Final Case Study

1. For the last 8 months, Justin’s parents have started to notice a difference in his behavior, compared to his 1^st grade classmates. Justin has consistently failed to pay attention to details and he tends to makes careless mistakes in schoolwork or other activities. While playing in “centers” at schools, his teachers have reported that he often has trouble sustaining attention during tasks or play, and seems to move from one item to the next quickly. When in class he can not follow directions, and his parents have seen this at home too even when they are speaking directly to him. Justin is having difficulty following through on instructions in the classroom and often fails to finish schoolwork. At home, mom reports that he is unable to complete his chores or other tasks that she asks him to complete. She is constantly reminding him to do the task over and over. When it comes to keeping tracks of his toys, school work, clothes etc he has problems getting organized. He tends to both at home and school lose the items that he needs, forget where he put his completed homework, or completely forget to hand it in, When it comes to bringing homework home, he will forget to write it down, leave a book at school, only bring half the assignment home, or will lose some aspect of the item. When trying to do work he is easily distracted and tends to let his mind wander. When is he trying to concentrate in class during lessons. Justin will fidgets and squirms frequently, and becomes a distraction to other students. He often leaves his seat in the classroom or in other situations when remaining seated is expected and required. When he is playing whether for a free time, a recess, or at gym he is very rough, aggressive and louder than the rest of the children. He is always running down the halls and in the classroom, even though he is repeatedly asked to stop. Mom has stated that she sees the same behaviors at home; he is running down the hallways, jumping on the furniture, rough with his younger siblings and loud no matter where he is.  Justin has a very hard time staying quiet throughout the day and seems to talk excessively, even when repeatedly asked to stop. The teachers have tried to reinforce when he is quiet because mom has showed some success with this at home. Justin calls out in the classroom, especially when others are talking, or when it is not his turn, he has a very hard time waiting his turn and will blurt out answers before the questions are even asked. Mom and the teacher have both confirmed that the behaviors are seen at school and at home on regular basis. He has been referred to the school psychologist for testing and further evaluations.

2. Sarah is 6 years old, she is a happy little girl who is always friendly and outgoing. Since she was two she has trouble based on parental reports, responding to her name, she did not turn around for loud noises, and hardly seemed to hear anything in her environment. Sarah was given a cochlear implant at the age of 4 and since then has been able to hear, due to the fact that before the age of 4 she did not have much of hearing- her speech is delayed and she is shy with new people because she has a hard time following along in conversation. She receives speech in and out of school, and is currently much further along in her progress than anticipated. Sarah does struggle with some social areas, along with academic areas. She has a hard time in reading, spelling, but loves math and anything with art. She is very creative and loves to create projects on her free time. She also loves to listen to music and finds this very reinforcing. Family is seeking more home intervention and is unhappy with the services at school.
3. Michael who was referred by the Pediatrician for an evaluation following his 2 year old exam. In the beginning  of his development Mom stated that she has seen the same delays that the Dr. has and also has the same concerns. When called even if only a foot or less away Michael will not respond to his name. He does not even turn his head towards the voice. Michael is not able to follow simple one step directions like come here, sit down, or pick up. He does not really use words to request or say what he wants. Every once in a while, not consistently, he will repeat a word that is modeled. When playing around other children in the 2’s group mom has him in, he does not even notice the other children, he plays by himself, and does not really play, he will just hold 2 objects in his hand (usually the same 2) and when they are taken away he will fall the floor screaming and crying in a very intense tantrum. When he does play he tends to line items up in the same pattern or order, then he will move the line to another room or to another place. He does not seem to know how to play with toys and even if mom sits down to show him or to help him he does not make eye contact will not look at her or imitate what she is doing. He will not point to desired items, and if he wants something will just grab them, if not given what he wants immediately, he will tantrum. When greeted by someone he will not wave hi or bye and will not smile even when someone is smiling at him. Michael seems to be in his own world and does not want others to be in it with him. He tends to be more attached to certain items then he is to his parents or other familiar people. He will play with the same item over and over and repeat the same actions over and over until you break the cycle which can then lead to tantrums. 
4. Marianne is 10  years old, and has been struggling with school lately. She has not met any of the standards on the state wide assessments in math and reading, but her scores are not low enough for to qualify for special education services. Her parents have reported that at home she has become frustrated easily and gets overwhelmed with homework and tends to melt down each night. These behaviors have increased at home and at school. Marianne realizes that she is not meeting the standards of other students and has started to feel down on herself. The school has suggested private tutors but the family reports that they can not afford that at this moment. Marianne is struggling to answer word problems in math which can also be affected by her comprehension in reading, which she struggles with. She tends to be all over the place and has no systematic way of breaking down the word problems and or the reading questions. When she starts the problems she looks for the numbers in the question right away and do not read the problem carefully.  An example would be that one day she saw the numbers 55 and 40 and immediately wrote the answer was 95 yet if she read the problem she would have seen that the question was asking you to find the average, but she just added them without even reading the question. When asked what the question asked she did not have an answer. Marianne’s mother has asked that she receive services from the school and from her teacher.
5. Megan is 9 years old, and begins her day by getting up early and making noise. Her father unfortunately has mentioned how much this bothers him. So she turns on the TV, or if that has been mysteriously disconnected, bangs things around until her parents come out. Breakfast is the first battleground of the day. Megan does not like what is being served once it is placed in front of her. She seems to be able to sense how hurried her parents are. When they are very rushed, she is more stubborn and might refuse it altogether. It would be a safe bet that she would tell her Mom that the toast tastes like poop. This gets her the first “time out” of the day. In the mornings she goes toschool or goes off with her grandmother or over to her aunts if there is no school. Otherwise Megan mother is unable to do anything. Megan can not entertain herself for more than a few moments. She likes to spend her time purposefully annoying her mom, at least so it seems. Megan will demand over and over that she wants something. For example, play dough. She knows it must be made first. So her mom finally gives in and makes it. Megan plays with it about one minute and says, “Let’s do something else”. Her mother reminds her that they are doing something, the very thing that Megan has been demanding for the last hour. “No, let’s do something else" So after Megan’s mother screamed so hard she was hoarse when her husband came home, Megan gets to go out almost every morning. At School she is very impatient with others, very aggressive, and the teacher says that she can be very distributive. Only once has she had a tantrum there at the school that her mother had to be called in to get her.  Megan gets along with the other children as long as she can tell them what to do. Most of the children try to avoid her, but there are a few that understand and play with her.  Her grandmother and Aunt all follow the same “time out” plan. This means she goes to a certain room until she calms down. The room is empty now at Megan’s grandmother. She broke the toys, and they were removed. She banged the furniture around and it was removed. What sets Megan off is not getting to do what she wants. She screams, tells people she hates them, and swings pretty hard. After a half hour it is usually over, but not always. Megan will usually tell her mom or Grandmother about these tantrums. The story is always twisted a little. For example, Megan will tell her Grandmother that her mom locked her in her room because she was watching TV. Her grandmother used to believe these stories, and Megan could tell the whole story of how she was watching this show, and her mom just came in and dragged her to her room. Now it turns out that Grandma doesn’t think much of TV anyways, and so this made a certain amount of sense to her. This led to more than one heated argument between the Grandma and her mom. Of course there was almost no truth to this at all. It took the tables being turned for the Grandma to really believe that her Granddaughter could set up an argument like this. Megan came home and told her mom that Grandma let her eat four cookies and an ice cream cone for a treat and that she was very full. Megan’s mom doesn’t think much of treats, and could see how this might happen and thought she would have to talk to her mom. Finally they both realized what Megan was doing. Most of the afternoon with Meganis spent chasing her around trying to wear her out. It doesn’t seem to work, but it is worth a try. When she is at her aunts, she tries to wreck her cousin’s stuff. When is she good? When there are no other cousins around and she has the complete attention of her Aunt or Grandpa. Megan loves the bedtime battle. She also loves to go to the Mall. But she never gets to go there or hardly anywhere else. She acts up so badly that her family is very embarrassed. Her mother shops and visits only when she is at school. The classroom teacher has reported that there are more and more incidents in the classroom and at a school and would like to work with the family to get her behavior under control.

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