Education and Training in Developmental Disabilities - Division on ...
Education and Training in Developmental Disabilities - Division on ...
Education and Training in Developmental Disabilities - Division on ...
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Method<br />
Sett<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
The sett<str<strong>on</strong>g>in</str<strong>on</strong>g>g was an elementary <str<strong>on</strong>g>and</str<strong>on</strong>g> a junior<br />
high school with<str<strong>on</strong>g>in</str<strong>on</strong>g> a public school district,<br />
located with<str<strong>on</strong>g>in</str<strong>on</strong>g> a town of approximately 45,000<br />
people, with 10,416 students mak<str<strong>on</strong>g>in</str<strong>on</strong>g>g up the<br />
district’s populati<strong>on</strong>. Of this number, 1470<br />
students received special educati<strong>on</strong> <str<strong>on</strong>g>and</str<strong>on</strong>g> related<br />
services. Three participants ate their<br />
meals <str<strong>on</strong>g>in</str<strong>on</strong>g> the lunchroom with peers, while six<br />
participants were fed by school pers<strong>on</strong>nel <str<strong>on</strong>g>in</str<strong>on</strong>g><br />
their classrooms, due to safety c<strong>on</strong>cerns, need<br />
for proximity to healthcare pers<strong>on</strong>nel, <str<strong>on</strong>g>and</str<strong>on</strong>g>/or<br />
perceived negative effects of the distract<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
lunchroom envir<strong>on</strong>ment.<br />
Participants<br />
Participants were n<str<strong>on</strong>g>in</str<strong>on</strong>g>e children <str<strong>on</strong>g>and</str<strong>on</strong>g> youth<br />
with moderate to severe/profound cognitive<br />
disabilities between the ages of 4 <str<strong>on</strong>g>and</str<strong>on</strong>g> 17. All<br />
participants received special educati<strong>on</strong> services<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> had been previously identified with<br />
feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g impairments to the extent to which<br />
they were fed, assisted <str<strong>on</strong>g>in</str<strong>on</strong>g> feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g, or supervised<br />
dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g self-feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>in</str<strong>on</strong>g> the school envir<strong>on</strong>ment.<br />
Categories of cognitive <str<strong>on</strong>g>and</str<strong>on</strong>g> physical<br />
disability were established <str<strong>on</strong>g>in</str<strong>on</strong>g> compliance with<br />
the criteria stated <str<strong>on</strong>g>in</str<strong>on</strong>g> the Individuals with <str<strong>on</strong>g>Disabilities</str<strong>on</strong>g><br />
<str<strong>on</strong>g>Educati<strong>on</strong></str<strong>on</strong>g> Act (P.L. 101-476). Licensed<br />
psychologists <str<strong>on</strong>g>and</str<strong>on</strong>g> students’ eligibility<br />
teams had made a determ<str<strong>on</strong>g>in</str<strong>on</strong>g>ati<strong>on</strong> of participants’<br />
classificati<strong>on</strong> through use of appropriate<br />
measures of general <str<strong>on</strong>g>in</str<strong>on</strong>g>tellectual functi<strong>on</strong><str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> adaptive behavior. See Table 1 for<br />
participant demographic characteristics <str<strong>on</strong>g>and</str<strong>on</strong>g><br />
goal targets. Two participant groups (1 <str<strong>on</strong>g>and</str<strong>on</strong>g> 2)<br />
were formed by c<strong>on</strong>venience, that is, they<br />
were grouped by classroom <str<strong>on</strong>g>and</str<strong>on</strong>g> schedules.<br />
Group 3 was formed with <strong>on</strong>e participant<br />
from <strong>on</strong>e classroom <str<strong>on</strong>g>and</str<strong>on</strong>g> two participants from<br />
another classroom to achieve equal numbers<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g> each group.<br />
Brett, Participant 1, was a 15-year-old male<br />
diagnosed with Fragile X syndrome <str<strong>on</strong>g>and</str<strong>on</strong>g> associated<br />
developmental delays. His cognitive disability<br />
was estimated at moderate/severe. Observati<strong>on</strong>,<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>terviews, <str<strong>on</strong>g>and</str<strong>on</strong>g> the Schedule for Oral<br />
Motor Assessment (SOMA) (Skuse, Stevens<strong>on</strong>,<br />
Reilly, & Mathisen, 1995) evaluati<strong>on</strong> revealed<br />
the follow<str<strong>on</strong>g>in</str<strong>on</strong>g>g feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g characteristics: (a) stuff<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
his mouth with large bites of food, (b)<br />
82 / <str<strong>on</strong>g>Educati<strong>on</strong></str<strong>on</strong>g> <str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>Tra<str<strong>on</strong>g>in</str<strong>on</strong>g><str<strong>on</strong>g>in</str<strong>on</strong>g>g</str<strong>on</strong>g> <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>Developmental</str<strong>on</strong>g> <str<strong>on</strong>g>Disabilities</str<strong>on</strong>g>-March 2005<br />
often not swallow<str<strong>on</strong>g>in</str<strong>on</strong>g>g between bites, <str<strong>on</strong>g>and</str<strong>on</strong>g> (c)<br />
apparent decreased awareness of food <strong>on</strong> his<br />
face as evidenced by lack of appropriate napk<str<strong>on</strong>g>in</str<strong>on</strong>g><br />
use. Brett was c<strong>on</strong>sidered at risk for chok<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
due to the large bites of food <str<strong>on</strong>g>in</str<strong>on</strong>g> his mouth<br />
prior to swallow<str<strong>on</strong>g>in</str<strong>on</strong>g>g. Additi<strong>on</strong>ally, these mealtime<br />
behaviors were not c<strong>on</strong>sidered to be socially<br />
acceptable. Two primary goals were<br />
identified for Brett (see Table 1).<br />
Jas<strong>on</strong>, Participant 2, was a 17-year-old male<br />
diagnosed with Down syndrome <str<strong>on</strong>g>and</str<strong>on</strong>g> associated<br />
developmental delays. His level of cognitive<br />
disability was estimated at moderate/severe.<br />
Observati<strong>on</strong>, <str<strong>on</strong>g>in</str<strong>on</strong>g>terviews, <str<strong>on</strong>g>and</str<strong>on</strong>g> the SOMA<br />
evaluati<strong>on</strong> revealed the primary feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g characteristics:<br />
(a) stuff<str<strong>on</strong>g>in</str<strong>on</strong>g>g his mouth with large<br />
bites of food, (b) often not swallow<str<strong>on</strong>g>in</str<strong>on</strong>g>g between<br />
bites; (c) decreased chew<str<strong>on</strong>g>in</str<strong>on</strong>g>g ability, (d)<br />
severe t<strong>on</strong>gue thrust, <str<strong>on</strong>g>and</str<strong>on</strong>g> (e) apparent decreased<br />
awareness of food <strong>on</strong> his face as evidenced<br />
of lack of appropriate napk<str<strong>on</strong>g>in</str<strong>on</strong>g> use.<br />
Two primary goals were identified for Jas<strong>on</strong><br />
(see Table 1).<br />
Denver, Participant 3, was a 14-year-old<br />
male diagnosed with seizure disorder <str<strong>on</strong>g>and</str<strong>on</strong>g> developmental<br />
delays of unknown orig<str<strong>on</strong>g>in</str<strong>on</strong>g>. His<br />
level of cognitive disability was estimated at<br />
moderate. Observati<strong>on</strong>, <str<strong>on</strong>g>in</str<strong>on</strong>g>terviews, <str<strong>on</strong>g>and</str<strong>on</strong>g> the<br />
SOMA evaluati<strong>on</strong> revealed the follow<str<strong>on</strong>g>in</str<strong>on</strong>g>g feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
characteristics: (a) many food spills from<br />
the spo<strong>on</strong> <str<strong>on</strong>g>and</str<strong>on</strong>g> the mouth while eat<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>and</str<strong>on</strong>g> (b)<br />
open mouth/lips with chew<str<strong>on</strong>g>in</str<strong>on</strong>g>g. While these<br />
characteristics did not place him at a high risk<br />
for chok<str<strong>on</strong>g>in</str<strong>on</strong>g>g, they were determ<str<strong>on</strong>g>in</str<strong>on</strong>g>ed to decrease<br />
social acceptability. Therefore, two<br />
goals were identified for Denver (see Table 1).<br />
Nate, Participant 4, was a 6-year-old male<br />
diagnosed with Trisomy 13, a sec<strong>on</strong>dary seizure<br />
disorder, <str<strong>on</strong>g>and</str<strong>on</strong>g> m<str<strong>on</strong>g>in</str<strong>on</strong>g>imal visi<strong>on</strong>. The level<br />
of Nate’s cognitive disability was estimated at<br />
severe. Although Nate had a percutaneous<br />
endoscopic gastr<strong>on</strong>omy (PEG) tube, it was reportedly<br />
used <strong>on</strong>ly when he was ill. Nate exhibited<br />
sensory defensiveness by cry<str<strong>on</strong>g>in</str<strong>on</strong>g>g or<br />
mov<str<strong>on</strong>g>in</str<strong>on</strong>g>g away when touched around or <str<strong>on</strong>g>in</str<strong>on</strong>g> the<br />
mouth. Observati<strong>on</strong>, <str<strong>on</strong>g>in</str<strong>on</strong>g>terviews, <str<strong>on</strong>g>and</str<strong>on</strong>g> the<br />
SOMA evaluati<strong>on</strong> revealed the follow<str<strong>on</strong>g>in</str<strong>on</strong>g>g feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
characteristics: (a) a passive oral manipulati<strong>on</strong><br />
of food for “textured” pureed c<strong>on</strong>sistency<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> (b) total dependence <strong>on</strong> the feeder<br />
for the provisi<strong>on</strong> of food, although Nate had<br />
the physical ability to br<str<strong>on</strong>g>in</str<strong>on</strong>g>g his h<str<strong>on</strong>g>and</str<strong>on</strong>g> toward<br />
his face <str<strong>on</strong>g>in</str<strong>on</strong>g> other circumstances. Two primary<br />
goals were identified for Nate (see Table 1).