Sample IEP For Global Developmental Delay

Student Name: Simon Smith
Student No.: nnn-nnn-nnn
Birth Date: 90/09/15 (yr/mo/day)
Grade: 4
School:
School Division:
Referral Date: (yr/mo/day)
Case Manager:
Program Planning Team:

Name	Position	Signature
	Parents
	Student Services Administrator
	Principal
	Resource Teacher
	Class Teacher
	Speech-Language (SLP)
	Occupational Therapist
	Physical Therapist

(Signature indicates you understand the IEP.)

Speech Therapy Matrix For School Based SLPs

Background Information

Relevant Medical/Diagnostic Information:

Simon has been diagnosed with a global developmental delay, of unknown origin.

Medical report on file.

He presents with severe delays in all areas of adaptive functioning, with the greatest delay in the communication and social domains.

The biggest concern is that Simon is not aware of his environment and places himself in a number of dangerous situations. The latest incident occurred when Simon left the school during the middle of the school day and wandered onto the road.

He has had seizures, but currently these are under control without medication.

Other Information:

Language Spoken: English

Agencies Involved: Children’s Special Services

School History (from pertinent Cumulative File Information):

Simon is in his 6^th year of school, having spent 2 years in Kindergarten (1 year half-time, 1 year full time). To date he has required Teaching Assistant support in the school, to assist with his individualized programming and address safety needs.

Domain: Social

Current Level of Performance:

Simon greets people inconsistently. He is echolaic, and will repeat words and phrases he has heard. He needs a verbal cue to make eye contact when speaking to others. Simon is interested in what others are doing, but will not approach a peer to initiate play. He will play with peers for approximately 3-5 minutes but he has difficulty keeping an interaction going.

Student Specific Outcomes:

1. Simon will greet teachers and classmates (by looking at the speaker and verbalizing “hello”) with 90% accuracy in 4 settings by the end of June.
2. Simon will play with peers from his circle of friends at school for 15 minutes over five consecutive days by the end of June.

Domain: Social

Student Specific Outcome 1:
Simon will greet teachers and classmates (by looking at the speaker and verbalizing “hello”) with 90% accuracy in 4 settings by the end of June.

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
1. By the end of October, Simon will make eye contact and say “hello” following a verbal cue by the teacher 3/5 days of the week when greeted during morning exercises	Prompt System:Verbal – For Eye Contact say “Simon, Look at _______” For Verbalizing say the greeting, ie. “Hello”	Education session for relevant school staff, Simon’s circle of friends and classmates	Teacher TA Simon SLP	Sept.		Teacher SLP TA Use of data sheet, embedded in Daily Planner

 

Domain: Social Student Specific Outcome 1: Greeting (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
2. By the end of January, Simon will make eye contact following a gestural cue and say “hello” following a verbal cue by the teacher 3/5 days of the week when greeted during morning exercises and morning recess	Prompt System:Gestural – For Eye contact point to your eyes then speaker’s eyes Verbal – say the greeting, ie. “Hello”	Education session for relevant school staff, Simon’s circle of friends and classmates	Teacher Recess Monitor TA Simon SLP	Nov.	End ofJan.	Teacher Recess Monitor SLP TA Use of Data Sheet, embedded in Daily Planner

 

Domain: Social Student Specific Outcome 1: Greeting (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
3. By the end of March Simon will make eye contact independently, and say “hello” with a gestural cue by the teacher 4/5 days of the week when greeted during morning exercises, morning recess and lunch.	Prompt System:Gestural – For greeting, point to your face while mouthing the word “hello”	Education session for relevant school staff, Simon’s circle of friends and classmates	Teacher Recess Monitor Lunch Monitor TA Simon SLP	Feb.	End ofMarch	Teacher Recess Monitor Lunch Monitor SLP TA Use of Data Sheet, Embedded in Daily Planner

 

Domain: Social Student Specific Outcome 1: Greetings (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
4. By the end of June, Simon will make eye contact and say “hello” independently for 9/10 days when greeted during morning exercises, lunch and morning and afternoon recesses.		Education session for relevant school staff, Simon’s circle of friends and classmates	Teacher Recess Monitors Lunch Monitor TA Simon SLP	April	End ofJune	Teacher Recess Monitors Lunch Monitor SLP TA Use of Data Sheet, embedded in Daily Planner

 

Domain: Social

Student Specific Outcome 2:
Simon will play with peers from his circle of friends at school for 15 minutes over five consecutive days by end of June.

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
1. By the end of October Simon will choose a playmate with direct adult prompting on 4/5 opportunities during a 5-day period.	Follow adult model. Use scripting of short phrases. Verbal instruction. Verbal prompt. Use natural teaching times. Develop circle of friends.		Teacher Resource teacher TA Parents SLP OT	Sept.	End of Oct.	Performance recorded as per evaluation included in the Daily Planner

 

Domain: Social Student Specific Outcome 2: Play with peers (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
2. By the end of January Simon will choose a playmate with minimal adult prompting on 4/5 opportunities during a 5-day period.	Gestural prompt. Expand circle of friends.		Teacher Resource teacher TA Parents SLP OT	Oct.	End of Jan.	Performance recorded as per evaluation included in the Daily Planner

 

Domain: Social Student Specific Outcome 2: Play with peers (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
3. By the end of March Simon will play with a playmate for 10 minutes at recess 4 out of 5 days with minimal adult support.	Gestural cues. Circle of friends. Structured activities.	Playground equipment: ropes, slides, balls, monkey bars, etc.Personal items	Teacher Resource teacher TA Parents SLP OT	Feb.	End of March	Performance recorded as per evaluation included in the Daily Planner

 

Domain: Social Student Specific Outcome 2: Play with peers (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
4. By the end of June Simon will play with a playmate for 15 minutes at recess.			Teacher Resource teacher TA Parents SLP OT	April	End of June	Performance recorded as per evaluation included in the Daily Planner

 

Domain: Motor

Current Level of Performance:

Simon demonstrates average ability in gross motor skills, as noted in formal testing (see P.T./OT report June 1998)

His greatest area of concern is in following directions and visually attending to an activity during gross motor play. In the fine motor area, Simon is right-hand dominant and demonstrates a mature grasp pattern with utensils, i.e. pencil, scissors and paint brush. He has below average ability with activities that require eye hand coordination or bilateral coordination. He is able to match all letters of the alphabet, using both upper and lower case. He does not identify any letters upon request. He is only able to print the following letters of the alphabet; a, b, c, d, e, f, g, h, i, m, n, o, s, t,. He does not stay on the line (baseline samples on file), and does not visually attend to his work. Simon enjoys puzzles and demonstrates average ability in this area. He is quite interested in the computer and enjoys concrete question/answer type programs.

Student Specific Outcome:
Simon will print all of the letters of the alphabet, demonstrating satisfactory formation (the identity of each letter should be obvious), on 9/ 10 samples by the end of June.

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
1. By the end of October, Simon will be able to print the lettersj, k, l, p, with satisfactory formation, on 9 / 10 times samples	Gradual sequence of letter writing from tracing, copying over broken letters, following mazes in shape of letters, to independent printing with proper formation.	Tracing sheets Segmented letter sheets Mazes	Resource teacher Teacher TA	Sept.	End of Oct.	Samples collected weekly as per schedule attached to daily plannerrating of letter formation to be conducted by resource teacher, teacher and OT, using team developed rubric

 

Domain: Motor Student Specific Outcome: Printing (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
2. By the end of January, Simon will be able to print the lettersq, r, u, v, with satisfactory formation, on 9/ 10 samples	Multisensory approach:Tactile: use a variety of media, (crayons, paint, chalk), use hands (ie, trace letters with a finger, finger paint, letter puzzles) and then utensils (ie pencils, paintbrushes chalk)	crayons, pencils,paint (regular and fingerpaint) chalk letter puzzles (felt, paper) paintbrushes, sponges	Resource teacher Teacher TA	Nov.	End of Jan.	Samples collected weekly as per schedule attached to daily plannerrating of letter formation to be conducted by resource teacher, teacher and OT, using team developed rubric

 

Domain: Motor Student Specific Outcome: Printing (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
3. By the end of March, Simon will be able to print the lettersw, x, y, z, with satisfactory formation, on 9/ 10 samples.	Kinesthetic:have Simon trace / make the letters with large body movements, following the letter outline on the gym floor, making large letters with pieces of rope, felt, etc.	Ropelarge pieces of paper, or material	Resource teacher Teacher TA	Feb.	End of March	Samples collected weekly as per schedule attached to daily plannerrating of letter formation to be conducted by resource teacher, teacher and OT, using team developed rubric

Domain: Motor Student Specific Outcome: Printing (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
4. By the end of June, Simon will be able to print all of the lettersof the alphabet, with satisfactory formation on 9/ 10 samples.	Visual:cue Simon into looking what he is doing, use simple phrases and prompts Auditory: talk to Simon about the movements he is making to form the letters, using simple phrases		Resource teacher Teacher TA	April	End of June	Samples collected weekly as per schedule attached to daily plannerrating of letter formation to be conducted by resource teacher, teacher and OT, using team developed rubric

Domain: Self Management

Current Level of Performance:

Simon is able to able to undress and dress independently but requires assistance with all fasteners (zippers, snaps, buttons). He has a tendency to tug at the fastener until it comes apart, or his clothing is ripped. He will not attempt to do up fasteners. Simon does not visually attend to this activity, nor use his hands in a coordinated fashion. He is able to use the toilet, he is time trained and requires a regular schedule to insure success. He can complete all aspects of the toileting routine with supervision to stay on task. He stays for lunch at school and does not require any assistance with this activity of daily living. He readily puts away materials he has used in the class, and likes everything in the correct spot.

Student Specific Outcome: 
Simon will undo zippers independently and do up zippers with physical assistance by the end of June.

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
1. By the end of October Simon will undo zippers with physical assistance.	Use natural teaching times, arrival and departure from class, bathroom timeBegin with jackets before moving onto pant zippers	Large LoopLoose Fitting Jackets	TA Parents OT	Sept.	End of Oct.	Performance recorded as per evaluation included in the Daily Planner

 

Domain: Self Management Student Specific Outcome: Zippers (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
2. By the end of January Simon will undo zippers with physical prompting and do up zippers with full physical guidance	Use loose fitting jacketsPlace large loop on zipper tag Encourage Simon to visually attend to the task at hand		TA Parents OT	Nov.	End of Jan.	Performance recorded as per evaluation included in the Daily Planner

 

Domain: Self Management Student Specific Outcome: Zippers (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
3. By the end of March Simon will undo zippers independently and do up zippers with full physical guidance	Use backward chaining method, ie. Trainer prompts student through entire process, leaving the last part or parts for student to complete (see OT report)		TA Parents OT	Feb.	End of March	Performance recorded as per evaluation included in the Daily Planner

 

Domain: Self Management Student Specific Outcome: Zippers (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
4. By the end of June Simon will undo zippers independently and do up zippers with physical assistance			TA Parents OT	April	End of June	Performance recorded as per evaluation included in the Daily Planner

Domain: Academic

Current Level of Performance:

Simon’s greatest challenge in this area is his inability to follow directions and visually attend to an activity. Simon demonstrates functional use of objects, and will point to common objects when asked. Simon will point to body parts on another person when asked, but not himself. He is not able to draw a person upon request. He does not demonstrate understanding of emotions. Simon shows a preference for brightly coloured objects. He is able to match the colours red and blue inconsistently. He is able to complete a form board with a circle, square , triangle and rectangle. He is also able to match these shapes, although will not identify them when asked to point to them.. He is able to graduate size, with either nesting cups, stacking rings or blocks. Simon demonstrated the concept of “One”.

He is able to match all letters of the alphabet, using both upper and lower case. He does not identify any letters upon request. He is only able to print the following letters of the alphabet; a, b, c, d, e, f, g, h, i, m, n, o, s, t,.

Simon will sit and look at books, although he does not like a story read to him.

Student Specific Outcomes:
Simon will sort/classify items using the attribute of color 9/10 times by the end of June.

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
1. By the end of October Simon will match items of similar color 8/10 times.	Cue Simon to visually attend to task.Use natural teaching times. Identify and label colors for Simon. Use a variety of items and contexts.	Classroom materials:crayons, paint, chalk, blocks, etc. Manipulatives: pattern blocks, peg board, bingo chips, color tiles, attribute blocks, etc. Personal items- socks, shoes, mittens, hats, etc	Teacher Resource teacher TA Parents SLP OT	Sept.	End of Oct.	Performance recorded as per evaluation included in the Daily Planner

 

Domain: Academic Student Specific Outcomes: Sort/classify (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
2. By the end of January Simon will sort/classify red, blue, black, yellow items 5/10 times	Verbal statements should be controlled for length, complexity and difficulty of the vocabulary.		Teacher Resource teacher TA Parents SLP OT	Nov.	End of Jan.	Performance recorded as per evaluation included in the Daily Planner

 

Domain: Academic Student Specific Outcomes: Sort/classify (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
3. By the end of March Simon will sort/classify red, blue, black, yellow, green, brown, and white items 5/10 times.			Teacher Resource teacher TA Parents SLP OT	Feb.	End of March	Performance recorded as per evaluation included in the Daily Planner

 

Domain: Academic Student Specific Outcomes: Sort/classify (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
4. By the end of June Simon will sort/classify items using the attribute of color 9/10 times by the end of June.			Teacher Resource teacher TA Parents SLP OT	April.	End of June.	Performance recorded as per evaluation included in the Daily Planner

Domain: Communication

Current Level of Performance:

Simon’s greatest area of concern is in following directions. Simon is easily distracted and has a poor attention span. Simon can follow one step instructions inconsistently. His attention is better at the start of a class and at the start of the day. Simon needs cueing to ensure he is on task. Simon has difficulty understanding fast speech and long sentences. Current Speech Language Therapy Report on file, which outlines formal test results in this area.

Student Specific Outcome:
Simon will follow the directions “in”, “on”, “under”, “in front of”, “behind” in two settings 9/10 times by the end of June.

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
1. By the end of October Simon will follow the directions of “in”, “on”, “under”, in the first class period 8/10 times.	Introduce prepositions in relationship to Simon’s body.Model prepositions. Encourage Simon to visually attend to task. Act out verbal commands.	Classroom materials- pencils, ruler, paintbrushes, blocks, etc.Personal items- coat, hat, shoes, mittens, etc.	Teacher Resource teacher TA Parents SLP OT	Sept.	End of Oct.	Performance recorded as per evaluation included in the Daily Planner

 

Domain: Communication Student Specific Outcomes: Following directions (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
2. By the end of January Simon will follow the directions of “in”, “on”, “under” during recess play activities 8/10 times.	.Move objects in space.Use motor actions. Sentence patterning, e.g., preposition changes while object of the preposition and the action are constant,	Playground equipment- ropes, slides, monkey bars, etc.Personal items	Teacher Resource teacher TA Parents SLP OT	Oct.	End of Jan.	Performance recorded as per evaluation included in the Daily Planner

 

Domain: Communication Student Specific Outcomes: Following directions (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
3. By the end of March Simon will follow the directions “in”, “on”, “under”, “in front of”, “behind” in the first class period of the day, 8/10 times.	Sentence patterning eg. object of preposition changes. Change combination of actions, prepositions and objects of the preposition. Use natural teaching times during activities.		Teacher Resource teacher TA Parents SLP OT	Feb.	End of March	Performance recorded as per evaluation included in the Daily Planner

 

Domain: CommunicationStudent Specific Outcomes: Following directions (cont.)

Performance Objectives	Instructional Strategies	Materials/ Resources	Roles/ Responsibilities	Date Started	Date Completed	Evaluation and Review
4. By the end of June Simon will follow the directions “in”, “on”, “under”, “in front of”, “behind” in the first class period and during recess play activities 9/10 times.			Teacher Resource teacher TA Parents SLP OT	April	End of June	Performance recorded as per evaluation included in the Daily Planner

Simon’s Daily Plan: Mornings September to November

Class / Simon’s Schedule	IEP Performance Objectives	Task Analysis	Intervention / Resources	Evaluation	Comments
9:00Arrival / Sharing Time	Self Management:Simon will undo his zipper with physical assistance Social: Simon will make eye contact and say hello with verbal prompting	Unzipping: Hand over hand to start Remove hand for last ½ of unzipping May need to provide hand over hand support at the fastener	Gain Simon’s attention before starting task Use large loop on zippering Encourage Simon to place L hand on bottom of jacket, R hand to pull down zipper Prompt System for Greeting:Eye contact; say “Simon, look at _________”Verbalizing; say “Hello” Wait 1 minute before repeating prompt After 2 prompts w/o response, record a “-“	Unzipping I A Eye Contact +nbsp;- Verbalizing + –
9:40Language Activities	Communication:Simon will follow the directions in, on, under, in front of, behind Fine Motor: Simon will print the letters J, K, L, P	Order to Teach: in and on under in front of and behind Order to Teach: L P J K	Gain Simon’s attention before starting activity Use related resources to ELA curriculum, activities and materials used by peers Use body and object within activities before moving into paper/ pencil task Use multi-sensory approach Use a variety of mediums and materials See IEP and OT report for more details	Prepositions:+ – Letters: _______ + – _______ + –
10:20Recess / Bathroom	Self Management:Simon will undo his zipper with physical assistance Reinforce-ment of Social (greetings), Communication (prepositions) and Motor (printing) objectives	Unzipping: Hand over hand to start Remove hand for last ½ of unzipping May need to provide hand over hand support at the fastener	Gain Simon’s attention before starting task Use large loop on zipper ring Encourage Simon to place L hand on bottom of jacket, R hand to pull down zipper	1. Unzipping I A
10:45Mathematics	Academic:Simon will match items of similar colors Reinforcement of Communication objectives (prepositions)	Order to Teach: red blue black yellow green brown white	Gain Simon’s attention before starting task Use related resources to Math curriculum, activities and materials used by peers Verbal statements given during teaching should be simple and short See IEP and SLP report for more details	Colours:_______+ – _______+ – _______+ –
<11:15Art	Reinforcement of Communication (prepositions), Social (greetings) and Academic (matching) Objectives
12:00Lunch / Bathroom	Self Management:Simon will unzip his zipper with physical assistance Reinforcement of Social (greetings) Objectives	Unzipping: Hand over hand to start Remove hand for last ½ of unzipping May need to provide hand over hand support at the fastener	Gain Simon’s attention before starting task and use large loop on zipper ring Encourage Simon to place L hand on bottom of jacket, R hand to pull down zipper	1. Unzipping I A
12:45Circle of Friends	Social:Simon will choose a playmate with direct adult prompting Reinforcement of Social (greetings) Objectives and others as appropriate		Gain Simon’s attention before starting task Use verbal and physical prompt to encourage Simon choose playmate Simon can point to a peer or photo of a peer if he can not articulate their name to indicate choice Initially only have him choose between a choice of 2 peers, gradually working up to 5	Choose peer I A(record choices given, prompt required, choice made and how he indicated in comments)