NAME: Ting-ting (Tiffany) Cheng
DOB: 12/09/94 AGE: 5.0
PARENTS: Shei & Lin-Yun Cheng

Medical Issues. Tiffany suffers from the effect of Rett's syndrome. As a result, she wears arm braces that restrict her from sticking her hands in her mouth. Without the restraints, Tiffany is likely to have one of her hands in her mouth 90% of the time. Her gait is awkward with wide spacing of her feet, and she is at risk of falling and tumbling. Her lack of protective responses (e.g., extending her arms to break a fall) makes constant surveillance necessary.

Behaviors. As indicated above, mouthing (Ting ting's only significant "behavior") is being addressed by the use of arm restraints. At this time, Ting ting's limited understanding of cause/effect, contingency relations inhibits the use of traditional contingency-management strategies (e.g., DRO, DRL, or DRA contingency schedules) that have been demonstrated in the research literature to be effective in reducing undesirable behaviors.

School. Tiffany continues to participate in an "Autistic pre-R' classroom two times per week, Tuesdays and Thursdays, for 30 minutes.

Therapy at Home Ting ting's home program was closed out with a focus on teaching her functional skills such as communicating requests (via a modified PECS program), and participating in self-help skills, physical exercise, and functional routines (e.g., changing her diaper). She was also working on following simple requests such as "stand up" and "sit down".

Tiffany has made progress in learning to hold a fork for the purpose of spearing a food item and bringing it to her mouth. At this time she can pick up the fork, but requires assistance in spearing the food item. She is also showing progress in being able to indicate a preference by touching one of two clear cassette cases where one contains a desired food item and the other is left empty. In doing this task, Tiffany shows that she can cross midline in order to touch the case with the food item in it.

Tiffany's gains within the program were favorably noted by Dr. Uta Francke of the Chidren's Hospital of Stanford. However, the adaptations and modifications of the core CARD program that had been necessary to accomplish these gains have reached a point at which it was no longer appropriate to categorize the program as a "CARD" program. These modifications reached the point where they taxed the clinical expertise of this office and the integrity of the service model.

Tiffany's services through CARD were terminated as of 12/31/1999.