Appendix D

Case Studies for Lesson Plan 4

Case 1-Infant:

Infant Sensory Case Study

Alyssa is a 10 month old infant girl who lives a home with both of her parents and her sister who is two
years old. It is notable that her sister has been diagnosed with autism which affects the home
environment and family dynamics. Alyssas mother requested an evaluation because she is having
difficulty with bottle feeding and transitioning Alyssa to solid foods. Alyssa will only be fed by bottle if
held at a distance facing away from her mother. She refuses all solid foods by turning her head, fussing,
and spitting foods out. Her mother is also concerned about Alyssas motor development. Alyssa prefers
to be held all the time by her parents and does not like to be put down to play. She has limited
interaction with toys, but can grasp and pick up small toys within her reach. She is beginning to learn to
sit up with support for very short amounts of time when on her mothers lap, but especially dislikes
being placed on her tummy. She fusses during bath time, especially when having her face washed.
Alyssa enjoys car rides and going for a walk in her stroller. Her mother states that she sleeps well, but it
takes an hour to get her to go to sleep for naps and at night.

Case 2-Toddler:

Toddler Sensory Case Study

Jessie is 22 months old and lives at home with both of her parents. During the initial interview
Jessies mom reported that mealtime is a challenge because Jessie often refuses to eat and ultimately
shes fed by an adult. Despite her fussing, she needs to eat in order to gain weight, so her parents
persist. Jessie becomes increasingly distressed and the mealtime experience becomes unpleasant. The
family enjoys eating out, but their choice of restaurants is limited only to several familiar places that
offer menu items they know Jessie will eat. Otherwise, Jessies parents feed her before they take her
out and then hope that she will be content while her parents order and eat their own meals.

She doesnt play well by herselfshe generally needs someone to get on the floor with her and start
playing with the toy. After watching, she will try to repeat the same activity but her efforts dont
continue without prompting. She doesn't seem to show a preference for music or childrens television
programs. Jessie doesnt interact when she is around other toddlers in the neighborhood. She generally
sits near her mother and watches their play. She becomes easily upset when children come near her
and attempt to interact. After several minutes she cries and clings to her mother. She enjoys sitting in
the stroller for walks around the neighborhood, but is less content for walks in the nearby
community park.

Case 3-Child

Child Sensory Case Study

Sam was a 6-year-old male who lived with his parents, older brother, and younger sister in a suburban
area. He was the product of a full-term pregnancy remarkable for external cephalic version during the
third trimester. Sam aspirated on afterbirth immediately following delivery. The family was advised to
keep his head elevated for several weeks following this incident. No other complications were noted at
birth. Sams medical history is remarkable for two placements of bilateral pressure equalizing tubes as
well as chronic constipation. He has been diagnosed with a chromosomal abnormality, attention deficit
hyperactivity disorder (for which he is receiving no medication), and possible anxiety disorder. During
his last re-evaluation, his parents expressed concerns about his overall delays, behavior, sensory
processing, and delays in self-help skills. When questioned about her primary concerns specifically, his
mother noted the following:

I am really concerned about what he is going to look like when we send him to kindergarten. He seeks
constant attention from me. If I am not able to give him my attention right away, he will seek the
attention in a negative way. He will do whatever works. He uses loud, bad, or junk language randomly
and when he is frustrated which is making it really tough to go places like Wal-Mart or even to church.
He needs to stay with us until the kids are dismissed for childrens church, but he makes it about 5 or 10
minutes at most. He can be very physically aggressive without a trigger or warning. He just randomly
hits his dad or his brother and sister if they are closest to him. He may pinch or scratch. If I hold him to
make him stop, it can take 5 minutes or more to calm him down.

Sam demonstrated some of these behaviors during his OT examination using junk language at least 12
times during the session and other negative attention seeking behaviors. In addition to Sams difficulty
with attention seeking and problem behaviors, he has fallen behind in age appropriate attainment of
fine motor skills and activities of daily living. Regarding his activities of daily living, Sams mother voiced
these concerns:

Sam still has frequent accidents. He will not have a BM in the toilet (at home). He hides from us and
goes in his underwear. He is frequently constipated and when he is able to go, he has very large stools.
He will act like he cant pee because he wants help. He will hold it forever until he has an accident if we
dont help him. He gets a bath every other night because he does not like to have his hair washed. He
really does not want to put his clothes on by himself. He will avoid it and wont even try to do the
buttons or snaps on his clothes. He will tolerate help brushing his teeth and hair, but does not really like
it.

Case 4-Adolescent

Adolescent Sensory Case Study

Marcus is a 16 year old who was referred for occupational therapy evaluation. Marcus has a calm, laid-
back personality. He enjoys art/drawing, listening to music, and has 2-6 close male friends who he
enjoys camping and going to the lake with in the summer and hangs out with during the school year at
his/their homes. Marcuss mom clarified that she is only comfortable with him spending time with one
of his friends because she knows she can trust Marcus with him. Marcus has never participated in
organized sports and dislikes sports and PE.

Marcuss mother initiated multiple services to help him finish his high school education and transition to
independent living, including occupational therapy, counseling, physical therapy, psychologist, and
closer consultation with the school district.
Marcus is the oldest of seven children. The youngest child in the home is 6. He has an extensive
medical history with multiple diagnoses of Aspergers Disorder (ASD), ADHD, Tourettes Syndrome, and
Anxiety. He has received occupational therapy services in the past, but it has been greater than 5 years
ago. He has a current IEP at his school district to ensure appropriate adaptations to his work and school
day.

Marcus was born full-term, vacuum-assisted delivery, and experienced no complications after birth. His
mother states she did have toxemia during pregnancy. He achieved all developmental milestones in the
first three years of life on time or early, with the exception of a mild speech delay. His mother reports
extreme temper tantrums during his early years, which continue as anger outbursts currently.

His mother reports that Marcus has experienced severe difficulty with school and particularly during
high school years. She is concerned that he is not achieving the basic learning and skills needed to
transition in two years to independent living after high school. She is very unhappy with services that
have historically been provided at public school. So, this year they are trying homeschool/online school,
re-initiating multiple therapies, and participation in a technical program to teach him vocational skills.
He has received occupational, speech and physical therapy services in the past, but none in the past 5
years.

The caregiver is asking for support so Marcus can behave appropriately in social situations, for example,
coping strategies that Marcus can use independently when overwhelmed by sensory stimulation or
social demands in his environment without adult intervention. She is also requesting support so Marcus
can complete basic and instrumental activities of daily living independently with few to none verbal
reminders from his mom (showering, clothing changes, tooth brushing, and cleaning his room) . His
mother also would like assistance with preparing Marcus for transition from school to community,
including preparation for employment, independent living, and community integration.

Right now, when Marcus is in a family environment he is easily overwhelmed by siblings and his home
environment which can lead to altercations with other families. He often isolates himself and prefers
being alone in his room to listen to music. He requires frequent-constant verbal reminders for basic
ADLs and self-care routine and schedule from his mother. If not prompted by verbal reminders, Marcus
will neglect showering, changing clothing, homework, etc. These challenges make it difficult for Marcus
to build independence in self-care and educational demands at home. Kristy reports that it can be
difficult for Marcus to participate in activities because he struggles with managing his moods and
physical/emotional response to negative stimuli, and is often aggressive in the home environment.