This is an example of how an Active Learning Materials and Activities Planning Sheet might be used to gather information for program planning for a student utilizing an Active Learning approach. Gathering information takes a little time, many conversations with caregivers, some trial and error, and a lot of observation. This form is meant to help a team get started planning together for their student. 

Adapted from personal notes from a seminar by van Dijk, J. 1985 and information from Dr. Lilli Nielsen in Functional Scheme and some of her other books.

You may download blank forms to use with your student in both Word and PDF formats.


 

Child's Name:   David Denton

Date  September 16, 2018          


Appetite and Aversion

Over a period of time (at least 3-4 weeks) through listening to stories from others and through observation of the child, simply list things the child likes and things he doesn't like. We all enjoy things that we are good at and that we understand. The child's "Likes" will be his areas of strength and use sensory channels that are working. His "Dislikes" may include aversive materials or experiences, as well as areas of need and sensory channels that may not be working efficiently. The information gathered on this form will give you underlying themes that you can use for identifying objects and activities to use in Active Learning instruction.

 

Appetite or Likes

 

Aversion or Dislikes

 Gentle vibration

 Other children crying or screaming

 Music

 Icky, sticky stuff on his hands or feet

 Food/eating - especially sweet tastes

 People messing with his feet

 Water play (prefers warm water)

 Soft squishy textures

Green and blue things, shiny things

 Cold water

Rough Textures  
Metal Objects  

 


Pathways to Learning Summary Information:

What sensory channels is the child using the most? How would you rank them (with 1 being the sensory channel used most and 6 being the channel used least)? What are the child’s behaviors that help you know this?

Sensory Channel

Rank

How do you know?

Vision

5

nystagmus, exotropia and suspected CVI – responds to light and a few colors (green/blue)

Hearing

3

Responds to music and select people’s voices ….. possible auditory processing since he seems more in tuned to pitch/rhythm and has CP/Seizures

Touch

4

Does not use many exploratory patterns with hands and feet, but does seem very responsive with mouth, lips, tongue

Taste

1

LOVES to eat

Smell

2

Seems to recognize food prep just by smell

Proprioceptive

6

Unsure – has ONH and may have some issues being aware of own body


Other Considerations

Include other information that might be important to note in planning, such as seizure activity, special diets, allergies, etc.

  • STUDENT has a seizure disorder with many seizures throughout the day.  Special consideration should be given to materials, need for breaks, duration of activity and so forth. He is also on a Ketogenic diet so special consideration should be given to any foods used.
  • STUDENT is suspected of having CVI and a CVI range might be needed to help pinpoint accommodations to materials and environments.
  • Given diagnosis of Optic Nerve Hypoplasia there may be some additional issues related to body awareness.

Questions

1.  What are possible attributes of materials that might appeal to his/her top three sensory channels? (Color, shape, texture, size, etc.)

  • Blue, green
  • Rough like sandpaper, scratchy Styrofoam, emery boards, etc.
  • Slim profiles since grasp is not well developed
  • Things to poke fingers in
  • Likes metal – chains of all sizes
  • Lotion, lightly scented (check with mom about preferences and seizure)
  • Burlap bag of coffee beans, hard candies
  • Water and sand play

2.  What do you currently observe the child doing with his/her hands (e.g., grab and release, bat at fisted, transfer hand to hand, throwing, scratching)?

  • Scratching, Batting
  • Grasp (but not let go)

3.  What do you currently observe the child doing with arms, feet and legs?

  • Moves and kicks legs and arms
  • Pushes up with forearms and hands when prone
  • Goes into hyperextension and lifts arms and legs off the ground while in prone

4.  What do you currently observe the child doing with his/her head, mouth, lips and tongue?

  • Sucks fist
  • Opens and closes mouth and thrusts tongue when being fed. Moves jaw up and down.
  • Combines vocalization with mouth and tongue movements. Moves tongue from side to side.
  • Closes lips over spoon to feed
5.  What kinds of vocal play do you observe? (e.g., babbling, squealing, clicking, etc.)
  • Grrr sound
  • Squeal
  • Awah sound
6.  What sounds does he/she respond to? (e.g., dad’s voice, computer generated sounds, door slamming, etc.)
  • Music
  • Mom’s voice
7.  What kind of scents does he/she like or dislike? (types of smells or particular things that smell)
  • Food smells
  • Check with mom about essential oils and lotions she likes to use
8.  What kinds of foods or flavors does he/she like or dislike?
  • On Ketogenic diet
  • Likes sweet things
9.  What kind of touch does he/she like or dislike? (e.g., light, heavy, deep pressure, etc.)
  • Deep or heavy

Social and Emotional Development

In order to utilize the best educational approach with your student, what Dr. Nielsen calls the Five Phases of Educational Treatment, we need to look at the child’s behavior.  Look at the behaviors described below and place an X in the row(s) where you see behaviors that are demonstrated by your student.

Developmental Age

Child contacts or responds to contact by:

X

Birth-3 months

  • clutching fingers or some hair of the adult
  • clutching some of the adult's clothing
  • smacking lips,
  • making "grrr" sounds
  • by nodding, sucking, and grunting
  • can be calmed by being taken in the arms and cuddles
  • transfer of clutching/grasping to biting, pinching may be seen in older children

X

4-6 months

  • babbling or crying consciously to get adult’s attention or when nothing is wrong
  • may scream or cry most of the day - possible that the screaming is a child's attempt at babbling
  • may respond to contact by babbling
  • shows anxiety to unfamiliar rooms, persons, toys
 

6-9 months

  • molding his/her body into the shape of adults
  • snuggles close to the adult
  • touches adult’s face or puts finger in eyes, mouth
  • likes to be moved from the arms of one familiar person to another
  • imitates the adult’s movements, reaches hand toward light switch after adult turns on light
  • seeing Mom or Dad after return causes joy
  • shows joy when recognizing familiar voices
  • may want to move his or her body the way he or she wants to move their body
  • may be pulling their arms away and, kind of, hiding them
  • may want to sit in a specific way
  • if able to be held by an adult, may want to be held or positioned a certain way
 

9-15 months

  • "showing objects” - wants to share interests with adult
  • if adult does not respond, may attempt to establish contact by hitting the adult with the object (banging objects)
  • refuses contact with persons whom he does not feel attached to
  • puts arms around adult he feels attached to
  • wants to drink from adult’s cup or feed adult
  • laughs and babbles in interactions with adult
  • enjoys adult-learner games such as clapping hands and playing with lips
  • may hit themselves or other people
  • moving to the adult (pull to standing, walking or crawling)
  • acts like he/she wants to sit on adult's lap, but as soon as he/she gets there, wants to get down
  • may lean against the adult briefly, or rest an arm or a hand on the adult briefly
 

15-18 months

  • picks up an object and gives it to adult with expectation adult will give the object back
  • if adult will not engage in game, child looks for another adult who will engage in game
  • tests activities that are allowed and not allowed
  • demonstrates strong attachment to one or a few objects
  • often has the need for physical contact, wants to be carried and sit on lap
 

18-24 months

  • lends adult most cherished toy
  • engages in building games as a contact game
  • can react intensely to changes in daily routine
  •  throws a tantrum when crossed
  • presents strong feelings of ownership: my mother, my toy
  • plays language games with adults – jingles and rhymes
 
2-3 years
  • contacts by hiding and then revealing himself with a shocked attitude
  •  involves adult in hiding games and games of searching for each other
  •  Involves adult in rough and tumble games
  • wants to interfere in activities of an adult
  • demonstrates his will in the presence of other children by claiming ownership of his toy
  • appreciates help with things like dressing and undressing
  • has a strong need for physical contact, holding hands while walking
  • is able to engage in contact with only one adult at a time
  • uses language more often in contacting others
  • has difficulty accepting criticism
  • has difficulty choosing between yes/no, coming/going, milk/juice, etc.
  • can be quite rigid and will change results by demonstrating anger, passivity or withdrawal
 
3-4 years
  • contacts by standing next to adult and leaning against him
  • shows great independence, often thinks he can do more than he actually can
  • can become very despaired when he has to receive help from the adult
  • direct physical contact is most often replaced by conversation
  • is eager to help with domestic activities
  • leans against, places an elbow against or looks at an adult to receive a smile or a comment-- and then looks at others present to share with them this emotional experience
 

Describe your general impressions about the individual’s ability to self-regulate, show empathy, manage strong emotions, identify his/her own feelings, read others emotions, and establish and maintain relationships:

He is reluctant to work with or tolerate many people.  He loves his paraprofessional and classroom teacher, but just seems to tolerate the rest. Responds with animation to the sound of mom’s voice and is very relaxed with mom, dad, and siblings. Loves to be held and cuddled by parents and paraprofessional. Sometimes pulls hair of adult when interacting. When over-stimulated he appears to go to sleep. Very reluctant to interact or tolerate class peers. Definitely prefers adults.


Ideas for Specific Objects to Include in Instruction:

List the items (Lilli says 70 or more) you want to try using and check to see if the properties match the student’s preferences in his/her top 3 sensory channels (list below). You should consider using multiples of objects with similar but slightly different features. Remember to have a quantity of everyday objects included in the mix. This can also serve as a shopping list for items you need to find. You can also continue to add new items to the list over time.  Be sure to have at least some items that will appeal to the highest ranked Pathways to Learning.

Our Student's Ranked Pathways to Learning

  1. Taste
  2. Smell
  3. Hearing
  4. Touch
  5. Vision
  6. Proprioception
ItemVisionHearingTouchTasteSmellProprioception
Burlap bag with beans, rice, coffee beans    x  x    x  
Rough scrubbers      x      
Emery boards      x      
Sandpaper      x      
Corrugated cardboard      x    x  
Oil filters (clean with heavy cardboard)      x      
Metal spoons of all sizes and shapes  x  x  x      
Metal measuring cups of all sizes and shapes  x  x  x      
Metal strainer  x    x      
Shiny blue/green ribbons  x    x      
Wooden castanets    x  x      
Wooden wind chimes    x  x      
Heavy metal or porcelain bells    x  x      
Shiny Christmas decorations  x    x      
Netting other scratchy materials  x    x      
Metal chains of all sizes      x      x
Vibrating toothbrush, hand massagers    x  x      
Things with holes to poke fingers into such as spaghetti strainer, candy tray, large metal nuts for bolts      x      
Woodpile wood lizard - make of cedar    x  x    x  
Blue/green mylar pompoms, ribbons  x    x      
Scrub Daddy sponges  x    x      
Strands of wooden, metal and plastic buttons  x  x  x      
Collection of wooden popsicle sticks  x    x      
Beads (wooden, glass, metal)  x    x      
Strings of hard candy  x    x  x  x  
Seed pod rattles    x  x      x
Balls with holes in them (wiffle, etc.)      x      
Metal bowls    x  x      
Tipping boards with wooden dowels    x  x      
Hair rollers, Velcro, brush, etc. of various sizes      x      
Strings and laces with knots of various sizes      x      
Chinese rattles with acute points    x  x      
Bottle brush, hairbrush and all kinds of stiff brushes      x      
Strips of paper, especially metallic glazed paper    x  x      
Lollipops made from round sticks dipped in melted sugar and corn flakes      x  x  x  
Wire whisks of all sizes and shapes  x  x  x      
Forks and spoons  x  x  x      
Greaseproof paper, tissue paper, wrapping paper (folded or crumpled)  x  x  x      
Key bunches of various shapes and materials  x  x  x      
Egg slicers    x  x      
Boxes fitted with rubber bands    x  x      x
Potpourri bags      x    x  
Scented lotions (especially used in Lotion Routines)      x    x  
Leather strips            
Strumming instruments (ukulele, dulcimer, guitar, etc.)    x  x      x
Toothpaste (small amounts on toothbrush)      x  x  x  
Sugar cane      x  x  x  
Harmonicas, penny whistles, etc.    x  x      
Aluminum pie pans, trays  x  x  x      


Plan for completing the Functional Scheme:

Decide as a team how and by when you will address all sections of the Functional Scheme.  It is recommended that team members work in pairs on each section for better verification of the student’s use of skills across multiple domains and with multiple people.  Use the chart below to plan who will be responsible for each section.  You may choose the official due date or assign an earlier due date to each section to spread work out across time.  COMS=Certified Orientation and Mobility Specialist, CT=Classroom teacher, Para=Paraeducator, OT=Occupational Therapis, PT=Physical Therapist, SLP=Speech-Language Pathologist, TDHH= Teacher of the Deaf and Hard of Hearing, TVI=Teacher of Students with Visual Impairments. Completing the entire Functional Scheme on an individual learner may take quite a bit of time, especially if the team is just meeting the student. Setting a timeline helps to keep everyone on track and in communication about skills to focus on during instruction.

Section

Name and Title of Participants Responsible for Section 

Official

Due Date

Team Assigned

Due Date

Gross Movement

Kevin Lauder, PT & Elise Davidson, COMS

10/1/18

May 15, 2017

Fine Movement

Cheryl Schultz, OT &Hillary Keyton, TVI

10/1/18

May 30, 2017

Mouth Movement

Cheryl Schultz, OT & Kate Kitchens, Parent

10/1/18

May 30, 2017

Visual Perception

Hillary Keyton, TVI & Elise Davidson, COMS

10/1/18

June 15, 2017

Auditory Perception

Perkins Canton, TDHH & Hillary Keyton, TVI

10/1/18

June 15, 2017

Haptic-tactile Perception

Cheryl Schultz, OT & Hillary Keyton, TVI

10/1/18

May 30, 2017

Smell & Taste

Cheryl Schultz, OT & Hillary Keyton, TVI

10/1/18

May 30, 2017

Spatial Relations

Hillary Keyton, TVI  & Elise Davidson, COMS

10/1/18

June 15, 2017

Emotional Perception

Matt Scott, CT, Susie Walker, Para & Kate Kitchens, Parent

10/1/18

September 1, 2017

Object Perception

TVI/CT Hillary Keyton, TVI & Matt Scott, CT

10/1/18

September 1, 2017

Language: Non-verbal

Perkins Canton, TDHH & Hillary Keyton, TVI

10/1/18

June 15, 2017

Language: Verbal

Perkins Canton, TDHH  & Hillary Keyton, TVI

10/1/18

June 15, 2017

Comprehension of Language

Perkins Canton, TDHH & Hillary Keyton, TVI

10/1/18

June 15, 2017

Social Perception

Matt Scott, CT, Susie Walker, Para & Kate Kitchens, Parent

10/1/18

September 1, 2017

Perception through Play & Activity

Kevin Lauder, PT & Cheryl Schultz, OT

10/1/18

May 30, 2017

Developmentally Impeding Functions

Matt Scott, CT & Kate Kitchens, Parent

10/1/18

September 1, 2017

Toileting Skills

Matt Scott, CT, Susie Walker, Para & Kate Kitchens, Parent

10/1/18

September 1, 2017

Undressing and Dressing

Cheryl Schultz, OT, Matt Scott, CT, Susie Walker, Para & Kate Kitchens, Parent

10/1/18

May 30, 2017

Personal Hygiene

Cheryl Schultz, OT, Matt Scott, CT, Susie Walker, Para & Kate Kitchens, Parent

10/1/18

May 30, 2017

Eating Skills

Cheryl Schultz, OT, Matt Scott, CT, Susie Walker, Para & Kate Kitchens, Parent

10/1/18

May 30, 2017


Goals, Objectives, Skills – Data for Child Progress Reporting:

You may find it helpful to have a list of goals/objectives and/or skills that will be the focus of data collection for documenting child progress. You can list them for specific environments and activities and post them near each environment so all staff know what behaviors they should take note of during an observation. Or you may have them in a child’s folder so any staff member can select an environment or activity to observe and collect data. This also could serve as the basis for your lesson plan.

Environments or Activities

Goal/Objective or Skills Child Should Demonstrate

# Observed

Other Skills to Watch For

# Observed

Kicking using Essef Board

Positioned in a swing, hammock special chair or on the floor in supine during independent and interactive play STUDENT will kick with his legs/feet to produce sounds when provided a variety of materials during independent and interactive play at least 10 times within a 15 minute observation period.

||||

Sitting unsupported Vocalizing

Listening and experimenting with sounds

Making contact with adult through touch and/or vocalization

| - vocalizing to get adult attention

Kicking using an Essef Board and tray of materials

|||

Sitting unsupported Vocalizing

Listening and experimenting with sounds

Making contact with adult through touch and/or vocalization

 

Kicking in water during footbath

|||| ||

Sitting unsupported Vocalizing

Listening and experimenting with sounds

Making contact with adult through touch and/or vocalization

 

Little Room

When given a variety of materials in several different learning environments during independent and interactive play (e.g. Little Room, Snack time) appropriate for mouthing and tasting STUDENT will actively bring things to his mouth and/or explore with lips and tongue at least three times during a 15 minute observation time.

||||

Use of hands to scratch and poke Hands/fingers to mouth Vocalizing

Making contact with adult through touch and/or vocalization

||| - vocalizing

Adult-child interaction during snack and sensory play

||

Use of hands to scratch and poke Hands/fingers to mouth Vocalizing

Making contact with adult through touch and/or vocalization

|| - vocalizing for contact

Position Board Water or sand table

When given visually preferred (green, blue, shiny) objects on a position board or in a tray, water table or sand table, STUDENT will use a visually directed reach to make contact with desired object at least 2 times within a 15 minute observation period.

|

Grasp and release Batting

Scratching

||- batting

Support Bench Resonance Board When placed in a prone position using a Support Bench or Resonance Board STUDENT will extend one arm to reach preferred objects in containers at least 5 times within a 15 minute period. |

Grasp and release Batting

Scratching Vocalizing

Making contact with adult through touch and/or vocalization

|| batting

||| - vocalizing

Little Room Resonance Board In a variety of learning environments in both independent and interactive play when given objects that make a  preferred sound STUDENT will reach out towards sound producing objects at least 5 times during a 15 minute observation period. ||||

Grasp and release Vocalizing

Making contact with adult through touch and/or vocalization

|||| - vocalizing

Team Notes

10/12/18 – MS – Had many seizures today and was very lethargic

10/14/18 – MS – Much better today! Very Active in Little Room and vocalized a lot! Actually vocalized throughout the day. Also tolerated being on his stomach on the Support Bench for 15 minutes. Need to check with parents to see if there was a change in his seizure medications that might account for these improvements.