June 27 Post Four

Sarah, Casey's mom has been in a downward spiral, ever since she decided to give up her schooling and her depression has gotten the best of her. Sarah lacks initiative and feels as if her life does not have meaning. She acknowledges that in order to better Casey, she also needs to better herself. Her mom suggests that she starts going to a support group for mothers who have children with disabilities. Her mom gives her information for an organization known as the National Organization on Fetal Alcohol Syndrome in Virginia, where she can call day and night or contact them by e-mail and they will be happy to answer all her questions about her daughter, and how to better herself in these circumstances. She also starts going to a support group, where she learns how to cope with her past mistakes, such as using alcohol during her pregnancy with Casey and how to forgive her ex-boyfriend, Jacob for abandoning them. Sarah was forced to grow up very fast, by giving birth to Casey her freshman year in college, and it is time that she learns to put the past behind her and move on with her life for the betterment of her family. She also attends parent workshops put on by the NOFAS-VA where she learns that getting the best care for her daughter is what is necessary.

                One day, Sarah decides gains enough courage to call Jacob, asking him for help, and giving him the full report of Casey's disabilities. Sarah tells him how her family is now on welfare, and in order to benefit their daughter and her needs, Jacob needs to start paying child support. Jacob always knew that his daughter had disabilities, but what in awestruck when Sarah shared with him, that she would be meeting with Casey's school for an IEP meeting. Casey is now 5 years old and in Kindergarten, and developmentally, physically, and cognitively significantly behind the other children in her classroom, and Jacob agrees to come to the IEP meeting with her at the school to fully understand and access his child's needs.

                When Sarah took Casey to the doctor a couple months back, he got in writing her saying that she drank during her pregnancy and that Fetal Alcohol Syndrome was a factor in how Casey is developing today. Time has passed, and it is now time for Sarah and Jacob to meet with Casey's IEP team to access what would be the best outcome and possibilities for their daughter.  They agree to have Casey tested, and they will conclude the results.

                A speech language pathologist is called in, to access Casey and her speaking. At five years old, Casey should be able to form sentences, but her speech is incomprehensible. Her speech has no specific sound pattern and is not responsible to verbal commands. Casey cannot retain information, and it is coherent that she has learning disabilities. At her age, she should be able to learn from experience, consequences, and practice, but Casey is not high functioning. Casey used to be able to write her name and the letters of the alphabet, but this learned task at one time, cannot be retrieved now.  When Sarah is asked how Casey manages doing her schoolwork at home, Sarah responds that Casey, has difficulty organizing her time and whenever Sarah tries to make Casey sit still, Casey has a tantrum which can include hitting and biting Sarah, which leads to behavioral issues including being stubborn and unwilling to cooperate.

                Due to the brain injuries that Casey suffered as a child, Casey will need to learn function skills, if Casey would like to be any kind of independent as an adult. The Speech-language pathologist suggests that using strategies such as token economies and positive reinforcement may be the beneficiary practices to help Casey. Using ABA strategies and focusing and rewarding behavior, the desired behavior they would want Casey to display would be repeated. ABA can bring about positive and meaningful change, and this could be a positive option for Casey.

                The IEP team, decides to develop a plan for Casey, they establish their team, establish the focus, and collect and analyze the data for Casey by establishing their vision and their goals and objectives for how to treat her. They notice that Casey also does not have any social skills, and she often plays by herself at recess and talks to herself. She is not sociable, and her kindergarten teacher notices that she lacks social skills and does not acknowledge other classmates.  The School nurse also notes that Casey is very tiny for her age. She has droopy eyes and asks Sarah about her sleeping habits, because she does not think that Casey gets enough sleep at night. Casey displays signs of hyperactivity, stubbornness, and an inability to concentrate, it is evident to everyone involved in the IEP meeting that Casey has a developmental delay and due to the FASD she may have an intellectual disability. She is not learning in her regular kindergarten classroom, and they decide she would work better by being placed in a resource room, and by having a Teacher's Assistant with her at all times, if she would be put in her regular Ed classroom for given activities. The IEP team asks Sarah if Casey has mood changes frequently, and Sarah says yes.

                Like the other children in her class, Casey should be able to process information, use reasoning, and be able to solve problems. All of which, Casey cannot. She cannot retain information, and her functioning is way behind the other children her age. Due to Casey's difficulty accepting change, they are unsure how moving Casey in the resource room will go, so they will try to make the transition as smooth as possible for her.

Questions:

1. Do you think Casey will ever be able to live independently due to her disabilities from the Fetal Alcohol Syndrome?

2. Should Casey be taught basic skills in her resource room, or should they still try to teach her a basic curriculum?

3. What strategies of learning and techniques do you feel would work best for Casey? Do you think Casey would work well with other children in her resource room?

4. What services outside of the School setting (such as psychological, Physical Therapy) would work well for Casey, if needed?

5. Can the government provide Casey with any services for FASD for Casey?

Decision Point: How does Jacob handle the situation with Casey and what actions does he take when he realizes the full extent of his daughter's disabilities? ​

June 24 Post Three

Due to the stress of Casey's developmental issues, Sarah decided to give up going to school, but decided to keep her part time job, because she could not handle doing both. Worrying about the needs of Casey and how she is doing at her pre-school and how she is developing is only adding to Sarah's depression issues. Casey has just turned five, and she is still not toilet trained or able to pick up hygiene skills or acknowledges when she needs to go to the bathroom. 

Sarah is realizing that Casey needs more than she can handle. She applies to the government for assistance and is planning on taking advantage of their Child Support System, in order to benefit her daughter. Since Casey is now 5, she has barely graduated her pre-school program and has been enrolled in Kindergarten and will be starting. A couple weeks before Kindegarten starts, Sarah takes Casey to see a child's primary Care Physician. Sarah is hoping the doctor can make a diagnosis or make a referral to a geneticist or neurologist who will diagnosis Casey. The first thing the doctor asks Sarah, is if there is any documentation of alcohol exposure during her pregnancy, and Sarah says yes. Sarah puts it in writing for the doctor as a written testimony stating that their was alcohol consumption during her pregnancy, which the doctor takes as a factor to what may be going on with Casey.  The doctor notices that Casey's weight is only in the 7th percentile for her age, which is very low, and her head circumference is very small for her age. He notices that her eye openings are very small, has flattened cheeckbones, and an indistinct philitrum. The doctor will need to do further testing, but he is almost certain that Casey has fetal alcohol syndrome.  

A couple weeks later, Casey starts her half day Kindergarten program, and the teacher notices, that when she speaks to Casey, she does not respond. When it is time to go outside for reccess, the teacher rings a bell, and Casey does not respond to the noise, or any loud sounds that she may hear in the classroom. Casey has no friends, and is not sociable in the classroom and does not even smile to her other classmates, she acts as if she is in a dreamlike state most of the time, and the teacher is getting very concerned. Casey shows no interest in the teacher, other students, does not follow three step directions, and when she does speak, it is unclear and mumbled. Casey used to be able to write her name, at the end of her pre-school program, but has lost the ability to write letters, a skill she once had. 

When Casey comes home from school, Sarah asks her how her day was and if she learns anything, but Casey responds with only sounds and not words. Whenever Sarah mentions the word school, Casey turns into a different child, and has extreme mood swings. Sarah is also noticing that Casey acts with impulsiveness and has a lack of self discipline when she tries to sit her down and do her spelling HW. Since Sarah, gave up her schooling, she wants Casey to thrive, but she is realizing that she can not do it alone, and calls Casey's father for help and wants him to go along to the doctor, when they go for more tests, but he refuses. He wants nothing to do with his daughter who has a disability and will not claim her ever in his life. Growing up in a single parent household, Casey is growing up without a father, another influence in her life, who could help and teach her to grow. She is being raised by a single mother, who is having trouble with her own emotional issues you can tell that Casey knows that something is not right with her mother, but when she witnesses Sarah crying, she smacks her and does not offer comfort. She shows no signs of emotions, or sympathy towards others. 

At School, Casey's kindergarten teacher is becoming very concerned for Casey, and a letter is sent home with Casey, saying they would like to test her and form an IEP board on her behalf, to better benefit her in school. Her teacher notices, that her teaching, is not benefiting Casey, seeing as Casey is not picking up on basic math terms and can not recall any of the letters of the alphabet, without having them on pictures. She is not learning and her behavior issues and intellectual problems, are keeping her from learning to the maximum extent. It is evident that Casey needs more help. 

1) Will Casey be eligible for IEP services through the school, due to her fetal Alcohol Syndrome? What services through the IEP will most benefit Casey?

2) If Casey does not get services and progresses in school, what are some risks and issues that may arise with Casey as she gets older, and how could this affect her education?

3) What services, outside of a school setting, could Casey benefit from? The narrative refers to the 'Child Support System.' A system by that name does not exist in Virginia; what social services are available in Virginia for a child like Casey? 

4) Do you think that Casey could benefit from Applied Behavior Analysis?

Decision Point: Does Sarah accept the IEP offer from the school to have Casey tested? 

June 20 Post Two

Jacob could not bring himself to tell his parents about Casey, so he then decides to maintain minimal contact with Sarah and the baby. Given Sarah’s history of depression, Sarah was overwhelmed with being a new single parent and sole provider for Casey. She experienced a severe case of post partum depression which caused her to be emotionally unavailable for Casey. She struggled to provide Casey’s physical needs. Casey’s cries were often ignored which forced her to retreat and engage in self soothing behaviors. She would resort to thumb sucking and progressed to rocking back and forth. It also contributed to Casey’s autistic like behaviors as she developed into a toddler. Casey demonstrated unrelated behaviors and had difficulty bonding. Sarah’s mother was extremely concerned about Sarah’s emotional state and how it was affecting her baby. She was also aware of her inability to provide Sarah with more financial support since her husband lost his job and had to take another job with significantly less pay. Her mother suggested that Sarah move in with them and transfer to a community college close to home. She suggested that Sarah could go to school as a part time student, and get a part time job to help meet expenses. This would also help Sarah’s mother provide child care while Sarah was at school and work.

Sarah never realized the extent of the damage that alcohol had on her baby. As Casey grew older, she demonstrated developmental delays in all areas. Cognitive functioning was markedly delayed as evidenced by her inability to identify simple objects in her environment both expressively and receptively. This meant that she was unable to identify objects in her home such as a chair, a table, or a toy. She also was not responsive to simple verbal commands such as, “give me the toy” or “are you hungry?” Casey lacked the normal curiosity of developing toddlers her age. Her developmental milestones such as walking and talking were absent.

            Casey is now two years old and her speech is incomprehensible. Whenever she talked, her speech sounds were garbled and demonstrated no specific sound pattern. She has just begun to crawl and pull herself up to stand, which should have been done at one year old. Her delays have been compounded by behavioral issues. Casey demonstrates an inability to maintain focus on toys or activities. She tends to be hyperactive and demonstrates frequent outbursts of temper which includes screaming, hitting, biting, and throwing objects. She does not relate to other toddlers and does not engage in parallel play. This means that when in the company of other toddlers who are individually playing with toys, Casey could not sit with them and play with a toy. Parallel play does not require personal interaction. Yet, Casey was incapable of this most basic skill.  She showed no interest in other peers who may be engaged with a toy, game, or pretend play. These behaviors are typical of children at this age. Casey would not even imitate behaviors such as clapping hands or stamping feet.

            At age 3, Casey entered a part time nursery school program and still was not toilet trained. Shortly after enrolling, Sarah received many complaints from her teacher stating that Casey could not stay seated for a long period of time, would hit other children in class, and continued to throw toys across the classroom. She could not participate in activities with her peers, because she was significantly behind them developmentally.

1)    Will Casey be eligible for special education services in the future? What services might be beneficial for Casey and Sarah now?

2)    What are some educational issues Casey is facing in school as a child with fetal alcohol syndrome?

3)    Given Sarah’s financial situation, what government resources would she be entitled to? i.e. welfare, food stamps

Decision Point: Does Sarah drop out of college and stay home with Casey knowing that she can always return to school?

June 17 Post One

            Sarah Schmidt is a freshman in college, and she is originally from the small town of Boyce, VA. Before she left for school, Sarah found out that her dad might lose his job. This meant that her parents might not be able to pay for education after her first year. During her first few weeks at school, Sarah turned to alcohol as she had easy access to it. Alcohol helped her avoid handling her below average grades and the stress of possibly having to quit school. After months of binge drinking, Sarah found out that she became pregnant, and the father was another college freshman who she met at a party. Jacob Kowalski was shocked when he heard this news, and he did not take it well. He was worried about what his family would think of him after finding out he was going to be a father at 19 years old. Because of this, Jacob made the decision to stay out of Sarah and the baby’s life and continue life as normal.

After finding out she was pregnant, Sarah immediately panicked, because she knew she had been drinking excessively not knowing she was pregnant. She quit drinking, but this did not stop the early effects of alcohol, because her daughter was born with severe fetal alcohol syndrome. She named her daughter Casey who was born underweight, and she had to spend a few weeks in the ICU. Refusing to take a break from school, Sarah moved out of her dorm and into a small apartment with Casey. The apartment was in a bad part of town, and it was not previously taken care of as there were holes in the walls. Her parents have been providing money to her for rent, but Sarah was not sure how long they could keep providing her money. Desperate for help, she asked Jacob to take care of the baby while she was at class and vice versa. This caused a lot of stress between the two of them, because neither of them knew how to balance school and their baby. In addition, they did not pay much attention to Casey while they were home. Casey continued to show signs of developmental issues as she had poor muscle tone and poor coordination skills. She also was not gaining much weight which concerned Sarah and Jacob.

Questions:

           

1. Describe the importance of child-parent attachment for a newborn (refer to Ed Tronick Still Face on YouTube). What are the risks inherent in “not paying much attention” to Casey?

2. Outline the risks associated with prenatal alcohol exposure. What are the physical, cognitive, and socio-emotional effects of prenatal alcohol exposure? Outline the risks.

3. When a child is born with severe fetal alcohol syndrome, is the mother reported to the Department of Social Services for child abuse? Why or why not?

           

DECISION POINT: Does Jacob tell his mother and father about the baby? Why or why not?