As a parent, this is nothing worse than seeing your child in pain and not being able to do anything about it. I knew that testing Buddy for school would be hard on us, but I didn’t count on just how much. I almost had to be physically restrained from interfering. I know they had to push him to see it. I know they had to expose him to loud noises and watch him cover his ears. I know they had to overstimulate him and see him meltdown. It hurt. I start to tear up just thinking about it.
It was two grueling hours. Here is the report. It’s quite long, so you can scroll to the bottom for the summary. Please note that though at one point he tests with “minimal to no symptoms,” that was a specific test and the next page goes on to state that they felt the test was not an accurate assessment and is he on the spectrum. Part of this issue was during one of their tests, Buddy was guessing and occasionally happened on the right answer. Thankfully, they seem to understand and account for that.
Since they mention his sister’s name, I’ll refer to her as Lily in the blog if I have to include her.
Disability Report: AUTISM SPECTRUM DISORDER
As Part of the FULL and INDIVIDUAL EVALUATION
The following report has been provided to the parent in advance of the Admission, Review and Dismissal meeting for informational purposes; however, this document will be embedded within the final Full and Individual Evaluation.
The Licensed Specialist in School Psychology acknowledges responsibility only for those current test results, statements, and recommendations based on her assessment findings for the disability of Emotional Disturbance and/or Autism Spectrum Disorder.
REASON FOR REFERRAL:
Buddy was referred by his parents for a multi-disciplinary team evaluation in order to address behavioral concerns. The Admissions, Review, and Dismissal Committee will use evaluation findings in educational planning for this student. Consent for evaluation was received on 4/30/15.
Review of Records
Request for Parental Information (RPI)
Autism Spectrum Ratings Scales (ASRS)
Childhood Autism Rating Scale, Second Edition (CARS-2)
The following information was gleaned from the RPI as well as a parent interview. Buddy was born two weeks late weighing 11 pounds, 11 ounces. his known development milestones were reported to be: spoke first words-48 months, spoke sentences-53 months, and toilet trained-55 months. his medical history was reported to be unremarkable. The family medical history includes Autism Spectrum Disorder and mental illness.
Currently, Buddy lives at home with both of his parents, a 10 year old brother, and a 2 year old sister. In his free time, Buddy enjoys climbing, Angry Birds, Plants vs Zombies, blocks, trains, and cuddling. He gets bored quickly when playing outside. he used to resist coloring, but now colors when his sister does. When coloring, he copies a picture rather than creating a novel picture. His strengths were reported to be physical strength, getting into anything, love and loyalty with his sister. This includes attacking a nurse that made his sister cry when drawing blood. Buddy loves playing with other children, but cannot understand or consider their feelings. He seeks friends by talking about his own interests.
Buddy is able to engage in age-appropriate gross motor skills and self-help skills (aside from determining whether his clothes are inside out or backwards). Buddy was reported to pass crawling and went straight to walking. Buddy communicates through words, gestures, and short phrases. He can follow simple directions and responds to his name when he is not absorbed in play. Unusual language patterns reported include knowing complete scripts from Blue’s Clues and using inflection less often than peers.
Buddy is reported to have sensory sensitivities to loud or high pitched sounds, touch, and green foods (including green candy). He sometimes wears headphones in order to protect him from sounds. His family gives him a choice to wear the headphones and at times he chooses to go without. he has a high pain tolerance, does not like being touched, and dislikes tags in clothing. Buddy is insistent upon following routines. If changes are needed, the family must give him warning and explanation. They must also give him several warnings if changes in activities are made. In response to changes in his routine Buddy will cry, scream, and curl into a ball. Buddy his reported to steal food and hide it. As a result, the family has had to place locks on the food; however, Buddy is still able to steal food. He often will beg for more food after he has finished so that he can hide it.
Buddy is a self-learner and is resistant to being taught by a person. He will attend to activities when he is interested. If Buddy does not have any interest in a subject, he will not learn it. For example, his mother has been trying to teach him the alphabet, numbers, and colors for over a year. His father noted that Buddy “is late to start everything, but does it flawlessly when he finally does.” Additionally, once he has learned it one way, he insists on it always being that way.
The multidisciplinary team included 2 Licenses Specialists in School Psychology (LSSPs) and a Speech and Language Pathologist. Upon entering the assessment room, Buddy appeared anxious and shy. He introduced himself and his family members and then transitioned to the table along with his mother. The following is a summary of his abilities in communication, social relating, and repetitive behaviors.
Language and Communication, Social Interaction, and Emotional Response
Observations by the SLP: Buddy used language for many functions including the following: to comment (“oh, blocks! Cool!” and “Oh my goodness!”), to direct attention (“look, Lily, a baby) [sic], to label, and to ask questions “what’s that?”). he used 3-6 word sentences. he rarely used requests. Periodically, he was prompted to ask for the item he wanted and/or given a phrase to repeat but he switched his focus to something else. Buddy’s parents report that he uses scripts from Blue’s Clues that fit the situation he is in. For example, his mother explained how he repeated lines from the show when asked to look for his shoes.
Observations by the LSSPs: During the assessment, Buddy was observed to age-appropriate sentence structure and was able to answer questions appropriately; however, he did not use pronouns. he did not use any instances of non-functional language including delayed or immediate echolalia or jargon; however, he is reported to repeat TV scripts verbatim in other situations. Buddy was unable to ask for help when prompted; however, later he spontaneously requested help. Buddy’s nonverbal communication included inflection (when giving superheroes voices), brief eye contact, showing objects, and pointing to objects. he appeared to rely on his verbal communication rather than using nonverbal communication to express his needs and desires.
Buddy was resistant to social interaction when it was forced. Instead, he wanted to play to be of his own choosing. he was agreeable to playing with examiners when he desired to do so. His play initiations were limited to directing attention to items by making statements or showing objects. He did not check to see if anyone listened to him. When the examiners withdrew from play, Buddy was content with continuing to play by himself rather than seeking out interactions. Buddy appeared to enjoy a lot of presented toys. He occasionally shared his enjoyment with the examiners by directing their attention, but he did not attempt to share his objects that he found enjoyable. Buddy did not make continued eye contact and even avoided eye contact sometimes; however, he was able to use eye contact as a way to check in socially.
Buddy used a consistent smile excepted when he was unhappy with activity changes. Subtle changes in facial expression were not observed. Buddy began pulling at his ear when he started to become irritated. When unhappy, he expressed emotion through protesting, turning his back or putting his head down, rocking back and forth briefly, and shutting his eyes. When he was requested to do the non-preferred activity again, Buddy ran over to his father for a hug and afterwards laid on the floor in the fetal position. Buddy was not easily soothed or distracted as is typical for same-aged peers.
Patterns of Behavior, Interest in Materials, and Play
Buddy demonstrated rigid thinking in that he always expected to be in charge and wanted activities to go his own way. he did not cope well to changes that were incongruent with his expectations. Buddy was reluctant to demonstrate his skills until he was motivated by his own interest to do things. He did not perform upon commands; but did some requested skills naturally during play. For example, Buddy was asked several times to build a tower with blocks. He protested. After examiners stopped asking, Buddy built a tower.
Buddy demonstrated dislike of sounds which included screaming and appearing startled. He conditioned to sounds as they were repeated. He was observed to look at the lights briefly. Buddy was resistant to touching the PinArt. After complying, Buddy stated that it hurt. He was observed to refrain from touching a variety of items. He refused to smell presented scents; however, it is not clear whether this was due to an olfactory response or non-interest. He did not comment on the smells of other presented items. During the assessment, Buddy’s activity level appeared to be age-appropriate as he was able to attend to tasks and waited patiently when needed.
During the assessment, Buddy was insistent upon playing with items of his own interests. When suggestions were made, he refused to transition if he did not find the activity enjoyable. At times, his refusal was just due to him not being in control. Buddy was able to engage in joint interactive play during dinosaur play. he easily tolerates his sister’s presence in his play area. When playing with Legos, Buddy was more interested in pulling out items and labeling them than playing with them. When prompted to build something, he began using the Lego figures appropriately, but did not build as requested. During solitary play, Buddy was observed to engage in self-talk.
Autism Spectrum Rating Scales (ASRS):
The ASRS are designed to measure behaviors of children and youth aged 2 through 18 years, reported by parents and teachers that are associated with the Autism Spectrum Disorders (ASD). All scale scores are set to the T-score metric, which has a normative mean of 50 and a standard deviation of 10. Scores from 65-70 are “elevated” while scores over 70 are “highly elevated.” It should be noted that the ASRS measures the presence of characteristics related to Autism and not the primary etiology of these behaviors.
Unusual Behaviors 82
Peer Socialization 73
Adult Socialization 76
Social/Emotional Reciprocity 71
Atypical Language 68
Behavioral Rigidity 81
Sensory Sensitivity 79
Total Score 82
Buddy’s mother completed the ASRS. She reported that he exhibits numerous characteristics of Autism. Buddy’s mother described his most significant difference as his rigid behavior including insisting on routines, doing things exactly the same way each time, and overreacting to changes. Additionally, he struggles significantly with regulating his own attention. He leaves tasks incomplete, does not wait his turn, fidgets, and is easily distracted. Buddy exhibits sensory sensitivity to sounds, tags in clothing, touch, and putting non-edibles in his mouth. Socially, Buddy appears to do better with peers than adults, though he struggles with both. he is interested in playing with peers, but also choses [sic] to play alone at times. Additionally, Buddy does not understand social cues and cannot take the perspective of another.
Childhood Autism Rating Scale, Second Edition — Standard Version:
The CARSs-SV is a fifteen item behavioral rating scale developed to identify children with autism spectrum disorders. Scores between 15 and 29.5 are indicative of “Minimal to No Symptoms.” Scores falling in the range of 30-36.5 indicate “Mild-to-Moderate Symptoms of Autism Spectrum Disorder”. [sic] Scores in the range of 37 and higher indicate “Severe Symptoms of Autism Spectrum Disorder.”
Individual Item Score Description
Relating to People 2.5 The child shows some aloofness at times and can be fussy if interactions are forced; however, when interested, the child is able to participate in interaction.
Imitation 2 Imitates simple behaviors when requested and prompted. At times, requires prodding.
Emotional Response 2.5 The child shows signs of inappropriate type and/or degree of emotional response. Reactions may be excessive or unrelated to the situation.
Body Use 1 The child moves with the same ease, agility, and coordination as an average child.
Object Use 1.5 The child uses toys appropriately, but may refuse or avoid some items. Able to engage in imaginative play.
Adaptation to Change 3 The child actively resists changes in routines, tries to continue the old activity, or is difficult to distract.
Visual Response 2 The child may need to be reminded where to look, avoids eye contact, and may look at items in unusual ways.
Listening Response 2.5 The child has definite sound aversion; however, is able to tolerate some sounds once has conditioned to the,
Taste/Smell/Touch Response 2 The child is reported to put items in his mouth, has a high pain tolerance, has specific food preferences, and avoids tags in clothing.
Fear or Nervousness 2 Sometimes shows too much fear or nervousness
Nonverbal Communication 1.5 Verbal communication included age-appropriate sentences, though lacks some pragmatic language abilities. Child is reported to engage in scripting, though it was not observed during assessment.
Activity level 1.5 Immature use of nonverbal communication. Able to use gestures and other forms of nonverbal communication, though it is less frequent than peers.
Level and Consistency of
Intellectual Response 1 The child is as intelligent as a neurotypical child and does not have and apparent unusual skills.
General Impressions 2 Shows a mild amount of symptoms
Total Raw Score Description
28.5 Minimal to No Symptoms
The multidisciplinary team rated him as having numerous strengths, including using his body appropriately, playing with toys, and communicating. His weaknesses include adapting to changes in routines and activities, displaying appropriate emotional response, and social relationships.
Though his score in within the “Minimal to No Symptoms” range, the assessment team believes that Buddy exhibits characteristics of Autism. It is likely that Buddy’s behavior is not appropriately described by the Standard version (selected due to his age) and his differences would be more aptly described by the High-Functioning Version (ages 6 and over). Regardless, Buddy’s score of 28.5 is indicative of some differences related to Autism since it is higher than the lowest possible score of 15.
SUMMARY OF FINDINGS AND SPECIAL EDUCATION RECOMMENDATION:
Buddy is a 4 year old who was referred by his parents for an Autism Spectrum Disorder assessment. According to the RPI and parent interview, Buddy had a developmental delay in communication, but began speaking in sentences at 53 months of age. Non-functional language at home includes scripting television shows. Socially, Buddy is interested in playing with peers, but struggles to do so. He seeks interactions by talking about his own interests. Buddy’s parents reported that he insists on routines, is difficult o transition, and has sensory sensitivities to auditory and tactile stimuli.
During the team assessment, Nicholas did not engage in non-functional language. His communication tended to be based upon his own interests and own ideas. he was resistant to forced social interaction, but was able to engage in interaction when he desired to do so. He appeared to be interested in playing with others as long as they followed his commands and demands. Buddy demonstrated a strict adherence to his own rigid thinking. When examiners did not meet his demands, Buddy became agitated. he was not easily soothed.
Formal assessment completed by his mother indicated that Buddy exhibits numerous characteristics of Autism Spectrum Disorder with notable weaknesses in Self-Regulation and Behavior Rigidity. The CARS-2 SV completed by the multidisciplinary team base don collected data indicated that Buddy fell within the “Minimal to No Symptoms Range” range; however, the assessment team still felt that Buddy demonstrated a pattern of behaviors consistent with Autism Spectrum Disorder. The behaviors observed ny the multidisciplinary team do warrant intervention and indicate that his educational progress might be negatively impacted, despite the fact that his score on this assessment did not reach the level necessary for identification of “Mild to Moderate Symptoms.”
Based upon collected data, Buddy does demonstrate significant differences in verbal communication, nonverbal communication, and social interaction. In addition, he demonstrates repetitive behaviors and sensory sensitivities. There, Buddy does meet Special Education disability criteria as a student with Autism Spectrum Disorder.
LSSP RECOMMENDATIONS BASED UPON AUTISM ASSESSMENT:
Buddy was resistant to learning things that he does not find interesting or important. Incorporate his interests into lessons whenever possible.
Use visual aids whenever possible to increase understanding.