Jill Smith is a 12-year-old girl in 5th grade attending Washington Intermediate School.

Jill Smith is a 12-year-old girl in 5th grade attending Washington Intermediate School. Jill has been diagnosed with Autism Spectrum Disorder. Jill’s school is a full inclusion school; there are no pull-out or self-contained classrooms. All of the special education services and supports that Jill receives during the day are provided to her in the general education classroom. Jill participates in the classroom activities on a modified curriculum. Academically, she functions at a level much lower than her same age peers. Jill accesses the standard curriculum on approximately a kindergarten level. Jill has a part-time paraprofessional assigned to her to assist with transitions and personal needs. Jill also receives speech and language services in the classroom from an SLP 3 days a week for 30 minutes.

Jill was diagnosed with ASD just after her 3rd birthday. Jill is a healthy child but large for her age. She is 5’3 and weighs approximately 134 lbs. Parents report an uneventful pregnancy and a normal delivery. Jill’s mother reported that she was a colicky baby and cried frequently. She was also easily startled as a child. Yet, Jill met all of her developmental milestones on time until about 2 years old. Her mother reports that Jill always seems to be distant and appeared to be easily agitated. Her parents reported that she slowly stopped progressing, as if she hit a wall. Her hearing and vision are considered to be normal. Jill can communicate with short phrases such as “Jill, yes” or “Hi, Jill.” Although she has many phrases in her vocabulary, Jill prefers not to use these.

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Jill is the youngest of three siblings. Her older sisters attend the local high school. While they report feeling embarrassed by their sister’s behavior in public, they both agree that their mother is doing all she can. Jill’s father is in the military and currently serving a 6-month deployment. The family anticipates his return in about 5 months. Jill’s face lights up when her father enters the room. He is very patient and tends to hold firmer boundaries than Jill’s mother. Jill’s mother works part-time during the day and one Saturday a month. She earned an AA degree in general studies at the local college. Her father earned a bachelor’s degree in engineering from the state college and entered the military full time just after graduation. He is currently serving as an officer in the Navy. There is no history of mental illness in the family.

Jill’s parents have not sought pharmaceutical interventions for Jill’s ASD symptoms. Instead, they have altered the family diet to include only organic, all natural foods and dietary supplements. Jill is only offered healthy, organic food options at home and school. She has very little access to sweets and treats. Jill prefers to eat white rice to anything else. She does not like foods with a loose consistency such as pudding or sauces.

Jill has her own bedroom on the main floor of the house. She dislikes climbing the stairs. Jill shares a bathroom with her parents. Jill’s room is very colorful and she often saves small tokens such a bottle caps and twist ties. Jill is very protective of her collections and will carry them with her throughout the day. Jill will spend hours searching the house for items missing from her collections, often forgoing sleeping and eating. She frequently will not rest until she finds the missing item or it is replaced by a new one. Jill has experienced night terrors in the past, sleeping only a few hours at a time. However, her parents have allowed her to watch TV in the evenings and she typically will fall asleep within an hour. She loves watching “The Tom and Jerry Show” with the sound off. If Jill’s day was particularly upsetting, she may not sleep at all in the evening. Instead she will rock on the floor and sometimes hits her head on the bedpost. Yet, her mother states this is a rare occurrence.

A typical morning for Jill begins when the sun rises. She typically wakes herself and sits at the kitchen counter waiting to be served breakfast. Her sisters make sure Jill has cereal before they leave for school. Jill’s mother drives her to school each morning because Jill dislikes the school bus. On mornings when there are interruptions to the routine, such as her sisters getting up late, Jill will cry or moan loudly until someone attends to her needs. Jill’s teachers feel that she is capable of getting her own cereal in the morning, but her mother reports that it is much easier and less messy to serve her. Jill often appears confused on the weekends and repeats the word “school” throughout the day. Her family members try to ignore her behaviors and tell her “No school today.”

At school, Jill’s social interactions are parallel in nature. She seldom makes eye contact with her classmates. While she will say hello to students and call them by name, she does not engage others in play very often. She will sit in a group and walk with the class most days but seldom talks to her classmates. Overall, Jill appears to enjoy the presence of her classmates but seldom interacts with them directly. If asked a specific question on her level, Jill can contribute one word answers to a group discussion. Yet a great amount of prompting is necessary. She enjoys going to recess and playing on the swings. She often wanders the perimeter of the playground area humming to herself.

Jill is a student obsessed with order and routine. She can become easily agitated with changes to the routine or environment. For example, fire drills, classroom visitors, or ½ days tend to frustrate Jill. Jill’s desk is neat and organized. She will often stop during the day to ensure all of her things are in order according to color and size. If other students bump her desk or move her things, she will cry and say “No, no, Jill.” Additionally, Jill becomes especially upset if she thinks something is missing from her desk. Her teachers must show her all items are present before Jill will move to a new task.

Jill enjoys being outside. She also likes to color and to draw. She is especially fond of bright colors and shiny objects. Jill’s teachers have provided her with brightly colored manipulatives to use throughout the day. They have also allowed her to have more freedom to move around the classroom. Jill is especially fond of her paraprofessional.

Events
Recently Jill’s teachers have noticed an increase in several concerning behaviors. She appears to be developing an aversion to the cafeteria although she generally enjoys eating her lunch. Since the weather has turned cooler the students must eat inside. Her teachers have noticed that when the students are instructed to prepare for lunch, Jill will sit still and stare at her desk. When prompted to get her things together for lunch, she often begins to rock back and forth humming. The paraprofessional who assists Jill with transitions typically gathers her things and leads her to the lunchroom. Many days Jill will comply with little resistance. Yet over the last month, Jill has displayed an increase in vocalizations and repeats short phrases. When Jill is particularly upset, she will also rock or sway back and forth while walking. Once the rocking begins, her teachers note that Jill typically ignores verbal redirection. Often just outside of the cafeteria, Jill will begin to slap her leg repeatedly while humming and rocking. In one observation a teacher noted, “The look in Jill’s eyes becomes distant and she appears to disconnect from all communication. It’s as if she has retreated into herself and closed the door to the world.” Once inside the cafeteria, Jill will cup her ears, rock and repeatedly cry “No, no Jill.” Her behaviors are tenacious. At times she may hit other students when engaged in her slapping behaviors or knock into small children when rocking. Once Jill is removed from the cafeteria her behaviors tend to deescalate, although the rocking and humming may continue throughout the day.

Jill’s mother has noted that she displays similar behaviors when the family attends church. Jill does not like attending the children’s service, nor the worship portion of the adult service. Jill is easily startled when the congregation claps. Volunteers have offered to sit with Jill in the vestibule while her mother and siblings attend church. Mrs. Smith reports that she is reluctant to allow others to assist with Jill because she is easily upset by change.

This week, a guest speaker came to the music classroom to demonstrate various instruments used in the orchestra. The paraprofessional accompanied Jill to the classroom. Jill was hesitant about the stranger and remained on the side of the classroom, attentive but not looking at the speaker. While demonstrating the string instruments, Jill seemed to enjoy the presentation. However, immediately when the trumpet was sounded, Jill was startled. She began to shout out, “No, no Jill” and rock violently back and forth. The music teacher tried to calm Jill but her presence only made things worse. The paraprofessional tried to coax Jill into the hall but she refused to communicate and seemed as if she could not hear instruction. As Jill’s fit continued, her classroom teacher and special education teacher were called to assist. When they arrived they reported seeing Jill slapping herself in the head with an open palm, screaming, “No, no Jill” and rocking violently. With the assistance of the paraprofessional, the teachers carried Jill into a private room and spoke quietly to her. They also held her arms so that she could not hit herself. It took almost an hour to calm Jill enough for her to return to the classroom. Not long afterward, Jill’s mother checked her out of school early and brought her home to rest in her room.

Jill’s mother has noticed that each incident at school and home seems to be worse than the previous and that the recovery time is longer each time. She has also noted that Jill seems to withdraw further into herself after each incident. She is very concerned that she will lose Jill if things do not change.

Problem
Jill’s teachers are concerned that if her outbursts continue or become worse she may not be able to participate in the general education classroom. Jill’s mother is adamant about keeping her in a general education classroom. All staff members who interact with Jill and her parents are meeting together to discuss the change in her behavior and develop an intervention plan to assist Jill. As a part of the assessment team, you must complete the Functional Assessment Interview form to facilitate this discussion.