staff, and another to talk with
the doctor. Yet another form is necessary for the staff
and doctor to talk with the El staff. This is critical for open
communication.
■ Coordinate scheduling of therapies and doctor appoint
ments.
■ Share openly with program staff, volunteers, and other
families.
■ Provide dinner or snacks for training sessions.
■ Provide snacks and lunch when scheduled food is not on
the child’s allowed list.
■ Bring in experts to train staff and volunteers.
What Educators Can Do to
Facilitate Identification and
Intervention
■ Keep anecdotal records of developmental skills
■ Monitor the child closely for safety issues
■ Talk to families and therapists
■ Serve as liaison between families and therapists as
needed
■ Ask questions
■ Attend trainings
■ Encourage the child’s language use and interaction with
peers and adults
■ Adapt food offerings at snack and lunch
■ Help with bus duty
Young Children May 2013
Vakil, S., E. Welton, B. O’Connor, & L.S. Kline. 2009. “Inclusion Means
Everyonc^The Role of the Early Childhood Educator When Includ
ing Young Children With Autism in the Classroom.” Early Childhood
Education Journal 36 (4): 321-26.
Volkmar, F.R., C. Lord, A. Bailey, R.T. Schultz, & A. Klin. 2004. “Autism
and Pervasive Developmental Dis s.” Journal of Child Psychology
and Psychiatry 4 (1): 135-70.
Wesley, P.W., & V. sse. 2004. “Consultation as a Framework for Pro
ductive Collaboration in Early Intervention.” Journal of Educational
and Psychological Consultation 15 (2): 127-50.
Woods, J. J., & A.M. Wetherby. 2003. “Early Identification of and
Intervention for Infants and Toddlers Who Are At Risk for Autism
Spectrum Dis .” Language, Speech and Plearing Services in
Schools 34 (3): 180-93.
APA (American Psychological Association). 2000. Diagnostic and Statis
tical Manual of Mental Dis s. 4th ed. Washington, DC: APA.
Banda, D.R., E. Grimmett, & S.L. Hart. 2009. “Activity Schedules: Help
ing Students With Autism Spectrum Dis s in General Education
Classrooms Manage Transition Issues.” Teaching Exceptional Chil
dren 41 (4): 16-21.
Boyd, B.A., S.L. Odom, B.P. Humphreys, & A.M. Sam. 2010. “Infants and
Toddlers With Autism Spectrum Dis : Early Identification and
Early Intervention.” Journal of Early Intervention 32 (2): 75-98.
activities. These little things allow
Woody to continue to work on his skills
while remaining a member of his peer
group.
Center staff hold monthly meet
ings with Woody’s parents to assist
everyone involved with understand
ing Woody’s needs and his program.
Together we celebrate small successes,
and problem solve difficulties. Woody
has slowly regained some of his verbal
communication and interacts with
a few of his peers on a limited basis.
While autism remains an obvious part
of Woody, his unique personality has
begun to re-emerge.
Through the care, compassion, and
flexibility of the early care staff and
teachers, Woody was able to remain in
his natural environment, his parents
were able to continue to work, and the
staff and volunteers learned strategies
to work with children under the age
of 3 who are diagnosed on the autism
spectrum. The intervention has been a
successful collaboration that continues
as Woody turns 3 and transitions to
school-age services. The public school
staff came to the Bombeck Center
for his transition meeting so Lois, Dr.
Baldwin, and Woody’s parents could
share information. Woody’s Individu
alized Education Program continues
the strategies and goals that have
proven successful in the early care and
education setting.
References
Our Natural Playgrounds
Promote Mastery
of the Early
Learning Standards
i . V. .:
I f ff>. ;
■ . . . S t u m p Garden
.yT-‘-A’-W
1 • ‘ i – ‘ ‘
Arch Bridge
Log Garden
www.adventurouschild.com
CDC (Centers for Disease Control and Prevention). 2012. “Prevalence of
Autism Spectrum Dis s—Autism and Developmental Disabilities
Monitoring Network, 14 Sites, United States, 2008.” Morbidity and
Mortality Weekly Report, www.cdc.gov/mmwr/preview/mmwrhtml/
ss6103al.htm.
Hodgdon, L.A. 2011. Visual Strategies for Improving Communication:
Practical Supports for Autism Spectrum Dis s. Rev. ed. Troy, MI:
QuirkRoberts.
Copyright © 2013 by the National Association for the Education of Young Children.
See Permissions and Reprints online at www.naeyc.org/yc/permissions.
May 2013 Young Children 49
http://www.cdc.gov/mmwr/preview/mmwrhtml/
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