Progress Report

Last Thursday we met with all the therapists and teachers at Brown to go over Chase's progress in the last 3 months.  3 months ago we all met and went over the goals that they had set for him in his FSP for the next 6 months and added any goals we had for him as well.  We are at the half way point now, which is hard to believe in itself, and I could not be more excited and proud of Chase at the progress he has made the last 3 months!  Below is his report, my thoughts are added in red :).

COMMUNICATION
Chase has made impressive progress on his communication goals in the past 3 months.  Three months ago we introduced the use of the iPad app Proloquo into Chase's program to target requesting and a large focus of his programming has been aimed at expanding his ability to request.  Currently, Chase has mastered all of the goals outlined on his FSP for requesting for items using the phrase "I want + item".  We have continued to expand upon the way in which Chase is using his iPad to request including targeting the use of environmental regulators "all done" and "help" on the home screen, expanding his phrase lengths to include a variety of verb phrases such as "I want + to play + toy" and "I want + to eat + food", and requesting to go "potty" using a button located on his home screen as well.  We were having some issues at home with Chase getting frustrated and upset when Miles was being loud so we added a "be quiet Miles" button to the home screen as well and it quickly became his favorite button to hit! :)  As we continue to progress through the Proloquo teaching progression we have tracked no only Chase's accuracy but also the frequency with which he is using a particular phrase to ensure that he is using all targeted skills frequently enough to continue to be meaningful over time.  In the area of receptive language Chase made great progress on his labeling common objects goals and has acquired a wide enough number of targets to move on to more advanced receptive programming.  He is currently targeting receptive identification of adjectives and recently mastered the targets "big" and "small" using objects.  Next we will target a generalization phrase of big/small using pictures before moving on to other adjectives.

Basically, Chase has far surpassed the goals we had set for him for a 6 month time period in a matter of 3 months and is breezing thru the Proloquo app.  This is such an amazing thing because it has opened up worlds of communication for him and cut back on so many tantrum-like behaviors due to frustration and lack of communication!  

ACADEMIC SKILLS
Over the past 3 months an emphasis has been placed on Chase's communication including his use of the iPad.  We have targeted Chase's academic skills in the contexts of the one-on-one sessions as well as the classroom environment.  He has engaged in imitation with objects and has demonstrated mastery of imitating banging hammer and eating actions with objects.  Chase has worked on his visual performance by matching items and has begun matching non-identical items.  In the classroom, Chase has engaged in the handwriting without tears programs and has begun working on imitating vertical lines across all settings.  He has also begun to work on manipulating objects by completing an AB pattern with the support of boxes.  He is doing this in the context of work center in the classroom environment.

The AB/AB patterns that Chase is currently working on is to get him ready to start learning early math skills.

SOCIAL INTERACTION
Chase has made gains in his capacity to engage in social games activities as he has learned the routine of the classroom.  He is participating in social interactions with his peers by giving and receiving items without a prompt and hand an item to a peer following a gestural prompt.  During social games Chase will remain in the activity for the whole duration.  He will participate in motor games such as musical chairs with prompting from an adult.  He has demonstrated the ability to learn simple actions with board games.  We will continue to work on increasing his independence with these activities.

PLAY
Chase engages in organized play and has demonstrated the ability to imitate two-step play actions.  Two-step play actions were described to be as "going to get a moon rock and bringing it back to the space ship" during space week, or "leading the horses in to the barn and closing the door behind them" during farm week.  Chase will attend to a toy upon an adults prompting and requires some support to maintain engagement.  Chase can continue to work on increasing the duration of engagement with a variety of toys.  When following the classroom routine Chase participates in thematic play.  He is demonstrating the ability to imitate simple pretend play actions.  We will continue to increase the duration and variety of his play.

EDUCATIONAL PREPARATION
Chase transitions from one activity to the next with some prompting from an adult.  He participates in every activity and has worked on using environmental regulators to communicate with his teachers including signs for "more" and the "all done" basket.  As Chase makes gains in his communication with the use of the iPad we will continue to increase the expectations for his participation in group instruction.  Chase sits in his chair facing the teacher during group instruction with little redirection.  The classroom teacher said she could tell that he really wanted to participate in pointing out or "saying" different things along with the stories being told or during calendar and weather so they are going to add folders to his iPad that correlate with the circle time activities so that he can participate more.  Chase demonstrates some sensory seeking behavior and at times mild protest behavior during group instruction.  We will increase his access to requesting for activities that are regulating throughout the classroom routine.

MOTOR SKILLS/MOTOR PLANNING
We have put a lot of focus over the past few months on targeting Chase's fine motor skills.  He has mastered a number of fine motor goals including sorting with tweezers and squeeze toys.  Both his toleration of and ability to participate in these kinds of tasks has greatly increased.  He is getting stronger and is therefor ready for more challenging fine motor goals like clothespins, which is his current goal.  He is making steady progress with this goal and is gaining independence.  We will continue to require him to participate in fine motor strengthening skills to increase his endurance and strength.

SELF-CARE SKILLS
The biggest thing to celebrate is Chase's mastery of the potty training protocol!  Chase is potty trained!!!  He stays dry on his toileting schedule and is learning ask to go potty using his iPad.  He participates well with the toileting routine and has a lot of independence in this area, occasionally requiring some support to start the process of putting on pants or to adjust clothing as necessary.  Chase has also gained independence with the hand washing routine, occasionally requiring gestural or verbal prompts to complete the process.  We will continue to place the bar higher and work towards complete independence.

We had NO IDEA that he could independently push his pants down and put them back on all by himself!!!  He has totally had us fooled at home in to helping him do that along with washing his hands...NO MORE, BUDDY! :)

SENSORY PROCESSING
Chase has been exposed to a variety of sensory activities including jumping, squeezing, climbing, and swinging.  One of Chase's strengths is that he loves these kinds of activities and will often request for them using his iPad.  His toleration of the squeeze machine and the platform swing has grown.  Chase likes to be on the swing for small amounts of time with nobody pushing the swing.  We will use this interest to increase his tolerance of being on the swing while somebody is pushing him.

We have noticed a HUGE decrease in sensory-seeking behaviors at home (or "hyperactivity") since he has learned which activities he needs at certain times and has learned to ask for them when needed.

FEEDING AND ORAL MOTOR
Chase has increased his food repertoire greatly in the last 3 months.  He has added 6 foods to his diet including apples, pears, various flavors of applesauce, veggie and fruit pouches, grapes, and various types of yogurt.  Along with these foods, Chase has done a great job tolerating and eating new foods such as oranges, carrots, green beans, peas, macaroni and cheese, PediaSure, and gummy vitamins.  He is drinking from an open cup with assistance and is working toward independence.  Chase has mastered using a fork and spoon to feed himself and does so spontaneously with no prompting or support.  Chase is progressing nicely in feeding and has shown that he is open to and interested in trying new and non-preferred foods.  Chase will continue to participate in oral motor exercises to strengthen his oral skills and to get him ready for feeding therapy.

Meal time is 100% better than it was 3 months ago!  Chase will now try just about anything, whereas we used to have to force it in his mouth for him to taste it.  He will "bite" or "chew it up" or "drink" pretty much anything we ask him to.  Not always without whining, but it's much less of a struggle than it used to be!!!  This is a HUGE success for us at home!

FAMILY AND BEHAVIORAL GOALS
The primary news for this review is Chase's remarkable achievement of potty training!  It was a bumpy and tortuous road, but he made it, and it was an amazing thing to witness.  I am confident this skill - which, in behavioral circles, may be considered PIVOTAL, will lead him to make greater strides across all areas of his life, ultimately yielding greater independence in a number of domains.  Thanks to his wonderful family for working so closely with BCA to make this happen.

The family will continue to remain as involved as possible, particularly in the area of working on DLP goals at home.  The goal would be for both parents in tandem to complete all the DLP goals at least 3 times per week.  Further, both parents should continue to work to complete all of their participation credits each month.

According to staff ratings, Chase is engaged between 75-90% of his time at BCA.  This is generally an appropriate amount of engagement for him to acquire new skills, but it would benefit him to increase his engagement in all areas.  Thus, we must focus on this as a goal in the months ahead by reducing opportunities for him to "zone out" and increase opportunities for engagement across all parts of his day.

Chase will remain engaged in adult-directed activities (work, play, etc) during his time at BCA for greater than 90% of his time across the day.