I have recieved Marshall's official Autism Report. It was 11 pages long.
I wrote a lot about how we got to this point and how Marshall
developed as a baby and what not, so i have not included those
parts below, or the recommendations moving forward.
Below is the Psychology Assesment which very specifically
explains the details that make Autism a part of Marshall's life.
Thought you might like to read it from a perspective
that is not my own :)
As a side note, i hope you don't mind reading this centered.
I have always had difficulty with making paragraphs, or breaks
in my writing once it's published, so i find it
easier to read if i just centre it!
Psychology Assessment:
Test Results:
Developmental Review / Autism Symptom Review
The Autism Diagnostic Interview-Revised (ADI-R) was completed
with Marshall's mother. She provided the following information
regarding Marshall's developmental history
and current symptom presentation.
With regard to his communication skills, as noted, Marshall's speech
and language development has been significantly delayed.
He has just started using single word speech on a regular basis.
It is often hard to know what he wants. He sometimes
will just go and get what he wants and occasionally uses pointing.
There is some use of another's hand as a tool.
He will also pull parents to things he wants but then just stand there.
He will point at objects of interest. He rarely uses gestures
such as nodding or shaking his head for “yes” and “no”.
He will wave at others and clap his hands.
He rarely imitates other but will copy things he sees on t.v.
During his play, he is generally quiet. He has started making
some noises when pushing cars.
With regard to his social development,
there have been ongoing concerns with eye contact
but improvement has been noted in the past year as this
issue has been specifically targeted in interventions with him.
Social smiling is noted at times but only with very familiar people.
Showing of objects has occurred recently and this
behaviour as been specially worked on with him.
With this support and intervention,
he has been showing things to his mother and this is
sometimes coordinated with eye contact. Marshall likes
running outside, going on the trampoline, and playing with bubbles.
He likes climbing on things.
He will get excited about
activities and will jump up and down and smile when excited.
There is limited shared enjoyment with others.
As noted, he is often quiet during play and play is solitary.
He engages in some pretend play and will feed a doll.
He does not share toys with others but sometimes shares food.
He does not offer comfort to others but if someone is upset,
he will come to his mother for comfort for himself.
He does show a range of emotions which are connected
to the situation. His response to others is variable.
Sometimes he will run and greet familiar people
but other times he will not respond.
He likes to be tickled by others and play social games.
He will run and follow other children around but often
plays in his own way. He will not respond if other
children approach him.
With regard to the presence of restricted, repetitive,
and stereotyped patterns of behavior,
no unusual preoccupations are noted or a circumscribed interest.
There is engagement in repetitive play.
He will line up objects or organize objects in certain ways.
He will organize puzzles so that the edges are lined up in a specific way.
There is lots of peering at objects from different angles.
For a period of time, he would only play with toys on a table
so he could peer at objects along the table edge.
He has been very focused on wheels on objects
and will spin wheels repetitively.
He will line up cars in specific patterns along the end of his bed
and can get upset if they are rearranged.
He has a particular interest in very small objects such as pieces of lint.
His play has improved a bit recently and he also
engages in some functional play with toys.
There are some rituals around bedtime and he needs certain
objects piled up in his bed before sleeping.
His cups have to be on a certain spot on the table
and if it is moved, he will move it right back.
He likes the feel of certain textures.
There is no history of hand or finger mannerisms.
He does engage in some spinning.
In sum, given the information provided by Marshall's mother,
scores on the ADI-R fell above autism spectrum cut-offs
(in the autistic range) for
Qualitative Abnormalities in Reciprocal Social Interaction
and Qualitative Abnormalities in Communication
(scored for Nonverbal subject).
The score for Restricted, Repetitive, and
Stereotyped Patterns of Behavior fell right at the cut-off.
Assessment of Child's Presentation and Behavior
The Autism Diagnostic Observation Schedule –
was completed with Marshall.
With regard to his language and communication,
Marshall engaged in occasional use of single words
and used a couple of phrases which were not used within
context or to communicate with others.
He was noted to jabber or engaging in his own gibberish speech.
He did say “hello” when talking into a toy phone.
He repeated the phrase “open for close” when playing with a pop-up toy.
Intonation was somewhat flat when stating these phrases.
He often echoed questions asked of him rather than answering.
He engaged in a repetitive "tica, tica" noise at times.
No pointing or use of other nonverbal gestures was observed.
He did not make requests but would whine and cry when
he wanted something.
At times, he would just take the object he wanted
out of the examiners' hands.
He did not imitate actions of the examiner.
With regard to his reciprocal social interactions,
Marshall was often nonresponsive to attempts
to engage with him.
He did not respond to his name being called by the examiner
on multiple occasions but did respond to his
name being called by his mom.
Eye contact was minimal or at times was used in an odd manner
(excessive staring at examiner's face).
There was no joint attention to activities or toys.
He did not respond to social smiling.
Facial expressions were not used to regulate social interactions.
He did not engage in play with the
examiner and it was difficult to have a sense of
shared enjoyment in activities.
He did enjoy exploring a variety of toys on his own.
He showed some objects to his mother and to the examiner
but eye contact was not consistently integrated with this.
He did bring an object (balloon) over the examiner to
repeat an activity with it but put the object directly into
the examiner's mouth without making eye contact
or other verbal request.
There was some use of other's body as a tool.
In general, Marshall was very self-directed
and significant tantrum behaviour was noted when
having to switch activities.
With regard to his play behaviors, as noted, Marshall did explore
the toys and played with cause-effect toys.
He engaged in significant peering behaviour with toys.
He would lie on the floor at times to peer at toys in a specific manner.
Hand mannerisms were noted and he would often
engage in some hand posturing while peering at toys.
He engaged in some brief pretend play (saying hello into a toy phone).
He did engage in some brief imitation of functional
use of toys (hops frogs, flies plane) but did not make
accompanying noises spontaneously.
Some spinning while observing toys was noted.
In sum, scores on the ADOS fell in the autistic range
in both the Communication and
Reciprocal Social Interaction domains.
Assesment of Child's Presentation and Behavior
(Note: A percentile indicates a child’s standing relative
to other children of the same age.
For example, the 50th percentile means that the child
scored as well as 50 children out of 100 of the same age.
Percentiles that reflect the average range are from
about the 25 to the 75th.)
Given the developmental delays and language delays,
Marshall was administered the Mullen Scales of Early Learning
in order to assess his current skill level.
Scores are provided with regard to Visual Reception,
Fine Motor skills, and Receptive and Expressive Language skills.
Marshall scored as follows:
Overall, Marshall's early learning or cognitive development
fell in the very low range, at the 1st percentile for his age group.
His score fell in the range associated with a
moderate developmental delay.
With regard to his visual processing or visual problem-solving skills,
overall, Marshall's skills fell around the 14 month level.
He was able to look for hidden objects.
He showed interest in a book and flipped through pages
but did not attend to specific pictures in the book.
He could complete an inset puzzle of basic shapes.
He had a hard time demonstrating object associations
(i.e., pretending to drink from a cup, putting a brush on his head).
He was not able to match or sort objects.
He could not nest a set of varying sized cups
from smallest to largest.
With regard to his fine motor skills, his skills fell around
the 22 month level. He was able to turn pages in a book
and put blocks in and out of a container.
He could put coins in a slot.
He was able to imitate drawings of vertical and horizontal straight lines.
He could stack a few blocks.
With regards to his receptive language skills,
abilities fell around the 16 month age level.
Autism symptoms significantly affect his responsiveness
to language and others speaking to him.
He did respond to his name if used by his caregiver but not
when used by others. He did give a toy upon request but did not
follow other directions and instructions.
He does understand inhibitory words such as "no" and "stop".
He could identify some pictures in books but not action words
(i..e, who is sleeping? eating?).
He did not understand various directional or
spatial concepts (in, on, under, behind).
With regards to his expressive language skills,
abilities fell around the 17 month age level.
He used single word speech.
He does jabber with inflection at times but does not
combine vocalization well with gestures.
He could name a few common objects presented to him.
As noted, he used some phrases but these words seemed
to be stated as one word rather than putting these three
words together himself. Speech articulation concerns were noted.
He did use the word “mine” but other
pronouns were not noted.
He is not counting.
Visual-Motor Functioning
Visual-motor integration skills were assessed
and fell in the low average range,
at the 18th percentile but were an area of relative strength for him.
His age-equivalency score was 2 years, 7 months of age.
He imitated the drawing of a circle, vertical lines,
and horizontal lines. He was not able to copy these figures on his own.
Marshall used both his right and left hand on drawing tasks.
He had a whole-fisted grasp of the pencil.
Pencil control is just emerging and he had some
difficulties in this regard.
Adaptive Behaviour
A variety of everyday skills are assessed
including communication skills,
social skills, and daily living skills.
Parents rate what children are never, sometimes,
and always able to do.
Marshall scored as follows:
Marshall's parents reported overall significantly delayed development
of adaptive behavior skills and the
Adaptive Behavior Composite fell at the 2nd percentile for his age.
His score fell in the range associated with
mild developmental delays.
Communication skills fell in the Low range,
below the 1st percentile for his age.
Marshall understands the words “yes” and “no”.
His response to his name is inconsistent.
He can point to some major body parts and some
common objects in books.
His response to directions is variable.
He is not interested at this point in listening to stories or books.
He has just recently been saying “Mama” and
wanting to call others by a name.
He will say “dad” only if copying after his sister says this.
He will point to things he wants.
He is starting to repeat some single words and says some one word requests.
Phrase speech is not yet established.
He is not identifying letters or numbers yet.
Daily Living skills fell in the Moderately Low range,
at the 4th percentile for his age.
He can drink from a cup and use utensils.
He is not toilet trained.
He can take off clothes and pull up pants with elastic waistbands.
He is not able to do zippers or buttons.
He is sometimes aware of hot objects but continues to go close to it
and needs reminders.
He is not interested in helping with chores
and gets upset when asked to clean up things.
He understands what a phone is for
but does not talk into a phone.
His mother notes that this is confusing for him.
His behaviour in the car is appropriate and he sometimes
stays on the sidewalk when walking in the community.
He is not counting.
He does not turn on the t.v. himself or use a computer.
Socialization skills fell in the Moderately Low range,
at the 4th percentile.
Symptoms of autism significantly affect social interactions.
At play groups, he has generally shown no awareness
of the other children there.
There has been some improvement over the past year
and he will allow others to interact with him more.
He will sometimes follow other kids or watch them.
He sometimes shows objects to others.
He does not initiate interactions with other children.
He does not imitate others.
He does show preference for familiar people a
nd is affectionate with his family.
He does come to his mother for comfort when upset
or when he needs something.
He has a hard time with sharing or taking turns.
He is not engaging in make believe play.
It can be hard to transition Marshall from one activity to another.
It depends on what he is doing or if he is ready to switch activities.
He is learning to say “thank-you”.
Motor skills fell in the Moderately Low range,
at the 7th percentile for his age.
Marshall can run smoothly.
He is throwing and kicking balls.
He has difficulty with catching balls.
He is just starting to pedal a tricycle.
He will climb on playground equipment.
In terms of fine motor skills,
he can turn pages in a book and stack blocks.
He does not build other three-dimensional structures with blocks.
He has difficulty opening doorknobs or unwrapping small objects.
He can complete inset puzzles.
He has difficulty with holding a pencil appropriately or using scissors.
Behavioural and Emotional Functioning
With regard to externalizing difficulties,
the Hyperactivity fell in the “at-risk” range (95th percentile).
Marshall is often unable to slow down and has poor self-control.
He has difficulties with waiting to take turns and being overly active.
He often has tantrums.
The Attention Problems scale fell in
the clinically significant range (97th percentile).
Marshall has a very short attention span and is very easily distracted.
He has difficulties listening to directions and
paying attention to others when they are speaking.
The Aggression scale fell within normal limits and
significant concerns were not noted in this regard.
In talking with Marshall's mother, she noted that Marshall does engage
in significant tantrum behaviour when he wants something
or things do not go his way.
He is not usually aggressive to others, however.
He is very hyperactive and cannot sit in circle time activities.
He will run off on his own and needs to keep moving.
With regard to internalizing difficulties,
the Anxiety scale fell within normal limits.
The Depression scale fell in the “at-risk” range (89th percentile)
given difficulties with emotional regulation.
He often pouts, whines, or cries easily.
He changes moods quickly and is very easily frustrated.
Autism symptoms and communication difficulties
also have a significant effect on mood at this point.
The Atypicality scale fell in the
clinically significant range (98th percentile).
Marshall often seems unaware of others and often babbles to himself.
He often says things that do not make sense or fit the context.
He sometimes is confused or can stare blankly.
The Withdrawal scale fell in the “at-risk” range (84th percentile).
He does not make friends and often avoids other children.
He refuses to join group activities.
Summary:
Marhsall is a 3 year old boy who was referred for an assessment
by physician Dr. Alan Moore for suspected autism spectrum disorder.
The results of the current assessment found that
Marshall does meet the DSM-IV-TR
(Diagnostic and Statistical Manual for Mental Disorder,
Fourth Edition, Text Revision)
criteria for a diagnosis of autism spectrum disorder,
specifically Autistic Disorder.
These findings were based on clinical interviews,
review of developmental history, and interactions and
observations of Marshall, including the use of standardized
instruments for the assessment of autism symptoms.
He presents with the triad of symptoms diagnostic
of an autistic disorder which include impairments
in the development of social interactions skills, impairments in the
development of communication skills (verbal and nonverbal),
and the presence of restricted and
repetitive patterns of interests and behavior.
Developmentally, Marshall's current functioning falls
in the range associated with a moderate developmental delay
or impairment, at the 1st percentile for his age group.
Parent reports of his adaptive behavioral functioning at home
are generally consistent with the cognitive and developmental findings,
and fell at the 2nd percentile for his age.
On the Mullen Scale of Early Learning,
visual information processing skills fell at the 14 month age level.
Fine motor skills fell at the 22 month age level.
Expressive and receptive language skills are delayed and fell at
the 17 and 16 month age level.
Communication skills are significantly impacted by his
autism symptoms at this point.
Visual-motor integration skills were an area of relative strength
and fell just below average on a drawing task.
Given developmental functioning at this time,
a moderate developmental delay is noted for Marshall.
Given his young age and the severity of his autism symptoms,
reassessment is recommended in a few years time to
monitor his progress in this regard.
Of note, Marshall has been making improvements recently in
both his language skills and willingness to engage more with others.
Behaviourally, there are significant concerns for Marshall.
Parents report significant concerns with hyperactivity
and low attention span at this point.
He is extremely active and has poor self-control.
He engages in tantrum behaviour when he does not get what he wants
or has to be directed by others.
He is easily frustrated and has difficulties regulating his emotions.
He is not aggressive with others, however.
During the assessment, he exhibited similar concerns
and had significant difficulty with transitions and
direction being given to him by others.
Marshall does love being outside and engaging in active play.
I, Sonja, agree with the findings of Dr. Brown's report. Reading this i was surprised and somewhat depressed at Marshall's percentages on the scales. I knew he was behind, but to say that he is at 1% on many levels seems sad and not hopeful sounding. Also, the results showing 'at risk' range for depression was surprising to me. Anyways, it was a moment of sadness followed by happiness that we can now move forward getting Marshall so much help to give him the best life we can!
