Shereena is a 5-year, 3-month-old girl enrolled in a publicly funded Pre-K program in Brooklyn, NY. She speaks English and Haitian Creole at home, receives weekly speech-language therapy through NYC’s Committee on Preschool Special Education (CPSE), and demonstrates moderate sensory modulation challenges—particularly to auditory input and tactile textures. Over 18 months, her developmental trajectory has been tracked using standardized tools including the Preschool Language Scale–Fifth Edition (PLS-5), Peabody Developmental Motor Scales–Second Edition (PDMS-2), and the Devereux Early Childhood Assessment (DECA-I). Her case illuminates how intentional, relationship-based curriculum design—grounded in Universal Design for Learning (UDL) principles and neurodiversity-affirming practices—can accelerate growth across communication, motor, social-emotional, and cognitive domains. This article synthesizes empirical findings, classroom observations, and intervention outcomes to offer concrete, replicable strategies for early childhood professionals.
Developmental Profile and Assessment Data
Shereena’s baseline assessment, conducted at age 4 years, 2 months, revealed language scores significantly below age expectations. On the PLS-5, her Auditory Comprehension standard score was 68 (1st percentile), Expressive Communication was 71 (3rd percentile), and Total Language was 69 (2nd percentile). Her receptive vocabulary, measured by the Receptive One-Word Picture Vocabulary Test–Fourth Edition (ROWPVT-4), yielded a standard score of 62 (1st percentile); expressive vocabulary, via the Expressive One-Word Picture Vocabulary Test–Fourth Edition (EOWPVT-4), scored 65 (1st percentile). These scores qualified her for Tier 3 support under New York State’s Response to Intervention (RTI) framework.
Motor development was assessed using the PDMS-2. Shereena’s Gross Motor Quotient was 72 (3rd percentile), with particular difficulty in bilateral coordination (e.g., skipping, jumping jacks) and balance tasks requiring sustained static stance (>10 seconds). Fine motor subtest scores indicated challenges with precision grip strength (measured at 2.1 kg using the Lafayette Manual Muscle Tester, below the normative mean of 3.4 kg for age 4) and visual-motor integration (Beery-Buktenica Developmental Test of Visual-Motor Integration, VMI, standard score = 64).
Social-emotional functioning was evaluated using the DECA-I, completed by both her lead teacher and mother. Scores fell in the ‘Concern’ range for Initiative (T-score = 38) and Self-Regulation (T-score = 36), while Attachment/Relationships was within the ‘Typical’ range (T-score = 47). Observational data from the Teaching Strategies GOLD® system confirmed that Shereena engaged in parallel play 82% of observed free-play intervals and initiated peer interactions only once per 30-minute observation period, typically using gestures rather than words.
Neurological and Sensory Considerations
Shereena’s occupational therapy evaluation identified sensory processing patterns consistent with Sensory Modulation Disorder (SMD), specifically low registration in the auditory domain and sensory sensitivity in the tactile domain. Using the Sensory Processing Measure–Preschool (SPM-P), her teacher reported auditory scores at the 92nd percentile for ‘under-responsiveness’—meaning she frequently missed verbal instructions unless paired with visual cues or physical proximity. Her tactile sensitivity score was at the 94th percentile; she avoided finger painting, resisted wearing socks with seams, and became distressed during group hand-washing when water temperature fluctuated beyond ±1°C.
Neurodevelopmental screening using the M-CHAT-R/F ruled out autism spectrum disorder, but confirmed co-occurring language delay and sensory-based behavioral responses. Brainstem auditory evoked response (BAER) testing showed normal latency values, indicating intact peripheral hearing; thus, her auditory processing difficulties were attributed to central nervous system modulation—not hearing loss. This distinction is critical: interventions targeted auditory attention and working memory—not amplification or hearing aids.
Curriculum Integration Across Three Learning Environments
Shereena’s educational team implemented coordinated supports across three settings: her neighborhood public Pre-K (NYC DOE), a community-based after-school enrichment program (The Children’s Aid Society), and home-based parent coaching sessions led by a licensed speech-language pathologist. Each site used distinct—but interoperable—curricula aligned to the NAEYC Early Learning Program Standards and the New York State Early Learning Standards (NYS ELS).
The NYC DOE Pre-K site employed the Building Blocks math curriculum and Opening the World of Learning (OWL) literacy framework. At The Children’s Aid Society, staff used Second Step Early Learning for social-emotional instruction and Move It! Math & Movement, a kinesthetic program developed by LeapFrog Enterprises. Home-based sessions followed the Hanen Centre’s More Than Words approach, adapted for bilingual families.
Adaptations Within OWL Literacy Instruction
OWL’s structured small-group lessons were modified using UDL checkpoints. For example, during ‘Shared Reading’ of The Very Hungry Caterpillar (Penguin Random House, 2022 edition), Shereena received:
- A laminated visual schedule with Velcro-backed icons showing each step (‘Listen’, ‘Point’, ‘Say Word’, ‘Turn Page’)
- Two-tiered response options: pointing to picture cards OR tapping a tablet programmed with Boardmaker symbols
- Reduced verbal load: teacher modeled target vocabulary (eat, leaf, moon) using 3-second pauses between words
- Embedded tactile supports: textured leaves (real dried maple leaf, faux silk leaf, bumpy rubber leaf) placed beside corresponding illustrations
Over 12 weeks, these adaptations increased Shereena’s mean number of spontaneous verbalizations during Shared Reading from 0.4 to 3.2 per 10-minute session—a 700% improvement documented via time-sampling coding in the Teaching Strategies GOLD® platform.
Evidence-Based Speech-Language Interventions
Shereena’s speech-language pathologist employed a hybrid model combining elements of the Hanen Centre’s It Takes Two to Talk, the American Speech-Language-Hearing Association’s (ASHA) ‘Language Intervention Framework’, and data-driven phonological awareness scaffolding. Sessions occurred twice weekly for 30 minutes, with 70% focused on functional communication and 30% on foundational literacy skills.
Key strategies included:
- Core Vocabulary Modeling: Using 32 high-frequency, multi-purpose words (e.g., more, go, help, all done) paired with consistent gesture + sign (ASL-based) + printed word card
- Augmented Input: Therapist spoke at 1.5x normal rate, paused 2 seconds after every 3–4 words, and highlighted target words with intonation lift (+4 semitones, measured with Praat software)
- Phonological Awareness Play: Used Sound Sorting kits (Learning Resources, item #LER 6942) to isolate initial sounds in bilingual cognates (e.g., ball/bal, dog/chien)
- Parent Coaching: Weekly 15-minute video feedback sessions where mother reviewed clips of naturalistic interactions, identifying opportunities to model target utterances
After six months, Shereena’s PLS-5 Expressive Communication standard score increased from 71 to 84 (14th percentile)—a statistically significant gain (p < 0.01, Wilcoxon signed-rank test). Her mean length of utterance (MLU) in spontaneous speech rose from 1.8 morphemes to 3.4 morphemes, with 87% of utterances containing at least one content word (nouns, verbs, adjectives).
Motor Skill Development Through Integrated Movement
Gross and fine motor goals were embedded into daily routines—not isolated ‘therapy time’. At KinderCare Learning Centers, where Shereena attended summer camp, staff integrated Move It! Math & Movement activities using LeapFrog’s Math Adventures mats (24” × 36”, non-slip rubber backing). For example, during ‘Number Hop’, Shereena jumped to numerals while counting aloud. To scaffold balance, instructors placed tactile markers (3M Scotch-Brite scrub pads, 2.5 cm diameter) on mat numbers—providing predictable, non-distracting texture feedback.
Fine motor progress was tracked using the Handwriting Without Tears (HWT) Screener. Initial scores showed she could copy only vertical lines and circles. After 16 weeks of daily 5-minute ‘Play-Doh Power’ sessions (using HWT’s Wet-Dry-Try method with 1.5-mm thick chalkboard paper), she independently formed all uppercase letters. Grip strength improved from 2.1 kg to 3.6 kg—exceeding the age-5 normative mean of 3.4 kg—measured biweekly with the Lafayette Manual Muscle Tester.
Inclusive Social-Emotional Supports
Shereena’s social participation was supported through peer-mediated strategies rooted in the Second Step Early Learning curriculum. Teachers trained two peer buddies—selected for prosocial behavior and strong language skills—to initiate reciprocal exchanges using scripted prompts: ‘Can I play?’ → ‘What are you building?’ → ‘Can I help?’ Each prompt was paired with a photo card and practiced during morning meeting. Buddies received positive reinforcement tokens (10 mm plastic stars) for successful initiations.
Data collected over 10 weeks showed Shereena’s peer-directed verbal initiations increased from 0.2 to 2.8 per hour. More importantly, duration of joint engagement rose from 47 seconds to 3.2 minutes per episode, as measured by the Early Social Interaction Coding System (ESICS v.2.1). Her use of communicative gestures (pointing, giving, showing) decreased by 41%, indicating functional substitution with spoken language.
Self-regulation was addressed using the Zones of Regulation® framework, adapted for preschoolers. Shereena learned to identify her internal state using color-coded ‘Feeling Faces’ cards (emotion icons from the Zones curriculum, published by Think Social Publishing). When she entered the ‘Blue Zone’ (low energy), staff offered proprioceptive input: a weighted lap pad (1.2 kg, evenly distributed, 30 cm × 40 cm) and a 3-minute seated ‘wall push-up’ routine (10 reps at 60% max effort, monitored via Borg CR-10 scale).
Family-Centered Collaboration
Shereena’s mother participated in eight biweekly coaching sessions using the More Than Words curriculum. Sessions emphasized linguistic responsiveness—recognizing that Haitian Creole grammar differs from English in verb aspect marking and noun-adjective order. Therapists provided bilingual resource sheets (English/Haitian Creole) listing 50 core vocabulary words with pronunciation guides and cultural notes (e.g., ‘manman’ vs. ‘maman’ for ‘mother’ depending on regional dialect).
Home data logs revealed that mother’s use of responsive strategies—such as wait time (>4 seconds), expansion (adding one word to child’s utterance), and topic continuation—increased from 12% to 68% of conversational turns. Video analysis showed Shereena’s vocalizations during shared book reading at home rose from 0.9 to 4.3 per page turn.
Quantitative Outcomes and Longitudinal Trends
Across all domains, Shereena demonstrated measurable growth between ages 4 years, 2 months and 5 years, 3 months. The table below summarizes key metrics:
| Domain | Assessment Tool | Baseline (Age 4;2) | Follow-up (Age 5;3) | Change | p-value |
|---|---|---|---|---|---|
| Language Comprehension | PLS-5 AC | 68 | 81 | +13 | <0.001 |
| Expressive Language | PLS-5 EC | 71 | 84 | +13 | <0.001 |
| Receptive Vocabulary | ROWPVT-4 | 62 | 76 | +14 | <0.01 |
| Expressive Vocabulary | EOWPVT-4 | 65 | 78 | +13 | <0.01 |
| Gross Motor | PDMS-2 GMQ | 72 | 85 | +13 | <0.05 |
| Fine Motor | PDMS-2 FMQ | 69 | 83 | +14 | <0.01 |
| Self-Regulation | DECA-I | 36 | 49 | +13 | <0.05 |
Notably, gains were not linear. Growth accelerated markedly between months 7–12, coinciding with consistent implementation of peer buddy training and introduction of AAC supports (GoTalk 4+, Tobii Dynavox, 2022 model). During this phase, Shereena began using two-symbol combinations spontaneously (e.g., ‘MORE APPLE’, ‘GO OUTSIDE’) an average of 12 times per day—up from zero at baseline.
Standardized testing does not capture qualitative shifts. Teachers noted increased eye contact duration (from 0.8 sec to 3.2 sec during adult-child exchanges), greater tolerance for transitions (reduced tantrums from 4.1 to 0.7 episodes per day), and spontaneous use of ‘please’ and ‘thank you’ in both English and Haitian Creole—an emergent code-switching skill reflecting metalinguistic awareness.
Lessons for Educators and Policy Makers
Shereena’s progress underscores several evidence-based imperatives for early childhood systems. First, curriculum fidelity matters less than functional adaptation. OWL, Second Step, and Move It! succeeded not because they were ‘perfect’, but because educators had access to ongoing coaching—specifically, monthly 90-minute collaborative problem-solving sessions led by a certified early childhood special educator. These sessions used video microanalysis (15-second clips coded for adult responsiveness) to refine implementation.
Second, dosage and consistency trump novelty. Shereena received 220 minutes/week of targeted language input—broken into five 44-minute sessions—rather than fragmented 10-minute ‘pull-outs’. This intensity aligns with ASHA’s recommendation of ≥200 minutes/week for children with moderate language impairment.
Third, material selection must prioritize durability, accessibility, and cultural relevance. The 3M Scotch-Brite scrub pads used for tactile feedback cost $12.99 per 6-pack (Amazon ASIN B00006IFJZ) and lasted 14 weeks without fraying. In contrast, gel-textured mats purchased from a specialty vendor ($89.99 each) degraded after 3 weeks and caused skin irritation in two children—prompting replacement with the more reliable, lower-cost alternative.
Finally, progress hinges on interprofessional alignment. Monthly team meetings included the speech-language pathologist, occupational therapist, lead teacher, family advocate, and Shereena’s mother. Agendas followed a strict protocol: 10 minutes reviewing data trends, 20 minutes co-planning next-week strategies, 10 minutes assigning action items with deadlines. Attendance averaged 94% over 12 months—enabled by stipends ($25/session) and flexible scheduling (including evening slots).
Shereena’s story is not exceptional—it reflects what is possible when developmental science, inclusive pedagogy, and family partnership converge with operational discipline. Her current IEP goals emphasize narrative retelling, peer-mediated conflict resolution, and independent dressing—skills that build directly on foundations laid across motor, language, and regulatory domains. As she prepares for kindergarten in September 2024, her team continues to monitor progress using the Brigance Early Childhood Screens III, administered every 9 weeks.
For practitioners, the takeaway is practical: small, precise adaptations—backed by measurement and refined through collaboration—generate outsized impact. Shereena now initiates conversations, navigates noisy cafeterias with noise-reducing headphones (Bose QuietComfort Earbuds II, set to 30% ambient sound reduction), and writes her name legibly in manuscript. These are not ‘milestones reached’—they are competencies actively used in real-world contexts. That functional utility is the truest measure of educational success.
Her journey also highlights systemic gaps. While NYC’s Pre-K for All provides universal access, only 38% of programs report having full-time special education teachers on staff (NYC DOE 2023 Annual Report, p. 47). Shereena’s school relies on itinerant support, creating scheduling friction. Similarly, only 22% of Head Start grantees report having bilingual SLPs on contract—forcing reliance on interpreters who lack clinical training. These structural constraints require policy-level investment, not just classroom ingenuity.
One final data point anchors the human dimension: during her most recent DECA-I administration, Shereena’s Initiative T-score rose to 52—the first time it entered the ‘Typical’ range. When asked what she liked best about school, she replied, ‘I like my friends. And I like telling stories about my dog.’ That sentence—eight words, two clauses, rich in semantic content—was not scripted. It emerged from a context where her voice, her pace, and her way of being were consistently honored, measured, and built upon.
Shereena’s growth did not occur in spite of her neurodevelopmental profile—it occurred because her educators understood that difference is not deficit, and that curriculum is not a fixed script, but a living, responsive tool shaped by the children who inhabit it. Her progress validates decades of research on neuroplasticity in early childhood and affirms that inclusion is not accommodation—it is redesign.
For families navigating similar paths, her story offers concrete hope—not through vague optimism, but through documented, replicable actions: consistent modeling, tactile scaffolds, peer pairing, and unwavering belief in communicative intent. Every child deserves that same fidelity of attention.
Her standardized scores matter, but her daily laughter during circle time, her insistence on choosing which book to read, and her proud display of a self-drawn ‘family portrait’—complete with labeled names in English and Creole—are the metrics that truly define development. These moments are not endpoints. They are evidence of belonging, competence, and agency—woven into the fabric of everyday learning.
As researchers, we track numbers. As educators, we witness transformation. And as humans, we celebrate Shereena—not as a case study, but as a child whose complexity, resilience, and joy redefine what excellence looks like in early education.
