Honeybunches had his 2nd visit with the Developmental Behavioral Pediatrician down at the big hospital on July 14th. Today (July 19th) I got the evaluation report in the mail. I was impressed with how quickly it came and how thorough the report is. :)
Here are some of the highlights:
"Methods of Assessment:
Clinical Observation
Parent Report
Review of Medical Records
Review of School Records
Achenback System of Empirically Based Assessment (ASEBA)
Autism Diagnostic Observation Scale"
The report then goes into his history from birth through now including issues during his birth, health history, his developmental issues, previous diagnostic history, hospitalization history, medication history and all that fun stuff.
She went into detail about issues he has with his fine motor, sensory, gross motor, language and communication, cognitive, personal-social, self care, feeding/growth/nutrition, sleep, emotional-behavioral and relationships with adults and siblings in the family.
She clearly wrote under "Educational History" that "--is identified as a child with: Autism Spectrum Disorder".
I like how under "Current Developmental Status" she wrote:
"His mother has advocated strongly for good special educational services and he has made nice progress in recent years..." :) She also wrote in there how "He reports being bullied, but did not want to discuss it." I plan on going into that further with the school at his IEP meeting in September, requesting something be put into his IEP in regards to a bullying safety plan if that's something that exists or at least ways to protect him from bullying. I know as he gets older, that becomes more prominent.
Under "Behavioral Observations" she wrote how "-- answered my questions nicely at the beginning of the interview, but then became so focused on leaving in order to eat that he had difficulty answering questions. -- turned his body away from me while talking on several occasions and had poor eye contact. He seemed to understand that he has behavior problems but had little insight into how they affected others. The prosody of his speech was fairly flat limited affect.... He brightened when we talked about his interest in money and promptly showed me both his money and the signatures on his money. -- indicated that he liked to do worksheets both at school and at home. He also indicated that he loved riding his bike and scooter..."
Regarding the ADOS-2, Module 3 she wrote:
"The ADOS-2 is a semi-structured, standardizes assessment to evaluate language and communication skills, reciprocal social interaction, play, stereotyped behaviors and restricted interests. It includes a number of activities such as make believe play and cartoons. Module 3 is used for children and adolescents who use fluent speech to communicate..."
"-- used fluent speech to communicate. The child's speech patterns were fairy typical, but he used little variation in pitch or tone. -- directed vocalizations to me, but often did not look at me. He did not echo other's speech. -- used language that tended to be more formal than that of children at a similar developmental level with some occasional idiosyncratic utterances. -- occasionally offered information about his or her own thoughts and experiences, but was not able to share much information about his feelings. He had difficulty describing his emotional experience. His conversational speech included some spontaneous elaboration of his own responses for the my benefit and provided some leads to follow, but this was less in amount than would be expected for his expressive language level and limited in flexibility. He took my leads in conversation if they were on a topic that was of interest to him. If I gave a conversational lead that was either not dramatic or not related to his interests, he would simply say "Yep" and change the topic. -- used some spontaneous use of descriptive gestures in the demonstration task and the description of a cartoon. However, he had a very difficult time integrating eye contact, verbalization and gesture..."
Reciprocal Social Interaction:
"--- was pleasant to work with throughout the assessment. But, midway through the assessment he noticed a tiny spider web and spider in the corner of the room. He stared at it throughout the rest of the assessment, and then discussed insects at a much higher rate. He was difficult to engage in a play scenario with super heroes. He wanted to use the tools to remove the leg of one of the heroes and focused on this throughout the play scenario... -- showed poorly modulated eye contact to initiate, terminate and regulate social interaction..."
She went into his speech-communication issues that she noticed in detail.
He told her that "Friends are people you met and did not seem to have insight into give and take relationships... He expressed that he wanted to be a banker or a cop and live in a bank when he grows up."
Conclusion:
"The ADOS-2 can be considered a reasonable estimate of --'s behaviors and skills in social communication. On the ADOS-2, --'s scores were consistent with the diagnosis of Autism Spectrum Disorder...
ADOS Classification and Concern Level: Autism Spectrum Disorder, Moderate."
Then she went into why he meets the criteria, what criteria he met, etc which I previously wrote about in a recent post entitled Dev. Beh. Pedi eval part 1.
She gave recommendations for the school including:
"He requires a very individualized instruction and a functionally informed positive behavioral support plan in the classroom and home environments. I believe he would benefit from a highly structured curriculum like SRA connecting math concepts and reading mastery. If -- states he does not want to attend a crowded assembly or a similar situation, his request should be accommodated. It is much better that he asks for this in advance rather than having an aggressive episode. The behavior analyst should make sure that frequent preference assessments are conducted so that effective reinforcers can be used in his behavioral plan. -- often asks perseverative questions. If he asks a question once, answer it. If he asks the same question again within a relatively short period of time, have him write the answer down. Then you can respond to future repetitive questions by pointing to the written answer. He may benefit from the use of a Time Timer at home and school. --may benefit from teachers systematically creating schedule changes and rewarding him for tolerating these changes..."
She recommended "Color coding his schedule to indicate whether an item is a definitely scheduled item or if something is just a possibility. -- has improved over the years and although his aggression has decreased, it is more complicated when he is aggressive now due to his strength and size... "
"-- needs to work on skills that will lead to independence in his living environment, community and in a vocational setting. The Assessment of Functional Living Skills is an assessment skills tracking system encouraged on the guide for the development of skills that will help individuals with disabilities be as independent as possible. The AFLS could be used to guide a portion of --'s school educational program." (She then went into many more details about the AFLS.)
Again, I am impressed with this evaluation report and the previous intake report she sent! Now, time to write a letter to send to the school requesting this AFLS evaluation be part of his three-year IEP eval and also write some new accommodations I want added to his IEP based on this report...
