Multidisciplinary Team Report for Emma Bair

Name: Emma Bair

Date of Birth: 6/10/2014
Age: 3 years 11 months
Evaluation Date: 5/16/2018
Evaluators: Danie Duffin, Aspen Haderlie
Report Authors: Aspen Haderlie (1), Danie Duffin (2)

Reason for Referral (1)

Emma’s parents are concerned with her lack of verbal communication. Emma was diagnosed with a
hearing impairment and has recently received hearing aids because of it. Emma’s parents already know
she qualifies for Special Education services, but they want to know what the most effective ways will be
to help catch Emma up in the different developmental domains. Through observation, parent interviews,
trial intervention, and formal testing we will determine what domains Emma is behind in the most and
strategies we can use to aid in catching her up.

Background

Family Information and Social Emotional History: (2)

Emma has a very supportive and loving family. She lives with her mother Melissa and her father Adam.
Her father works and is the primary person who takes Emma places she needs to be. Her father is the
only one who is currently able to drive. Emma’s mother is a stay at home mom and takes care of Emma
while her husband is at work. Emma’s mother will also help Emma learn new signs and help encourage
her to verbalize the things she wants. Emma is “usually shy” around new people she meets and will
eventually “warm up to them.” Until Emma feels more confident around new people then she will
continue to stay by her mother’s side. Once Emma feels more confident she becomes more willing to
communicate with those she feels understands her and will allow them to play with her. Emma is eager
to show people her colors and her animal names. Emma’s mother shared that she very rarely has
tantrums and when she does she just pouts and cries. Her mother shared that it is very rare for this to
happen. It was also stated that Emma enjoys wearing her hearing aids. When she is attending church,
school, or in the park Emma asks to have them on.

Medical (1)
Emma was born with a genetic condition where she doesn’t have her nasal bone. Instead she “just has a
cute button nose.” Up to this point there have not been problems or concerns with the lack of a nasal
bone. Emma also was born without a full distal phalange on her fingers. She does have the distal
phalange, but it is half the size of what is typical. Emma’s mom, Melissa, reported that Emma did not
pass her newborn hearing test, but passed the following two hearing screenings. Emma passed the rest
the newborn tests and has continued to pass the tests for her vision. Melissa also reported that Emma
was born with the hearing impairment but was not diagnosed until she was 3. Upon the diagnosis the
doctors confirmed that her hearing impairment had been from birth. Emma’s Father, Adam, reported
that with the exception of the seasonal flu, Emma is typically a very healthy and active girl.

Developmental History (1)

When Emma was born there were indicators of a hearing impairment. She was diagnosed with a hearing
impairment when she was 3 years old. Leading up to the diagnosis, Emma’s parents were concerned
with Emma’s lack of communication. Not only was she not responding to sounds around her, but she
wasn’t participating in any type of verbal communication. The family started learning sign language and
using sign with Emma because of her speech delay. The family has continued to learn and use sign with
Emma. Her father reported that she knew somewhere between 575-600 signs and uses sign language
regularly to communicate. The family reported that while Emma has been slightly delayed in most
categories the one she is the furthest behind in is communication. The Speech pathologist that Emma
goes to has said that Emma has the verbal communication skills of about an 18-month-old. Emma likes
to help her parents around the house in their various activities and enjoys playing both inside and
outside. Melissa reported that Emma is very active and typically a happy little girl. Emma is toilet trained
and is usually able to communicate her wants and needs through sign language and gestures. Emma
prefers to wear her hearing aids when she is around other people (at church, school at the store etc.) but
usually wants to take them off when she gets home due to what her parents and speech pathologist
assume is listening fatigue.

Educational History (1)

Emma currently attends three different preschools during the week. Two times a week she attends the
BYU-Idaho preschool on campus. She also attends a preschool through Burton Elementary (part of
Madison School District) where Emma does have an IEP in place. Emma also attends a local community
preschool once a week.

Observations

Home Observation: (2)

During the observation Emma showed preference to specific activities. At one point her mother asked
Emma to tell the observers her colors. Emma refused to do so until she went and got her capes. Her
mother stated that her capes were her most prized possession and that it was interesting that she
warmed up to the observers so quickly. Emma took one of the observers down to play with her in her
playroom. She continued to prefer to show her the different colors she knew as well as her little kitchen.
Emma then went upstairs and wanted to ride her bicycle. Emma was fixated on riding her bike and when
originally told no by her mother continued to ask by signing bike. Emma’s mother eventually allowed her
to go outside to play on the bike. Once on the bike Emma continued to sign asking if she could ride it.
Once told yes and where to ride it Emma rode her bike with no complications. Emma continued to ride
her bike for about 30 minutes. She would sign to go faster. Emma would also stop riding her bike once
she did not see the observer right beside her. When given the opportunity to continue riding or go
inside, Emma chose to continue to stay outside. Once prompted to go inside Emma went without any
hesitation. On the way inside Emma found things to look at and was curious as to what they were. When
she was not able to figure out what they were she brought them inside to her mother to show her and
ask. Once given the sign as to what it was Emma became satisfied.

Emma was able to perform each task with ease. She had no difficulty when outside and knew exactly
where she could or could not go. It was apparent that once the observer was not right beside her on the
bike she would stop and look for them. The only struggle that was seen during this observation was that
of communication. Emma would try to sign on her bicycle while she was riding it and quickly realized
that she needs to stop completely in order to sign what her needs were.

BYU-Idaho Preschool Observation (1)

During the observation Emma responded to both verbal and sign language commands expressed
some of her wants and needs through sign language and gesturing. When Emma first entered the
preschool a student teacher said “Emma it's time to wash hands” while doing a hand washing gesture
with her hands. Emma then walked into the bathroom and proceeded to independently wash her hands
in an appropriate manner. When Emma saw an animal cage on the table she walked over to it and after
seeing what was inside signed the word “spider”. Emma signed the word spider several times through
the observation when she would go back over and look at the spider. Multiple times throughout the
observation Emma would direct a student teacher’s attention toward an object or toy using gestures
such as pointing and occasionally signing one word. At one point, Emma signed the word ‘cold’ and then
pointed over to where her jacket was hanging up when the student teacher asked if she wanted her
jacket. At one time a student teacher was talking to another student and said something about going
outside and needing a coat first. This conversation was not directed at Emma but she went and got her
coat off the hook and took it to another student teacher and started pointing out the door.

Emma was able to accomplish all of the physical tasks she tried to engage in. Emma was seen walking
around consistently as well as a little bit of running. When handed a paper plate and hole punches,
Emma was able to punch holes in the plate. The first attempt at this hole punching activity required
more time for Emma to successfully punch through the plate, but she continued to get faster and faster
the more she did it. Emma was seeing playing with a toy cash register where she was pushing buttons,
pulling money out and putting it back inside the register. Upon finding the stilts, Emma grabbed the rope
and stepped up onto the stilts and started walking around slowly exhibiting some control.

During the observation Emma was able to complete some self-help activities independently while she
still needed some help on others. Emma was asked to go wash her hands twice during the observations.
Both times Emma was able to turn on the water, get soap and scrub her hands, rinse, turn water off, get
a paper towel, dry hands, and throw the towel away all independently. After signing and saying she was
cold, a student teacher went to grab Emma's jacket. The student teacher grabbed a jacket that wasn't
Emma's and Emma shook her head and pointed to her jacket. She then proceeded to stick her arms
through the jacket as the student teacher held it up for her.

Trial intervention (2):

One of the goals that was set up for Emma was that of her doing things that were asked of her. Due to
Emma being hard of hearing coming up with activities for her to do were of highest concern. It was
decided to use an activity using colored blocks due to her knowing her colors. Emma was asked verbally
to hand the green block to one of the observers. Once asked, Emma did not respond. She was asked
again this time using sign language. Emma then continued to look at the observer who was asking her to
pick up the block. The observers then modeled what was needed from Emma. It was then again asked if
Emma to pick up the green block and hand it to a specific observer. It was then that Emma followed the
instructions. We continued to do this until all the blocks were collected.

Emma would typically respond to instructions that were signed to her. Even though Emma had her
hearing aids in, Emma would refuse to answer any verbally asked questions. She would continue to stay
engaged but would only answer once signs were given to her. Verbal cues are continued to be given to
Emma to help build her vocabulary.

Interview-Functional Assessment Interview - Routine Based Interview (1)

During the Routine Based Interview we had with Emma’s mother, Melissa, shared some of the major
concerns she and Adam (Emma’s Father) had. Some of their concerns were as follows:

● They can tell Emma understand them, but she doesn’t always respond to them when only verbal
language is used.
 ● While Emma seems to enjoy playing with other kids, she typically doesn’t ever initiate play with
others.
● They are very concerned with Emma’s communication overall and highlighted this as their
biggest concern. Emma uses sign language pretty well to communicate her wants and her needs,
but very rarely uses verbal language without being prompted.

In the morning Emma will typically wake up and play in her crib until her mom comes and gets her out.
Emma then picks out her own clothes for the day and continues to get dressed mostly independently.
Emma then eats breakfast with her mom. Emma is able to feed herself completely by herself. After
breakfast on Monday through Thursday Adam takes Emma to Speech Therapy for 30-45 minutes. Once a
week Emma will then go to Occupation therapy. After OT, Emma and her dad come home and Emma
typically plays inside for about an hour before lunch. Emma eats lunch with her mother and then her dad
comes and drives her to one of per preschools. Emma’s parents say that they never have any problems
dropping her off or picking her up at preschool. After preschool Emma comes home and plays for the
afternoon. Some days she has play dates with other children from the community. Other days Emma will
play downstairs either with herself or she will sometimes involve her mom in the play. When it is nice
outside they will go to Emma’s Grandma’s house and play out in her yard. When it is time for dinner
Emma likes to help her dad in the kitchen as they cook and prepare dinner. After dinner Emma knows it
is bath time. Emma enjoys playing in the tub but doesn’t like it when they need to wash her hair. After
bath time is over, Emma goes and picks out her own pajamas for the night. It is very important for Emma
to pick out her own PJ’s. Her family will then read books together or watch TV until it is time for Emma to
go to bed. Her Dad will carry Emma up to her crib, hand her a book, cover her with a blanket and say
goodnight. Emma will typically play silently for 20-30 minutes before falling asleep.

Testing (1)

Vineland II - Parent/Caregiver Survey (Vineland II) - Measures adaptive behavior of individuals through
five main domains; Communication, Daily Living Skills, Socialization, Motor Skills, and Maladaptive
Behavior. Administered: 5/11/18

Raw Score Standard Score Percentile Rank Confidence Interval

Communication - 59 .3 +/-3

Receptive 11 - +/-1

Expressive 21 - +/-3

Daily living Skills 79 8 +/-9

Personal 31 - - +/- 2
Domestic 6 - - +/-3

Community 10 - - +/-3

Socialization - 66 1 +/-7

Interpersonal Relationships 15 - - +/-2

Play and Leisure Time 19 - - +/-2

Coping Skills 7 - - +/-2

Motor Skills 70 2 +/-10

Gross 48 - - +/-2

Fine 28 - +/-2

Interpretation of Data

Motor (1)
Parent interviews, and observations indicate the Emma is performing at a level consistent with what is
expected in the motor domain for 3-4-year olds. Emma is able to walk and run around in control at
different speeds. She was able to demonstrate gross motor control as she walked around on the stilts.
This activity involved a combination of hand eye coronation, balance, and core strength. Emma is able to
ride her trike. She is also able to use a hole punch appropriately along with pushing buttons and hold a
pen with an appropriate pincer grasp. Emma also uses her hands through sign language to communicate
and is able to get the correct hand positions. There was some discrepancy between the results on the
Vineland-II and the information gathered through observations and interview. The testing indicated that
Emma was in the 1st percentile and significantly behind in her motor development. While there was a
discrepancy, it can still be expected for Emma to continue to develop at a typical rate alongside her
peers.

Emma can consistently:

● Ride her trike with control (turn, stop, change speeds)
● Open doors
● Hold a pen/pencil with an appropriate pincer grasp

Emma can partially or sometimes:

● Button up buttons
● Hop with both feet
 ● Open containers with lids

Emma cannot yet:

● Color within the lines
● Jump up the steps
● Kick a ball more than 10 feet.

Adaptive Behavior: (1)

Interview and observations indicate that Emma is behind in her adaptive behavior. The Vineland-II
indicated that Emma was in the 8th percentile. While all data indicated that Emma was behind, I feel like
the Vineland-II indicated that she was further behind than what we saw during the observations and
what was reported during the observations. At preschool Emma was observed, taking her coat off,
putting her coat on while an aid held it up for her, being able to wash her hands independently when
told to go wash her hands. Her mother reported during an interview that Emma likes to help in the
kitchen while cooking. She often helps mix things and they have started working on cracking eggs. Her
mother also reported that Emma is able to feed herself and this was observed during a home
observation. Emma had asked for a cereal and her mom went and poured her a bowl of cereal and milk.
Emma was then handed the bowl, and she was able to take the bowl to the table, get a spoon out of the
drawer, eat without spilling, then put her dishes in the sink all with very minimal prompts from her
mother. During the Routine Based Interview Melissa talked about how Emma really likes picking out her
own clothes, especially her pajamas, and can get dressed mostly by herself. Melissa also reported that
Emma is toilet trained. Emma was also seen opening doors by turning knobs, blowing her nose, and
cleaning up her toys. Since Emma is developing typically, though a little delayed, in the adaptive domain
Emma can be expected to continue to meet adaptive behavior milestones and continue to become more
independent.

Emma can consistently:

● Use the bathroom appropriately
● Clean up when prompted
● Feed herself using spoon and fork

Emma can partially or sometimes:

● Dress/undress herself
● Cut items with a butter knife
● Open doors with different handles

Emma cannot yet:

● Understand the value of money
● Bathe herself
● Tie her shoelaces

Social emotional: (2)

Interviews and observations have shown Emma to be below average in her social emotional
development. Emma scored in the one percent of the normative sample on the Vineland-II. Emma’s
scores on the Vineland-II show that she struggles to interact with others.
During the interviews Emma’s mother stated that Emma has difficulty helping others cope and except
emotion. During the observation of Emma during preschool it showed that Emma only interacted with
the student teachers. She did not interact with any other children her age. This was shown when she
would stand next to a child near the sandbox but did not engage in any interaction or communication
with the child. It was also shown during the preschool observation when Emma would only go up to the
student teacher to talk about the animal cage on the table. Emma’s lack of interest in social interaction
will impact the types or number of relationships she experiences.

Emma can consistently:

● Sustain periods of play with toys and objects
● Mimic others behavior
● Communicate through sign.

Emma can partially or sometimes:

● Share her toys.
● Smile, wave, or laugh in response to positive interactions.
● Recognize some emotion in others.

Emma cannot yet:

● Engage in parallel play with other children.
● Consul others.
● Communicate verbally

Communication: (2)
Based on observations, interviews, and testing Emma falls below average. Emma was observed at the
Preschool as well as within the home. During the observations Emma showed to have very low verbal
skills. During the home interview it was mentioned that “Emma has the verbal capacity of an 18 month
old.” Emma has very minimal eye contact, has very little verbal word knowledge, and communicates
mainly through Sign Language. Emma may not respond verbally when spoken to, but will communicate
through sign. She also, when being spoken to verbally, will look to her mother to help her translate what
is being said. As seen during both observations, Emma look at the person talking to them and will do
what she is asked if some sign is given. Emma will most likely experience mild to moderate frustration
when she cannot express what she wants verbally.

Emma can consistently:

● Communicate through sign.
● Find ways to describe what she wants
● Say her colors when told to

Emma can partially or sometimes:

● Verbalize her colors
● Verbalize what she wants
● Recognize when someone is talking to her

Emma cannot yet:

● Communicate verbally
● Clearly communicate verbally he wants and needs
 ● Communicate without an interpreter

Recommendations (2)

Through testing, observations, and interviews stipulates that Emma has developmental delays in
communication, social emotional skills. Emma considered average in motor skills as well ad adaptive
skills. This shows that Emma is meeting the requirements for an IEP under section C in IDEA. Hence, it is
recommended that the team work directly with the family to cultivate a plan to meet Emma’s long term
goals and short term objectives. These are the following recommendations:

For the Professionals:

● Continue helping Emma with her verbal communication
● Offer speech therapy with the objectives to improve social and verbal communication skills.
● Create a plan with Emma’s parents to improve social interactions at home, church, and
preschool.
For the Classroom:
● Offer an interpreter for Emma during her class time.
● Involve Emma in peer activities to help her with communication and social skills.
● Consider using a reward to help Emma engage in peer behaviors and verbal responses.
For the Parents:
● Offer Emma opportunities to interact with her peers.
● Encourage Emma to communicate verbally to help with her communication skills.
● Communicate with Emma’s therapists and teachers to incorporate suggested interventions.

Summary (2)

Emma is a 3 year old girl who is a product of a typical 40-week pregnancy. Emma did not pass her
newborn hearing test, but passed the following two hearing screenings. Emma passed the rest the
newborn tests and has continued to pass the tests for her vision. Melissa also reported that Emma was
born with the hearing impairment but was not diagnosed until she was 3. Emma is able to communicate
through sign language but has an oral language capacity of that of an 18 month old. Through
observations, interviews, and interventions it is determined that Emma is currently performing below
average in the social emotional domain, the adaptive behavior domain, as well as in the communication
domain. She is currently performing at an average level in the motor development domain. These delays
qualify Emma under section C of IDEA. it is recommended that an IFSP be written with the family.
Furthermore it is recommended that she continue to attend early intervention services, which include
occupational therapy and speech therapy, until further notice. It is also recommended that Emma’s
parents and teachers continue to work with her on her communication, adaptive, and social
emotional development at home and in the toddler lab.

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