Autism Spectrum Disorder Diagnostic Assessment Report: Greg

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Autism Spectrum Disorder Diagnostic Assessment Report: Greg Example

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CONTENTS (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Biographical Details Referral Information Current Concerns Brief Background Information Cognitive Assessment Adaptive Behaviour Assessment Autism Spectrum Disorder Behavioural Assessment Autism Spectrum Disorder Diagnostic Criteria as per DSM-5 and Level of Support Required Comorbidity and Differential Diagnosis Screening Assessment ADHD Behavioural Assessment Observations and Clinical Presentation Summary Conclusion and Statement of Diagnosis Recommendations Appendix 1 – Clinical Cohort Research Findings

This report adheres to the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5TM) for Autism Spectrum Disorder.

BIOGRAPHICAL DETAILS Name: Date of Birth: Date of Assessment: Age at Assessment: Gender: School: Grade: Home Address: Mothers Name: Fathers Name: Parent’s Phone Number: Parent’s Email:

Greg Example 14/11/2004 29/04/2016 11 Male Primary School 6 123 Fourth Street SUBIACO WA 6008 Jenny John 0414 234 234 [email protected]

REFERRAL INFORMATION Greg was referred to Psychological and Educational Consultancy Services (PECS) by Dr James Smith (General Practitioner) for an Autism Spectrum Disorder assessment.

CURRENT CONCERNS From a presented list, Greg’s parents identified concerns in the following areas: • •

Learning Social skills

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BRIEF BACKGROUND INFORMATION Background information reported by Greg’s parent(s): • • • • • • • • • • • • • • • • • • • • • • •

Was born with no apparent complications Reached all of the major developmental milestones (e.g., walking, speaking, toileting) during the expected age ranges Is solely right-handed/right-footed No major medical or neurological conditions Normal auditory acuity reported (last tested in 2010) Requires glasses/contact lenses (last tested in 2016) Is prescribed Nasonex for allergies Has fine motor movement problems – Hypermobility Greg’s Hypermobility impedes his physical activity OT and Physiotherapy has strengthened Greg’s body and improved his fine/gross motor skills Swimming has been beneficial to both his body strength and communication with the teacher – he also likes swimming very much Greg’s dominant language is Mandarin Greg has been exposed to 6 months of full time English, following 3 years of 1.5 hours English tutoring per week Greg attends the Intensive English Centre learning programme Greg has difficulty socialising and making friends – he likes to have friends but his interpersonal skills are poor Socialising was a difficulty for Greg in China, as well as here in Australia School teacher has arranged a buddy to help Greg with daily school activities and play with him which in turn, has encouraged him to go to school Greg likes to talk with people he is familiar with, but appears to be nervous when facing unfamiliar people under new circumstances The teacher in China apparently had no concerns about Greg’s Reading and Mathematics Father thinks Greg can read no problem, but often has difficulty with the ‘why’ questions Greg can have an unsteady temper at times Greg’s parents indicated that they have always found something puzzling about Greg, but each quirky behaviour Greg had disappeared with time, without intervention Greg’s parents indicated that it is likely that this is now only coming to light, because in China there was more emphasis on Greg’s academic performance than his behaviour and social skills

Background information reported by Greg’s teacher: • Greg tends to repeat favoured words such as “margin together” with strange facial expressions • Greg used inappropriate scratching and fidgeting to suggest he wants to go to the toilet • Calming strategies have been used to address Greg’s fidgeting and scratching • Greg has difficulties socialising, maintaining friendships, and making eye contact • Social stories have been used to improve Greg’s social skills and eye contact • Greg has an awkward gait and has difficulties with large muscle control • An IEP is in place to address Greg’s lack of muscle control • Greg has comprehension difficulties, linking literal knowledge to inferential, interpretive, and evaluative questions • Greg has difficulties identifying line spacing and starting point of letters • Greg has excellent recall skills of basic number facts, but has difficulty understanding more complex concepts and problem solving

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Past testing: • OT Assessment (at age 11 years): Further OT intervention was recommended to address fine and gross motor skills, proprioception, strength, independence and assistance in self-care tasks, organisational skills, sensory preferences, and social skills. It was recommended that Greg be assessed for potential ASD, support for his cultural transition, and social skill intervention. •

School Psychologist Assessment (at age 11 years): Recommendations were made that Greg be seen by a psychologist for a nonverbal cognitive assessment. Additionally, GP / Paediatrician consultation was recommended to address developmental concerns, particularly comprehension and social communication. Lastly, extra support was recommended to improve English skills in literacy and numeracy.

Please note that only a brief overview was obtained due to Greg and his parents already having provided more detailed background information to the referrer. See checklists for more behavioural information.

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COGNITIVE ASSESSMENT Please note, a Cognitive Assessment is conducted due to Intellectual Disability/Global Developmental Delay needing to be ruled out (i.e. DSM-F Criteria D in a latter section) before an Autism Spectrum Disorder diagnosis can be given.

Cognitive Test Administered: Date of Administration Universal Nonverbal Intelligence Test-Second Edition (UNIT-2, 2016)

29/04/2016

UNIT-2 Overview: The Universal Nonverbal Intelligence Test—Second Edition (UNIT-2) assesses general intelligence (g) and three foundational cognitive abilities (i.e. Memory, Fluid Reasoning, and Quantitative Reasoning). The UNIT-2 is composed of six subtests (Symbolic Memory, Nonsymbolic Quantity, Analogic Reasoning, Spatial Memory, Numerical Series, and Cube Design), which are combined to form four possible global intelligence composites (the Abbreviated Battery, Standard Battery with Memory, Standard Battery without Memory, and the Full Scale Battery). The UNIT-2 FSIQ is composed of all six subtests and is the most comprehensive, reliable, and valid composite available for the UNIT-2. As such, it is of course the best overall measure of general intelligence.

UNIT-2 Subtests: Table 1: UNIT-2 Subtest Descriptions Subtests Each Symbolic Memory item depicts a sequence of universal symbols for baby, girl, boy, woman, and man in two colours (i.e., green and black). The youngest examinees (ages 5-7 years) are required to select the printed option on the stimulus plate that corresponds to one or more stimulus figures. Older examinees (ages 8-21 years) are shown a sequence of the universal human symbols on a page for 5 seconds. Examinees must re-create from memory the depicted sequence using the symbolic Memory Response Cards.

Symbolic Memory

Primary Abilities Shared With Other Subtests • Attention to Detail • Concentration • Perception of Meaningful Stimuli • Sequential Processing • Symbolic Mediation • Verbal Mediation • Visual Short-Term Memory Secondary Abilities Shared With Other Subtests • Concept Formation • Perceptual Organization • Visual–Motor Integration As a measure of short-term sequential and symbolic memory, an examinee's performance on the Symbolic Memory subtest may predict such behaviours as the examinee's ability to attend to and distinguish important from irrelevant information; organize, recall, and follow multi-step directions; sequence verbal information meaningfully (e.g., story telling, reading, decoding); understand and compute multi-step mathematics story problems; ignore extraneous, competing information during problem solving; and concentrate on the interrelationships between salient variables.

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Each Nonsymbolic Quantity item presents an array of white and/or black domino-like objects of various numerical values that create a numerical sequence, equation, analogy, or mathematical problem. Among the domino-like objects is one object with a red question mark. The examinee determines which one of the numerical value responses best fits the incomplete conceptual or numerical analogy, sequence, or problem. The examinee completes the item by pointing to one of the response options provided on the stimulus page.

Nonsymbolic Quantity

Primary abilities shared with other subtests • Abstract thinking • Analysis • Attention to detail • Concentration • Nonsymbolic mediation • Nonverbal reasoning • Perception of abstract stimuli • Perceptual organization

Secondary abilities shared with other subtests • Concept formation • Reasoning Performance on the Nonsymbolic Quantity subtest may predict such future behaviours as the examinee's ability to understand and solve abstract problems using symbols; determine the interrelationships between and among numbers; understand the relations represented by numbers; value classifications of symbolic systems; generalize learned principles to solve new problems (e.g., applying numerical rubrics learned in one context to a new but similar context); and use rules in a systematic fashion. Each Analogic Reasoning item is an incomplete conceptual or geometric analogy, presented in a matrix format. The examinee completes the analogy by pointing to one of four response options provided on the stimulus page.

Analogic Reasoning

Primary Abilities Shared With Other Subtests • Abstract Thinking • Analysis • Concept Formation • Evaluation • Perception of Meaningful Stimuli • Reasoning • Symbolic Mediation • Synthesis • Verbal Mediation Secondary Abilities Shared With Other Subtests • Attention to Detail • Perception of Abstract Stimuli • Perceptual Organization • Sequential Processing • Simultaneous Processing • Spatial Orientation

Performance on the Analogic Reasoning subtest may predict such future behaviours as the examinee's ability to understand and solve conceptual problems; determine the interrelationships between objects and actions (e.g., understand cause-and-effect relationships); produce rational arguments, based on sequential logic; generalize learned principles to solve new problems (e.g., applying centrifugal force to cause sediments to settle in a vial); and acquire and use rules in a systematic fashion.

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On the Spatial Memory subtest, the youngest examinees (ages 5-7 years) are required to select one of two or three options that matches a stimulus figure. Older examinees (ages 8-21 years) view a random pattern of green, black, or green and black dots presented on a 1 X 2, 2 X 2, 3 X 3, or 4 X 4 grid for a period of 5 seconds. After the stimulus is removed from sight, the examinee re-creates the spatial pattern by placing green and black circular chips on a blank response grid.

Spatial Memory

Primary Abilities Shared With Other Subtests • Attention to Detail • Concentration • Nonsymbolic Mediation • Perception of Abstract Stimuli • Perceptual Organization • Simultaneous Processing • Spatial Orientation • Visual Short-Term Memory Secondary Abilities Shared With Other Subtests • Visual–Motor Integration Correlates of Spatial Memory Performance Performance on the Spatial Memory subtest may predict such future behaviours as the examinee's ability to view the totality and central nature of problems; attend to, process, and recall visual details (e.g., editing, photography, chess); remember the crux of information, rather than the sequence in which the information was presented; concentrate on a problem until the problem is well understood; disassemble and reassemble objects (e.g., motors, computers) by memory; and sensitivity and awareness to minor changes in the environment (e.g., noting the addition or subtraction of important elements). Each Numerical Series item presents an array of numbers or mathematical symbols that create a perceptual match or an incomplete quantitative series. Among the numbers or symbols presented on the stimulus page is a red question mark. The examinee determines which of the response options (i.e., numerical values or symbols) best completes the incomplete series. The examinee completes the item by pointing to one of the response options provided on the stimulus page.

Numerical Series

Primary abilities shared with other subtests • Analysis • Concentration • Nonverbal reasoning • Perception of meaningful stimuli • Symbolic mediation • Visual-motor integration Secondary abilities shared with other subtests • Abstract thinking • Attention to detail • Perceptual organization • Reasoning • Sequential processing Performance on the Numerical Series subtest may predict such future behaviours as the examinee's ability to understand and solve math problems; determine the interrelationships between and among numbers; understand the relations represented by numbers; value classifications of numerical systems; generalize learned principles to solve new problems (e.g., applying numerical rubrics learned in one context to a new but similar context); and use rules in a systematic fashion.

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The Cube Design subtest involves the presentation, matching, and/or direct reproduction of two colour, abstract geometric designs. The youngest examinees (ages 5-7 years) match one of the three or four options to a stimulus design. Older examinees (ages 8-21 years) view a stimulus design and then reconstruct the design directly on the stimulus book or on the response mat using green and white 1-inch cubes.

Cube Design

Primary Abilities Shared With Other Subtests • Abstract Thinking • Analysis • Attention to Detail • Evaluation • Holistic Processing • Nonsymbolic Mediation • Nonverbal Reasoning • Perception of Abstract Stimuli • Perceptual Organization • Reasoning • Reproduction of a Model • Simultaneous Processing • Spatial Orientation • Synthesis • Three-Dimensional Representation • Visual–Motor Integration Secondary Abilities Shared With Other Subtests • Working Under Time Constraints Performance on the Cube Design subtest may predict the examinee's mechanical or graphic (e.g., artistic, drafting, geometry) competence; ability to divide aspects of problems into discrete parts for examination and recombination to provide a viable solution; tenacity in complex future problem-solving situations; reaction to activities that have deadlines or specific time limits; flexibility in evaluating and modifying solution strategies; and ability to orient in and around his or her environment (e.g., reading maps, following spatial directions).

Table 2: UNIT-2 Composite Descriptions Composites Memory Reasoning Quantitative FSIQ

The Memory Composite comprises the Symbolic Memory and Spatial Memory subtests. This Composite measures strategies for recall of multiple salient features simultaneously, including content, colour, orientation, number, location, and sequence. This Composite also measures discrimination, labelling, organisation, and categorization. The Reasoning Composite comprises the Analogic Reasoning and Cube Design subtests. This Composite measures pattern processing, awareness of visual–spatial juxtapositions, and understanding of geometric relationships. The Quantitative composite is composed of the Nonsymbolic Quantity and the Numerical Series subtests. This Composite measures numerical reasoning and relationships and number sense The UNIT2 FSIQ comprises all 6 subtests that make up the three separate construct-specific composites: Memory, Reasoning, and Quantitative. As such, it is of course the most comprehensive, reliable, and valid composite available for the UNIT2 and the best overall measure of general intelligence.

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Table 3: UNIT-2 Descriptive Classifications

Scaled Score 1–3 4–5 6–7 8–12 13–14 15–16 17–20 Examiner’s Details: EXAMINER: QUALIFICATIONS: TEST SITE:

Descriptive Term Very Delayed Delayed Below Average Average Above Average Superior Very Superior

Index Score <70 70–79 80–89 90–109 110–119 120–129 >=130

Renae Davies BPsych (Hons) Psychological & Educational Consultancy Services – Subiaco Office

Test Behaviour and Observations: Greg engaged in verbal stereotypy and consequent laughing outbursts throughout the assessment Was observed to be impulsive with decisions during the Analogic Reasoning subtest Greg found it difficult to grasp the idea of a 3D image during the Cube Design subtest, and was quick to give up. He acknowledged this by saying, “not easy, very hard”. It is my opinion that the scores that Greg achieved on the WISC-IV are an accurate reflection of his cognitive functioning at this particular point in time.

UNIT-2 Test Results: Age at Testing: 11 years 5 months

Table 4: UNIT-2 Composite Scores

WISC-IV Index Memory Reasoning Quantitative Full Scale (FSIQ)

Composite Score 97 100 103 100

Percentile Rank 42 50 58 50

95% Confidence Interval 90-105 94-106 98-108 96-104

Descriptive Term Average Average Average Average

Index scores have a mean Composite Score of 100 (50th percentile) and a standard deviation of 15. Percentile Rank refers to Greg’s standing among 100 children of similar age. Therefore, a Percentile Rank of 50 indicates that Greg performed exactly at the average level for his chronological age. The FSIQ is not considered to be valid if there is an 18+ difference between any of the Composites.

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Table 5: UNIT 2 Subtest Scaled Scores

Subtests Memory Symbolic Memory Spatial Memory Reasoning Analogic Reasoning Cube Design Quantitative Nonsymbolic Quantity Numerical Series

Scaled Score 1–3 4–5 6–7 8–12 13–14 15–16 17–20

Scaled Score

Percentile Rank

Descriptive Term

8 11

25 63

Average Average

11 9

63 37

Average Average

10 11

50 63

Average Average

Descriptive Term Very Delayed Delayed Below Average Average Above Average Superior Very Superior

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Index Score <70 70–79 80–89 90–109 110–119 120–129 >=130

ADAPTIVE BEHAVIOUR ASSESSMENT Please note, an Adaptive Behaviour Assessment is conducted due to it providing a wealth of information to address DSM-% Criterion D in a latter section (i.e. clinically significant impairment in important areas of functioning). It is considered by DSC an essential component of a “gold standard” assessment.

Adaptive Behaviour Tests Administered: Test

Date of Administration

Adaptive Behaviour Assessment System–Second Edition (ABAS-II, 2008)

29/04/2016

The Adaptive Behaviour Assessment System – Second Edition provides a comprehensive, normreferenced assessment of adaptive skills for individuals ages birth to 89 years. The ABAS-II may be used to assess an individual’s adaptive skills for diagnosis and classification of disabilities and disorders, identification of strengths and limitations, and to document and monitor an individual’s progress over time. The comprehensive range of specific adaptive skills and broad adaptive domains measured by the ABASII correspond to the specifications identified by the American Association of Mental Retardation (AAMR; 1992, 2002b) and the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition Text Revision (DSM-IV-TR; American Psychiatric Association, 2000). The ABAS-II consists of 5 rating forms, which can be completed independently by a respondent or may be read aloud to a respondent who has limited reading skills. Each rating form is easy to complete and score, requiring approximately 20 minutes to complete and 5-10 minutes to hand score. Respondents read and respond to all items and rate the extent to which the individual performs the adaptive skills when needed. The rating scale for the items allows respondents to indicate if the individual is able to independently perform an activity and, if so, how frequent he or she performs the activity when it is needed; 0 (Is not able), 1 (Never or Almost Never When Needed), 2 (Sometimes When Needed), or 3 (Always or Almost Always When Needed). Although it is possible to assess the adaptive skills of an individual with a single rating form, the use of multiple rating forms is recommended to provide a comprehensive assessment across a variety of settings. Significant limitations in adaptive behaviour are defined as performance at least 2 Standard Deviations below the mean on (a) the Conceptual, Social or Practical Domain, or (b) an overall score on a standardised measure that assesses these three adaptive domains (e.g. GAC).

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Skill Areas for Teacher, Parent and Adult Forms Communication

Community Use

Functional Academics

School/Home Living

Health and Safety

Leisure

Self-Care Self-Direction

Social

Work

Speech, language, and listening skills needed for communication with other people, including vocabulary, responding to questions, conversation skills etc Skills needed for functioning in the community, including use of community resources, shopping skills, getting around in the community etc Basic reading, writing, mathematics and other academic skills needed for daily, independent functioning, including telling time, measurement, writing notes and letters etc Skills needed for basic care of a home or living setting (or for the Teacher Form, school and classroom setting), including cleaning, straightening, property maintenance and repairs, food preparation, performing chores etc Skills needed for protection of health and to respond to illness and injury, including following safety rules, using medicines, showing caution etc Skills needed for engaging in and planning leisure and recreational activities, including playing with others, engaging in recreation at home, following rules in games etc Skills needed for personal care including eating, dressing, bathing, toileting, grooming, hygiene etc Skills needed for independence, responsibility and self-control, including starting and completing tasks, keeping a schedule. following time limits, following directions, making choices etc Skills needed to interact socially and get along with other people, including having friends, showing and recognising emotions, assisting others, using manners etc Skills needed for successful functioning and holding a part or fulltime job in a work setting, including completing work tasks, working with supervisors, and following a work schedule

Composite Score Scales The Conceptual Domain Composite score is derived from the sum of scaled scores from the Communication, Functional Academics and Self-Direction Skill Areas. Conceptual skills include receptive and expressive language, reading and writing, money concepts and self-direction. The Social Domain Composite score is derived from the sum of scaled scores from the Social and Leisure Skill Areas. Social skills include interpersonal relationships, responsibility, self-esteem, and gullibility, naiveté, following rules, obeying laws and avoiding victimisation. The Practical Domain Composite score is derived from the sum of scaled scores from the Self-Care, Home/School Living, Community Use, Health and Safety and Work Skill Areas. Practical skills include basic maintenance activities of daily living (e.g., eating, mobility, toileting, dressing), instrumental activities of daily living (e.g., meal preparation, housekeeping, transportation, taking medications, money management, telephone use) together with occupational skills and maintenance of safe environments. The General Ability Composite (GAC) score is derived from the sum of scaled scores from seven, nine or ten skill areas, depending on the age of the individual and the type of rating form. The GAC represents a comprehensive and global estimate of an individual’s adaptive functioning. The GAC describes the degree to which an individual’s adaptive skills generally compare to the adaptive skills of other individual’s within the same age group. 12

Adaptive Behaviour Test Results: (1) Parent Form (Ages 5-21) The Parent Form is a comprehensive, diagnostic measure of the adaptive skills that have primary relevance for children’s functioning in the home and community, and can be completed by parents or other primary care providers. The Parent Form is used for children in grades Kindergarten (K) through 12 or ages 5-21 years. The form extends through age 21 to include special education students and other students who continue to be served through a secondary school setting. This form includes 232 items, with 21 to 25 items per skill area. Age at Testing: 11 years 5 months

Table 1: Sum of Scaled Scores to Composite Score Conversions

Composite Conceptual Social Practical GAC

Sum of Scaled Scores 10 3 22 35

Composite Score 63 56 75 64

Percentile Rank 1 0.2 5 1

95% Confidence Interval 57-69 49-63 68-82 60-68

Qualitative Range Extremely Low Extremely Low Borderline Extremely Low

Adaptive Domain scores have a mean of 100 (50th percentile) and a standard deviation of 15. Percentile Rank refers to Greg’ standing among 100 individuals of a similar age.

Figure 1: ABAS-II Skill Area Scaled Score Profile

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Table 2: Raw Score to Scaled Score Conversions

Skill Areas Communication (Com) Community Use (CU) Functional Academics (FA) Home Living (HL) Health and Safety (HS) Leisure (LS) Self-Care (SC) Self-Direction (SD) Social (Soc)

Scaled Scores 5 7 2 1 9 2 5 3 1

Qualitative Range Borderline Below Average Extremely Low Extremely Low Average Extremely Low Borderline Extremely Low Extremely Low

Scaled scores have a mean of 10 (50th percentile) and a standard deviation of 3. Percentile Rank refers to Greg’ standing among 100 individuals of a similar age.

Table 3: ABAS Strengths and Weaknesses

Skill Areas Conceptual Communication Functional Pre-Academics Self-Direction Social Leisure Social Practical Community Use Home Living Health and Safety Self-Care

Skill Area Scaled Score

Mean Scaled Score

Difference from Critical Mean Value

5 2 3

3.89 3.89 3.89

1.11 -1.89 -0.89

2.29 2.17 2.15

2 1

3.89 3.89

-1.89 -2.89

2.31 2.22

7 1 9 5

3.89 3.89 3.89 3.89

3.11 -2.89 5.11 1.11

2.33 2.22 2.86 2.86

Strength or Weakness

Base Rate >25% 25% >25%

Weakness Strength Weakness Strength

10-25% 10-25% 10% 10-25% <1% >25%

Statistical Significance (Critical Values) at the .05 level

Skill Area Strengths and Weaknesses: Statistical analysis of the results revealed the following skill areas to be significant (.05) adaptive behaviour strengths or weaknesses relative to Greg’s own performance. Strengths: Two significant (.05) adaptive behaviour strengths relative to Greg’ own performance were found; namely Community Use and Health and Safety. Skills needed for functioning in the community, including use of community resources, shopping skills, getting around in the community etc. Skills needed for protection of health and to respond to illness and injury, including following safety rules, using medicines, showing caution etc.

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Weaknesses: Two significant (.05) adaptive behaviour weaknesses relative to Greg’ own performance were found; namely Social and Home Living. Skills needed to interact socially and get along with other people, including having friends, showing and recognising emotions, assisting others, using manners etc Skills needed for basic care of a home or living setting (or for the Teacher Form, school and classroom setting), including cleaning, straightening, property maintenance and repairs, food preparation, performing chores etc

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(2) Teacher Form (Ages 5-21) The Teacher Form is a comprehensive, diagnostic measure of the adaptive skills that have primary relevance for children’s functioning in a school setting and can be completed by teacher’s or teacher’s aides. The Teacher Form is used for children in grades K through 12 or ages 5-21 years. The form extends through age 21 to include special education students and other students who continue to be served through a secondary school setting. This form includes 193 items, with 15 to 22 items per skill area.

Age at Testing: 11 years 5 months

Table 1: Sum of Scaled Scores to Composite Score Conversions

Composite Conceptual Social Practical GAC

Sum of Scaled Scores 4 3 4 11

Composite Score 53 58 45 43

Percentile Rank 0.1 0.3 <0.1 <0.1

95% Confidence Interval 49-57 54-62 41-49 40-46

Qualitative Range Extremely Low Extremely Low Extremely Low Extremely Low

Adaptive Domain scores have a mean of 100 (50th percentile) and a standard deviation of 15. Percentile Rank refers to Greg’ standing among 100 individuals of a similar age.

Figure 1: ABAS-II Skill Area Scaled Score Profile

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Table 2: Raw Score to Scaled Score Conversions Skill Areas Communication (Com) Community Use (CU) Functional Academics (FA) Home Living (HL) Health and Safety (HS) Leisure (LS) Self-Care (SC) Self-Direction (SD) Social (Soc)

Scaled Scores 33 17 28 30 22 23 13 35 26

Qualitative Range 1 1 1 1 1 2 1 2 1

Scaled scores have a mean of 10 (50th percentile) and a standard deviation of 3. Percentile Rank refers to Greg’ standing among 100 individuals of a similar age.

Table 3: ABAS Strengths and Weaknesses

Skill Areas Conceptual Communication Functional Pre-Academics Self-Direction Social Leisure Social Practical Community Use Home Living Health and Safety Self-Care

Skill Area Scaled Score

Mean Scaled Score

Difference from Critical Mean Value

Strength or Weakness

1 1 2

1.22 1.22 1.22

-0.22 -0.22 0.78

1.92 1.67 1.65

>25% >25% >25%

2 1

1.22 1.22

0.78 -0.22

1.98 1.73

>25% >25%

1 1 1 1

1.22 1.22 1.22 1.22

-0.22 -0.22 -0.22 -0.22

2.61 1.92 2.01 2.12

>25% >25% >25% >25%

Base Rate

Statistical Significance (Critical Values) at the .05 level

Skill Area Strengths and Weaknesses: Statistical analysis of the results revealed no skill areas to be significant (.05) adaptive behaviour strengths or weaknesses relative to Greg’s own performance.

Adaptive Behaviour Summary: Greg’s overall level of adaptive behaviour is best described by his ABAS-II General Adaptive Composite score: Parent = (1st percentile; Extremely Low); Teacher = (0.1st percentile; Extremely Low). Greg’s father’s score for Greg on the Conceptual Domain fell at the 1st percentile, at the 0.2nd percentile for the Social Domain and at the 5th percentile for the Practical Domain. Greg’s teacher’s score for Greg on the Conceptual Domain fell at the 0.1st percentile, at the 0.3rd percentile for the Social Domain and at the 0.1st percentile for the Practical Domain.

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ASD SYMPTOMOLOGY ASSESSMENT Checklists Administered: Date of Administration (1) ASRS Parent Rating Scale: Long Form (ASRS -P, 2014)

04/05/2016

(2) ASRS Teacher Rating Scale: Long Form (ASRS -T, 2014)

03/05/2016

ASRS Overview: The Autism Spectrum Rating Scales (ASRS) is a multi-informant (Parent, and Teacher) assessment of Autism Spectrum Disorder in children and adolescents between 6 and 18 years of age. The checklists take into account aspects of the individual’s home, school, and social settings to provide a focused and thorough assessment of Autism Spectrum Disorder and the co-morbid problems most commonly associated with it in children and adolescents.

ASRS Subscales: ASRS Parent and Teacher Report Subtest Descriptions ASRS TOTAL SCORE

ASRS SCALES Social/Communication

Unusual Behaviours

Self-Regulation

DSM-5 SCALE TREATMENT SCALES Peer Socialisation

Adult Socialisation

Measures the extent to which the individual’s behavioural characteristics are similar to the behaviours of youth diagnosed with Autism Spectrum Disorder. Measures the extent to which the individual uses verbal and nonverbal communication appropriately to initiate, engage in, and maintain social contact. An elevated score indicates the individual has trouble using non-verbal and verbal language appropriately to initiate, participate in, and retain social interactions Measures the youth’s level of tolerance for changes in routine, engagement in apparently purposeless and stereotypical behaviours, and overreaction to certain sensory experiences. An elevated score indicates the individual has difficulty accepting changes in routine, overacts to particular sensory experiences, and participates in purposeless, stereotypical behaviours. Measures how well the individual controls his behaviour and thoughts, maintains focus, and resists distraction. An elevated score indicates the individual is argumentative, has difficulties with attention, and/or deficits in impulse/motor control. Measures how closely the individual’s symptoms match the DSM5 criteria for Autism Spectrum Disorder. Measures the individual’s willingness and capacity to successfully engage in activities that develop and maintain relationships with other youth. An elevated score indicates a decreased willingness or capacity to effectively engage in activities that cultivate and preserve relationships with other children. Measures the individual’s willingness and capacity to successfully engage in activities that develop and maintain relationships with adults. An elevated score indicates a decreased willingness or 18

Social/Emotional Reciprocity

Atypical Language

Stereotypy

Behavioural Rigidity

Sensory Sensitivity

Attention

capacity to effectively engage in activities that cultivate and preserve relationships with adults. Measures the individual’s ability to provide an appropriate emotional response to another person in a social situation. An elevated score indicates that the individual has difficulty providing an appropriate emotional response to another person in a specific social situation. Measures the individual ability to utilize spoken communication in a structured and conventional way. Elevated scores indicate that verbal communication may be unconventional, unstructured, or repetitive. Measures whether the individual engages in apparently purposeless and repetitive behaviours. Elevated score may indicate that they engage in repetitive or ritualistic movements, utterances, or body posture. Measures how well the individual tolerates changes in his environment, routines, activities, or behaviours. Elevated scores indicate that the individual would prefer for environments to remain unchanged. Consequently, there is a limited ability tolerating changes in behaviour, activities, or routine. Measures the level of tolerance for certain experiences sensed through touch, sound, vision, smell, or taste. May have under or over stimulated sight, hearing, touch, smell, and/or touch. Consequently may be over sensitive or under sensitive to temperature, clothing, light, and/or noise. Measures whether the individual is able to appropriately focus attention on one thing while ignoring other things Elevated scores indicate that the individual may appear disorganised or have difficulty focusing on things whilst ignoring external stimuli.

ASRS Interpretive Guidelines: Interpretive Guidelines for ASRS T and ASRS P-Scores and Percentiles T-Score <40 40-59 60-64 65-70 >70

Percentile <15 16-83 84-92 93-97 98-99.99

Interpretive Guidelines Low Score Average Score Slightly Elevated Score Elevated Score Very Elevated Score

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ASRS Checklist Results: (1) ASRS Parent Rating Scale: The ASRS-P is a reliable and valid instrument that contains 71 items pertaining to their perception of their child’s behaviour over the past month. ASRS-P Summary Results

ASRS Subscales ASRS TOTAL SCORE

T-Score* 66

Percentile 95

Classification Elevated Score

ASRS SCALES Social/Communication Unusual Behaviours Self-Regulation

73 64 57

99 92 76

Very Elevated Score Slightly Elevated Score Average Score

DSM-5 SCALE

66

95

Elevated Score

TREATMENT SCALES Peer-Socialisation Adult Socialisation Social/Emotional Reciprocity Atypical Language Stereotypy Behavioural Rigidity Sensory Sensitivity Attention

74 56 70 70 56 86 47 57

99 73 98 98 73 96 38 76

Very Elevated Score Average Score Very Elevated Score Very Elevated Score Average Score Elevated Score Average Score Average Score

*T-scores have a mean of 50 and a standard deviation of 10. *T-scores above 60 are deemed by the checklist authors to be clinically significant.

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(2) ASRS Teacher Rating Scale: The ASRS-T is a reliable and valid instrument that contains 71 items pertaining to their perception of their student’s behaviour over the past month. ASRS-T Summary Results

ASRS Subscales ASRS TOTAL SCORE

T-Score* 84

Percentile 99

Classification Very Elevated Score

ASRS SCALES Social/Communication Unusual Behaviours Self-Regulation

82 83 66

99 99 95

Very Elevated Score Very Elevated Score Elevated Score

DSM-5 SCALE

85

99

Very Elevated Score

TREATMENT SCALES Peer-Socialisation Adult Socialisation Social/Emotional Reciprocity Atypical Language Stereotypy Behavioural Rigidity Sensory Sensitivity Attention

81 71 84 80 77 72 79 63

99 98 99 99 99 99 99 90

Very Elevated Score Very Elevated Score Very Elevated Score Very Elevated Score Very Elevated Score Very Elevated Score Very Elevated Score Slightly Elevated Score

*T-scores have a mean of 50 and a standard deviation of 10. *T-scores above 60 are deemed by the checklist authors to be clinically significant.

Summary of ASRS results: The authors of the ASRS state that T-Scores greater than 60 are usually taken to indicate a clinically significant problem. Greg’s scores exceeded the cut-off for 8 subscales on the Parent-report ASRS checklist, and 13 subscales on the Teacher-report ASRS checklist. Ratings on the DSM-5 treatment scales indicate how closely Greg matches the DSM-5 criteria for Autism Spectrum Disorder. This DSM-5 T-score was 66 (95th percentile – Elevated Score) on his parent report, and 85 (99th percentile – Very Elevated Score) on his teacher report. The Total Score is a summary score and measures the extent to which the individual’s behavioural characteristics are similar to the behaviours of youth diagnosed with Autism Spectrum Disorder. It yielded a T-Score of 66 (95th percentile – Elevated Score) on his parent report, and 84 (99th percentile – Very Elevated Score) on his teacher report.

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AUTISM SPECTRUM DISORDER DIAGNOSTIC CRITERIA AS PER DSM-5 There are seven DSM-5™ criteria for Autism Spectrum Disorder, separated into two domains: Social Communication and Interaction (A) and Restricted, Repetitive Patterns of Behaviour (B). To meet the diagnostic criteria for Autism Spectrum Disorder, all three criteria from the Social Communication and Interaction domain (A) and at least two criteria from the Restricted, Repetitive Patterns of Behaviour domain (B) must be met. The difficulties must have been present in the early developmental period; cause clinically significant impairment in social, occupational, or other important area of functioning; and not be better explained by intellectual disability or global developmental delay. These criteria are addressed below for Greg, based on information gathered from direct observation, parent clinical interview, and parent checklist information.

DSM-5 CRITERIA A. PERSISTENT DEFICITS IN SOCIAL COMMUNICATION AND SOCIAL INTERACTION ACROSS MULTIPLE CONTEXTS, AS MANIFESTED BY THE FOLLOWING, CURRENTLY OR BY HISTORY: A1. Deficits in social-emotional reciprocity (e.g., abnormal social approach; failure of normal

back-and-forth conversation; reduced sharing of interests, emotions, or affect; failure to initiate or respond to social interactions). Examples of behaviours relevant to this criterion displayed by Greg: • • • • • • • • • • • • • • • • •

Greg does not appear to share enjoyment, interests, or activities with other people; even though his parents have tried to show him how to engage with others

Greg does not appear to be interested in what games others want to play or what others want to do Greg does not often smile back at his mother and father when they smile at him When Greg’s parents used to say “I’m going to get you” or cover their eyes for peek-a-boo, Greg did not get excited for what happens next Greg did not show any interest in playing imitative games such as pat-a-cake, peek-a-boo or “so big” as a child; even though they were introduced by his parents As a younger child, Greg did not imitate his mother and father when they waved bye-bye, clapped their hands for pat-a-cake or shook their head “no” Greg did not make hand gestures or movements to familiar songs such as “itsy-bitsy-spider” or “wheels on the bus Greg does not engage in activities at appropriate times; for example, when his grandmother passed away everyone was very busy and all he wanted to do was read his book. When he was not allowed to read his book he cried for a long time. Greg is very quiet when he is drawing and does not share his excitement with others after he has finished Greg will not come up and initiate a hug or kiss without being asked In a new or disturbing situation, Greg does not look at his parents for comfort Greg doesn’t often recognize how others are feeling, e.g., when they are happy, angry or sad. When Greg’s parents are upset, sad or ill, he will not try to comfort them; for example when his father’s mother passed away, he did not comfort him He does not understand the expressions of other people’s faces Greg’s behaviour is dictated by the rules he has to follow rather than the impact it has on other people When Greg is angry or unhappy he makes noises and doesn’t consider the impact on those around him Greg does not seem to understand when he is being teased and bullied 22

• • • • • • • •

Greg tends to ask socially inappropriate questions, e.g., if we take a taxi he will tell the driver private information about our family Greg cannot take turns in a conversation i.e., he likes to talk about his subject of interest and often repeats himself Sometimes Greg has to be forced to change topics because he is only interested in talking about a narrow topic of interest Greg appear to have abnormalities in relation to affection – this was apparent after three years of age Greg does not understand jokes unless they are very simple Greg doesn’t appear to do things to try and make others laugh Greg uses language that is immature for his age When Greg is emotionally stable, his tone and pace of voice is consistent

Information collected by the Speech Pathologist as part of their assessment: • • • • •

• • •



• •

Social Approach Greg did not verbally greet the assessor even after waiting. Parents report that Greg usually needs to be prompted to greet someone. Greg will usually farewell someone spontaneously. Greg’s parents report that he will often position his face very close to theirs’ when he comes to talk to them. Jenny commented that Greg’s cuddles and kisses can be excessively ‘strong’ and firm. He is also said to have a strong grip when he takes her arm. Greg’s parents have observed him using their hand as tool, for example using it to grab a pen. Sharing of Interests, Emotions or Affect Greg responded to the assessor’s introduction with a brief social smile. Greg shared some enjoyment today, such as in response to visual humour (e.g. the doll repeatedly falling off a horse). Greg frequently interrupted the adults’ conversation to show the assessor words or symbols he had drawn, each time asking for them to be labelled or read aloud but without engaging in social chat around these (e.g. ignoring questions such as ‘is that a street near your house?’). Greg will only bring selected items, for which he has a strong interest, to parents to show them (e.g. puzzles, shapes books on planets). When Greg brings his drawings to his parents, they believe this is for the purpose of seeking praise. Greg’s parents report that Greg rarely seeks to share joint attention by pointing out or commenting on things he notices. Greg’s parents report that Greg has huge difficulty coping with and sharing his emotions when a problem occurs. They can usually infer that he is upset from his behaviour; he will bite his hand without puncturing the skin, shudder slightly, cry, sometimes hit his head and or bang a table or chair repetitively when he is upset. When parents described this at the assessment Greg commented ‘very very rude’ as this is what he has been told by his teacher. Greg rarely approaches his parents for comfort and he doesn’t use words to express his feelings.

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• •

• •





Initiating and Responding to Social Interactions On assessment Greg presented as very passive, rarely initiating interactions and inconsistently responding to the assessor. When the adults spoke Greg sat at the table idly. Greg preferred to direct comments to his parents and he asked them to interpret for him several times. Overall, Greg was pleasant and cooperative. During language-loaded interactions (e.g. conversation, sharing a book) Greg often disengaged from the assessor. Greg initiates interactions with parents mostly to ‘seek protection’ and sometimes to seek assistance with an activity (e.g. to show him the next instruction in a construction). Conversation Back-and-forth conversation could not be developed today. Greg responded to simple, concrete questions most of the time. He displayed anxiety and distress in response to more complex or abstract questions, particularly those around social or emotional content (e.g. ‘do you like school?’ ‘tell me about a time when you felt cross’). Greg asked some questions about what words meant (e.g. ‘what is pour?’) however he did not ask conversational questions or respond to conversational comments (e.g. ‘I am not good at drawing…’). Julie Smith’s report from February 2016 states that Greg ‘showed some difficulties with socialemotional reciprocity.. he mainly responded when asked questions, rather than initiated conversation.’ This criterion is rated as having been Met.

A2.Deficits in nonverbal communicative behaviours used for social interaction (e.g., poorly integrated verbal and nonverbal communication; abnormalities in eye contact and body language; deficits in understanding and use of gestures; total lack of facial expressions and nonverbal communication).

Examples of behaviours relevant to this criterion displayed by Greg: • • • • • • • • • • • • • •

Greg has abnormalities with regard to mood; for example, he smiles and giggles for no apparent reason Greg showed limited emotion when his grandmother passed away, and did not show empathy at her recent funeral (1st of May 2016) Greg has a delayed reaction to environmental stimuli; for example, he will start laughing at a situation long after it has occurred

In general, Greg only looks others in the eye for a moment before looking down when he wants something or when he is talking to them Greg does not like making eye contact with unfamiliar people when they are close in proximity At times, Greg stands too close to people during conversations

Greg does not always turn his head to look at others when they start talking to him or doing things next to him; particularly when he is doing something he is interested in Greg responds better to visual instructions than verbal instructions Greg doesn’t appear to use words and gestures together regularly (coordinate use of words and gestures); for example, pointing to an object and saying “look Mommy,” waving bye-bye and saying “bye-bye,” and shaking his head and saying “no” Greg uses his mother’s and father’s hand like a tool, to place it on what he wants Greg points to things repetitively to show you that he is excited about something Greg’s shows a range of facial expressions; however they do not often match the situation; for example, when his grandmother fell down in the rain, Greg just laughed Greg has abnormalities with regard to mood (e.g., giggling or weeping for no apparent reason) In 2016, he wet his pants under stressful conditions – an MRI indicated no physical problems 24

Information collected by the Speech Pathologist as part of their assessment: • • • • • •

• • • • • • •

Greg’s social eye gaze was limited. He tended to look ahead, around the room or down at the table rather than at the assessor. When objects were present Greg had difficulty regularly shifting his gaze between these and the adult (though referential eye gaze was observed). Frequently Greg did not integrate eye contact with other forms of communication, such that Greg was often speaking whilst looking away from the adult. Greg’s parents commented that his eye contact is generally poor with unfamiliar people. Greg displayed integrated proximal pointing and referential eye gaze when showing his drawings and writing to the assessor. Greg was unable to use gesture or facial expression in a task requiring him to describe and mime actions associated with brushing his teeth. He briefly brought his index finger to his mouth and made a brushing motion, and briefly imitated a turning tap motion when explicitly asked, however even with significant prompting, Greg was unable to perform other gestures (e.g. drinking, wiping his face, drying his hands, etc). Greg was observed to use one descriptive gesture; when asked how it felt to be angry, Greg banged his chest and mimicked the assessor’s angry expression. Greg displayed facial expressions indicating emotional extremes only (enjoyment, fear/distress) and generally his facial expression was neutral. This is in keeping with parental reports. Greg did not direct subtle or otherwise facial expressions to share affect (e.g. to share humour, to express confusion, etc). Greg could identify when characters were ‘happy’ and ‘angry’ and he commented ‘oh!’ pointing to the man’s fearful expression in the story. Greg was was observed to use a learned, ‘teacher-like’ intonation pattern as he read. Greg raised his voice anxiously but also had frequent difficulty modulating his voice volume on assessment. Julie Smith’s report from February 2016 states that Greg : o ‘tended to look down with reduced eye contact but did look up when excited with noted body tensed and hand flexed)’ o ‘was noted to grin to himself frequently but was unable to explain why he was smiling’ This criterion is rated as having been Met.

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A3.Deficits in developing, maintaining, and understanding relationships (e.g., difficulties in adjusting behaviour to suit various social contexts; difficulties in sharing imaginative play or in making friends; absence of interest in peers). Examples of behaviours relevant to this criterion displayed by Greg: • •

At times, Greg has difficulties adjusting his behaviour to suit social contexts Greg shows an obvious disinterest in other children his own age and prefers to engage in solitary activities (e.g., painting, crosswords, and drawings)

• •

He has always had difficulty engaging in imaginative play Although Greg likes to play with other children, he lacks interpersonal skills and finds it difficult to make friends Greg finds it easier to communicate with adults than peers his own age Greg does not try to talk to or join other children in their play at school Greg can follow other children but does not understand them and will not follow the rules of games they play Greg said that he has one friend at school, but that boy has been specifically asked to engage with Greg as part of a buddy program The kids Greg has mentioned as friends, do not see Greg as their friend Greg has been to other people’s houses and has had students over to his house; however they have all disappeared and never come back. He seldom engages in make believe play and only dresses up in costumes if made to for school Greg has difficulty with adjusting his behaviour to suit the varying social contexts – for example smiling at another person getting in trouble at school, or laughing at his grandmother’s funeral

• • • • • • • •

Information collected by the Speech Pathologist as part of their assessment: • • • • •







Greg named his friend ‘Michael’ but did not respond to questions about their friendship other than to say they played soccer together. Greg laughed hysterically about another child getting in trouble at school and parents commented that Greg will find it funny when others break rules and ‘get in trouble.’ Greg’s parents have observed that their neighbours’ children often appear disinterested in playing with Greg and leave him after a short time. Greg has told his parents that he is unable to understand the rules of games. Julie Smith’s report from February 2016 states that Greg has o ‘difficulties developing and maintaining relationships… he has always had difficulty with making friends and did not socialise much in China, preferring to play on his own and draw. o ‘currently has only one friend at school but was unable to describe what they do or talk about’ o ‘the teacher reports he often demonstrates social inappropriateness in the classroom.’ Greg had significant difficulties engaging in imaginative play today. When presented with dolls and objects from a small world household set, Greg selected items and labelled them. He engaged the dolls in simple actions (e.g. riding on a horse) and made some comments about what he was doing (e.g. ‘haha he fall off’), however he was unable to develop a sequence of events or a coherent story. Greg sometimes tried to imitate the assessor’s actions or respond to simple prompts (e.g. ‘I’m thirsty’ - Greg gave the doll a drink) but he was largely unable to elaborate on the assessor’s ideas in play or engage in joint interactive play. Greg was able to generate a simple story based with objects that largely followed the assessor’s model and showed limited spontaneity. 26

• •

Greg’s parents have observed that he finds it difficulty to accept one object as representing another. Greg was not able to understand the emotional causality or theory-of-mind elements of the story (e.g. recognising that the man didn’t know about the cows approaching behind him) and became distressed when questioned about these. This criterion is rated as having been Met.

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B. RESTRICTED, REPETITIVE PATTERNS OF BEHAVIOUR, INTERESTS, OR ACTIVITIES, AS MANIFESTED BY AT LEAST TWO OF THE FOLLOWING, CURRENTLY OR BY HISTORY: B1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes; lining up toys or flipping objects; echolalia; idiosyncratic phrases). Examples of behaviours relevant to this criterion displayed by Greg: •



• • • • • • • • • • • •

Greg was observed to have verbal stereotypy that was followed with hysterical laughter throughout the cognitive assessment; for example, “louder: kiss the ball” (was from a TV or movie), “see you on Monday” (was said by teacher before the weekend), “Do you know my name, Greg” (social story), “Keep safe” (before he went back to China to visit sick family member). Greg explained what each of these verbals meant to the examiner. Greg was observed to mimic the examiners voice when answering a phone call after the assessment. This was done in the same tone of voice. Following the phone call, Greg fixated and repeated phone conversations he had mimicked in the past – for example; good morning, how are you, hello. Greg is quite talented at imitation, he can mimic tone of voice and multiple dialects Greg was observed to sing along to the songs and bop to the beat of each song on the radio Greg tends to repeat phrases, jingles, and commercials at home. At times, Greg uses stereotyped and repetitive language; for example, he will repeat ‘house’ or immediately’ over and over again When Greg does not want to do something, he will say “Whoahooh” Greg tends to use language that can only be understood by his parents Sometimes Greg exhibits repetitive whole body movements At times Greg spins the parts of a toy that rotate Greg used to pull toys apart From 12 to 24 months of age, Greg liked to whirl a plastic basin. After 24 months of age he gradually lost interest in that game When Greg was younger he liked the outside air conditioning unit because it had fans that rotated Greg flaps his right hand when he is excited or angry Information collected by the Speech Pathologist as part of their assessment:



• • • • • •

Immediate echolalia was observed on several occasions (e.g. copying the assessor saying ‘jump’ with the same intonation pattern, during make believe play). Parents have noticed this at home, and more so when Greg was younger. Greg repeats advertisements and slogans, and recently he has repeated the weather forecast in verbatim. Greg is able to mimic both of his grandmothers’ accents, dialects and tones of voice, and he uses these patterns of speech when talking with them. Greg’s parents report that he will often list things of interest (e.g. shapes, planets) without communicative purpose. Greg will reportedly engage in non-speech sound making when he is playing (e.g. building constructions) and when he is excited. Greg’s parents report that he does occasionally use ‘nonsense’ words. Greg was confused about what to do with the dolls or objects, and he engaged in repetitive placement of items inside other items, for example he placed a doll’s head in a cup, stood the doll in a sink and tried to fit it in a cupboard. Later he tried to place a large bath inside a small cupboard. This criterion is rated as having been Met. 28

B2. Insistence on sameness, inflexible adherence to routines, or ritualised patterns of verbal or nonverbal behaviour (e.g., extreme distress at small changes; difficulties with transitions; rigid thinking patterns; greeting rituals; need to take same route or eat same food every day).

Examples of behaviours relevant to this criterion displayed by Greg: • • • • • • •

Greg exhibits an inflexible adherence to specific non-functional routines and rituals; for example, Greg insists on reading the same books every night before bed Greg insists on catching the school bus every day, despite circumstances (i.e., doctors appointment) that may inhibit him from doing so Additionally, Greg gets very upset and angry for days if the bus driver decides to take a different route Books and stationary must remain in the place Greg put it, otherwise he gets very angry If Greg likes a certain pen, he will insist on using that pen only If a toy is lost or broken, Greg gets extremely angry Simple changes are perceived as catastrophic events to Greg; such that, when situations are changed unexpectedly, he cries and loses his temper

Information collected by the Speech Pathologist as part of their assessment: • • •

• •

• •



Greg perseverated on reading the text in a book despite prompts to describe the pictures, to the extent that the assessor needed to cover the text with paper. Greg often counted items on the pages aloud, interrupting the sharing of the story. Greg commented ‘it should be past tense’ about a line in the story. Greg asked about the meaning of ‘leap’ and when this was explained in the context of the story (the man was jumping), he responded ‘leap year.’ Greg’s parents reported that Greg is very interested in the rules of language and makes very literal interpretations of text. Greg’s parents report that he seldom understands humour and he will repeat a joke and laugh without appearing to understand why he is laughing. At the end of the session Greg appeared anxious to enquire to his parents about whether he was well behaved during the session. He also asked them on a few occasions what they were talking about with the assessor. Greg’s parents reported that he likes to catch the school bus, and if his father should have to take him he becomes angry, especially if he goes an alternate route. Greg needs to read books every night, if he is not able to do so he becomes distressed. Parents described that in days leading up to Greg’s grandmother’s funeral he insisted on reading despite the circumstances preventing this. Greg is said to become distressed if he hears a parent comment that something is ‘missing’ or lost and he will immediately try to find the said item. This criterion is rated as having been Met.

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B3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects; excessively circumscribed or perseverative interests). Examples of behaviours relevant to this criterion displayed by Greg: • • •



During the assessment at PECS, Greg was observed to have a fixated interest on writing the abbreviation of street signs, and mathematical symbols; for example, Reid HWY, Ocean Reef RD, Hodges DR, Shenton AVE, Grand BLVD, Mitchell FWY, %, $, etc. Greg remembers a lot and can write down a driving route from memory Greg’s father reported that Greg is often fixated on a narrow interest; for example, at the moment, he is preoccupied with eight planets in the solar and geometric shapes. He likes the songs, pictures, videos and descriptions of eight planets and geometric shapes. He is now familiar with lots of facts associated with these topics. When Greg was younger, he was very fixated on a particular toy Information collected by the Speech Pathologist as part of their assessment:

• •

Greg has a very limited range of interests, which include puzzles, crosswords, building lego/other constructions according to the manuals, drawing and writing. When Greg was encouraged to draw he wrote a series of symbols (e.g. Celcius, Fahrenheit, currency, etc.), number and shape puzzles as well as words, which he frequently showed to the assessor or requested that the assessor read. The text and words included names of streets, traffic signs, shop signs/names, acronyms (e.g. LJBC: Lake Joondalup Baptist College), and school mottos (e.g. ‘wisdom justice mercy’). Later he drew circles around many words. This criterion is rated as having been Met.

B4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature; adverse response to specific sounds or textures; excessive smelling or touching of objects; visual fascination with lights or movement). Examples of behaviours relevant to this criterion displayed by Greg: • • • • • • • • •

During the assessment, Greg was observed to run from one side of the room to the other whilst laughing – which may indicate a fascination with the sensation of air or visual movement From the ages of 3 to 5 years of age, Greg disliked the sensation of getting his hair cut. He would often cry and refuse the haircut. He still does not like getting his hair cut, but no longer gets upset Greg doesn’t like people touching his head Greg cannot stand dirt on his basketball or clothes When Greg was younger, he refused to wear new clothes, due to it itching his skin Greg does not like loud or crowded places; for example, he did not like China because there were “too many people” on the streets Greg has a low pain tolerance Greg has had a fascination with spinning and the circular movement of fans Information collected by the Speech Pathologist as part of their assessment:

• •

None observed. Julie Smith’s report from February 2016 states that Greg ‘can be a picky eater with food textures’. This criterion is rated as having been Met. 30

C. SYMPTOMS MUST BE PRESENT IN THE EARLY DEVELOPMENTAL PERIOD (BUT MAY NOT BECOME FULLY MANIFEST UNTIL SOCIAL DEMANDS EXCEED LIMITED CAPACITIES, OR MAY BE MASKED BY LEARNED STRATEGIES IN LATER LIFE): Greg’s parents reported that they have noticed something a little bit “strange” about Greg’s behaviour since he was 2 years of age (e.g., hypersensitivity and repetitive behaviour); however, in China, more emphasis was placed on Greg’s academics than his social skills and behaviour. It is only since moving to Australia that this has become more apparent. At present he is only 11 years of age. This criterion is rated as having been Met.

D. SYMPTOMS CAUSE CLINICALLY SIGNIFICANT IMPAIRMENT IN SOCIAL, OCCUPATIONAL, OR OTHER IMPORTANT AREAS OF CURRENT FUNCTION. Observations, parental information and parent/teacher checklist results (i.e., ABAS) indicate that Greg’s difficulties cause significant impairment in multiple important areas of his current functioning. This criterion is rated as having been Met.

E. THE DISTURBANCE IS NOT BETTER ACCOUNTED FOR BY INTELLECTUAL DISABILITY OR GLOBAL DEVELOPMENTAL DELAY. Greg’s cognitive profile (FSIQ= 50th percentile) illustrates that he does not have an intellectual disability. This criterion is rated as having been Met.

SUMMARY OF THE ASD DSM-5 CRITERIA AND LEVEL OF SUPPORT REQUIRED A. Social Communication and Interaction 1. Criterion Met 2. Criterion Met 3. Criterion Met Total Met Severity

3 Requiring moderate support

C. Present in Early Developmental Period 1. Criterion Met E. No Intellectual Disability/Global Delay 1. Criterion Met

B. Restricted, Repetitive Patterns of Behaviour 1. Criterion Met 2. Criterion Met 3. Criterion Met 4. Criterion Met Total Met 4 Requiring mild-moderate support Severity D. Symptoms Cause Clinically Significant Impairment 1. Criterion Met F. Specifiers 1. Without accompanying Intellectual Impairment 2. With accompanying Language Impairment

As indicated in the summary table above, Greg meets sufficient DSM-5 criteria for a diagnosis of Autism Spectrum Disorder; requiring moderate support for deficits in social communication, and mild-moderate support for restricted, repetitive behaviours.

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COMORBIDITY AND DIFFERENTIAL DIAGNOSIS SCREENING ASSESSMENT Global Screening Test Administered:

Date of Administration

*child & adolescent psychprofiler (CAPP; Langsford, Houghton, & Douglas 2014)

29/04/2016

CAPP Outline: The CAPP comprises 126 items and utilises three separate screening forms; the Self-report Form (SRF: 126 items), Parent-report Form (PRF: 126 items), and Teacher-report Form (TRF: 126 items) for the simultaneous screening of 14 of the most prevalent disorders in children and adolescents (see next page). The CAPP comprises screening criteria that closely resemble the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5: American Psychiatric Association: APA, 2013). The CAPP is appropriate for the screening of behaviour of children and adolescents between the ages of 2 and 17 years, however, only the Parent-report and Teacher-report Forms are administered for children aged below 10 years due to the reading level requirements of the Self-report Form. All items of the CAPP require responses to be made on a six-point scale pertaining to the perceived frequency of the behaviour (ie., Never, Rarely, Sometimes, Regularly, Often, or Very Often). When calculating disorder screening scores, the items are coded as follows: Never = 0, Rarely = 0, Sometimes = 0, Regularly = 1, Often = 1, and Very Often = 1. These values were chosen because although many people with and without disorders may exhibit similar behaviours, it is the frequency of the behaviour that determines whether it is of clinical significance. A small number of exceptions to these scoring rules apply where some of the behaviours (e.g., fighting with a weapon, stealing) are considered to be of sufficient severity that 'Sometimes' is also awarded a score of 1. Therefore, the summation of the items within each disorder produces a screening score for that disorder, which if exceeding the screening cut off score, designates that the individual has been awarded a positive screen for that disorder. In order to ensure its validity and reliability, the first version of the psychprofiler was subjected to a series of rigorous psychometric analyses over a number of years. This process has involved validation against a large mainstream sample (n>1000) as well as clinical calibration against individuals with formal diagnoses. These analyses found the psychprofiler to be a highly reliable and valid screening instrument. The CAPP is primarily administered in order to provide an objective indication of whether the individual exhibits behaviours characteristic of a suspected disorder, possible comorbid disorders, and issues pertaining to differential diagnosis. The psychprofiler has been the most widely used Australian psychiatric / psychological / educational global screening instrument since 2004. For further information regarding the CAPP, please visit www.psychprofiler.com or contact Dr Shane Langsford on (08) 9388 8044. Please note that any indication of a positive screen on the CAPP does not constitute a formal diagnosis. A positive screen merely indicates that the individual has met sufficient criteria for a disorder to warrant further investigation.

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Disorders included in the CAPP: Anxiety Disorders: ✯ Generalised Anxiety Disorder ✯ Separation Anxiety Disorder Attention-Deficit/Hyperactivity Disorder: ✯ Attention-Deficit/Hyperactivity Disorder Autism Spectrum Disorder: ✯ Autism Spectrum Disorder Communication Disorders: ✯ Language Disorder ✯ Speech Sound Disorder Depressive Disorders: ✯ Persistent Depressive Disorder Disruptive, Impulse-Control, & Conduct Disorders: ✯ Conduct Disorder ✯ Oppositional Defiant Disorder Feeding and Eating Disorders: ✯ Anorexia Nervosa ✯ Bulimia Nervosa Obsessive-Compulsive and Related Disorders: ✯ Obsessive-Compulsive Disorder Specific Learning Disorders: ✯ Specific Learning Disorder – Reading, Mathematics, and Written Expression Trauma and Stressor-Related Disorders: ✯ Posttraumatic Stress Disorder

CAPP Results: Greg’s parents did not report any positive screens Greg’s teacher reported positive screens for: • •

Autism Spectrum Disorder Language Disorder

Please note that any indication of a positive screen on the CAPP does not constitute a formal diagnosis. A positive screen merely indicates that the individual has met sufficient criteria for a disorder to warrant further investigation. Please refer to the CAPP Report(s) for the individual behaviours which were responsible for the positive screens elicited.

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ADHD BEHAVIOURAL ASSESSMENT Checklists Administered: Date of Administration (1) Conners’ 3 Parent Rating Scale: Long Form (Conners 3-P, 2014)

23/04/2016

Conners’ 3 Overview: The Conners 3 is a multi-informant (Self, Parent, and Teacher) assessment of Attention Deficit/Hyperactivity Disorder in children and adolescents between 6 and 18 years of age. The checklists take into account aspects of the individual’s home, school, and social settings to provide a focused and thorough assessment of Attention Deficit/Hyperactivity Disorder and the co-morbid problems most commonly associated with it in children and adolescents. Parents and teachers can rate youth from ages 6 to 18 years. Self-reports can be completed by youth aged 8 to 18 years.

Conners’ Subscales: Conners’ Parent and Teacher Report Subtest Descriptions A: Aggression

B: Inattention

C: Hyperactivity/Impulsivity D: Peer Relations E: Learning Problems1 F: Executive Functioning1 G: DSM-5 ADHD Inattentive H: DSM-5 ADHD HyperactiveImpulsive I: DSM-5 Conduct Disorder J: DSM-5 Oppositional Defiant Disorder K: Conners 3 GI Restless-Impulsive L: Conners 3 GI Emotional Lability

M: Conners 3 GI Total

N: Conners 3 ADHD Index

Are likely to be physically and verbally aggressive, may show tendencies that are destructive and demonstrate poor control over their anger/aggression. May bully others, be argumentative, and break rules. Have poor concentration, attention and difficulty focusing their mind on work. Often make careless mistakes, have difficulty starting and completing tasks, and tend to be easily bored. Have difficulty sitting still for very long, feel restless and impulsive. May be easily excited and talk too much. May have poor social skills, limited social connections and difficulty with friendships. Appears to be unaccepted by their peers. Tend to struggle academically. May have difficulty learning and/or remembering new concepts and need more help and explanation. Have poor planning, organisational and prioritising skills. Have difficulty starting or finishing tasks. High scores indicate an above average correspondence with the DSM-5 diagnostic criteria for Inattentive type ADHD High scores indicate an above average correspondence with the DSM-5 diagnostic criteria for Hyperactive-Impulsive type ADHD High scores indicate an above average correspondence to DSM-5 criteria for Conduct Disorder. High scores indicate an above average correspondence to DSM-5 criteria for Oppositional Defiant Disorder. A high score on this index indicates a strong tendency toward hyperactivity as well as inattentiveness, both components of ADHD. A high score on this index indicates a strong tendency for pronounced emotional reaction, such as crying, getting angry, or experiencing frequent and sudden mood swings This index presents a global view of the Restless-Impulsivity and Emotional Lability indices, and can also be used as an indicator of overall psychopathology. Identifies children/ adolescents “at risk” for ADHD

1

Learning Problems and Executive Functioning are subscales of Learning Problems/Executive Functioning on the Conners’ 3-T.

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Conners’ 3 Interpretive Guidelines: The authors of the Conners’ 3 Rating Scales (Conners’ 3) state that T-Scores greater than 60 are usually taken to indicate a clinically significant problem. Interpretive Guidelines for Conners’ T-Scores and Percentiles T-Score

Percentile

<30 30-34 35-39 40-44 45-55 56-60 61-65 66-70 >70

<2 2-5 6-15 16-26 27-73 74-85 86-94 95-98 >98

Interpretive Guidelines Markedly Atypical (Low Scores are Good: Not a Concern) Moderately Atypical (Low Scores are Good: Not a Concern) Mildly Atypical (Low Scores are Good: Not a Concern) Slightly Atypical (Low Scores are Good: Not a Concern) Average (Typical Score: Should Not Raise a Concern) Slightly Atypical (Borderline: Should Raise a Concern) Mildly Atypical (Possibly Significant Problem) Moderately Atypical (Indicates Significant Problem) Markedly Atypical (Indicates Significant Problem)

Furthermore, the greater number of subscales that show clinically relevant elevation (i.e T-Scores above 60), the greater likelihood that the Conners 3 scores indicate a moderate to severe problem. High scores on the ADHD Index are considered by the checklist authors to be useful for differentiating clinical ADHD individuals from non-clinical individuals. Please note, that the ADHD Index score reported is a probability % figure, not a T-score like the other Indexes.

Checklist Results: (2) Conners’ 3 Parent Rating Scale: The Conners’ 3-P is a reliable and valid instrument that contains 110 items pertaining to their perception of their child’s behaviour over the past month. Conners’ 3-P Summary Results

Conners’ Subscales Inattention Hyperactivity/Impulsivity Learning Problems Executive Functioning Defiance/Aggression Peer Relations DSM-5 Symptoms: Inattentive DSM-5 Symptoms: Hyperactive-Impulsive DSM-5 Symptoms: Conduct Disorder DSM-5 Symptoms: Oppositional Defiant Disorder Connors Global Index: Restless-Impulsive Connors Global Index: Emotional Lability Connors Global Index: Total ADHD Index#

T-Score* 61 59 54 56 52 90 60 57 43 68 63 77 69 51 % probability

*T-scores have a mean of 50 and a standard deviation of 10. *T-scores above 60 are deemed by the checklist authors to be clinically significant. # ADHD Index score reported is a probability % figure, not a T-score like the other Indexes.

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Summary of Conners’ results: The authors of the Conners’ 3 state that T-Scores greater than 60 are usually taken to indicate a clinically significant problem. Furthermore, the greater number of subscales that show clinically relevant elevation (i.e T-Scores above 60), the greater likelihood that the Conners’ 3 scores indicate a moderate to severe problem. Greg’s scores exceeded the cut-off for 6 subscales on the Parent-report Conners’ checklist. Greg’s parent-report score on the ADHD Index indicates that there is a 51% probability that he has ADHD, (unless another factor/diagnosis better explains the behaviours reported).

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OBSERVATIONS AND CLINICAL PRESENTATION Rapport: • The examiner was able to establish good rapport with Greg – initially Greg’s father translated verbal instructions, which was followed by the examiner and Greg communicating through hand signals, writing, and verbal language • Greg appeared to be comfortable with examiner immediately, and made an effort to communicate General Appearance: • Greg’s physical appearance was neat Psychomotor Behaviour: • Was observed as having a normal gait. • His coordination of movements was observed to be awkward. • Posture was relaxed. • Tended to fidget with objects around him • Had difficulty staying seated – was observed to get up and run from one side of the room to the other repetitively whilst laughing • Was observed as having poor eye contact Mood/Affect: • Was observed as having a happy affect • Greg’s affect /mood was inconsistent throughout the assessment • Became emotional during testing when he incorrectly drew a symbol during the Coding subtest – it was the first symbol he drew and become so emotional and agitated that we had to start again on a new piece of paper • Was observed as being overly excitable during the assessment – would laugh frequently at verbal self-stimulating behaviour and verbal cues of others Speech: • His spoken language ability was judged to be below the level expected for someone his age – however it is possible that this is due to exposure – Greg has only lived in Australia for 6 months • Greg did not initiate speech independently – speech was initiated by words that he had written, mimicking others, verbal stereotypy, and responses to questions and hand signals Cognitive: • No obvious behaviours were observed that suggest cognitive deficiencies Attention: • Greg put in a reasonable amount of effort throughout the assessment • Greg’s level of concentration/attention was observed as being sufficient during testing • Greg was observed to write down irrelevant complex Mathematic equations, excessive street names, landmarks, and schools – despite being asked to do a specific written task

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SUMMARY Reason for Referral: Greg was referred to Psychological and Educational Consultancy Services (PECS) by Dr Senq-J Lee (Consultant Paediatrician) for a Comprehensive Psychological Assessment. Current Concerns: From a presented list, Greg’s parents identified concerns in the following areas: • •

Learning Social skills

Cognitive Assessment: Greg achieved index scores at the following levels: • Memory • Reasoning • Quantitative • Full Scale (FSIQ)

= 42nd percentile = 50th percentile = 58th percentile = 50th percentile

The results clearly indicate that an Intellectual Disability is not present. Adaptive Behaviour: Greg’s overall level of adaptive behaviour is best described by his ABAS-II General Adaptive Composite score: Parent = (1st percentile; Extremely Low); Teacher = (0.1st percentile; Extremely Low). Greg’s father’s score for Greg on the Conceptual Domain fell at the 1st percentile, at the 0.2nd percentile for the Social Domain and at the 5th percentile for the Practical Domain. Greg’s teacher’s score for Greg on the Conceptual Domain fell at the 0.1st percentile, at the 0.3rd percentile for the Social Domain and at the 0.1st percentile for the Practical Domain. ASD Symptomology Assessment: Ratings on the DSM-5 treatment scales indicate how closely Greg matches the DSM-5 criteria for Autism Spectrum Disorder. This DSM-5 T-score was 66 (95th percentile – Elevated Score) on his parent report, and 85 (99th percentile – Very Elevated Score) on his teacher report. The Total Score is a summary score and measures the extent to which the individual’s behavioural characteristics are similar to the behaviours of youth diagnosed with Autism Spectrum Disorder. It yielded a T-Score of 66 (95th percentile – Elevated Score) on his parent report, and 84 (99th percentile – Very Elevated Score) on his teacher report.

Autism Spectrum Disorder DSM-5 Criteria: As indicated in the summary table above, Greg meets sufficient DSM-5 criteria for a diagnosis of Autism Spectrum Disorder; requiring moderate support for deficits in social communication, and mild-moderate support for restricted, repetitive behaviours.

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Comorbidity and Differential Diagnosis Behavioural Assessment: Greg’s parents did not report any positive screens Greg’s teacher reported positive screens for: • •

Autism Spectrum Disorder Language Disorder

ADHD Behavioural Assessment: Greg’s scores exceeded the cut-off for 6 subscales on the Parent-report Conners’ checklist. Greg’s parent-report score on the ADHD Index indicates that there is a 51% probability that he has ADHD, (unless another factor/diagnosis better explains the behaviours reported).

Main Observations and Clinical Presentation: • The examiner was able to establish good rapport with Greg – initially Greg’s father translated verbal instructions, which was followed by the examiner and Greg communicating through hand signals, writing, and verbal language • Greg appeared to be comfortable with examiner immediately, and made an effort to communicate • His coordination of movements was observed to be awkward. • Had difficulty staying seated – was observed to get up and run from one side of the room to the other repetitively whilst laughing • Was observed as having poor eye contact • Became emotional during testing when he incorrectly drew a symbol during the Coding subtest – it was the first symbol he drew and become so emotional and agitated that we had to start again on a new piece of paper • Was observed as being overly excitable during the assessment – would laugh frequently at verbal self-stimulating behaviour and verbal cues of others • His spoken language ability was judged to be below the level expected for someone his age – however it is possible that this is due to exposure – Greg has only lived in Australia for 6 months • Greg did not initiate speech independently – speech was initiated by words that he had written, mimicking others, verbal stereotypy, and responses to questions and hand signals • Greg was observed to write down irrelevant complex Mathematic equations, excessive street names, landmarks, and schools – despite being asked to do a specific written task

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CONCLUSION AND STATEMENT OF DIAGNOSIS Greg meets sufficient DSM-5 criteria for a provisional diagnosis of Autism Spectrum Disorder; requiring moderate support for deficits in social communication, and mild-moderate support for restricted, repetitive behaviours. A formal diagnosis requires both a Paediatrician and a Speech Pathologist to concur with the findings of this assessment report. Observations, parental information and checklist results (ie ABAS) indicate that Greg’ difficulties cause significant impairment in multiple important areas of his current functioning. Greg’ cognitive profile confirms that an Intellectual Disability/Global Developmental Delay is not responsible for his difficulties/behaviours.

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RECOMMENDATIONS Please note, PECS does not provide micro-strategies (e.g., sit student at front of classroom, etc) as part of their recommendations. PECS provides recommendations on what further assessment is required, what intervention is necessary, and who is the most appropriate to provide the assessment/intervention recommended.

Paediatric Involvement: (1)

Greg should be seen by a Paediatrician for the purpose of a formal decision of a diagnosis of Autism Spectrum Disorder, now that the Psychologist’s and Speech Pathologist’s assessment have both been completed.

Speech Pathologist Involvement: (1)

Greg should continue Speech Pathology to further develop his receptive and expressive language skills.

Occupational Therapist Involvement: (1)

Greg should undergo a sensory assessment with an Occupational Therapist to identify and assist his hyper reactivity to sensory input

DSC Involvement: (1)

Should the Paediatrician concur with the Autism Spectrum Disorder diagnosis, confirmation of that in writing should be sent to Disability Services Commission, along with a copy of this report.

School Involvement: (1)

A case-conference involving Greg's parents and the key school personnel should be held to discuss Greg's individual learning requirements.

Social Skills Development: (1)

Greg would benefit from a programme of Social Skills training and engaging in more social activities. Behaviour Tonics Level 1, 252 Cambridge Street, WEMBLEY WA 6014 Phone: (08) 9382 1182 www.behaviourtonics.com.a Connect for Kids 99 Loftus Street, LEEDERVILLE WA 6007 Phone: 0402 101 060 www.connectforkids.com.au

Health & Well-Being: (1)

Greg needs to continue/implement regular exercise and maintain a healthy diet. Please note, the above is a generic recommendation that should be followed by all and is not a recommendation specific to Darcy due to any of his results or reported behaviours.

Dr Shane Langsford Date of Report Managing Director -PECS Registered Psychologist APS College of Educational & Developmental Psychologists Academic Member 41

APPENDIX 1 – CLINICAL COHORT RESEARCH FINDINGS Clinical Cohort: Autistic Disorder: When compared with matched controls (n=19) as part of the WISC-IV norming process, children with Autistic Disorder were found to present with significantly lower scores (p<.01) and substantially different (ES>1.00) than their matched controls on all of the WISC-IV Composites. The scaled score differences were significant for all subtests except Arithmetic (p = .80) and Block Design (p=.07). In particular, large effect sizes (effect sizes indicate the substantiveness of the significant result) were found between the children with Autistic Disorder and the matched controls for (in descending order) Letter-Number Sequencing (ES=1.83), Comprehension (ES=1.72), and Symbol Search (ES=1.60). Of the core subtests, only the 3 PRI subtests (ie Block Design, Picture Concepts, and Matrix Reasoning) failed to elicit an ES of greater than 1. A large study comparing children with autism across WISC-III indexes, found that as a group they displayed a profile of lower Processing Speed Index (PSI) and Freedom form Distractibility (FDI; a measure of basic attention, concentration and working memory), relative to their Verbal Comprehension Index (VCI) and Perceptual Organisation Index (POI) scores (Calhoun, & Dickerson Mayes, 2005). Furthermore, a pattern of lower performance on the Coding subtest, relative to the Symbol Search subtest (both of which comprise the Processing Speed Index), has been consistently found, at a group level. This would tend to suggest that these children are more likely to display weaknesses in processing speed, basic attention, as well as writing. Given this it is of importance to assess a child’s writing ability, if they are identified as having Autistic Disorder. There is a high rate of comorbidity between Autistic Disorder and learning disorders, with one study finding that 75% of children with Autistic Disorder also had at least one learning disorder.

Clinical Cohort: Asperger’s Disorder: When compared with matched controls (n=27) as part of the WISC-IV norming process, children with Asperger’s Disorder were found to present with significantly lower scores (p<.01) and substantially different (ES=0.94) than their matched controls for the WISC-IV PSI Composites. The scaled score differences were significant (p<.05) for the subtests of Picture Concepts, Coding, Comprehension, and Symbol Search. In particular, large effect sizes (effect sizes indicate the substantiveness of the significant result) were found between the children with Asperger’s Disorder and the matched controls for (in descending order) Coding (ES=1.06), Comprehension (ES=1.72), and Symbol Search (ES=1.60). Similarities (p=.36; ASD group actually scored higher than the matched controls) and Arithmetic (p=1.00) were found to be the subtests least effected by Asperger’s Disorder and in this case it was found that Darcy performed very well on these subtests. Please note that only small sample sizes were used in the above studies, therefore, empirical findings are difficult.

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Autism Spectrum Disorder Diagnostic Assessment Report: Greg

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