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Overview
Rule Out Step 1
Rule Out Step 2
Rule Out Step 3
Rule Out Step 4
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Childhood
Disabilities: Early
Identification and Intervention
Rule Out Model for the Early Identification and Treatment of Children with
Developmental Disabilities
Rule
Out Step 3
Content:
Step
3 Rule Out Issues
There
are three (3) areas which are the direct
result of the child’s physiological state plus sensory, cognitive and motor
traits and the basic interactions with his
caregivers and the environment. They are:
1.
The child’s
developmental level
2.
“Normal” coping
behaviors
3.
“Abnormal” coping
behaviors
It
must be true that, if we were to know the child’s physiological state,
sensory, cognitive and motor traits, all of the relevant impacting factors on
them and the developmental level, then all observed "dysfunctional" behaviors
would be understood as predictable
given the entire scenario. Unfortunately, many diagnoses are made only on
observed behaviors with no consideration for the issues address in steps 1 and
2. . This can be very misleading, since many
of these "abnormal" behaviors may be caused by very different
combinations of physiological state and sensory, cognitive and motor traits and
their interaction with relevant impacting factors. This combination of issues
identified in steps 1 and 2 requires VERY different intervention strategies to be successful.
Secondary Behaviors
which are a result of the interaction of the physical state, sensory, cognitive
and motor traits and impacting factors include:
- Speech:
(pronunciation problems)
- Language
(poor sentence structure, vocabulary, receptive language, expressive language)
- Reading
- Memory
- Attention
(restless, inconsistent, careless, insatiable, distractible)
- Impulsivity
- Socialization:
(unusual responses to sensory stimuli, resistance to change and insistence on
routines, difficulties with typical social interactions, social and emotional
unrelatedness, stereotyped behavior - routines, rituals and attachment to
objects, lack of eye contact).
- Fine
Motor Skills: (clumsiness, poor pencil grip, poor letter formation): Impaired
fine motor skill, including dysphasia and apraxia, impaired motor planning,
Hypotonia - low muscle tone, soft ears, double jointed, upper body weakness
Developmental
Level and Executive Developmental Functions:
The
four executive developmental functions are a result of the interaction of
the physiological state, sensory, cognitive and motor traits and external
impacting factors. Executive functions are any behaviors, which serve to organize a
series of events over a long period of time, i.e.:
- Prolongation:
Holding & evaluating events in working memory
- Separation
& regulation of affect: Splitting facts from feelings
- Internalization
of language: Reflection, self-control, will power
- Reconstitution:
Break events into parts and reassemble into new ideas
Diminished
proficiency in executive functions may contribute to a developmental disorder by leading to:
- Deficient
self-regulation of behavior, mood, response
- Impaired
ability to organize/plan behavior over time
- Inability
to direct behavior toward the future
- Diminished
social effectiveness and adaptability
Theory
of the Mind Research Addresses Learned Behaviors
Theory
of the Mind (TOM) research offers an explanation for the social, cognitive, and
communicative impairments of children with developmental disorders
(Baron-Cohen, 1996; Happe, 1995, 1997; Tager-Flusberg & Sullivan, 1994). TOM
is the ability to understand the mental states of the self and others, including
such states as wanting, feeling, believing, and thinking (Baron-Cohen, Leslie,
& Frith, 1985; Bartsch & Wellman, 1995 through the acquisition of such
skills as eye contact and joint attention (Greenspan, 1995). Children with these
disorders seem to develop these early TOM related abilities much later in age
(Sparrevohn & Howie, 1995) and have problems generalizing these abilities
beyond the tasks, due to the lack of the sense of "self" for lack of
healthy social contexts and contacts with the community (Hadwin, Simon
Baron-Cohen, Howlin, & Hill, 1997).
External
Factors Impacting Observed Dysfunctional Behaviors
The
dysfunctionas behaviors typical to children with developmental disabilities evoke responses from everyone the child
interacts with: parents, friends, but also society in the form of schools,
public places, legal system, the community at large, etc. Their responses help
modify these dysfunctional behaviors. In the case of abnormal behaviors
inappropriate intervention will further damage the child’s functioning. Some
inappropriate interventions are:
- Sole
use of drugs to control behavior
- Isolating
the child in a locked facility
- Restricting
the child to a special needs environment and not including "typical"
children
These
inappropriate interventions can lead to even more disruptive behaviors
Step
3 Assessments
The
child’s "developmental level of functioning" must be assessed at
this step of the rule out process. A determination must be made of how the child’s
physiological state, sensory, cognitive and motor traits have interacted with the caregivers and the environment to bring the child
sequentially through the essential developmental levels.
Assessment
used in Step 3 include:
- Individual
developmental evaluation and observation of child
- Observation
of parent(s) - child interaction
- Developmental
history, with history of marriage, family and parents’ own families
- Functional
assessment of Child
- Psychological evaluation
- Assessment daily
functioning in activities of daily living
- Developmental
assessment or intellectual assessment
- Speech
Therapy
- Occupational therapy /
sensory integration evaluation
Additional
assessments needed to do a complete diagnostic work up:
- Physical therapy evaluation
- Educational achievement in reading
and math/processing/perceptual evaluation
Services
Needed at Step Three
Discrete Trial Learning, Play Therapy, Parent Training, Child and
Behavioral Management, Organizing Skills Training, Study Skills Training, Social
Skills Training, Tutoring, Language Enhanced Classroom, Inclusion Classroom,
Classroom Modifications, Resource Room, Contained Treatment Setting, Medications
(last resort).
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