TASK FOR COMPLETION #1

Case Study #1

 Maria

Maria is a 6 year 5 month old female who has been diagnosed with multiple disabilities including mild cognitive impairment and a profound hearing loss in her left ear that is unaided.  She has a history of ear infections and has received pressure equalization (PE) tubes.  Her vision is reportedly within normal limits.  Maria has little or no functional speech, but uses several communication modalities to express her basic needs and wants including gestures, manual signs, and spoken word approximations.  Maria demonstrates developmental delays in receptive and expressive language skills, fine motor skills, and self-help skills.  Maria is independently ambulatory and has functional use of her upper extremities.  She demonstrates low muscle tone and generalized muscle weakness.  Maria resides at home with her family where the primary language spoken is Spanish.

Maria attends a general education, half-day kindergarten program with assistance provided throughout the day by a paraprofessional who is bilingual in English and Spanish.  Maria receives assistance from the paraprofessional for most activities due to her lack of expressive communication, delayed receptive comprehension, fine motor difficulties, and noncompliant behaviors.  Maria appears to enjoy interacting with her peers and often imitates their models within the classroom environment. 

Maria’s general education kindergarten teacher has expressed concern that Maria does not have sufficient expressive communication skills to participate in the classroom to her fullest potential.  The teacher also feels that Maria’s lack of expressive communication abilities is causing Maria to be frustrated and act out within the classroom.  You are part of the transdisciplinary team that has been formed to determine the most appropriate augmentative and alternative communication system to increase Maria’s expressive communication abilities.  Following are the results of assessments that have been completed over the past month: 

Peabody Picture Vocabulary Test (PPVT) – a standardized measure of receptive single-word vocabulary knowledge; requires the student to respond by pointing to a named picture from among four choices.

English administration = raw score of 5; standard score of 40; extremely low range

Spanish administration = raw score of 5; standard score of 40; extremely low range

Expressive One-Word Picture Vocabulary Test (EOWPVT) – standardized measure of expressive language skills; requires the student to label pictures 

Maria was unable to provide spoken responses during the test.  She used alternative modalities to express her knowledge.  She pointed to objects in the environment (e.g., her own socks, shoes, eyes).  She used gestures (e.g., waved her hand back and forth when presented with a picture of a swing).  She used manual signs (e.g., dog, cat, wheel). 

Selected subtests of the Comprehensive Test of Nonverbal Intelligence (CTONI) – a standardized measure of nonverbal reasoning abilities; requires the student to respond by pointing to select from a group of pictures or designs involving analogies, categorizations, and sequences. 

Maria obtained the following scores that indicate her performance was significantly below that of same-aged peers:

Pictorial categories = raw score of 6; standard score of 8

Geometric categories = raw score of 6; standard score of 8

Pictorial sequences = raw score of 3; standard score of 7

Following is an inventory of Maria’s current vocabulary demonstrated across modalities:

As part of the evaluation procedure, Maria was assessed on her ability to understand the representational value of Picture Communication Symbols (PCS) from Mayer-Johnson.  Maria was presented with arrays of PCS representing familiar nouns.  Each array was contained on an 8 ½ x 11 inch sized page.  The arrays ranged in size from 4 symbols per page to 128 symbols per page.  Maria easily pointed to named symbols up through 32 symbols per page.  When presented with the page containing 72 symbols, Maria displayed refusal behaviors and needed constant redirection to stay on task. 

Maria was then asked to identify PCS representing various parts of speech (e.g., verbs, people, locations).  She correctly identified a small number of concrete verbs (i.e., eat, drink, sleep, read).  She was unable to identify PCS representing other parts of speech. 

Maria was presented with a touch screen device that contained 8 PCS, four of which represented her favorite snacks and the other four representing less desired food items.  After Maria explored all of the symbols by activating them numerous times, the available snack items were placed in view, but out of reach.  She immediately activated the symbol for CRACKERS to request “cheese crackers.”  Maria consistently activated the symbol needed to request her desired snack from a field of eight.  When the field size was increased to 16 symbols, Maria experienced numerous miss-hits as a result of the side of her hand dragging across the screen. 

Use the Feature List as a reference to complete the Feature Match Guide for AAC for Maria.  The Guide has been started for you.  Identify three AAC devices that best meet Maria’s needs.  Write a brief summary of the device you would recommend for a trial period.