Case of

Deryn
GENERAL INFORMATION

Name: Deryn Nickname: Deryn

Date of birth: August 5, 2017 Age: 2.6 YO
DOA : February 3, 2020
Parents: Father Occupation: Businessman
Mother Occupation: Coach
Sibling
Diagnosis: Global Developmental Delays
Appraisal Measures Conducted Administered

▪ Brigance Diagnostic and Administered

▪ Denver II
▪ Sensory Processing Checklist
▪ ICD10 – F88
▪ Interview with the parent
▪ Clinical Observation
▪ Informal survey
Reason for developing an IEP: Deryn was identified as exceptional.

LRE: Self-Contained Class

Support Service: One-on-one occupational Therapy,

And Speech/Language program

Present Level of Performance:

Deryn’s gross motor skills need refinement specially in balancing e.g., stand on tiptoes momentarily and on one foot: walks on straight
line and walks backward: jumps off floor with both feet: hops on preferred foot: walks up and kicks a stationary playground ball, throws
ball overhead, among other things. (age norm: 1.8 yo)

Schedules: Monday-Wednesday 8:00 AM – 10:00 AM (Home Based) Therapy

 Goal 1: Gross Motor
By end of February 2020, Deryn will move efficiently to navigate her environment like, balance, engage in games and outdoor activities and
well-being, 60% of the time.

Objective:
1. Deryn will acquire skills by engaging motor activities, like walking ,jumping and hoping and playing kicking stationary playground.60% at the time
2. Deryn will able to learn how to balance and coordinate shifting her weight and moving her right and left foot 60% of the time.
3. Deryn will develop her large muscle, coordination through cross crawling activity. 60% at the time
4. Deryn will improve eye – hand coordination skills such as ball skill (throwing, catching, kicking) 60 of the time.
(such as balance)
Set of Activities:
1. Cross Crawling Activity
- You need space and an obstacle chair course.
Place the chair in front of the child
Model the Activity
- I’m going first, to show to the child the activity and she will going to imitate.
- Give verbal command
- Show the visual picture to the child how to crawl under the chair.
- Use visual timer
How to do it:
- Ask the child to put her two hands on the floor and then, bend her knees to touch on the floor and certainly move her left
hand and followed by her right hand by moving her knees at the same time, to crawl under the chair repeatedly at least
3/5 times until she learned the task.
2 Playground Activities

Set visual timer

Let the child play in the playground with protective gear like helmet and knee cap.

Give at least 10 minutes in every playground games.

10 minutes playing in trampoline

10 minutes playing in slides

10 minutes playing in swing

10 minutes playing stationary horse riding

10 minutes playing stationary playground ball, like kicking

Throwing ball.

.
 Gross Motor Chart

Motor skills Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8

Balance 1 2 1 3 3 4 3 4

Stands on tiptoes 0 1 1 3 4 3 4 5

Walk on straight line 1 1 2 3 3 4 4 4

Walk on Backward 0 2 3 2 3 3 3 4

Jumping 1 1 2 2 4 4 4 5

Stationary Playground 1 2 3 4 4 4 4 5
 Gross Motor graph

Chart Title
6

0
Balance Stand on tiptoes Walks on straight Walks backward Jumping Stationary
line Playground

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8

SCALE:

1 – Poor
2 – Good
3 – Very Good
4 – Satisfactory
5 – Excellent
▪ During the first week of intervention and therapy, the child has a poor performance in the following motor skills such as, balance, Stands on
tiptoes, Walk on straight line, Walk on Backward, Jumping, Stationary Playground. In the 2 nd and 3rd week show’s that there is a little
improvement on the motor skills while in the 4th up to the last week, I can say that the child show more improvement and interest to be able
to do the given task.
 Over Responsiveness

Deryn exhibits some over-responsivity probable difference: ( More than others)

- Distressed by being dressed, especially in certain fabrics or textures

- Extremely ticklish
- Becomes inconsolably upset in a wet or dirty diaper
- Potty trained early due to distress of wet dirty diapers
- Upset by having dirty hands or face
- May gag when eating foods with certain textures or flavors (has a very limited diet)
- Difficult to get to try new foods or textures
- Avoids putting toys and other objects in mouth; doesn’t explore the world through the mouth like most babies
- Distressed by certain generally mundane odors
- Avoids certain types of toys (vibrating, rough textured toys, slippery/slimy toys, brightly colored objects, flashing objects etc.)
- Can’t sleep if room isn’t completely dark and/or quiet; wakes up at the slightest noise or light
- When able to walk, is unstable and afraid of falling
- Doesn’t enjoy movement games, baby swings, playground equipment, stroller, wagon, or car rides etc.
- Distressed when suddenly moved or head/body is tipped (may become afraid, arch back, get started etc.)
- Distressed when being moved (i.e., rocked, swung, bounced, or thrown in the air)
- Doesn’t tolerate being in certain positions, i.e., on back, on stomach, sitting, etc.
- Gets overwhelmed, cries, or falls asleep when over stimulated.
 OVER RESPONSIVENESS

Goal 1:
At the end of February 2020, Deryn will be able to decreased or lessen her over responsiveness in touching such as, distressed by being dressed
specially in certain fabrics or textures, in extreme ticklish, become inconsolably upset in a wet or dirty diaper, upset by having dirty hands and face and
avoid certain types of toys ( vibrating, rough textured. Slippery/slimy toys) . 60% at the time.
Objective:
- Deryn will be able to learn how to used rough clothes like satin and silk
- Deryn will be able to improve her sensitivity in holding objects like clay and sandpaper
- Deryn will be able to exposed in different dirty objects like mud
- Deyn will be able to play a slime toys
Goal 2:
At the end of February 2020, Deryn will be able to increased or improve her over responsiveness in tasting of foods such as difficult to get to try new
foods or textures and my gag when eating foods with certain textures or flavors. 60 % at the time.
Objective:
- Deryn will able to practice to eat sweet, sour and salty food
- Deryn will be able to learn to eat different kinds of food like rice, fruits and vegetables.
Goal 3:
At the end of February 2020, Deryn will ne able to learn her over responsiveness in seeing and hearing such as avoids certain toys ( brightly colored and
flashing objects) and can’t sleep if room isn’t completely dark and/or quiet; wakes up at the slightest noise or light). 60 % at the time

Objective:
- Exposed to play different toys with flashing light like battery operated dolls.
- Learn how to sleep when the light switch on.
- Learn to cope up with noise without being disturb when sleeping.
  
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1. Distressed by being dressed, especially in certain fabrics or textures

- Deryn refuse to wear use certain fabrics on texture, it causes an irritation because of the sensitive skin, she feel itchy and uncomfortable to
wear.
Suggested Strategies:
- Wear something that is tight.
- Choose clothes that more comfortable to wear, cut off the label or tags.
- If wearing sock make sure that select the small size that will provide pressure
- Flexible

2. Extremely ticklish
Suggested Strategies: Frozen Toy Activities
Step 1 :
- Show to her the frozen dinosaur egg
Step 2:
- Ask the child to hold the frozen dinosaur egg
Step 3 :
- Let the child to play the frozen dinosaur egg until it melts to her hands
Step 4:
- Let the child feel the cold and make sure that she enjoy the game.
3. Potty trained early due to distress of wet dirty diapers
HOW TO TEACH THE CHILD TO USE RESTROOM
Physical prompting: Bring the child to the RESTROOM
Modelling: show the child how to use the RESTROOM
Verbal : ask the child to pull down her pants, point the visual sign
ask the child to sit on toilet, point the visual sign
ask the child to use paper toilet to wipe with my assistance
ask the child to Pants up with my assistance
ask the child to wash hands,
Verbal praise : Good Job
4. Difficult to get to try new foods or textures
Suggested Strategies:
- use a desensitization approach to introduce new food
- Encourage snake tastes
- Start by having kids near the food and look at it, then the goal is to get comfortable
handling the food. Example: I am going to show to Deryn the apple and place it on the
table for 1 meter, then, the next session, I put it again for ½ meter until she manage to
hold and play the apple. The next step is to do the snake taste, I try to put it to her mouth
and have a quick lick and help to instruct her to let it on her tongue for a 10 second, then,
encourage to swallow a small bite. This may take a week or maybe a month.
- Set limit and agree if she want to taste it again. It is ok if she does not swallow the food,
the thing is build a trust.
- Present food in new ways.
- I will now introduce a new set of food which not familiar for her taste, example: I am going to try a banana,
I encourage again to try and taste it.
5. Avoids putting toys and other objects in mouth; doesn’t explore the world through the mouth like most babies
- Use the ABA methods physically prompt by holding both hand of the child use visual timer for 10 minutes
do it everyday until the child will be able to learn to avoid from touching and putting any object to her mouth.
Give her a stimulus or reward for complying the given task by allowing her to play.
- place her both hand inside her pocket every time she attempts to put object in mouth.

6. Distressed by certain generally mundane odors

Sensory Strategy:
1. Provide activities which stimulate the olfactory sense
Step 1: Let the child play in the grass, give her at least 10 minutes
Step 2: Pick up a little grass
Step 3: Model and show to her what your doing
Step 4: Let the child touch the grass
Step 5: Put the grass to her nose to smell
7. Avoids certain types of toys (vibrating, rough textured toys, slippery/slimy toys, brightly colored objects, flashing objects etc.)

▪ Provide deep pressure to the hands, such as placing your hand firmly on top of his and guiding him through an activity.

▪ Offer vibration on his hands from toys such as a Bumble ball

▪ Provide various types of textures, such as soft, hard, scratchy. Be sure to consistently monitor your child's response to the input.

▪ Provide various types of textures within a child's reach (such as a basket or box), which will allows your child access to explore these items on his own.

8. Can’t sleep if room isn’t completely dark and/or quiet; wakes up at the slightest noise or light

▪ Shut down television, video games, and other stimulating activities at least an hour before bedtime
To prevent sensory distractions during the night, put heavy curtains on your child's windows to block out the light,
install thick carpeting, and make sure the door doesn't creak. You can also make sure that the temperature of the
room and choice of bedding fit with your child’s sensory needs.
9. When able to walk, is unstable and afraid of falling
Suggest Strategies: Graded Exposure
- Explain to the child that we are going to walk
- Me and the child will walking together
- Exposed the child to a rough road
- Support the child by holding her hand carefully to avoid falling on the ground
- Let her walk slowly until she manage to step and walk
- Give her verbal praise if she manage to do the task

10. Distressed when suddenly moved or head/body is tipped ( may become afraid, arch, back, get startled, etc.)
Suggested Strategies:
- Always prepare the child for the movement
- Use a visual cues to show what is going to happen and use this each time
- Give the child to calm before the movement
11. Distressed when being moved ( i. e., rocked, swung, bounced, or thrown in the air)
- Lying on stomach over gym ball and maintain balance through arms,
if child has fear on being move this activities will help to overcome the
fear in and distressed.

12. Doesn't tolerate being in certain positions, (i. e., on back, on stomach, sitting, etc. )
Vestibular Activities:
- Lying on stomach on a scooter board and propelling with arms ( avoid backward movement)
Step1 :
- Model to the child on how to lay on a scooter board
Step 2:
- Ask the child to lay down on a scooter board
Step 3:
- Hold the left arm and the right arm of the child to propel first her right arms until the scooter board begin to move,
then, followed by her left arm propel it to continue moving
Step 4:
- Ask the child to paddle her left and right arm to a forward direction
- Ask the child to repeat until she learn how to use the scooter board by herself.
Activity:
- Messy play
- I need:
- Things that with different textures or fabrics as well as wet, dry, sticky and dirty things. Sands and clay. Toys like vibrating,
slippery , slimy toys, a bowl of water and towel to clean hand if required.
How to do it:
- If the child is fearful of any materials let them play with it and a less threatening way. For example, prompt, hold the hand of the
child to start touching the object at the messy material and place her hand to the messy object. Use a visual timer to know how many
minute a child can sustain or hold on the object. Show to her that this game is safe. Model so that the child will imitate what I am
doing. For example, splatting it, poking, pulling, rolling and etc. Encourage the used of the whole hand ( including palm let to do it and
allow experience sensation). This activities gives opportunity to the child to expose, experience, increase her tolerance to a certain
object or a toy which she don’t want to use or play it.
 Over Responsiveness Monitoring
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8

Distressed by being dressed, especially in certain fabrics or textures 0 1 2 2 3 7 8 9

Extremely ticklish 1 2 2 5 5 6 9 10

Inconsolably upset in wet or dirty diapers 10 10 8 8 6 6 4 1

Potty trained early due to distress of wet or dirty diapers 10 8 6 6 4 4 2 2

Upset by having dirty hands or face 10 10 8 8 6 4 4 2

Difficult to get to try new foods or textures 0 1 0 1 2 5 5 6

Avoid putting objects in mouth; doesn’t explore the world through the 10 8 8 8 6 6 4 2
mouth like most babies
Distressed by certain generally mundane odors 0 1 3 4 6 7 7 9

Avoids certain types of toys (vibrating, rough textured, slippery/slimy toys, 1 1 4 5 6 7 8 10

brightly colored and flashing objects etc.)
Can’t sleep if room isn’t dark or quiet; Wakes up at the slightest noise or 10 10 8 8 6 6 4 2
light
When able to walk, is unstable and afraid of falling 10 10 8 6 6 4 4 2

Doesn’t enjoy movement games, baby swing, playground equipment, 10 8 8 6 6 4 4 2

stroller, wagon, or car rides etc.
 Over Responsiveness Graph
Distressed by being dressed, especially in certain fabrics or textures
Extremely ticklish
Inconsolably upset in wet or dirty diapers
Potty trained early due to distress of wet or dirty diapers
Upset by having dirty hands or face
Difficult to get to try new foods or textures
Avoid putting objects in mouth; doesn’t explore the world through the mouth like most babies
Distressed by certain generally mundane odors
Avoids certain types of toys (vibrating, rough textured, slippery/slimy toys, brightly colored and flashing objects etc.)
Can’t sleep if room isn’t dark or quiet; Wakes up at the slightest noise or light
When able to walk, is unstable and afraid of falling
Doesn’t enjoy movement games, baby swing, playground equipment, stroller, wagon, or car rides etc.
Distressed when suddenly moved or head/body is tipped (may become afraid, arch back, get startled etc.)
Distressed when being moved (i.e., rocked, swung, bounced, or thrown in the air)
Doesn’t tolerate being in certain positions, i.e., on back, stomach, etc.
Gets overwhelmed, cries, or falls asleep when over stimulated
0 2 4 6 8 10 12
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8
 Sensory seeking
Deryn exhibits some sensory seeking behavior; Probable Difference (More than others)
- Deryn loves to touch and be touched, has to touch everything;
- She always seems to engage in repetitive, non-purposeful play with a limited number of objects (walls, toys, table);
- She frequently bangs head, pinches, hits, bites, or hurts self or others (when upsets);
- She prefers food with very strong tastes flavors (prefers tasty food e.g., adobo)
- She needs a lot of sensory input to fall asleep (rocking, singing, rubbing skin etc.)
Goal 1
 At the end of February 2020, Deryn will decrease sensitivity tolerance from being tactile. 60 % at the time.
Goal 2
▪ At the end of February 2020, Deryn will be able to decrease to engage repetitive non-purposeful play. 60 % at the time.
Goal 3
▪ At the end of February 2020, Deryn will be lessen injurious behavior such as bangs head, punches, hit, bites or hurt herself. 60 % at the time.
Goal 4
▪ At the End of February 2020, Deryn eat nutritious food using food chaining (SOS) Sequential and Sensory Approached to eating, as follows;
1. Tolerance ( 10 minutes )
2. Interact ( 10 minutes )
3. Smell ( 5 minutes )
4. Touch ( various foods )
5. Tastes ( ¼ cup )
6. Eating ( ¼ cup )
Basic Mealtime Strategies:
1. Structure 3 meals + snacks per day
2. No “ grazing “
3. Manageable foods
4. Appropriate mealtime language
5. Positive reinforcement
6. Expose Deryn to a newly offered food on a daily constant basis
7. Keep mealtime and snacks a pleasant atmosphere
8. Avoid distractions during mealtime
9. Do not bribe, beg, or force Deryn to take a bite
10. Limit mealtime to less than 30 minutes
1. Deryn loves to touch and be touched, has to touch everything
Suggested Activities:
- Tactile activities
- Rubbing different textures again the skin
- Rolling over different textured surface
- Handling different textured object e.g. rough and smooth number, letter or shapes
- handling pets.
2. She always seems to engage in repetitive, non-purposeful play with a limited number of objects (walls, toys, table);
Suggested Strategies:
Social Story:
3. She frequently bangs head, pinches, hits, bites, or hurts self or others (when upsets);

What are the causes of her anger

- She bullied
- She have access of thing they want
- She is feeling unwell
- She has excessive reflux, allergies, ear infections or digestive issues.
- Somebody hurt them physically or verbally
Strategies.
: I am going to speak calmly and clearly to Deryn with a Neutral Voice of tone
I am going to use head protector if she bang the head to avoid further injuries
use gloves to avoid biting and pinches to avoid damage the hand.
give her squeeze ball for relaxation and relieve tension. Gently massage the body with oil to make her calm and feel
comfortable and relax.
4. She prefers food with very strong tastes flavors (prefers tasty food e.g., adobo)
Suggested Strategies:
- Use a desensitization process to introduce new food.
- Involve her for food preparation, just to get her attention and make her interested,
do not force her to taste let her smell the food
- Allow to preferred food on it at mealtime. This will encourage her to eat at mealtime.
- Create an eating pattern, new food should be introduce in mealtime.
- Make sure that the place is quiet and no distraction as long as the child is starting to eat.

5. She needs a lot of sensory input to fall asleep (rocking, singing, rubbing skin etc.)
Suggested Strategies:
- Deep pressure touch to arms and legs, also called hand hugs or squeezes.
- Try applying magnesium oil to the bottom of the child feet at bed time.
- A weighted blanket or heavy folded up to increase weight and pressures.
- Tight fitting pajamas or compression clothing at bed time
- Try a rocking chair in a quiet, calm, dark place night before bedtime
- Gentle, rhythmical and linear swinging in cuddle or hammock swing or compression swing for
at least 15 minutes before bedtime is a great idea.
 Week1 week2 week3 week4 week5 week6 week7 week8

Deryn Loves and be touched, has to touch 5 5 4 4 4 3 2 1

everything
Repetitive and non-purposeful play 5 5 4 4 4 3 2 1

Injurious behavior 5 5 4 3 4 3 1 1

Preferred strong taste and flavor 5 5 5 4 4 3 2 1

Needs a lot of sensory input 5 5 4 5 4 2 1 1

 Chart Title
6

0
Touch everything Non-purpose play Injurious Behavior Prefered strong taste and flavor needs a lot of sessory input

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8

 Sensory Diet For Deryn

▪ 2 Hours Session
▪ Tactile (touch)
▪ Distressed by being dressed, specially in certain fabric or texture
▪ Upset by having dirty hands or face
▪ Avoid certain types of toys (vibrating, rough textured toy)

MORNING
8:00 AM – 8:15 AM – playing dough
8:15 AM – 8:30 AM – Rolling on a therapy dough
8:30 AM – 8:45 AM – Squeeze a stress ball
8:45 AM – 9:00 AM – Sand play
Vestibular (Movement)
▪ Doesn’t enjoy movement games, baby swing, playground and equipment , stroller wagon
▪ Distressed when suddenly move or head/body is tipped
▪ Distressed when moved (rocked, swing, bounced or thrown in the air
9:00 AM – 9:15 AM – swing
9:15 AM – 9:30 AM – Ride a merry go-round
9:30 AM – 9:45 AM – Walk on a balance beam
9:45 AM – 10:00 AM – Wheelbarrow walk
Sensory diet created to address the specific needs of child to stay focus and alert.
 Social Story
Having a new games

Most of the time I play along with my old and my favorite toys

I am happy to see it again in again, I feel sad if may Mom put it away to hide where

I couldn’t find it .

My Mom buy a new toy she want me to replace it and have a new game, but I don’t

Need one.

She talked me and told me that she will be happy to see if I try. and

so I realized that I’m not happy anymore playing my old toy and

games, now I understand my Mom joined me, we play together and enjoy

So it’s time say goodbye my old toys.

 Recommendation
Deryn was diagnosed with Global Developmental Delays a term that describes a child who is behind in her milestones, an
intensive, behaviorally based intervention can help Deryn communication, language, and social skills, so she can able to meet the
the behavior that expected in her age.
She needs special education program that is truly special. Below are suggestion, as follow
1. Start behavioral therapy using Applied Behavior Analysis (ABA) Approach for least 2x a week
2. lessen intake of food with very strong tastes and flavor
3. use No – no show approach in addressing problem behavior
4. Request a copy of home program to ensure the consistency of approach
5. Visual support, visual cues and prompt that help Deryn perform skills with greater independence and accuracy
6. Need of social Stories

Next evaluation: December 20 2020

This assessment must be translated into an Individualized Educational Plan (IEP) where goals, objective/benchmarks are
specific, measurable, attainable, realistic and time- bound.

Thank you for giving us an opportunity to assess Deryn should have question, feel free to contact the undersigned at
telephone _____________

Assessed by:

Lowelli E. Concepcion