Julia Grimes
Julia is a very caring, sensitive, little girl who seems to know more than many may give her credit for. Her sense of humor is evident even with her lack of ability to verbally communicate. She is very resilient considering her disabilities and tries hard to progress despite multiple hurdles.
Julia seems to want to communicate her wants and needs with others - family members, other kids, and wants to make friends. She is getting extremely frustrated with her inability to communicate her needs, which is causing her to appear "unhappy" with crying and tantrums,when really, I believe she is just frustrated. Julia's significant cognitive delays/dysfunctions, and serious deficits in the areas of communication and attention are very much impacting her life, at school, daycare, and even at home.
Social Skills:
1. Julia lacks understanding of typical "play" for a four year old. She engages in a more one sided type of play, or sometimes parallel play - more commonly seen in children significantly younger than Julia.
2. Julia lacks the ability to focus or attend to a task for more than about one minute, as noted by both her neurologist, Dr. Julie Parsons, and her Speech Evaluator, Tracy Kovach. This affects her ability to participate in groups during school time, and her ability to entertain herself at home unsupervised for any period of time without getting frustrated.
3. Julia is unable to follow more complex instructions, though can occasionally follow simple one task commands if engaged one on one.
4. Julia does not understand the "boundaries" of play or social interaction as most typical four year old do. She acts in play and social situations as a child significantly younger, for example stealing toys, eating food off of others plates, dumping food off of plates, not using utensils with any regularity, inability to drink from a regular cup, not sharing and getting upset when a toy, etc is taken from her. She is known to walk up to kids and just touch their bodies or their hair, often with her hands that are wet with slobber, which upsets other children.
5. Julia does not always know how to respond appropriately to others feelings - she will often cry if another child ignores her or tells her no or seems upset with her. When I, her mother, am upset at home (angry), she often just cries, or if I, her mother am sad, she disregards the feelings and goes about wandering. However, when others around her are happy, she does often respond favorably with a laugh and a smile.
6. When frustrated or over stimulated, Julia will cry and often has been throwing tantrums (throwing herself on the floor). The only thing I have found that helps with this is to let her wander which helps her unwind, but is not appropriate in most social situations.
7. Julia's speech therapists have noted that Julia's receptive language very far exceeds her expressive language. This need to be taken into consideration when dealing with Julia, as she does understand a lot of what is said to her, she just is unable to let you know that she understands.
8. Julia does not seem to me to understand rules very clearly. Perhaps this is just a cognitive delay and her being in her terrible two's (though she is almost four), or perhaps it is due to her brain injury and cognitive dysfunction.
Julia's social deficits result in her being constantly frustrated. She does not understand why she is unable to play with other children in the way that they play - playing outside with toys, tricycles, running, etc. She is frustrated when she is "forced" to sit in one place to participate in activities as was noted by speech pathologist, Tracy Kovach, and as is seen by me, Julia's mother, and I assume her teachers at school. Julia's inability to communicate leaves her extremely frustrated, causing her to cry often and be upset, which upsets everyone around her, including friends, her brother, Jack, and her other family members. We are ALL frustrated and want to somehow help this issue dramatically.
Sensory Issues
9. Julia was noted by her speech pathologist and her neurologist, to have a very limited ability to concentrate on any one thing for more than a minutes time. This was seen as, in Julia's "world", she experiences everything going on around her all at once and is unable to differentiate or concentrate on any one thing at any given time. This makes it extremely difficult for Julia to participate in groups.
10. In contrast to most children who get overstimulated and need to be put in a quiet place to calm down; Julia, when overstimulated, usually calms herself down by wandering around until she is OK, however, as stated previously, in social settings this is not, and will not remain appropriate. .
Learning
12. It is difficult to assess Julia's learning or ability to learn with her being nonverbal.
13. Julia, at a neurology appointment in May 09, was noted to not imitate with drawing or coloring. She did not select colors consistently. She was not able to count any numbers.
14. In OT, PT, and ST, Julia is very inconsistent with placing puzzle pieces in the correct place. She is not consistent with a shape sorter, however, often she will hold up the correct shape to the correct hole in the sorter, but cannot get it in without assistance.
15. Julia has shown improvement in her response to simple commands, ie "put this in the trash", put the bowl in the sink", "give the remote to mommy", and similar commands. However, more complex understanding of following more than one step commands is lacking.
16. Is there a way to assess her IQ at such a young age with her being nonverbal?
17. She did not reach many (any?) of her goals from her last initial IEP meeting which is of great concern to me.
Life Care Skills
18. Julia is unable to dress herself, or even help to pull her pants up and down, or help to take her shirt off. I would like to see her improve somewhat in this area.
19. Julia is not toilet trained, though does show an interest in watching others use the toilet. Perhaps this could be an opportunity for her to learn to pull her pants up and down, if brought to the potty once a day, even if she does not use it.
20. Julia is unable to put shoes or socks on by herself. She can remove her shoes and socks no problem, but cannot put them on. She does show interest in doing this.
21. Julia fights to have her teeth brushed. Is there anything that could be done about this at school, ie - books about it to look at, or having someone help her with it after snack to somehow make it "fun" for her.
22. Julia does not know how to appropriately brush her hair, though does make an effort to do so in bringing the brush to her head.
Overall Affects of Julia's Disability
23. Difficulty with motor skills - left sided hemiplegia, unable to manipulate playground equipment safely without supervision, still occasionally falls, unable to ride a bike or tricycle or other toy requiring organized movement of both legs and arms. Needs supervision with most physical activities, especially playground equipment, stairs, and steps. Safety cannot be overemphasized.
24. No organizational skills.
25. Little, if any, planning skills.
26. Extreme difficulty with sustained attention.
27. Difficulty in exerting mental control (crying outbursts, etc).
28. Extreme difficulty with concentration.
29. No fear of anything - no stranger danger, no fear of cars if walking outside, little fear of unknown animals, no fear of unusual situations or environments.
30. Being nonverbal is her biggest hurdle at this point. She needs a way to communicate and she wants to communicate. Her focus and attention span are equally important.
Strengths
Julia is a delightful, sweet girl when in a very structured environment with one on one support. It was recommended by her neurologist, Dr. Julie Parsons, that she be placed in a special structured school, such as The Rise School in Denver, which she believes would be most appropriate in helping her attention span immensely, and her family agrees. I have spoken to Mark Graham at The Rise School about Julia and she is on the waiting list. Our only issues about this at this point is transportation to get her there, as it is in Denver and I must work full time, and of course, the cost which is about $1000 to $1500 per month.
Julia has shown to have a very good sense of humor and appreciates humor in others and loves to laugh.
Julia has improved in her motor skills significantly over the last two years.
Julia has shown herself to be both physically strong, and more importantly, psychologically strong, in that she is very willing to TRY to help herself. She wants to improve.
Future hopes
The sky is the limit as far as I, her mother, am concerned. Realistically, I would love to see Julia progress to a point of being able to live independently at some point in her future. I would love to see Julia be able to hold down a job, live on her own or with support of caregivers, and be a productive member of society. Julia will always have the support of her family and her friends and we will provide for her whatever we can to reach these goals.
I respectfully request this written report be included in the written record of this meeting as part of my parental input.
Dr. Susan Lawson-Grimes
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