October 15th, 2005
Observation Report
# 1
Name: Megan Thacker Client’s Initials: A.B.
Date of Observation: October 13, 2005 Age: 3
Length of Observation: Two hours Indiv. Yes Group
Client Disorder: Lang./Artic./Voice/Fluency/HI/Dysphagia Other: (specify) Autism1.) Describe 1 segment of the session you found to be effective (What appeared to go well? What was successful?).
During my observation, Allie demonstrated she was acquiring knowledge of the Picture Exchange Communication system. Allie had just completed an imitation exercise. She remained in the chair, looking kind of restless and clicking her tongue every-so-slightly. The special education teacher, Mrs. B., went into her filing cabinet, retrieved a bag, and sat across from Allie. Another individual, (an aid), sat beside Allie. Mrs. B. caught my eye, smiled, and said, “I guarantee you, this will catch her attention.” She reached into the bag and dropped a few pretzels on the table; she laid down a picture of a pretzel beside it. (It was just a simple black-and-white pretzel outline, obviously computer-generated.) Allie instinctively reached for the pretzels, but the aid gently grabbed her arm and re-directed it to the picture. Allie made a few disgruntled noises and tried, in vain, to be rid of this “leech” on her arm—to no avail. She reluctantly picked up the picture—the aid released her hand but stayed within arm’s length of the girl, I guess to ensure she didn’t dive for the pretzel again. Allie brusquely nudged Mrs. B’s hand with the picture. Allie had obviously been through this routine before. Mrs. B. automatically opened up her hand, accepted the picture, and asked, “Oh, do you want the pretzels?” She picked up three and handed them to Allie, who promptly shoved them in her mouth one-after-the-other. I was impressed that Allie knew exactly what to do with the picture with little prompting. I also thought that a tangible reinforcer seemed to work best in motivating Allie to accomplish a task.
2.) Describe 1 segment of the session you found to be less effective and/or confusing to you. (What do you think did not produce a desirable result? What did you not understand?)
Sometimes Mrs. B. would lose Allie’s attention when working with her on following one-step directions. Allie responded almost immediately to “Come here”, but when the teacher said, “Give me a high-five”, she appeared anxious and seemed increasingly withdrawn. The teacher simply moved on with “Sit down”, and after a few moments of processing, Allie obeyed. “Good job!” Mrs. B. said encouragingly. Honestly, I thought “Give me a high five!” was a horrible direction to give to a three-year-old, let alone a three-year-old child with autism. Individuals with autism interpret language extremely literally, and how would someone literally interpret, “Give me a high-five!”? Also, I don’t understand why she skipped the direction; I figured she would go ahead and “give her a high five” so at least Allie would have been exposed to the direction.
3.) Discuss 1 element of the session that surprised you and/or that you found contradictory to your understanding (information you have from class, common sense, experience, or expectations).
I didn’t think of this until I had completed my observation, but I remembered that during the use of the PECs system, as soon as Allie nudged Mrs. B’s hand with the picture, Mrs. B. accepted it. She responded immediately with, “Oh, do you want pretzels?" and then gave her the pretzels. However, Allie was not demonstrating any form of eye contact during the exchange. I remember reading somewhere that the exchange should not take place until the person wanting the object shares eye contact with the person giving the object. However, I did witness Allie use eye contact periodically throughout the session (meaning the capability is there.) And she must have developed some form of joint attention, because she could follow some instructions throughout the session. (Meaning she has some receptive language.)
4.) Write about:- What you learned from this observation
Before this observation, I had only heard of the PECs system. Even though I only got to observe Phase I, I still felt like it greatened my appreciation of the process. It provides the child with a way of communicating through interaction. It could lay the foundation for actual language, because it teaches how things can be indirectly represented. To express her needs, Allie will eventually be forced to distinguish between pictures on a communication board. She will (hopefully) develop the ability to pick out the picture of, for instance, the pretzel if she wants a pretzel. She will realize the picture is not the object (the pretzel) itself but merely a representation of the pretzel.
I also got a better understanding of how children with autism react to various auditory / tactile / and visual stimuli. These characteristics differ individual-to-individual, however, seeing Allie’s reactions in certain situations deepened my understanding of how people with autism may have different thresholds of tolerance than people without autism. For instance, during the session a garbage truck came around back. It beeped loudly, and made an almost thrashing sound as the back of the truck lowered and emptied its contents. Allie ran into the corner, curled up into a ball, and starting rocking, back and forth, back and forth. When the truck left and Mrs. B. finally persuaded Allie out of her corner, I could easily tell from her expression it wasn’t an issue of defiance; she had experienced a level of something . . . we probably don’t have a word for. Something like pain and over stimulation and panic, and yet not quite like any of those things.
- Your feelings/reactions of the impact of the therapist’s intervention on the client
I thought the special educator did a terrific job interacting with Allie. She seemed to have developed a genuine relationship with her; there was a sort of unspoken, mutual trust between the two of them. I do admit the possibility that I’m just interpreting what I want to interpret out of the situation, but I stand by my hypothesis. Even if Allie’s demeanor appeared somewhat disinterested, I noticed she usually responded in some way to Mrs. B. (Even if she didn’t exactly do as told.) Mrs. B told me I caught Allie on a good day, and at the beginning of the year she quickly became infamous for her screeching tantrums. However, she also said, “Allie has so much personality, she’s such a determined young girl. . . we just have to unlock that door so she can express what she’s thinking and feeling.” Mrs. B also said Allie’s mom was elated because Allie was finally taking to affection (e.g. she wouldn’t immediately squirm when hugged, patted, etc.)
- Your feelings/reactions of the impact of the client on you as an observer
Observing Allie only deepened my desire to work with children. I think it would be incredibly rewarding to have a positive impact on the life of a child, particularly a child with special needs. The odds are really against them—it makes all the difference in the world if someone is actually rooting for them. I realize a two-hour observation focused on one individual doesn’t give me a concrete idea of what a job of this magnitude entails. I left with more questions than answers. However, I also left more intrigued by the disorder, the treatment of the disorder, and curious to how a little girl like Allie could fall into an SLP’s scope of practice.