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IFSP update at 17 months old


Kidango Early Intervention Services
Progress Report

Child: Oliver Nakahara Date of Report: January 2009
DOB: 8/4/07 Parents: Nada & Daniel
Chronological Age: 17 months


Background: Oliver is a charming, loveable little boy who is now 17 months old. He greets me with a big smile and often creeps over to meet me at the door; when I leave at the end of our sessions, he waves goodbye. Oliver’s health has been good over the reporting period, with the exception of minor respiratory illnesses. He was diagnosed prenatally with Trisomy 21 (Down syndrome); for further information regarding his medical history please refer to previous reports and other records. Oliver lives with his parents, both of whom are employed full-time outside of the home; he attends a small home daycare program during their working hours.

Kidango Intervention Program: Oliver has been enrolled in home-based early intervention services since 11/7/07. He receives weekly home visits with Lisa Katzman, Physical Therapist, for up to five hours per month.

Other Services: Oliver receives direct physical therapy services on a weekly basis from Suzanne Souza, DPT. He has also had several home visit sessions with Candy Sullivan, Home Visit Specialist / Sign Language Instructor from the Center for Early Intervention on Deafness.

Family Concerns & Priorities: Provide Oliver with appropriate services so that his development progresses optimally, including weekly direct physical and speech therapy services.

Goals from last Progress Report (7/08): Within the next six months, Oliver will:
1. Place three or more objects inside a container – achieved
2. Look at simple pictures in books for longer periods of time – achieved
3. Babble by stringing together two or more syllables at a time – achieved
4. Increase the number of consonant-vowel combinations and signs that he uses – achieved
5. Use his tongue to make sounds – achieved
6. Look for family members when their names are called – achieved
7. Understand one or more simple question(s) – achieved
8. Understand more simple sign language – achieved
9. Creep in a hands/knees position for longer distances – achieved
10. Pull himself up to standing at low surfaces – achieved
11. Use a neat pincer grasp to pick up tiny pieces of food – progressing
12. Activate a variety of mechanical switches and buttons with help as needed – achieved
13. Manage a reasonable amount of separation anxiety with help as needed from a caregiver – achieved
14. Demonstrate a wider range of emotions with help to interpret and name his feelings – achieved
15. Have more opportunities to interact and play with peers – achieved
16. Use a spoon to scoop food and feed himself with help as needed – achieved
17. Finger-feed small pieces of food – achieved
18. Hold and drink from a bottle or sippy cup with little or no help – progressing.

Assessment Method: Oliver was evaluated using the Hawaii Early Learning Profile (H.E.L.P.), the Battelle Developmental Inventory, the Peabody Developmental Motor Scales, and the Rossetti Infant Toddler Language scale. He was assessed during both self-directed play and structured activities; clinical observations were made and parental report was obtained.

Cognitive Skills (how he thinks and solves problems): Oliver engages in a variety of simple relational play activities by combining two different but related objects, such as a stick and a drum or a ball and a container. He pushes and slides all kinds of toys on flat surfaces, and he especially enjoys doing this on the smooth wood floors in his home. He imitates many familiar, new, and invisible gestures; he knows and uses various simple signs, and he learns more signs on a regular basis. Oliver’s favorite videotape is “Baby Signing Time," and he received the next videotape in the series as a holiday gift; he is clearly fascinated by the new signs that he is observing and beginning to practice with his family. He is very persistent in searching for and attempting to retrieve hidden objects, particularly when the item in question is something that he knows is not meant as a toy! Oliver loves to pull toys on strings, especially if the action produces a loud sound. He operates a variety of mechanical buttons and switches with little or no help; he takes a ring stack apart and replaces four or more rings. Oliver really enjoys looking at pictures in books, and spends much more time on each page. He takes apart and reassembles three or four nesting cups or blocks with a little help. He is beginning to match sounds to animals; he says “mm” for the sound of a cow and he names a cat by saying “ah-goo!”. Oliver’s age equivalents in the cognitive area are 19 months in attention/memory skills and 16 months in perception/concepts skills.

Goals: Within six months, Oliver will:
1. Put shapes into the matching holes on a shape-sorter
2. Point to familiar people/objects upon request.

Expressive Language Skills (how he communicates): Oliver loves to babble now and he vocalizes at least four different syllables and several two-syllable combinations. He makes sounds when he sees an object move and during cooperative games with familiar adults. He imitates duplicated syllables and some consonant-vowel combinations. After Oliver wakes up, his parents often hear him having “conversations” with himself and his toys; he calls for his mother when he is ready to get out of his crib. He frequently vocalizes with intent and uses familiar signs to get a need met, to ask for help, and to request a change of activity. He says “mama” meaningfully approximately 80% of the time; he frequently says “dada,” but does not yet use the word as a name for his father. Oliver currently uses signs for: more, all done, milk, cold, dog, ball, shoe, cracker, bear, train, wash hands, sleep, bath, car, hot, thank you, airplane, and fish. He made up his own special sign for indicate that he wants to watch “Baby Signing Time.” Oliver’s expressive language skills are solid at the 6-9 month age range and emerging at the 9-12 month age range.

Goals: Within six months, Oliver will:
1. Say “dada” and “mama” consistently with meaning
2. Use familiar signs to ask for what he wants
3. More consistently imitate new sounds and words.

Receptive Language Skills (what he understands): Oliver recognizes his own name; he stops and looks toward the speaker when someone calls him. He also looks toward his parents when he hears their names. He waves in response to “bye bye,” lately with what could be described as a “finger wave.” Oliver gives objects and performs a routine activity upon request; he looks at familiar items when they are named or mentioned during conversation. He follows simple directions without gestures, such as “find your ball” or “give your toy a hug.” He sometimes shows understanding of simple questions such as “do you want some milk?” or “do you want to watch your video?” by using the appropriate sign to answer the question. Oliver gestures in response to requests such as “clap your hands” or “give me the toy,” and he enjoys participating in songs with hand or body movements. He sometimes vocalizes when asked to do so, and he is beginning to show more interest in new words that he hears. He identifies six body parts on himself or his parents, including: nose, mouth, ears, head, feet, and teeth; he is learning to point to his eyes and tummy. Oliver’s receptive language skills are solid at the 6-9 month age level, with many skills acquired and a few others emerging at the 9-12 month age range.

Goals: Within six months, Oliver will:
1. Follow more simple directions
2. Demonstrate better understanding of familiar questions by clearly using a sign, gesture, or word instead of crying
3. Show understanding of some prepositions (in, on, under).

Gross Motor Skills (how he moves his body) & Fine Motor Skills (how he uses his hands and eyes): Oliver balances in sitting and hands/knees position by himself, and he uses creeping on hands and knees as his primary mobility method. He audibly smacks his hands down onto the wood floors while he is creeping, so it is usually easy to tell where he is in the house. He still prefers ring-sitting, but he is much more flexible about trying other positions; he loves to pivot himself around in sitting by using his feet. Oliver pulls himself up to standing through a half-kneel position at various low surfaces in his home; he usually moves back to the floor by plopping down into sitting. He cruises along the edges of couches and chairs, but does not yet move between different pieces of furniture. Oliver balances in standing with support from an adult or by leaning on his arms and upper body. He bears most of his weight on his feet and legs and takes a few steps with his hands held. He enjoys bouncing and rocking on a small, inflatable horse during our sessions. Oliver’s gross motor age equivalents are 11 months in stationary skills, 9 months in locomotion skills, and 12 months in object manipulation skills. For further information on gross motor status, please refer to current report by Suzanne Souza, DPT.

Oliver uses a variety of grasps, depending upon the size of the object, including a radial digital grasp to pick up tiny pieces of food. He clearly understands the concept of placing a pellet-sized object inside a bottle with a narrow opening, and he makes many attempts to accomplish the task. Oliver puts many round or disc-shaped objects inside containers with matching holes, and he is learning to place square and triangular shapes inside a sorter. He grasps a marker adaptively and spontaneously scribbles on paper; he easily transfers toys from one hand to the other, bangs two cubes together, and attempts to make a tower of two small blocks. He removes all the pieces from a form board, puts the circle back in its spot, and attempts to replace the square and triangle as well. Oliver takes many round pegs out of a pegboard and puts back two of them. He is learning to put large buttons onto a thick string with help. Oliver’s fine motor age equivalents are 12 months in grasping skills and 15 months in visual-motor integration skills.

Goals: Within six months, Oliver will:
1. Cruise between low pieces of furniture
2. Balance in standing by himself for short periods of time
3. Walk for a few steps without support
4. Creep down three to four stairs with less help
5. Pick up tiny objects with a neat pincer grasp
6. Stack two or more blocks.

Social - Emotional (how he interacts with others and expresses his feelings): Oliver is a wonderfully social and happy little boy, and this is an area of great strength for him. He is able to separate from his mother fairly easily in familiar environments such as his daycare program or his grandparents’ home. He is very curious and explores the environment enthusiastically now that he is able to creep and pull to standing. It won’t be long before Oliver is getting into even more mischief than he already does! He attempts self-direction during feeding and usually eats better when he is allowed to do it by himself. He needs and expects rituals and routines, but he is currently in the middle of changing his own daily schedule to exclude his morning nap.

Oliver has a great sense of humor and he laughs often at our silly behavior. He loves to make others laugh, and he frequently repeats sounds and gestures that accomplish that goal. He hands toys back to familiar adults spontaneously and upon request and cooperates with simple games such as rolling a ball back and forth with a partner. Oliver enjoys playing side-by-side with his peers at his daycare program more now than he previously did. He recently played next to another child at an activity table; he felt the other child’s hair, touched her gently, and at times tickled her and himself too! He has also gotten used to the daycare provider’s little dog: he says “ah-goo!” and signs “dog,” but shoos her away if she gets too close. Oliver’s age equivalents in the personal-social area are 24 months in adult interaction skills and 20 months in self-concept/social role skills.

Goals: Within six months, Oliver will:
1. Participate more actively during songs with gestures
2. Demonstrate understanding of “no-no” by changing his behavior.

Self - Help (how he eats, sleeps, and takes care of his needs): Oliver bites food voluntarily and chews food using rotary (side-to-side) jaw movement. He eats a varied diet of table food, finger feeding small pieces of food independently and scooping food to eat it from a spoon with help. He holds and tips either a sippy or an open-rim cup to get liquid into his mouth, but tends to let it dribble out of his mouth instead of swallowing it. Oliver chews on the sippy cup top but does not usually suck on it. He cooperates with dressing by extending his arms or legs; he removes a hat from his head and socks or unfastened shoes from his feet. He has great fun imitating adult behavior and responds very well to the introduction of new tasks, especially after repeated exposures to the same activity. Oliver explores cabinets and drawers in his home and loves to empty the dresser drawers in his room that are on his level. He reached up to the front door handle and pulled on it during a recent session – luckily, it was locked, so he couldn’t open it as well! He sleeps through the night and takes one or two naps during the day. Oliver has difficulty going to sleep without being rocked and/or patted after having a bottle, despite the fact that his parents follow the same routine each time. When laid down still awake, he tends to sit up and look around or lean over in sitting onto his legs instead of lying back down and going to sleep. Oliver’s age equivalent in the self-care area is 15 months.

Goals: Within six months, Oliver will:
1. Hold and drink from a sippy cup
2. Scoop food and feed himself using a spoon with less help
3. Show better understanding of his bedtime routine and improve his ability to go to sleep with less help.

Summary: Oliver is a delightful and socially interactive little boy who is very interested in communicating with other people. He continues to enjoy home-based early intervention services and is making excellent progress. His greatest strengths are in the cognitive and social-emotional areas, with motor and language skills being of most concern. Oliver’s parents provide a warm, loving, and supportive home environment where he can continue to grow and learn. We have a lot of fun during our sessions and it is a pleasure to work with Oliver and his family. If there are questions regarding this report or the services that are being provided, please feel free to contact me at (510) 656-3949, extension 304.

Recommendations:
1. Continue early intervention services via home visits for up to five hours per month
2. Continue home visits with hearing specialist for up to three times per month
3. Continue direct physical therapy treatment sessions for up to five hours per month
4. Facilitate direct speech/language and occupational therapy assessment and treatment as appropriate.
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