Preschool Case Study

Age: 4years 9 mos.

Reason for ECSE services: Down syndrome, intellectual disability requiring constant support, complex communication needs

Medical Information: Down syndrome, thyroid deficiency (takes synthyroid), strabismus, atlanto-axial subluxation, ventricular septal defect repair, feeding difficulties (aspirates on thin liquids, has difficulty chewing solid foods).

Family History: Rosa lives with her parents and grandmother. The family is from Puerto Rico. They moved here when Rosa was two years old. Rosa has no siblings. The family is deeply religious. The family travels back to Puerto Rico several times a year. The family is bi lingual. Rosa has had most of her medical interventions here in the United States. She did not participate in EI services. Family was reluctant to send her to preschool but finally agreed to do so when Rosa was 3 and half.

Medical History: Rosa was born full term. She was diagnosed with Down syndrome shortly after birth. Rosa was being monitored in Puerto Rico for her heart condition (ventricular septal defect) as well as for her overall developmental delays. Her parents report that she had frequent bouts of pneumonia as an infant. It was determined through medical tests that Rosa was aspirating on thin liquids like formula. She was NG fed for a few weeks, and then she did fairly well with formula that was thickened to nectar consistency. Her family moved here right before her second birthday. Rosa had heart surgery to repair the VSD at age 29 months. She continues to have difficulty with thin liquids, however, when liquids are thickened to nectar consistency she does not aspirate. She also has difficult chewing solid foods so right now her food is ground up. She still needs assistance with feeding herself. She has very low muscle tone. She walked at 30 months of age. She has been diagnosed with atlanto axial subluxation so she cannot participate in any rough and tumble play activities. She is also near sighted and will need surgery in the near future to correct strabismus. She does not like to wear her glasses. She has frequent ear infections that respond to antibiotics.

Educational History:Rosa attends her LEA inclusive preschool classroom. She enjoys coming to school. She receives the services of a preschool intervention specialist, an OT, a PT and an SLP. She attends 4 half days per week. There is also a nurse in the building for the program. Rosa walks although she tends to fall a lot. She is learning how to go up and down steps. Her fine motor skills are also delayed. She is able to pick up objects like small blocks but has difficulty picking up smaller objects. She finger feeds but does not yet use utensils consistently. She drinks from a cut out cup and a staff member must assist her with this because of the aspiration issues. She communicates using facial expressions, pointing, and vocalizations. Her parents speak Spanish to her at home and she hears English in school. Rosa has said 1 or 2 words in Spanish at home according to her parents. In school, she says hi to her peers during circle time. She can make choices of what she wants to play with by pointing to the objects. She uses gestures to communicate, for example she turns her head when she does not want any more food. She pushes an object away when she is done with.

Her IEP team including the parents has identified the following areas of need for Rosa:

1. Developself help skills of using utensils
2. Improving motor skills so that she can walk up and down steps
3. Communicate using signs, pictures or words

Dear guardian of the Rosa:

As you see; the educational institution is interested in Rosa academic achievement. Furthermore, we hope you let us know the information that attached to the letter; to help us in assessing the needs of your child, the consequent preparation and processing of Rosaintervention.
All these questions can help the staff to understand Rosa situation and needs. Also, it can help with Rosa IEP and daily schedule.

If you need any information, please feel free to ask about it. We as an educational institution care about your child and trying to give her the best education she can have.

Please answer these questions about:

• Rosa heart ventricular septal defect:

- Does the VSD hole still exist? How significant is the defect?
- What are the symptoms that Rose has?
- What is more likely causing Rose's symptoms?
- Does your child breathe rapidly or run out of breath when eating or crying?
- What are some activities that Rosa should not do?
- What medication does Rosa still take, and when does she take it?
- What is the right amount of medication for Rosa?
- What signs and symptoms should I watch for in class and at the playground?
- When do we have to call the doctor about Rosa's condition?
- Does Rosa have any electronic devices in her heart?
- What kind of treatment does Rosa get for her VSD?

• thyroid deficiency:

- Does the thyroid deficiency affect Rosa's heart, such as by slowing her heart rate?
- What is the ideal weather for Rose (class/playground temperature)?
- What do we need to do if Rose starts to choke?
- How much water should she get on a typical school day?
- What foods and drinks should she avoid?
- When should Rosa take her medicine, and how long should she wait to eat?
- Does the thyroid deficiency affect the growth of Rosa's teeth?
- Should we watch Rosa's blood pressure, and how often?
- What are some of the symptoms preceding pneumonia?
- What kind of medicine does she get while having pneumonia?

• Drinking and Feeding:

- What formula does Rosa need to drink?
- What type of food does she eat?
- Does Rosa need NG feeding in any condition?
- What is the right way to feed Rosa?

• atlanto axial subluxation:

- Does Rosa need any assistance with playing?
- Does Rosa need to have an assistant device?
- What kind of playing should she avoid?

• Vision and hearing:

- What kind of color can Rosa see clearly?
- Up to what distance can Rosa see clearly?
- For how long does Rosa need to focus?
- Is Rosa able to interact with electronic devices?
- What kind of ear infections does Rosa usually have?
- What medication does Rosa take for her ear infections?
- Do ear infections affect Rosa's ability to hear?

• Behavior:

Please let us know if Rosa facing any behavioral issue such as:

1. Hyper active
2. Social interacte
3. Aggressive behavior
4. Hurts himself/ others
5. Persistent behavior

Dear Guardian:

This question has covered significant features that are effective to ensure that Rosa team members will create an active and helpful plan. These questions are useful for all the team including OT, PT, school nurse, teachers and school workers. Also, it will help all the team to collaborate and work hard to make sure that every step counts for Rosa benefit. Thank you for your participate with us, and please feel free to ask and add anything you see helpful for Rosa.