1Running head: ACTIVITY INTERVENTION 2[Type text]

8ACTIVITY INTERVENTION

Assistive Technology Activity Based Intervention PlanJulia HartThe George Washington University

BackgroundEli is a 63-month-old boy with Potocki-Lupski Syndrome. Eli lives in the Washington, DC area with his mother, older sister, and younger sister. Elis father spends much of the year traveling abroad for work, but spends time with Eli when he is able to. Elis parents are originally from Italy, but they mainly speak English in the home. Eli and his sisters attend English-speaking schools. Eli attends a private, inclusive nursery school in Washington, DC five days per week. Eli is an active boy with a strong interest in animals and the natural world. He enjoys the outdoors and spends his playground time digging or exploring water. In the classroom, Elis teachers noted that he spends a great deal of his free time reading books. He often sits in the teachers chair and acts as though he is reading to the class at circle time. Potocki-Lupski SyndromePotocki-Lupski syndrome (PTLS) is a contiguous gene syndrome involving the microduplication of band 11.2 on the short arm of human chromosome 17 (17p11.2) (Potocki-Lupski Syndrome Foundation, 2014, para. 1). The incidence of PTLS is believed to be 1 in 25,000 (Treadwell-Deering, Powell, & Potocki, 2010). Individuals with Potocki-Lupski syndrome typically present with minor dysmorphic features (epicanthal folds, strabismus, mild micrognathia, down-slanting palpebral fissures), mild-moderate intellectual disability, feeding difficulties/failure to thrive, communication disorders, hypotonia, and autism spectrum disorders (Greco et al., 2008; Treadwell-Deering et al., 2010). There is some debate regarding classifying autism spectrum disorders (ASD) as a typical phenotype of PTLS, but one pivotal study of children with PTLS found 11 of the 15 children studied were identified as having ASD (Treadwell-Deering et al., 2010). Ercan-Sencicek and colleagues (2012) argued that ASD could not be considered a central characteristic of PTLS. In their study of a single patient presenting with the 17p11.2 duplication but no autistic characteristics the authors wrote, the central feature of the syndrome appears to be related to diminished speech and language capacity, rather than specific social deficits central to autism (Ercan-Sencicek et al., 2012, p. 700). EliEli currently does not receive special education services through an individualized education program (IEP). Elis mother chose not to pursue interventions for Eli once he aged out of his countys Infant and Toddler Program of home-based early intervention services. Eli did receive services in the home from approximately 12-36 months; his mother would not specify which services he received or how often they were provided. He has had minimal formal testing in the last two years, but the interventionist and Elis teachers do not believe that he has ASD. Elis teachers described his language as being similar to that of a two-year-old. Upon repeated urging by his teachers, Elis speech and language were evaluated by a speech and language pathologist (SLP) after his fifth birthday and he began receiving speech therapy. Eli also began receiving occupation therapy services soon after his birthday this year because Eli is extremely hypotonic and has poor fine motor skills for a child his age. Eli currently receives 1 h of speech and language therapy and 2 h of occupational therapy each week, by private providers.

Intervention Plans

Domain: Fine MotorInstructional Strategy: Cutting a paper into two pieces with scissors.AT Support: Self-opening scissors. Description: Cutting with scissors is a task that most children master in their preschool years. Because Elis fine motor skills are delayed, he struggles to complete more than a few snips with standard scissors. Many children in Elis class have been cutting paper hearts and designs recently and Eli has shown some interest in the task. These adapted scissors will provide support by self-opening, allowing Eli to work solely on the task of closing the scissors. If the scissors are successful at school, a pair might be sent home so that he can complete craft projects at home with his sisters. Resource: E Special Needs- http://www.especialneeds.com/scissors-special-needs-scissors.html

Domain: CommunicationInstruction Strategy: Use animal names and sounds appropriately.AT Support: The Cow That Went Oink Activity Set (from Lakeshore Learning)Description: Elis vocabulary is extremely limited. His teachers have noticed that he calls several animals by the same name and often refers to animals by their sounds rather than their names. For example, he calls ducks quack and pigs sheep. Eli loves stories, so acting out a story that includes animals and their sounds will help to build Elis animal-related vocabulary. These are important childhood vocabulary words because many picture books use farm animals as the main characters, so being able to correctly name animals and their sounds will help Eli in further book-reading activities. Elis mother can be encouraged to integrate props into home story reading as well. Resource: Lakeshore Learning- http://www.lakeshorelearning.com/seo/p%7CHH656~~.jsp

Domain: Gross MotorInstruction Strategy: Sitting straight without back supportAT Support: Wiggle Seat/Disc-o-sitDescription: Eli struggles to sit without back support due to his low-tone and weak core. Sitting on the wiggle seat will help to engage Elis core and strengthen his muscles. This seat was recommended by his occupational therapist (OT). The OT suggested that Eli sit on the seat during circle time and meal times. An additional seat could be purchased for his home, if his mother is amenable. Resource: Pocket Full of Therapy: http://shoponline.pfot.com/seatcushions.htm

Domain: CognitiveInstructional Strategy: Name recognition throughout the school day.AT Support: Name card with photo.Description: At school, children are expected to recognize their name on their seat at circle time, on their artwork, on journals, and in many other contexts. Because Eli does not yet recognize his name or any of the letters, when tasks requiring name recognition occur, his teachers can present him with his name car that has his photo on it. The teachers will help Eli learn to match the name on the card with his name across locations and contexts. Elis mother can be encouraged to label items at home with his name so that Eli has greater exposure to his name. Resource: Home-made with sentence strips and small photos.

Domain: Self-HelpInstructional Strategy: Eat with a utensil with minimal mess.AT Support: Adapted utensilDescription: Eli is motivated to self-feed and does so with moderate success. When using a standard utensil, much of Elis food falls into his lap before the spoon makes it to his mouth. These adapted utensils may allow for easier handling, due to the wide grip, and smoother movement to the mouth, due to the angled head. Hopefully the adapted utensil will allow Eli to get more food in his mouth and less food on the floor. Additional utensils can be sent home if his mother would like to use them during meals at home. Resource: E Special Needs- http://www.especialneeds.com/easie-eaters-curved-eating-utensils.html

Domain: Social-EmotionalInstructional Strategy: Engage in a pretend play scenario with a peer.AT Support: Pretend restaurant menuDescription: Because Eli has begun initiating dramatic play restaurant scenarios with adults; this prop can be used to help him initiate play with a peer. In the classrooms dramatic play center, the teacher can show Eli the menu and help him present it to his peer. Eli will be prompted to ask, What would you like? which is a phrase already in his play schema. The pictures on the menu will help support the other child choose a food to order and scaffold the interaction. Eli can either present an imaginary food to the peer or use a plastic food prop from the play kitchen. Elis mother can also be given a copy of the menu, so that he can replicate the play scenario at home with his sisters. Resource: https://www.pinterest.com/pin/199988039672513610/

ReferencesErcan-Sencicek, A. G., Wright, N. R., Frost, S. J., Fulbright, R. K., Felsenfeld, S., Hart, L., Grigorenko, E. L. (2012). Searching for Potocki-Lupski syndrome phenotype: A patient with language impairment and no autism. Brain & Development, 34, 700-703. Potocki-Lupski Foundation (2014). PTLS info. Retrieved from http://ptlsfoundation.org/ptls-info/Treadwell-Dearing, D. E., Powell, P., & Potocki, L. (2010). Cognitive and behavioral characterization of the Potocki-Lupski Syndrome (duplication 17p11.2). Journal of Developmental & Behavioral Pediatrics, 31(2), 137-143.