I have mentioned this before, but to repeat…my younger sister Sydney decided to obtain a masters in Autism Education and ABA therapy about three months ago. I remember the day she called me to tell me she was going through with this, and I got chills. My heart was so full that day.
One of the requirements for a particular class, was to write a research paper including a case study of a child having autism. Sydney, without hesitation, decided to write the case study on Cali. I provided her with loads of information including the write-ups on Cali’s official diagnosis. She looked it over, studied it through, and came up with something perfect. In fact I felt so grateful to have her use words and explanations that were much more basic and easily understandable. Reading through Cali’s official diagnosis can be a bit overwhelming with too many numbers and complicated test results. I thought many of you would love the chance to read through this amazing case study write-up. Thank you Sydney. Not just for this, but for making the decision to follow this entire coarse of continuing your education. Who knows, maybe one day I will follow in your footsteps…
Cali was born in a hospital on September 2008. She was a healthy 6 pound 13 ounce baby with no complications during delivery or postnatally. She lives with her biological parents and younger sister, Ava. Her mother is a stay at home mom and her father works in an office close to home. Cali sees all family members multiple times a day. Cali has a large extended family, some of which live close to her in Utah.
Cali met her early milestones in life. Her mother reports that she did show resistance to cuddling as an infant but other than that was a very typical baby. Cali showed no delay in fine or gross motor development. She rolled over, crawled, and walked at appropriate times. Around 20 months Cali began saying single words and progressed to a vocabulary of 50 single words. Around 22 months her parents began to have concerns when her progress seemed to plateau. She was no longer acquiring new vocabulary. Receptively Cali was able to understand “no” and could answer yes or no questions but was not able to communicate with open-ended questions. Cali also had some nonverbal communication. She would shake her head no and point to things but did not go much beyond that. At this time her younger sister was 7 months old and Cali had yet to show much interest in her. Cali did however have very strong reactions to hearing her sister cry. Cali’s parents noted that it was also very hard to establish eye-contact with Cali. While she showed interest in what others were doing, she did not generally join in. Cali played correctly with toys and did not tend to have repetitive play. She would tend to move quickly from one activity to the next without much meaningful play accruing without a model. Due to the above characteristics, Cali’s parents brought her to Autism Journeys, a consulting and treatment center, for an evaluation.
The first evaluation that was administered to Cali was an initial speech/language evaluation. This was done on January 31, 2011 by a licensed speech pathologist. Cali was assessed using the Receptive-Expressive Emergent Language Scale-3 (REEL-3), a caregiver report, and an informal observation. The average score for this test is 100 with a standard deviation of +/- 15, making scores of 85-115 within the normal range. Cali scored a 77 on her receptive ability score, a 73 on expressive ability and an overall 70 on her language ability score. At the time of the test Cali had a chronological age of 28 months. Her tests scores revealed her receptive language age as 16 months and her expressive language age as 15 months. It was recommended that Cali begin speech/language therapy and also receive a complete psychological and developmental evaluation. Cali began right away receiving therapy for speech and her parents scheduled further evaluations.
The ADOS module I was administered to Cali on February 28, 2011 by Natalie H. Roth Ph.D., a licensed psychologist. Module I was used due to her meeting the module I criteria of either being preverbal or using mainly single words. The first area that the ADOS looked at was Cali’s skills in social communication. Cali’s delays in this area ranged from mild to more marked. She displayed limited gesturing and did not make direct vocalizations towards others. The next aspect tested by the ADOS was Cali’s abilities in reciprocal social interaction. Cali also presented with mild to marked delays in this area. Cali displayed the most difficulty with the ability to make frequent eye contact. She did however demonstrate some shared enjoyment when playing interactively but this was not consistent and seemed to depend on the context or object being played with. Cali was able to follow the examiners gaze to distal objects. Dr. Roth noted that Cali was able to play functionally with objects and mimic her lead. While she did not show much creative or imaginative play, she demonstrated no usual sensory interest in objects or people. Cali also did not display any usual repetitive behaviors. After the conclusion of the ADOS, it was determined that Cali scored a 15 placing her within the range for an Autistic Spectrum Disorder. Dr. Roth followed up with Cali a week later to administer an IQ test and noted in her findings that Cali’s score on the ADOS was most likely an underestimate of her abilities. Cali seemed better able to share enjoyment, display affect, and look for the reactions of others.
On March 7, 2011, Cali was evaluated on the Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III) by the same psychologist. Through the WPPSI-III, Cali received a score of 82 on IQ and her factor scores were 88 on verbal, 81on performance/nonverbal and 94 on Global Language skills. Each of these scores had a mean of 100 with a standard deviation of 15 making the typical range between 85-115. The WPPSI-III broke down Cali’s Verbal and performance/nonverbal scores. In the verbal category she scored 7 on Information and 9 on Receptive Vocabulary. In the performance/nonverbal category she scored 6 on Block Design, 9 on Picture Naming and 7 on Object Assembly. These scores had a mean of 10 with a standard deviation of 3 making a score between 7-13 typical. From the WPPSI-III test Cali was given full score that places her within a low average range at the 12th percentile. Her verbal and nonverbal scores were in the low average range as well. Cali’s global language score was in the average range and placed her in the 34th percentile for that category.
Based on these three diagnostic measures, it was recommended that Cali’s parents seek intervention for Cali. The examiner noted that Cali seemed very bright and was very willing to work with others. After several weeks of speech therapy it was observed that Cali responded very well to intervention and was highly capable of learning. The examiner also acknowledged that Cali had very supportive and proactive parents. Dr. Roth anticipated strong progress with the appropriate intervention.
Cali’s parents began therapy right away. Cali receives intervention from a team at Autism Jouneys. This facility uses a collaborative approach meaning that Cali is served by a team of individuals who work together. Cali is seen by a speech pathologist, occupational therapist, autism specialist, and a psychologist who does the evaluations. This team of professionals works together to provide Cali with intervention. Each week Cali receives 3 hours of speech therapy in the home by a licensed speech pathologist, 4 hours in the home of developmental/ABA therapy by the autism specialist, 1 hour of occupational therapy at the center and ongoing therapy delivered by her mother on average 10.5 hours a week. Cali also does 1 hour of outside hippotherapy a week and attends mainstream preschool for 4 hours a week. In total Cali is receiving 23.5 hours of therapy throughout the week including her time spent at preschool. Cali has seen monumental gains from intervention.
After almost a year of speech therapy, Cali was evaluated using the Clinical Evaluation of Language Fundamentals Preschool – 2nd Edition (CELF-P2) assessment. This test has an average score of 100 with a standard deviation of +/- 15. In March of 2012 Cali received a score of 73 for core language, 83 for receptive, 69 for expressive, 81 for language content, and a 71 for language structure. In October of 2012, Cali’s progress was evaluated again using the same assessment (CELF-P2). This time her scores were 86 for core language, 81 for receptive language, 81 for expressive language, 81 for language content and 80 for language structure. Cali’s score of 86 for core language places her within the normal range for core language. In 7 months’ time, Cali’s core language, expressive language, and language structure improved between 9 and 13 points each. Her language content remained the same and her receptive language dropped by 2 points. All of her current scores are close to reaching the bottom of the normal range.
Cali turned 4 years old in September. She is making remarkable progress. Cali responds very well to therapy and tends to learn things quickly. Some of the greatest areas of progress are her language, her ability to transition smoothly, and her ability to interact with others. At the time of her initial evaluation, three of her mothers biggest concerns were Cali’s tantrums, her obliviousness to her sister, and her delayed speech. These areas are no longer points of great concern. Cali and her younger sister are the best of friends. They love each other and enjoy playing with one another. Cali shares in her younger sister’s joys and excitement. As shown above, through Cali’s recent speech evaluations, Cali’s speech is progressing greatly. While she still has room for improvement, the developmetal gap is quickly closing. Tantrums are also few and far between. Cali responds very well to techniques aimed at helping her transition smoothly. If a timer is set and Cali is told only 5 more minutes, then she is perfectly okay to be done after 5 minutes. Cali also learns very well from social stories. Her mother has found that if Cali is shown a social story before a big event she is able to handle it with ease and the out of ordinary does not throw her off. While Cali has a remarkable team of therapists working along side her, it must be noted that she has an incredibly dedicated and hard working mother. Cali’s mother does not let a day go by without ensuring Cali’s learning and therapy takes place. She is extremely involved in creating the best environment for Cali at home, school, church, therapy, or wherever else they may be. Cali is an incredible 4 year old girl whom I believe will continue to progress and close any current or future developmental gaps. She has a remarkable brain for learning new things and a personality that is determined and loves to make others proud. I believe she will continue to work hard and continue to improve.