Joshua Hull ASP 494 Child Case Analysis #2 Name (initials only): TR DOB: 11/25/10 Sex: M Hearing age:

0 Educational placement: none Health: Good overall Health Co-occurring conditions: Autism Description of hearing loss: SN hearing loss Degree: Severe to Profound Type: Sensory Neural Configuration: flat Laterality: Bilateral Type of amplification: none Type of ALD: None This twelve month old client has not seen any professionals previous to these evaluations concerning his hearing due to family issues and lack of support from the clients mother. The client was diagnosed with Autism yesterday. The clients aunts or legal guardians have put in a request to pursue cochlear implants within a month. The client will be enrolled in Child Hearing Services immediately after the operation has been completed. When TRs aunts brought him to TEIS we first looked at his case history and did some informal observations of TR. Our observations were consistent with the case history which stated that he had a sever to profound SN hearing loss. Also we observed that TR had lack of communicative intent, poor eye contact with the clinician, inappropriate play with his toys, and he displayed repetitive selfstimulatory movements. 2) Guardian Counseling recommendation: TRs aunts have displayed many signs of high stress levels concerning TRs situation. Less than three months ago they had no idea that they would become TRs guardian and now they just found out he is autistic and almost completely deaf. This situation is a lot to take in for new parents. We are recommending that the guardians seek a professional psychiatrist to talk about their feelings and frustrations. We are also referring them to a local support group for parents with autism. We have also gotten a list of parents here at CHS that are willing to talk to the two aunts about what it was like for them discovering that their child has a profound hearing loss and what the process has been like for them while dealing with their own situation to give TRs aunts some perspective about what it is going to be like during TRs therapy process.
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Due to the mothers lack of interest in the well being of TR before the aunts got guardianship TRs mother never took advantage of and early intervention services before. His hearing loss and Autism should have been identified a long time ago if she had taken TR to the appropriate doctor check ups that children his age should go to. If he had been diagnosed with his hearing loss earlier he would have probably

gotten hearing aids at first but most likely would have made little difference due to his type of hearing loss but he would have to wait until he was one year old to get his cochlear implant. He would have gotten an IFSP that would have included training of the parents on how to deal with a child with autism and hearing loss and the would be six months further along at least as far as getting used to therapy sessions and doctor visits. We are going to recommend a very high intensive schedule for therapy here at our Aural Rehabilitation center as well as intensive training for both his aunts so that they can conduct intervention at all times for TR because children with autism need constant intervention. We are also recommending Speech therapy after the surgery two to three times a week. TR is a candidate for a cochlear implant and both of his aunts wish to get him one this month. He is a candidate because she has a severe to profound SN hearing loss. The Cochlear Implant process is a seven step process. These are the seven steps in the process: initial contact, pre-implant counseling, formal evaluation, surgery, fitting and activation, follow-up, and aural rehabilitation. 5) First we will be working on TRs Detection skils: for example does TR respond to the presence or absence of sound, pay attention to sound, or respond when there is no sound. We will be working to get TR to show us selective attention to sounds and demonstrate Meaningful Auditory Integration Then we will work on Discrimination skills: for example working on having TR show that he can perceive similarities and differences between two or more speech stimuli/attend to difference and respond differently to different sounds. We would like TR to show that he can discriminate between moderately different speech stimuli as well. Then we will work on Identification: Have TR label by repeating, pointing to or writing the speech stimuli. We want TR to show identification of common phrases/actions/ songs. Lastly we would work on Comprehension: have TR understand the meaning of speech by answering questions, following instructions, paraphrasing, and hopefully have conversations. 6) For TR we are going to work on his detection skills first after TR gets his cochlear implant. After we are done working on his detection skills we will move on to his discrimination skills. We will evaluate his rate of progress carefully and concentrate on one skill at a time intensely before moving on to the next skill. In his condition if he shows any engagement or responses at all at this point we will consider that progress.
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Some services available to TR through IDEA are family counseling, speech pathology and audiology, occupational and physical therapy, case management, psychological services, medical services for dx and evaluation, screening and assessment, as well as transportation to and from services. Public schools will also pay for mapping if TRs parents opt for cochlear implants. Instrumental in developing the most effective IEP for TR is the multidisciplinary team. This is made up of an audiologist, speech pathologist, his teacher, special education teacher, occupational therapist and physical therapist and most importantly TRs aunts. In the case of his cochlear implant, a surgeon will be included on the team. TRs IEP

related to his school placement when he is old enough will include: classroom placement, communication mode, and listening device. He will be assessed using the Early Speech Perception Test (ESP). When TR is three years old he will have an audiological diagnostic follow-up every 6 months.
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At the age of five TR will be assessed using the Early Speech Perception Test as well as the Auditory Verbal Scales for Listening. TRs rate of progress should be somewhere around three months of progress for every twelve months that pass or less. This is the typical rate for children who are profoundly deaf and autistic. He will have a very intense schedule of treatment which will probably include aural rehabilitation three times a week or more and speech therapy two times a week or more. He will need constant intervention all day everyday and that is why his aunts will need intensive training and constant updates from his therapists so that they are working on his goals at all times. TR is going to have social, emotional and cognitive delays already based on his autism alone. The hearing impairment is only going to make these delays worse exponentially. If his therapy with using his cochlear implants goes well and he develops some sort of communication it will help his delays but also may not. TR will need to be in intensive intervention programs for most of his life. He will never get a chance to be in a mainstream school based on his condition of hearing impaired and autism. There are many local Autistic specific centers that TRs aunts will have to choose from but in TRs case they will need to find one that has some experience with working with hearing impairments. In TRs case we are going to explore all options of communication. Whatever he responds to best will determine which path we take but we will start out with English, sign language or picture cards. The Ipad is beginning to gain popularity as a alternate communication device as well and will be explored if needed. We will choose whatever option best suits TR to help him gain independence.

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