specialedsupport.weebly.com€¦ · Web viewDoes your child have difficulties with receptive language (difficulty following instructions in the classroom and playground – difficulty

STUDENT’S Name: __________________________________________________________ DOB: _____________________________________________________________________

HAVE YOU HAD CONTACT WITH THE FOLLOWING?

Diagnostic and Assessment Team, Kogarah? YES / NO

Does your child have an ADHC Caseworker? YES / NO

Caseworker’s name:________________________________________________________

MEDICAL HISTORY

Childhood illnesses – has your child had any of the following?

MEASLES YES / NOMUMPS YES / NOCHICKEN POX YES / NOWHOOPING COUGH YES / NOFEBRILE CONVULSIONS YES / NOEPILEPSY YES / NOASTHMA YES / NORHEUMATIC FEVER YES / NOCONGENITAL HEART DISEASE YES / NOALLERGIES (Please give details) YES / NO

OTHER SIGNIFICANT ILLNESSES?

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Has your child has vision or hearing tests? If yes what were the results?________________________________________________________________________________________________________________________________________________________________

School Letterhead

THERAPY (past and present)

SPEECH YES / NO ________________________________________________________If yes, Name and Phone number ___________________________________________________

PHYSIO YES / NO ________________________________________________________If yes, Name and Phone number ___________________________________________________

OCCUPATIONAL YES / NO __________________________________________________If yes, Name and Phone number ___________________________________________________

COMMUNICATION

o Does your child have difficulties with receptive language (difficulty following instructions in the classroom and playground – difficulty in understanding 1 to 2 part instructions).

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o Please identify the current form of communication (i.e. if your child uses alternative communication system – visual, voice output device, sign etc.) or if your child is able to use single words or sentences.

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o Are there any behavioural issues related to poor or limited communication skills?Does your child have a current behaviour management plan?Please describe:-

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o Does your child’s eating habits cause some concern (eg. Poor chewing, coughing, only eats certain foods)?Please describe:-

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o What areas with regards to communication would you like the school to work on with you and your child?

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ADAPTIVE SKILLS

o Does your child use any special equipment (eg devices to assist with mobility, self-care or areas of daily functioning, or assisted technology)?Please describe:-

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o Does the school environment need to be modified to cater for your child’s needs?Please describe:-

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o Does your child need assistance with fine motor skills (eg. Pencil grip, cutting, drawing, hand preference)?Please describe:-

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o Does your child need assistance with self-care skills (eg. dressing, toileting, using cutlery, routines)?Please describe:-

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Is your child toilet trained? YES / NO

If yesa) Is he / she trained for bowel? YES / NOb) Is he / she trained for bladder? YES / NOc) Does your child initiate toileting? YES / NOd) Does your child manage own clothing adjustment? YES / NOe) Does your child use a toilet or potty chair? YES / NOf) Does your child was their hands after using the toilet? YES / NOg) Where applicable does your child need assistance with

menstruation? YES / NO

If noa) Has there been any attempt to toilet train your child? YES / NO

If yes, what happened?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b) Does child show discomfort or indicates when wet / soiled? YES / NOc) Does child show regularity?

eg. bowel movements after meals, in the mornings? YES / NOd) Is he / she happy to sit on toilet, potty? YES / NO

What areas in regards to adaptive skills would you like the school to work on with you and your child?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

MOBILITYo Does your child have difficulty with walking (poor balance, falls or trips frequently, needs

support)?Please describe:-

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o Is your child able to walk distances (tires easily, refuses to walk, needs frequent rests)?Please describe:-

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o Does your child require specialised equipment for standing, mobilising (eg. standing frame, walker, wheelchair or orthotics)?Please describe:-

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o Does your child have difficulty climbing stairs (holds onto rail, two feet per step)?Please describe:-

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What areas would you like the school to work on with you and your child?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ADDITIONAL INFORMATION

o Does your child socialise and play appropriately with peers?Please describe:-

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o Does your child participate appropriately in group time, small groups or large groups?Please describe:-

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o Is your child able to follow rules and routines?Please describe:-

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o Does your child have specific sensory needs or difficulties i.e. loud noises, smells (due to a dislike, or a desire for touch, visual or auditory input or movement)?Please describe:-

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BEHAVIOUR MANAGEMENT

o Is there any situation your child finds uncomfortable? How does your child indicate this?Please describe:-

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o How do you comfort your child when he / she is upset?Please describe:-

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o What is an effective reward for your child?Please describe:-

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o Does your child display behaviours that may result in harm to self or others? Has there been a behaviour management plan developed for your child?Please describe:-

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Thank you for providing this information to the school.

Signed ______________________________________ Dated __________________________

Student’s Name:

Class:

Age:

DOB:

Year:

Communication:This student has no verbal communication skills. He has a very limited attention span and needs full verbal and physical prompting in order to remain with the group and follow most directions. He needs one on one supervision as he will put an object into his mouth and can chew and swallow it. Use limited speech with this student along with visual communication / objects and gestures to help this student understand what is happening or what activity is next.This student can get unsettled and frustrated and communicate this by crying, jumping and thrashing his arms and legs around. Care needs to be taken when staff and other students are around him as he can hurt people with this limb movement. A calm deep voice with lots of facial expression and gestures is to be used in order for him to understand.

Personal Care:This student wears pull ups or nappies that are purchased by the school. He needs full assistance in all his toileting needs. He is in the process of being toilet trained to use the toilet for bowel motion and urinating. This is a slow process and the timing of taking him to the toilet needs consistent throughout the day and week. This student can use cutlery if spoon or fork is loaded but needs 1:1 to ensure that he remains seated at the table and eats his food appropriately. He is able to drink from a pop top bottle or cup. When he has enough he may start throwing his food and water.

Mobility:This student has full mobility but has no awareness of danger or road safety skills. He needs 1:1 supervision to remain with the group and to stay safe. If he does not want to walk he can at times drop to the floor. Give him a few moments before he is asked to stand up and often he will respond to the sign, verbal prompt of “stand up” and physical assistance such as taking his hand and unfolding his legs to stand.

At all times this student has to be encouraged to stand up independently. Hold his hand at all times, when walking from one place to another or during an outing.

Social Skills / Behaviour:This student needs 1:1 support verbal and physical prompt to complete all activities. He needs to be given simple single instructions. If he gets upset he hits his leg or head, bites his hands, drops to the floor or may pinch others. He needs to be talked to quietly and calmly and redirected to another activity. If it does not work, let him remain on the floor until he calms down and then ask him to stand up.

Interests / Preferences:This student likes swimming. The Multi-sensory room helps him to settle down when he is unsettled and usually he looks very relaxed there. He will play with electronic toys, but as he has a short span of attention, after a couple of minutes he loses interest and will try to put it in his mouth.

Health Care Procedures:No medication is given to this student while at school.

Who is …………? Date:What does he / she need to learn and why.

1. STUDENT PROFILE

Likes To be completed in term one to identify priorities

To be completed in term 4 to communicate with next teacher

Dislikes

CommunicationReceptive

What he / she needs to learn and why

CommunicationExpressive


Social


Living Skills


Sensory needs

Classroom rules and routines


Academic


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Student Profile

Student’s NameAge: DOB: Class year:

List of Medical Conditions

List of Medical Procedures

List Of Medication

1.

Medical Condition

Medical Procedures

Medication

Communication

Expressive language: This student is non-verbal. He uses eye gaze to communicate.

This student has a very clear, well established “yes” “no” response. Herolls his eyes up for “yes” and shakes his head and vocalises for “no”.

When given choices, student will indicate his choice using his “yes”“no” response or by looking at the object or picture.

Student is learning to recognise and put meaning to PCS. Receptive language: Student shows great understanding of spoken

language. His receptive skills are very good. He shows these byresponding to most of the questions asked. Student is a very motivated student and enjoys social interaction.

Student can show reactions by smiling, and making eye contact.

1. Communication Skills Choice Making Engaging Attending to all activities Recognition of PCS

2. Literacy Skills Recognition of sight words Sentence building Letter blending – work formation Spelling

3. Numeracy Skills Recognition of numbers 1-20 Counting / sorting Simple addition

4. Physical Management Skills Strengthening body Gross motor (movement) Fine motor (grasping, stretching)

2.

5. Personal Needs Toileting independence

6. Sensory Development Awareness of different textures Tolerance of different textures and mediums

7. Technology Skills Independence using a touch screen computer and a

Current Priorities

Concept keyboard

Student uses a wheelchair stroller for mobility. He is reliant on staff to move him from place to place.

In group activities, student sits in a class chair with supports. Student requires full assistance when going to the toilet. Bike riding – student uses the blue 20” bike.

Student enters and exits the pool via the hoist chair. Student requires full assistance whilst in the pool. He can use floatation aids

whilst in the pool. See hydrotherapy program for individual activities.

Student loves being engaged. He enjoys reading and maths activities. He has a general love school and all activities.

3.

Student Profile – Students Name

Class: Age : DOB: - NO REGULAR MEDICATION GIVEN AT SCHOOL, can be given Pain relief after she has had a negative outburst.Student is on the autistic spectrum. She is usually very quiet, not very energetic student who is happy to watch. She can become very anxious and needs careful management. She does not like actively participating and especially if she is in the limelight e.g. getting awards at assembly. When she is anxious she will talk about her special interests (e.g. people nationality, what would happen if “x” happened). She needs the questions no matter how bizarre to be answered and prefers her “set” response. If she becomes very agitated she will hit / kick staff and try to break windows with her head, whilst screaming and slapping her own head very hard and definitely not do what was asked of

Physical Management

Hydrotherapy Program

Interests

her. Time, making all around her safe and minimal responses to her will help in calming her down. Then high sugar foods, drink of water and pain relief.When she is becoming anxious she laughs out loud or talks to herself.She needs to be supported by staff being calm and positive with her and if demands are to be made on her; they need to be positive and using social stories using symbols.She sucks her thumb and can become very distressed if one asks her to stop this. She also has a heavy irregular menstrual cycle and this does affect her well-being and add to her stress levels. This is being actively addressed by the medical profession.She will join in activities, but prefers to sit and watch or talk about her special interests.Communication:Receptive: She can respond to instructions about the here and now, she can answer questions about things which are familiar to her.Expressive: Student enjoys talking to staff and will interact positively with her peers. She can use 3 word sentences.

Personal Care: This student no longer wears a nappy to school, and only very occasionally has any accidents. Staff do need to insist that she uses the toilet throughout the day. She can dress and undress herself only needing assistance with her bra. She has a very healthy appreciation for sweet and junk food and often is very hungry on arrival. She will take her peer’s food.Student will state inappropriate things to staff or ask them inappropriate questions, ask her to think about what she is saying.

Mobility: Student can be nervous when using the gym and in the pool, but she can doggy paddle a width with her head out of the water. Climb on the equipment and throw and catch a large ball when stationery. After any physical activity, she is very tired and will sometimes have a negative outburst.

Interests / Preferences:She loves listening to music, dancing, talking to staff about her special interest and drawing people with crayons on plain paper, although she tends to do the same drawings of people. She has had a lot of time absent from school, with her health and transport problems (she only re-joined transport last year and her mother travels with her, for everyone’s safety) and would prefer to stay at home.

– January 2011, updated February 2012

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specialedsupport.weebly.com€¦ · Web viewDoes your child have difficulties with receptive language (difficulty following instructions in the classroom and playground – difficulty