EXAMPLE REPORT

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Phone: (08) 9388 8044 www.pecs.net.au

Example Autistic Disorder Diagnostic Assessment Report:

Jane Smith

CONFIDENTIAL – NOT TO BE RELEASED WITHOUT PERMISSION OF THE

PARENT/GUARDIAN

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This Example Comprehensive Psychological Report is provided to act as an example of the breadth and thoroughness of an ASD assessment performed by Psychological & Educational Consultancy Services (PECS). This example report also reflects changes relating to the recent release of the DSM-5 (APA, 2013).

CONTENTS

(1) Biographical Details (2) Referral Information (3) Statement of Diagnosis (4) Summary of the DSM-5 Criteria for Autism Spectrum Disorder (5) Current Concerns (6) Brief Background Information (7) Current Assessment (8) Formal Assessments (9) Cognitive Assessment (10) Adaptive Behaviour Assessment (11) Global Screening Assessment (12) Autism Spectrum Disorder Behavioural Assessment (13) Autism Spectrum Disorder Diagnostic Criteria as per DSM-5 (14) Summary (15) Discussion of the Assessment (16) Recommendations (17) Appendix 1 – WPPSI-IV Subtest Descriptions (18) Appendix 2 – Supporting Evidence (19) Appendix 3 – 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.

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BIOGRAPHICAL DETAILS

Name: Jane Smith Date of Birth: 31/07/2009 Date of Assessment: 01/07/2013 Age at Assessment: 3 years 11 months Gender: Female Address: 123 West Coast Drive, TRIGG WA 6029 Phone Number: 0444 444 444 Parents: Mrs Smith School: N/A Grade: N/A Assessed by: Dr Shane Langsford, Registered Psychologist and

Kristie Robins, Registered Psychologist Referring Practitioner: Dr John Brown, Paediatrician

REFERRAL INFORMATION Jane was referred to Psychological and Educational Consultancy Services (PECS) by Dr John Brown (Consultant Paediatrician) for a Comprehensive Psychological Assessment and indication of whether the results are reflective of an individual with Autism Spectrum Disorder (ASD).

STATEMENT OF DIAGNOSIS Jane meets sufficient DSM-5 criteria for Autism, requiring substantial support for deficits in social communication and requiring very substantial support for restricted, repetitive behaviours.

SUMMARY OF THE DSM-5 CRITERIA

Summary of the DSM-5™ Criteria for Autism Spectrum Disorder

A. Social Communication and Interaction (must meet all three criteria): Criterion A1 Rated by Speech Pathologist Met Criterion A2 Rated by Speech Pathologist Met Criterion A3 Rated by Psychologist Met B. Restricted, Repetitive Behaviours (must meet at least two criteria): Criterion B1 Rated by Speech Pathologist Met Criterion B2 Rated by Psychologist Met Criterion B3 Rated by Psychologist Met Criterion B4 Rated by Psychologist Met C. Symptoms must be present in the early developmental period: Met D. Symptoms cause clinically significant impairment in current functioning: Met E. Symptoms not better accounted for by intellectual disability or GDD: Met

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CURRENT CONCERNS From a presented list, Jane’s mother identified concerns in the following areas:

• Attention • Receptive language • Expressive language • Behaviour • Anxiety • Gross motor • Fine motor • Social skills

BRIEF BACKGROUND INFORMATION Relevant information reported during the initial interview session or referral letter:

• Jane is the younger of 2 children of Mrs Smith. Jane lives with her mother and older sister (aged 13 years).

• Jane was born prematurely (5 weeks) due to antenatal haemorrhages from Placenta Praevia; she spent time in a neonatal intensive care unit and required assistance with breathing.

• Jane has a diagnosis of Global Developmental Delay. • Suffered from recurrent otitis media with effusion and tongue tie; released as a baby; some speech

clarity issues and drooling reported by Jane’s mother. • No prescription medication use. • Reached all of the major developmental milestones (e.g., walking, speaking, toileting) late.

o Commando crawling at age 11 months. o 4 point crawling at age 12-13 months. o Walking unaided at age 2 years. o First word (“ba” for baby) at age 20 months. o Limited single word repertoire at age 2 years. o 2-3 word combinations at age 3 years.

• Is a mix of right and left handed/footed. • Normal visual and auditory acuity reported. • Jane’s father and paternal grandfather both have a diagnosis of Bipolar Disorder. One of Jane’s

mother’s aunts and her daughter have Anxiety Disorder. Jane’s maternal cousin (14 years) has a diagnosis of high functioning Autism.

• Past assessments and/or interventions include; o Speech Therapy and Occupational Therapy (at 18 months of age). o Referred to the Clarkson Child Development Centre for therapy. o Speech Pathology in January 2013 (at age 3 years 5 months) – ongoing. o Occupational Therapy in January 2013 (at age 3 years 5 months) – ongoing.

• Primary concerns reported include; o Behaviour – aggressive with both adults and peers, including punching and kicking. o Having to know everything (e.g., constant question asking). Jane will scream at her mother

if she does not respond. o Talking repetitively. o Everything is on Jane’s terms or she becomes aggressive or screams. o Her ability to cope in a mainstream classroom if she does not have a diagnosis to make her

eligible to remain in education support. Jane’s mother’s concerns are related to Jane’s poor social skills with her peers and tendency to be aggressive, or to appear aggressive even if this is not her intent.

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Past testing:

• Speech Pathology Assessment in January 2013 (at age 3 years 5 months): Jane presents with a moderate expressive and receptive language delay (in the presence of what appears to be normal intelligence), with severely disordered social skills, delayed play skills and a significant difficulty with attention and concentration.

o I have been seeing Jane for weekly therapy since January 2013 and have queried a diagnosis of autism or severe sensory processing disorder since her first session.

o Jane finds it very difficult to control her impulses. o She is extremely sensitive to noise and spends most of the time asking “what’s that noise?” o Her voice is often angry and frustrated, but when asked if she is angry she will say no. o She seeks constant movement and has a need for movement breaks after sitting at a table

for more than five minutes. o She has a need to control her environment and the activity.

The current goals of therapy are as follows: o For Jane to use a calm voice when requesting something or telling and to recognise when

her voice sounds angry. o For Jane to stay with a non-preferred activity for more than 3 minutes. o For Jane to use slow, clear speech and eye-contact when talking. o For Jane to use the pronouns he/she, increase her action word vocabulary and use correct

question sentence structure. o To introduce Jane to pretend play sequences. o For Jane to understand the purpose of questions and wait for the other person’s answer. o For Jane to understand the pronouns I/You. o For Jane to say hello to other children and engage in simple turn-taking.

• Occupational Therapy Assessment in January 2013 (at age 3 years 5 months): Jane presented as anxious, she moved constantly during the assessment and appeared to struggle to complete tasks. Her play skills (minimal observation) consisted of organising objects and she resisted stopping until she was content that all objects were where she wanted them. However her play was limited to this, no symbolic or imaginative play was observed. Jane frequently went to her mother for reassurance, and needed lots of encouragement to complete the gross-motor tasks presented. Jane struggled with fine-motor tasks (puzzles, threading, drawing) - becoming frustrated and, to some extent, impulsive (aggressive?), throwing objects and refusing to complete some tasks - again, seeking regular reassurance from her mother. Plan:

o Develop a sensory diet that addresses Jane's 'sensory seeking' needs. o Increase Jane's general strength, in particular her core strength - addressing both her

extensors and flexors. o Decrease Jane's gravitational insecurity - provide gradual linear movement (initially

seated, progressing to prone) and options for home also. This will allow us to then begin addressing Jane's vestibular processing difficulties.

• General Practitioner Mental Status Examination in June 2013 (at age 3 years 10 months): o Appearance and general behaviour: difficult to settle o Thinking: features of ADHD o Attention and concentration: ADHD o Mood: happy o Sleep: poor – wakes several times a night o Appetite: very good o Anxiety symptoms: yes

See checklists for more behavioural information.

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CURRENT ASSESSMENT

Jane attended the assessment appointment with her mother, Mrs Smith at the Psychological and Educational Consultancy Services, Subiaco office. Significant separation anxiety was witnessed at the start of the testing period, as Jane would not allow her mother to sit in a separate room to her, repeating “Mummy stay”. Jane’s mother remained in the testing room, throughout the testing period. Jane was observed to be a very social child, conversing unprompted with the examiner, and on one occasion, sitting next to the examiner, placing her hand on the examiner’s arm and commenting “Don’t be sad”. Jane had significant difficulty remaining still and seated throughout the testing period, often wandering around the room, or standing up while answering questions. Attention and concentration were at times difficult to maintain.

FORMAL ASSESSMENTS The following standardised assessments were used in the current assessment. While the result of each assessment informs the final diagnostic decision, all results are considered together with family history and clinical observation in making a diagnostic decision.

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COGNITIVE ASSESSMENT

Psychometric Tests Administered:

Test Date of Administration

Wechsler Preschool and Primary Scale of Intelligence – Fourth Edition (WPPSI-IV, 2012) 01/07/13 Examiner’s Details: EXAMINER: Kristie Robins TITLE: Registered Psychologist REGISTRATION: #PSY0001579297 TEST SITE: Office at Psychological & Educational Consultancy Services Test Behaviour: Jane was observed to have difficulty understanding the instructions during the Picture Memory subtest, instead, labelling each of the test items. It is my opinion that the scores that Jane achieved on the WPPSI-IV are an accurate reflection of her cognitive functioning at this particular point in time. Psychometric Test Results:

Age at Testing: 3 years 11 months

Table 1: WPPSI-IV Index Scores

WPPSI-IV Scale

Composite

Score

Percentile

Rank

95% Confidence

Interval

Qualitative Intellectual

Classification Verbal Comprehension Index (VCI) 98 45 91-105 Average Visual Spatial Index (VSI) 80 9 74-91 Low Average Working Memory Index (WMI) 50 <0.1 46-63 Extremely Low Full Scale (FSIQ) Not Valid

Index scores have a mean Composite Score of 100 (50th percentile) and a standard deviation of 15. Percentile Rank refers to Jane’ standing among 100 children of similar age.

Therefore, a Percentile Rank of 50 indicates that Jane performed exactly at the average level for her chronological age. FSIQ is not considered to be valid if there is a 15+ difference between any of the Indexes.

The Verbal Comprehension Index incorporates the 2 subtests of Receptive Vocabulary and Information and is a measure of knowledge acquired from a child’s environment, verbal concept formation and verbal reasoning. The Visual Spatial Index comprises the 2 subtests of Block Design and Object Assembly and is a measure of visual spatial processing, integration and synthesis of part-whole relationships, attentiveness to visual detail, nonverbal concept formation and visual-motor integration. The Working Memory Index comprises the 2 subtests of Picture Memory and Zoo Locations and is a measure of visual working memory, visual-spatial memory, and the ability to resist proactive interference. Working memory involves attention, concentration, mental control and reasoning.

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The Full Scale (FSIQ) refers to an individual’s performance across 5 of the core subtests of the WPPSI-IV (Receptive Vocabulary, Information, Block Design, Object Assembly, and Picture Memory) and is the best estimate of their general cognitive ability, unless there is marked variability among the Index Composite Scores (i.e. 15+ difference between the Indexes).

Table 2: WPPSI-IV Index Discrepancy Summaries

WPPSI-Composite

Difference

Critical Cutoff

Exceeds .05 Statistical

Significance

Base Rate

Verbal Comprehension – Visual Spatial 18 11.75 Yes 6.5% Verbal Comprehension – Working Memory 48 10.60 Yes 0.0% Visual Spatial – Working Memory 30 12.12 Yes 0.7% Statistical significance (critical values) at the .05 level. Base rate for ability level. Between Index Interpretation: Jane performed much better on verbal than on nonverbal reasoning tasks. The 18 point difference between the VCI and VSI scores is statistically significant at the .05 level. The 30 point difference between the VSI and WMI scores is statistically significant at the .05 level. Jane’s abilities to sustain attention, concentrate, and exert mental control are a weakness relative to her nonverbal and verbal reasoning abilities. A weakness in mental control may make the processing of complex information more time consuming for Jane, drain her mental energies more quickly as compared to other children her age, and perhaps result in more frequent errors on a variety of learning tasks. Visual Spatial weaknesses can cause difficulty learning in the classroom and performing to ability in exams by:

• Struggling in terms of reading maps, understanding diagrams or working on tasks that require the child to draw meaning from complex visual material.

• The student may experience difficulty finding her place when copying from the board or a book. Such difficulty might slow rate of task completion.

• The student may experience difficulty telling time and understanding temporal relationships. • The student may experience difficulty forming a visual representation of a concept in her mind

(e.g., change of solar position with latitude). • The student may experience difficulty with visual memory for symbols. • Social difficulties, given that these children will tend to find it more difficult to read nonverbal

cues (i.e. body language, facial expressions, personal space). These children may also have difficulties in terms of understanding humour, or sarcasm; they will tend to interpret it literally.

• These children will struggle with the social use of language, even in the context of a complex vocabulary.

• Poor graphomotor skills- messy handwriting, difficulty with drawing.

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Working Memory weaknesses can cause difficulty learning in the classroom and performing to ability in exams by:

• Difficulty absorbing teachers instructions, particularly if they contain more than one step • Wide ranging difficulties in both maths and reading, both of which are activities that place high

demand on working memory ability. • May show overall lower achievement across classroom activities, due to the impact of working

memory weaknesses on efficiency in terms of learning new information. These children appear to be slower than peers in terms of learning new skills.

• Difficulty performing mental maths calculations • Struggling to copy information from the board, both accurately and quickly • Frequent errors across tasks that involve the child to recall small amounts of information, while at

the same time performing another task. • Difficulty performing tasks with a number of steps, they may miss out steps or make mistakes in

terms of not carefully paying attention to the details. • Appearing to have a relatively short attention span, they may appear inattentive or distractible.

Table 3: WPPSI-IV Subtest Level Pairwise Difference Comparison

Subtest Comparison

Score 1

Score 2

Difference

Critical Value

Significant Difference

Base Rate

RV – IN 12 7 5 2.68 Yes 6.1% BD – OA 6 7 -1 3.26 No 43.1% PM – ZL 1 2 -1 2.87 No 42.9% Statistical significance (critical values) at the .05 level. Within Index/Within-Factor Interpretation: Jane’s within-Index score pattern illustrated statistically significant discrepancies among the Verbal Comprehension Index, therefore, independent interpretation of the individual subtests comprising the VCI may be wise rather than interpretation of the Index as a whole.

Table 4: WPPSI-IV Subtest Scaled Scores

Subtests

Scaled Score

Percentile

Rank

Age

Equivalent Verbal Comprehension Index Receptive Vocabulary 12 75 4:9 Information 7 16 3:1 *Picture Naming 13 84 5:3 Visual Spatial Index Block Design 6 9 2:9 Object Assembly 7 16 2:10 Working Memory Index Picture Memory 1 0.1 <2:6 Zoo Locations 2 0.4 <2:6

See Appendix 1 for complete subtest descriptions *Non-core subtest

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Table 5: WPPSI-IV Subtest Discrepancies From Index Subtest Mean

Subtest

Subtest Scaled Score

Mean Scaled Score

Difference From Mean

Critical Cutoff

Exceeds .05Statistical

Significance

Base

Rate@ Verbal Comprehension Index

Receptive Vocabulary 12 5.80 6.20 2.20 Significant Strength <1%

Information 7 5.80 1.20 2.20 >25%

*Picture Naming 13 5.80 7.20 2.50 Significant Strength

Visual Spatial Index Block Design 6 5.80 0.20 2.78 >25% Object Assembly 7 5.80 1.20 2.47 >25% Working Memory Index

Picture Memory 1 5.80 -4.80 2.00 Significant Weakness 2-5%

Zoo Locations 2 5.80 -3.80 2.37 Significant Weakness 2-5%

Comparison score mean derived from the six core subtest scores. Statistical significance (critical values) at the .05 level. Intellectual Strengths and Weaknesses: Statistical analysis of the results revealed the following subtests to be significant (.05) cognitive strengths or weaknesses relative to Jane’ own performance. Strengths: Two significant (.05) cognitive strengths relative to Jane’s own performance were found; namely Receptive Vocabulary and Picture Naming. Receptive Vocabulary - The child selects the response option that best represents the word the examiner reads aloud. Picture Naming - The child names depicted objects. Weaknesses: Two significant (.05) cognitive weaknesses relative to Jane’s own performance were found; namely Picture Memory and Zoo Locations. Picture Memory - The child views a stimulus page of one or more pictures for a specified time and then selects the pictures from options on a response page. Zoo Locations - The child views one or more animal cards placed on a zoo layout for a specified time and then places each card in the previously viewed locations.

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ADAPTIVE BEHAVIOUR ASSESSMENT

Adaptive Behaviour Tests Administered:

Test Date of Administration

Adaptive Behaviour Assessment System–Second Edition (ABAS-II, 2008) 23/06/14 The Adaptive Behaviour Assessment System – Second Edition provides a comprehensive, norm-referenced 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 ABAS-II 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/Daycare Provider and Parent/Primary Caregiver Forms

Communication Speech, language, and listening skills needed for communication

with other people, including vocabulary, responding to questions, conversation skills, nonverbal communication skills etc

Community Use Skills needed for functioning and appropriate behaviour in the community, including getting around in the community, expression of interest in activities outside the home, recognition of different facilities, etc

Functional Pre-Academics Basic pre-academics skills that form the foundations for reading, writing, mathematics and other skills needed for daily, independent functioning, including letter recognition, counting, drawing simple shapes etc

School/Home Living Skills needed for basic care of a home or living setting or a school or classroom setting, including cleaning, straightening, helping adults with household tasks, taking care of personal possessions etc

Health and Safety Skills needed for protection of health and to respond to illness and injury, including following safety rules, using medicines, showing caution, keeping out of physical danger etc

Leisure Skills needed for engaging in and planning leisure and recreational activities, including playing with others, playing with toys, engaging in recreation at home, following rules in games etc

Self-Care Skills needed for personal care including eating, dressing, bathing, toileting, grooming, hygiene etc

Self-Direction Skills needed for independence, responsibility and self-control, including making choices about food and clothing, starting and completing tasks, following a daily routine, following directions etc

Social Skills needed to interact socially and get along with other people, including expressing affection, having friends, showing and recognising emotions, assisting others, using manners etc

Motor Basic fine and gross motor skills needed for locomotion, manipulation of the environment and the development of more complex activities such as sports, including sitting, pulling up to a standing position, walking, fine motor control, kicking etc

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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, 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. Adaptive Behaviour Test Results: (1) Parent/Primary Caregiver Form (Ages 0-5) The Parent/Primary Caregiver Form is a comprehensive, diagnostic measure of the adaptive skills that have primary relevance for the functioning of infants, toddlers and preschoolers in the home and other settings, and can be completed by parents or other primary care providers. The Parent/Primary caregiver Form is used for children ages birth-5 years, and includes 241 items, with 22 to 27 items per skill area.

Age at Testing: 4 years 11 months

Table 1: Sum of Scaled Scores to Composite Score Conversions

Composite

Sum of Scaled Scores

Composite

Score

Percentile

Rank

95% Confidence

Interval

Qualitative

Range Conceptual 15 65 1 58-72 Extremely Low Social 7 59 0.3 50-68 Extremely Low Practical 11 53 0.1 46-60 Extremely Low GAC 36 55 0.1 50-60 Extremely Low

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

Jane’s parent-report score on the General Adaptive Composite indicates that her overall level of adaptive behaviour falls at the 0.1st percentile (Extremely Low). Jane’s parent-report score on the Conceptual Domain fell at the 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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Table 2: ABAS-II Discrepancy Summaries

Domain Composite

Difference

Critical Cutoff

Exceeds .05 Statistical

Significance

Base Rate Conceptual -- Social 6 11 No 30.0% Conceptual -- Practical 12 9.74 Yes 13.9% Social -- Practical 6 11.38 No 29.7%

Statistical Significance (Critical Values) at the .05 level Base rate refers to the clinical significance (vs Ability Sample) - <15% = clinically significant

Between Domain Interpretation: Jane functions much better on conceptual domain skills than on practical domain skills. The 12 point difference is statistically significant at the .05 level.

Figure 1: ABAS-II Skill Area Scaled Score Profile

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Table 3: Raw Score to Scaled Score Conversions

Skill Areas

Scaled Scores

Qualitative Range Communication (Com) 5 Borderline Community Use (CU) 4 Borderline

Functional Pre-Academics (FA) 7 Below Average

Home Living (HL) 4 Borderline

Health and Safety (HS) 1 Extremely Low

Leisure (LS) 5 Borderline

Self-Care (SC) 2 Extremely Low

Self-Direction (SD) 3 Extremely Low

Social (Soc) 2 Extremely Low

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

Table 4: Strengths and Weaknesses

Skill Areas

Skill Area

Scaled Score

Mean Scaled Score

Differencefrom Mean

CriticalValue

Strength or

Weakness

Base RateConceptual Communication 5 5.00 0.00 1.97 >25% Functional Pre-Academics 7 5.00 2.00 1.91 Strength 25% Self-Direction 3 5.00 -2.00 2.04 25% Social Leisure 5 2.00 3.00 3.23 30.8% Social 2 5.00 -3.00 3.23 30.8% Practical Community Use 4 2.75 1.25 2.23 >25% Home Living 4 2.75 1.25 2.04 >25% Health and Safety 1 2.75 -1.75 2.47 25% Self-Care 2 2.75 -0.75 2.68 >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 Jane’s own performance. Strengths: One significant (.05) adaptive behaviour strength relative to Jane’s own performance was found; namely Functional Pre-Academics. Weaknesses: Zero significant (.05) adaptive behaviour weaknesses relative to Jane’s own performance were found.

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(2) Teacher/Daycare Provider Form (Ages 2-5) The Teacher/Daycare Provider Form is a comprehensive, diagnostic measure of the adaptive skills that have primary relevance for toddler’s and preschooler’s functioning in the daycare centre, home daycare, preschool or school setting. Teachers, teacher’s aides, daycare instructors, or other daycare or childcare providers can be complete this form. The Teacher/Daycare Provider Form is used for children ages 2-5 years and includes 216 items, with 21 to 27 items per skill area.

Age at Testing: 4 years 11 months

Table 1: Sum of Scaled Scores to Composite Score Conversions

Composite

Sum of Scaled Scores

Composite

Score

Percentile

Rank

95% Confidence

Interval

Qualitative

Range Conceptual 24 86 18 80-92 Below Average Social 11 73 4 66-80 Borderline Practical 14 64 1 56-72 Extremely Low GAC Not Valid

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

GAC is not considered to be valid if considerable scatter exists among the skill area scaled scores.

Because of Jane’s unusually adaptive abilities, the General Adaptive Composite score is not a valid representation of her overall level of adaptive behaviour, and therefore was not calculated. Jane’s teacher-report score on the Conceptual Domain fell at the 18th percentile, at the 4th percentile for the Social Domain and at the 1st percentile for the Practical Domain.

Table 2: ABAS-II Discrepancy Summaries

Domain Composite

Difference

Critical Cutoff

Exceeds .05 Statistical

Significance

Base Rate Conceptual -- Social 13 8.81 Yes 9.1% Conceptual -- Practical 22 10.18 Yes 2.8% Social -- Practical 9 10.59 No 20.4%

Statistical Significance (Critical Values) at the .05 level Base rate refers to the clinical significance (vs Ability Sample) - <15% = clinically significant

Between Domain Interpretation: Jane functions much better on conceptual domain skills than on social domain skills. The 13 point difference is statistically significant at the .05 level. Jane functions much better on conceptual domain skills than on practical domain skills. The 22 point difference is statistically significant at the .05 level.

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Figure 1: ABAS-II Skill Area Scaled Score Profile

Table 3: Raw Score to Scaled Score Conversions

Skill Areas

Scaled Scores

Qualitative Range

Communication (Com) 7 Below Average Functional Pre-Academics (FA) 8 Average

School Living (SL) 5 Borderline

Health and Safety (HS) 5 Borderline

Leisure (LS) 6 Below Average

Self-Care (SC) 4 Borderline

Self-Direction (SD) 9 Average

Social (Soc) 5 Borderline Scaled scores have a mean of 10 (50th percentile) and a standard deviation of 3. Percentile Rank refers to Jane’s standing among 100 individuals of a similar age.

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Table 4: Strengths and Weaknesses

Skill Areas

Skill Area

Scaled Score

Mean Scaled Score

Differencefrom Mean

CriticalValue

Strength or

Weakness

Base RateConceptual Communication 7 8.00 -1.00 1.62 >25% Functional Pre-Academics 8 8.00 0.00 1.63 >25% Self-Direction 9 8.00 1.00 1.66 >25% Social Leisure 6 5.00 1.00 2.62 79.1% Social 5 6.00 -1.00 2.62 79.1% Practical School Living 5 4.67 0.33 1.80 >25% Health and Safety 5 4.67 0.33 2.15 >25% Self-Care 4 4.67 -0.67 2.34 >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 Jane’s own performance. Strengths: Zero significant (.05) adaptive behaviour strengths relative to Jane’s own performance were found. Weaknesses: Zero significant (.05) adaptive behaviour weaknesses relative to Jane’s own performance were found. Adaptive Behaviour Summary: Jane’s parent-report score on the General Adaptive Composite indicates that her overall level of adaptive behaviour falls at the 0.1st percentile (Extremely Low). Jane’s parent-report score on the Conceptual Domain fell at the 1st percentile, at the 0.3rd percentile for the Social Domain and at the 0.1st percentile for the Practical Domain. Because of Jane’s unusual adaptive abilities, the General Adaptive Composite teacher-report score is not a valid representation of her overall level of adaptive behaviour, and therefore was not calculated. Jane’s teacher-report score on the Conceptual Domain fell at the 18th percentile, at the 4th percentile for the Social Domain and at the 1st percentile for the Practical Domain.

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GLOBAL SCREENING ASSESSMENT

Screening Tests Administered: Date of

Test Administration

*child & adolescent psychprofiler (CAPP; ACER, 2007) 01/07/13 CAPP Outline: The CAPP utilises three separate screening forms; the Self-report Form (SRF: 111 items), Parent-report Form (PRF: 111 items), and Teacher-report Form (TRF: 91 items) for the simultaneous screening of the 20 most prevalent disorders in children and adolescents. The CAPP comprises screening criteria that closely resemble the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition-Text Revision (DSM-IV-TR: American Psychiatric Association: APA, 2000). 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 cutoff 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. For further information regarding the CAPP, please visit www.pecs.net.au 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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Global Behavioural Assessment Results: Jane’s mother reported positive screens for:

• Generalised Anxiety Disorder • Attention-Deficit/Hyperactivity Disorder: Predominantly Hyperactive/Impulsive Type • Conduct Disorder • Expressive Language Disorder • Autistic Disorder

A copy of the CAPP Report is included as an Appendix, as are the completed CAPP Forms. Please refer to the CAPP Report for the individual behaviours which were responsible for the positive screens elicited.

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AUTISM SPECTRUM DISORDER BEHAVIOURAL ASSESSMENT Checklists Administered:

Checklists Date of Administration (1) DSM-5 Questionnaire for Autism Spectrum Disorder 23/06/14 (2) Autism Spectrum Disorder Checklist 23/06/14 Checklists Results: (1) DSM-5 Questionnaire for Autism Spectrum Disorder: This questionnaire comprises the seven ASD items of the DSM-5 which are responded to on a four-point ordered Likert scale anchored by “Never/Rarely” and “Very Often”. For an individual to be deemed to possibly have Autism Spectrum Disorder they must report a score of 2 (Often) or 3 (Very Often) for all three of the three Social Communication and Social Interaction items, and at least two of the four Restricted, Repetitive Patterns of Behaviour, Interests or Activities items. Furthermore, two supplementary Yes/No questions pertaining to the caveats provided in DSM-5 must also be met. These questions relate to the length of symptoms, and the adverse affect of the symptoms on the individuals overall functioning. Results: Summary of Diagnostic Criteria as per DSM-5: There are seven DSM-5 criteria for Autism Spectrum Disorder in two domains. 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 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.

Social Communication and Interaction Restricted, Repetitive Patterns of Behaviour

1. Criterion met [2] 4. Not met [1] 2. Criterion met [2] 5. Criterion met [3] 3. Criterion met [2] 6. Criterion met [3] 7. Criterion met [3] (1) Have these behaviours been causing problems since early childhood? Yes (2) Do these behaviours adversely affect social, academic, and/or occupational functioning? Yes

********************************

3 Number of Deficits in Social Communication and Social Interaction criterion met. 3 Number of Restricted, Repetitive Patterns of Behaviour, Interests or Activities criterion met.

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(2) Autism Spectrum Disorder Checklist: The Autism Spectrum Disorder Checklist comprises 33 items which are responded to on a four-point ordered Likert scale anchored by “Never/Rarely” and “Very Often”, and 8 items responded to in a Yes/No fashion. If an individual reports a score of 2 (Often) or 3 (Very Often), for any of the Likert items, or a Yes, then that criterion is deemed to be met. Results: Jane’s mother reported a score of 2 or more for 20 of the 33 Likert items and reported Yes for 5 of the Yes/No items, which indicates that she believes that Jane exhibits a moderate number of behaviours characteristic of ASD.

Behaviours

Often

Very Often

Does your child exhibit odd responses to sensory stimuli (e.g., a high threshold to pain, oversensitive to sounds or being touched, exaggerated reaction to light or odours, fascination with certain stimuli)?

Has your child ever been highly attached to an inanimate object (e.g., piece of string or elastic band)? Does your child have abnormalities with regard to eating (e.g., limiting diet to a few foods)? Does your child have abnormalities with regard to sleeping (e.g., awakening at night due to rocking)? Does your child have abnormalities with regard to clothing (e.g., wanting to wear the same clothes every day)? Does your child have abnormalities with regard to mood (e.g., giggling or weeping for no apparent reason, or an apparent absence of emotional reaction)? Does your child have abnormalities in relation to fear (e.g., lack of fear in the face of real danger, fear shown in response to a harmless object)? Does your child have an abnormality in speech (e.g., abnormal pitch, intonation, rate, or rhythm)? Does your child exhibit any self-injurious behaviour (e.g., head banging, finger or wrist biting)? Does your child have an excellent long term memory but information tends to be repeated over and over regardless of appropriateness or relevance? Does your child tend to be intrusive (e.g., barging into peoples’ rooms) or invade others’ personal space (e.g., being too close when they talk to someone)? Does your child have a lack of imaginative play (e.g., does not play with dolls or action figures)? Does your child tend to repeat phrases, jingles, or commercials? Does your child have a stereotyped, repetitive use of language, or repeat what you say? Does your child not seem to understand simple questions, directions, or jokes? Does your child exhibit an inflexible adherence to specific non-functional routines or rituals (e.g., taking the same route to school, sitting in the same spot at the dinner table or on the couch)?

Are simple changes (e.g., place at the dinner table) perceived as catastrophic events by your child? Does your child tend to whirl around and around an object or on the floor? Does your child tend to dismantle objects (e.g., toys, watches)? Does your child tend to not play with toys in their intended manner (e.g., spinning the wheels of a toy truck rather than pushing it along the ground)? Is your child very good at one thing (e.g., reading) yet very poor at everything else? YES Has your child become more willing to interact as they got older, but don’t do it very well? YES Does your child seem to have primitive reflexes, or was there a delay in preference of hand? YES Is your child preoccupied with a narrow interest (e.g., baseball statistics)? YES Does your child exhibit other behavioural symptoms (e.g., hyperactivity, short attention span, impulsivity, aggressiveness, temper tantrums)? YES

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AUTISM SPECTRUM DISORDER DIAGNOSTIC CRITERIA AS PER DSM-5

There are seven DSM-5™ criteria for Autism Spectrum Disorder in two domains: Social Communication and Interaction and Behaviours. 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 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. Further supporting evidence for each criteria is provided in Appendix 2. This report contains ratings for A3, B2, B3, B4, C, D and E only. The other criteria will be rated by the Speech Pathologist. These criteria are addressed below for Jane, based on information gathered from direct observation, parent interview, parent completion of DSM-5 Questionnaire for Autism Spectrum Disorder and Behaviour Checklist, teacher completion of The Childhood Autism Rating Scale, a report from Jane’s Education Support Teacher and review of assessment results conducted by Speech Pathologist and Occupational Therapist. A. Persistent Deficits in Social Communication and Social Interaction across Multiple Contexts, as

Manifested by the Following, Currently or by History:

1. Deficits in social-emotional reciprocity. This criterion will be rated by the Speech Pathologist.

2. Deficits in nonverbal communicative behaviours used for social interaction. This criterion will be rated by the Speech Pathologist.

3. Deficits in developing, maintaining, and understanding relationships.

Parental report and observation indicated that Jane has significant difficulties in the area of developing, maintaining and understanding relationships. Jane tends to be “over the top” socially, she thinks everyone is her friend, even if she does not know them. Unfortunately, her way of socialising is being loud, with aggressive speech and horrible faces, without meaning to be that way. Jane will play alongside her peers, if she is not sure of what they are doing, however, most of the time she yells and tries to physically force them to do what she wants. At times she displays intimidating behaviours when a student does not play with her, including invading personal space, shouting loudly in their faces and at times chasing or pushing them to try and engage them in play. Her words are “They have to play with me”. She will imitate play when with an adult, in a structured play setting (e.g., speech therapy). When she is in a situation where there are a number of children, she will stand and watch. Often she needs prompting with turn taking, listening to others and sharing. Therapy has focused on teaching pretend play sequences, to say hello to other children and engage in simple turn-taking. This criterion is rated as met.

Current severity. Requiring substantial support in social communication.

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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:

1. Stereotyped or repetitive motor movements, use of objects, or speech. This criterion will be rated by the Speech Pathologist.

2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour.

Parental report and observation indicated that Jane has significant difficulties in the area of insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour. Changes in routine can cause distress. Minor changes are tolerated (e.g., breakfast time, what she has to eat etc), however, big changes (e.g., a cancelled appointment, changing what time we’re going to shops etc), result in a “major meltdown”. Jane’s teacher reported concerns in relation to Jane’s constant level of anxiety (e.g., she quickly dissolves into tears and heavy breathing over minor changes in the environment, timetable and people in the room). Jane’s teacher also reports Jane’s behaviour and speech is quite rigid and inappropriate or ritualistic behaviours are hard to shift (e.g., “From term one we told Jane about our classroom rule that she must first eat her sandwich before anything else in her lunchbox at lunchtime. For the next two weeks or so, Jane repeatedly asked “Do I eat my sandwich first?”, before beginning her lunch. Once we realised the pattern, we stopped answering her question and she stopped asking and was able to eat her own lunch. A few weeks later we had a cooking lesson where we made toasted sandwiches for lunch. Jane happily ate the sandwich she had made and then went to open her lunchbox and eat the sandwich her mum had sent her. I stopped her and said “Oh Jane, you don’t have to eat your sandwich first today, you ate a sandwich at cooking, you can choose a treat from your lunchbox if you like!”. Her eyes immediately filled with tears and she said “Please, I have to eat my sandwich first”. She was quite distressed and genuinely felt she couldn’t eat anything in her lunchbox until she had the sandwich first.”) This criterion is rated as met.

3. Highly restricted, fixated interests that are abnormal in intensity or focus.

Parental report and observation indicated that Jane has highly restricted, fixated interests that are abnormal in intensity or focus. Jane’s mother reported Jane is obsessed with vents and smoke detectors. She will stand under a vent and squeal up at it. She likes to talk about vents and smoke detectors when she sees one and it is hard to redirect her to another subject; continuing to come back to the subject. She also does this with several other things (e.g., if an alarm goes off, if she sees an ambulance, police car or fire engine, generally things that make noise). If you take away something that she is obsessing about or try to change the topic of conversation she will scream, hit, pinch and kick. This criterion is rated as met.

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4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment.

Parental report, teacher report, Occupational Therapist report, Speech Pathologist report and observation indicated that Jane has significant difficulties in the area of hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., Overheats very easily. Her overheating is getting worse. She overheats in winter because everyone has heaters on. She is constantly on edge and when it’s too much she hits, screams and destroys her surroundings. She calms down once she is cooled down, but it doesn’t take much to set her off again.). Jane finds certain sensory inputs noxious (e.g., from movement to touch to different textures in food). The result is that she avoids these sensory inputs (e.g., Doesn’t like wearing pants, skirts etc (bottoms). Dislikes certain clothing. She doesn’t seem to like tight clothes and she prefers soft material. She’ll wear jeans if they are pre-owned and worn in.). Jane displays some sensory seeking behaviours during play such as ramming into walls/other students when riding the bikes or throwing her body against other students. She seeks constant movement and has a need for movement breaks after sitting at a table for more than five minutes. She is extremely sensitive to noise (e.g., She is sensitive to the noise of babies/kids crying. Spends most of the time asking “what’s that noise?”). This criterion is rated as met.

Current severity. Requiring very substantial support in restricted, repetitive behaviours. 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):

Parental report indicated that Jane’s mother had become concerned regarding Jane’s language and social skills prior to 2 years of age (e.g., at approx. 20 months of age). This criterion is rated as met.

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current function.

Parental report, school report, Occupational Therapist report, Speech Pathologist report and observations from the assessment setting indicated that Jane’s difficulties cause significant impairment in all areas of her current functioning (i.e., social, communication, play etc). This criterion is rated as met.

E. The disturbance is not better accounted for by intellectual disability or global developmental

delay.

Jane’s cognitive profile illustrates an average intelligent individual (VCI=45th percentile) with disparate abilities (VSI=9th percentile, WMI=<0.1st percentile). This criterion is rated as met.

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Specifiers

With or without accompanying intellectual impairment. Despite the earlier diagnosis of Global Developmental Delay, Jane’s cognitive results indicate that she does not meet the criteria for an Intellectual Disability.

With or without accompanying language impairment.

To be rated by the Speech Pathologist.

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SUMMARY Reason for Referral: Jane was referred to Psychological and Educational Consultancy Services (PECS) by Dr John Brown (Consultant Paediatrician) for a Comprehensive Psychological Assessment and indication of whether the results are reflective of an individual with Autism Spectrum Disorder (ASD). Current Concerns: From a presented list, Jane’s mother identified concerns in the following areas:

• Attention • Receptive language • Expressive language • Behaviour • Anxiety • Gross motor • Fine motor • Social skills

Cognitive Assessment: Because of Jane’s unusually diverse cognitive abilities, the combined WPPSI-IV Full Scale IQ score is not a valid representation of her general cognitive ability, and therefore was not calculated. The discrepancy between Jane’s Verbal Comprehension ability (VCI = 45th percentile) and Visual Spatial ability (VSI = 9th percentile) scores was 18, which is statistically significant at the .05 level. Jane achieved a score at the <0.1st percentile for Working Memory (WMI). Adaptive Behaviour Assessment: Jane’s parent-report score on the General Adaptive Composite indicates that her overall level of adaptive behaviour falls at the 0.1st percentile (Extremely Low). Jane’s parent-report score on the Conceptual Domain fell at the 1st percentile, at the 0.3rd percentile for the Social Domain and at the 0.1st percentile for the Practical Domain. Because of Jane’s unusual adaptive abilities, the General Adaptive Composite teacher-report score is not a valid representation of her overall level of adaptive behaviour, and therefore was not calculated. Jane’s teacher-report score on the Conceptual Domain fell at the 18th percentile, at the 4th percentile for the Social Domain and at the 1st percentile for the Practical Domain. Global Behavioural Assessment: Jane’s mother reported positive screens for:

• Generalised Anxiety Disorder • Attention-Deficit/Hyperactivity Disorder: Predominantly Hyperactive/Impulsive Type • Conduct Disorder • Expressive Language Disorder • Autistic Disorder

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Autism Spectrum Disorder Assessment: Summary of Diagnostic Criteria as per DSM-5: There are seven DSM-5 criteria for Autism Spectrum Disorder in two domains. 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 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.

Social Communication and Interaction Restricted, Repetitive Patterns of Behaviour

1. Criterion met [2] 4. Not met [1] 2. Criterion met [2] 5. Criterion met [3] 3. Criterion met [2] 6. Criterion met [3] 7. Criterion met [3] (1) Have these behaviours been causing problems since early childhood? Yes (2) Do these behaviours adversely affect social, academic, and/or occupational functioning? Yes

********************************

3 Number of Deficits in Social Communication and Social Interaction criterion met. 3 Number of Restricted, Repetitive Patterns of Behaviour, Interests or Activities criterion met. Autism Spectrum Disorder Checklist: Jane’s mother reported a score of 2 or more for 20 of the 33 Likert items and reported Yes for 5 of the Yes/No items, which indicates that she believes that Jane exhibits a moderate number of behaviours characteristic of a ASD.

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DISCUSSION OF THE ASSESSMENT

Please note, this conclusion is based on the assessment results and background information currently available. Often, it is necessary/wise to perform follow-up confirmationary testing before definitive conclusive statements are made. Jane’s cognitive profile illustrates an average intelligent individual (VCI=45th percentile) with disparate abilities (VSI=9th percentile, WMI=<0.1st percentile). Although Jane has a diagnosis of Global Developmental Delay, she presents with a range of social communication and interaction difficulties, and repetitive, restricted behaviours, that are characteristic of a diagnosis of Autism Spectrum Disorder. Jane met all three of the criteria is Section A and all four of the criteria in Section B. As such she meets sufficient criteria for a diagnosis of Autism Spectrum Disorder, according to the DSM-5 criteria. Jane requires further assessment by Dr John Brown (Consultant Paediatrician) for the purpose of a formal decision of a diagnosis of Autism Spectrum Disorder, and the provision of appropriate intervention if deemed necessary.

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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) Jane should once again be seen by Dr John Brown, now that this new information is available for

incorporation into her paediatric assessment and for the purpose of a formal decision of a diagnosis of Autism Spectrum Disorder, and the provision of appropriate intervention if deemed necessary.

Speech Pathologist Involvement: (1) A copy of the report should be provided to Speech Pathologist. (2) Jane should continue Speech Pathology to further develop her receptive and expressive language

skills, and self-monitoring skills for emotional regulation. Occupational Therapist Involvement: (1) Jane should continue Occupational Therapy to assist with emotional regulation and meeting her

sensory needs, as well as building her fine and gross motor skills. Psychological Involvement: (1) Due to the large discrepancies identified within the cognitive tests, administration of another

assessment in 2 years or beyond would be wise.

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Early Intervention: (1) Jane may be eligible to receive therapy services from one of the following State Government

Funded early intervention providers until she enters Year 1. The early intervention providers include:

Autism Association of WA

215 Stubbs Terrace, SHENTON PARK WA 6008 Phone: (08) 9489 8900

www.autism.org.au

Intervention Services for Children with Autism and Developmental Delay (ISADD) 50 Angove Street, NORTH PERTH WA 6006

Phone: (08) 9227 6888 www.isadd.org

Kids are Kids! Therapy & Education Centre

26 Parry Avenue, BATEMAN WA 6150 Phone: (08) 9313 6566 www.kidsarekids.org.au

Therapy Focus

5/1140 Albany Highway, BENTLEY WA 6102 Phone: (08) 9478 9500

www.therapyfocus.org.au

Wize Therapy Lots 4-6, First Floor Booragoon Commercial Centre

175 Davy Street, BOORAGOON WA 6154 Phone: (08) 9317 7932

www.wizetherapy.com.au

Disability Services Commission (DSC) Phone: (08) 9329 2400

www.disability.wa.gov.au

There is a waitlist so it would be important to contact the providers as soon as possible. A comprehensive list of providers will be sent out through DSC.

(2) Jane may be eligible to receive Federal Government Funding through the Australian

Government “Helping Children with Autism” funding package. The funding provides $12,000 (up to $6,000 per child per financial year) to assist with the financial cost of accessing early intervention services. This funding is for families of children aged 0 to 7 years diagnosed with an Autism Spectrum Disorder.

Please make an appointment with an Autism Advisor from the Autism Association of WA.

Please note that children need to be made eligible for the funding before they turn 6 years old. Autism Advisors can be contacted on 9489 8900 or freecall 1800 636 427 (country callers only).

(3) The family may want to access additional therapy for Jane privately. Medicare’s Chronic Disease

Management program may provide financial assistance in the areas of Speech Pathology, Occupational Therapy, and Physiotherapy subsidised through Medicare. The program allows up to 5 services each calendar year.

Information regarding this option can be sought from the family’s General Practitioner who will determine if Jane is eligible for the program.

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(4) Medicare rebates are also available for private Psychology, Speech Pathology and Occupational

Therapy services through the Helping Children with Autism package. This program allows up to 20 services in total up until a child is 15 years of age. A referral from a private paediatrician is required.

(5) Parents may benefit from attending a free Early Days Workshop for Parents. Information on these

workshops is available through the Autism Advisor. (6) Online workshops are also available through http://raisingchildren.net.au/autism. There is a range

of topics including ‘Communication’, ‘Sleep’ and ‘Managing Stress’. (7) A range of books, DVDs and other resources with information on Autism Spectrum Disorders are

available from:

Activ Library 327 Cambridge Street, WEMBLEY WA 6014

Phone: (08) 9387 0458 www.activ.asn.au

(8) The family may be eligible for the Carers Allowance. Centrelink forms will be provided by DSC. (9) The Local Area Coordinator (LAC) is a useful resource for accessing supports and information

relevant to your local area. Contact details for the LAC are available through DSC. (10) Forms from the WA Autism Register will be provided to the family with this report. The register

aims to support research and information gathering about Autism Spectrum Disorders. Families are encouraged to participate in supporting the register by completing the consent and/or interest forms provided. Further information about the register can be found at:

Western Australian Register Autism Spectrum Disorders

Telethon Institute for Child Health Research Roberts Road, SUBIACO WA 6008

Phone: (08) 9489 7777 www.autismwa.org.au

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Kindergarten/Pre Primary: (1) Jane may benefit from some assistance at school to participate in classroom activities and

enhance learning. This report may be used as supporting documentation in an application through the Schools Plus program. This process can be initiated by Jane’s teacher.

(2) If deemed necessary by the school, the School of Special Educational Needs: Disability (SSEND),

should be contacted by the school to request assistance with school wide planning and development. All services are provided to the school staff, not the individual student.

The School of Special Educational Needs: Disability provides:

• Statewide expert support to schools to support students with disabilities and learning disabilities • Contextualised and evidence based professional learning courses and seminars to support school

communities and • Online research, information and resources • All services are provided to the school staff, not the students

The School provides specialised services through the following teams:

• Disability Visiting Teacher Service based in schools Assistive Technology Education Service • Autism Education Service • Disability High Support Needs education Service • Learning Disabilities Education Service • Resource library, including student equipment

School of Special Educational Needs: Disability (SSEND)

Giles Avenue, PADBURY WA 6025 Phone: (08) 9402 6100 http://cis.perthwa.net/

Dr Shane Langsford

Date of Report Managing Director -PECS

Registered Psychologist APS College of Educational & Developmental Psychologists Academic Member

CC: Parent Paediatrician Speech Pathologist Eligibility Officer, Disability Services Commission

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APPENDIX 1 – WPPSI-IV SUBTEST DESCRIPTIONS

VERBAL COMPREHENSION Information For picture items, the child selects the response option that best answers a

question about a general-knowledge topic. For verbal items, the child answers questions about a broad range of general-knowledge topics.

Similarities For picture items, the child selects the response option that is from the same category as two other depicted objects. For verbal items, the child is read two words that represent common objects or concepts and describes how they are similar. Ages 4:0-7:7 only

*Vocabulary For picture items, the child names the depicted object. For verbal items, the child defines words that are read aloud. Ages 4:0-7:7 only

*Comprehension * For picture items, the child selects the response option that represents the best response to a general principle or social situation. For verbal items, the child answers questions based on her or her understanding of general principles and social situations. Ages 4:0-7:7 only

VISUAL SPATIAL Block Design Working within a specified time limit, the child views a model and/or a

picture and uses one or two-colour blocks to re-create the design. Object Assembly Working within a specified time limit, the child assembles the pieces of a

puzzle to create a representation of an identified object. FLUID REASONING Matrix Reasoning The child views an incomplete matrix and selects the response option that

completes the matrix. Ages 4:0-7:7 only Picture Concepts The child views two or three rows of pictures and selects one picture

from each row to form a group with a common characteristic. Ages 4:0-7:7 only

WORKING MEMORY Picture Memory The child views a stimulus page of one or more pictures for a specified

time and then selects the pictures from options on a response page. Zoo Locations The child views one or more animal cards placed on a zoo layout for a

specified time and then places each card in the previously viewed locations.

PROCESSING SPEED Bug Search Working within a specified time limit, the child marks the bug in the

search group that matches the target bug. Ages 4:0-7:7 only Cancellation Working within a specified time limit, the child scans two arrangements

of objects (one random, one structured) and marks target objects. Ages 4:0-7:7 only

Animal Coding Working within a specified time limit and using a key, the child marks shapes that correspond to pictured animals. Ages 4:0-7:7 only

VOCABULARY ACQUISITION Receptive Vocabulary The child selects the response option that best represents the word the

examiner reads aloud. Picture Naming The child names depicted objects.

* denotes supplementary subtest which may not be administered unless deemed necessary

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APPENDIX 2 – SUPPORTING EVIDENCE

Supporting evidence for each diagnostic criteria (under A and B) as per DSM-5™. A. Persistent Deficits in Social Communication and Social Interaction across Multiple Contexts, as

Manifested by the Following, Currently or by History:

1. Deficits in social-emotional reciprocity. This criterion will be rated by the Speech Pathologist.

2. Deficits in nonverbal communicative behaviours used for social interaction. This criterion will be rated by the Speech Pathologist.

3. Deficits in developing, maintaining, and understanding relationships. This criterion is rated as met based on the below information:

Difficulties adjusting to suit various social contexts

• Mrs Smith reported Jane hurts others while playing; she seems to get carried away and becomes too rough.

• School Teacher reported Jane’s behaviour in an unfamiliar environment is markedly different to familiar situations. Her reaction is withdrawn, unusually shy and obviously uncomfortable (e.g., when taken to the Principal’s office to show her work, she looked at the carpet the entire time. Her speech became limited and what she did say was rushed and inaudible).

• Jane requires constant verbal reminders to speak at an appropriate volume, speed and tone. During news telling she will often bow her head, and speak extremely fast and quietly. In the same way, during desk work sessions 1:1 with a teacher, she will answer questions with an extremely loud voice, often pushing her face closer to the teacher to emphasise the word.

Difficulties in sharing imaginative play

• Mrs Smith reported a new thing Jane has started doing in the last few months, is lining her toys up. She does not do this all the time.

• Jane’s mood can change quickly. Jane’s mother reported she has noticed this happens when she is playing; she either gets to the point where she’s had enough and the other person/child hasn’t or something’s not being done the way she needs to do it.

• School Teacher reported Jane is able to request another student to play, however, she is unable to engage in appropriate play after this.

• Speech Pathologist reported Jane presents with severely disordered social skills, and delayed play skills.

• Current goals for speech therapy include: o For Jane to stay with a non-preferred activity for more than 3 minutes. o To introduce Jane to pretend play sequences. o For Jane to understand the purpose of questions and wait for the other person’s answer. o For Jane to say hello to other children and engage in simple turn-taking.

• Occupational Therapist reported Jane’s play skills (minimal observation) consisted of organising objects and she resisted stopping until she was content that all objects were where she wanted them. However her play was limited to this, no symbolic or imaginative play was observed.

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Difficulties in making friends

• Mrs Smith reported Jane climbs on others/does not respect personal space. She is physical with others, and has difficulty knowing when to stop.

• When playing with other children she is over eager and tries to force them to do what she wants and it has to be done a certain way. The more she does this the less they want to play which in turn makes her worse.

• Jane is over the top social, she thinks everyone is her friend even if she doesn't know them. Unfortunately her way of socialising is being loud, aggressive speech and horrible faces without meaning to be that way. When actually playing with kids she will play alongside if she's not sure what they're doing, but most of the time she yells and tries to physically force them to do what she wants. Her words are they have to play with her. She will imitate play when with an adult in a structured play setting like therapy. When she is in a situation where there are a lot of kids she will stand and watch. She needs prompting with turn taking, listening to others and sharing.

• School Teacher reported at times Jane displays intimidating behaviours when a student does not play with her, including invading personal space, shouting loudly in their faces and at times chasing or pushing them to try and engage them in play.

• During playtime, she seeks sensory feedback from peers by ramming her bike into others intentionally, and becoming quite pushy with peers even when asked to stop.

• Speech Pathologist reported Jane’s voice is often angry and frustrated, but when asked if she is angry she will say no. When shown how to take turns and play with toys she can do this, and when told that other people like to make their own choices she will tolerate it.

Absence of interest in peers

• Mrs Smith reported Jane tells people to stop talking to her. This happens all the time. She comes across rude and abrupt at times. She does it with people she knows but is worse with strangers.

• Screams at others. This happens all the time especially to kids or babies that are crying. • Makes loud noises when someone is talking. • School Teacher reported Jane has difficulty dealing with the emotions of other students. When

other students in our classroom begin to scream in distress, she appears unsure how to react and often resorts to laughing hysterically.

• We constantly prompt Jane to look at us when speaking, wait until we are finished speaking before she can speak and greet us when she enters the room.

• At times pushes past other students or walks into objects rather than navigating around them.

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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:

1. Stereotyped or repetitive motor movements, use of objects, or speech. This criterion will be rated by the Speech Pathologist.

2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour. This criterion is rated as met based on the below information:

Extreme distress at small changes

• Mrs Smith reported changes in routine can cause distress. Minor changes are ok (e.g., breakfast time, what she has to eat etc), but big changes (e.g., cancelled appointment, changing what time we’re going to shops etc), cause a major meltdown. This is a day to day basis.

• Jane now attends Ed Support where she has been doing well. There has been a recent change since going back to school after the holidays, that has made a difference in her behaviour. She has moved classrooms, same teacher and kids, just bigger classroom. Unfortunately this change has caused her to regress back to past behaviour. She has gone back to screaming all the time, hitting, kicking, parroting behaviour and speech, plus her sensory is a big issue again. These things have improved due to more structured routines and sensory input, but unfortunately, that’s not working at the moment. She’s also destructive.

• I'm not sure if this is classed as an obsession or not but Jane also has a need to know what is happening or where we are going in detail. She will get extremely distressed if she doesn't have the information or if something happens that she's not expecting i.e. taking a different route to the shops or an appointment being cancelled.

• School Teacher reported constant level of anxiety. She quickly dissolves into tears and heavy breathing over minor changes in the environment, timetable and people in the room.

• Can “freeze” when things are different, seems unsure of what to do and how to ask for help, even if situation has been explained.

• Small changes in environment cause obvious anxiety. New situations such as unfamiliar toilet block, can result in tears.

Difficulties with transitions

• Mrs Smith reported difficulty with transitions. It’s only with things she’s enjoying. Rigid thinking patterns

• Mrs Smith reported Jane enjoys repetitive play. It’s not so much repetitive play as it is things that she plays have to be done the same way.

• She doesn’t handle disappointment well. She will scream, kick and hit. This will go on for a long time.

• She thinks people/cars are following us just because they are behind us. When I try to explain that they are just going the same way, she will argue and scream.

• School Teacher reported at times Jane gets “stuck” in a pattern of errors and is not able to change the behaviour even when assisted.

• Jane engages in some strange routines such as asking the same question before she eats her lunch or suddenly “forgetting” or being unable to complete a task that she previously completed independently on a number of occasions.

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• Jane’s behaviour and speech is quite rigid and inappropriate or ritualistic behaviours are hard to shift.

• For the first three weeks of term, before every lunch she would ask “Do I eat my sandwich first?”. She also cried every time she was told to go to the toilet and was extremely anxious when she sat on the toilet but was unable to go.

• Speech Pathologist reported Jane finds it very difficult to control her impulses, for example, she understands she can’t touch something or put something in her mouth, but she says phrases like “I need to do it”.

• She has a need to control her environment and the activity (e.g., where her and her mum sit, how toys are played with).

Need to take same route or eat same food every day

• Mrs Smith reported if we are going to the shops and I take a different route, she will go off at me.

• When driving in the car I have to constantly explain where we are going and what way. If she doesn’t know or is expecting me to go another way or somewhere else, she will scream and kick the seats.

• School Teacher reported from term one we told Jane about our classroom rule that she must first eat her sandwich before anything else in her lunchbox at lunchtime. For the next two weeks or so, Jane repeatedly asked “Do I eat my sandwich first?”, before beginning her lunch. Once we realised the pattern, we stopped answering her question and she stopped asking and was able to eat her own lunch. A few weeks later we had a cooking lesson where we made toasted sandwiches for lunch. Jane happily ate the sandwich she had made and then went to open her lunchbox and eat the sandwich her mum had sent her. I stopped her and said “Oh Jane, you don’t have to eat your sandwich first today, you ate a sandwich at cooking, you can choose a treat from your lunchbox if you like!”. Her eyes immediately filled with tears and she said “Please, I have to eat my sandwich first”. She was quite distressed and genuinely felt she couldn’t eat anything in her lunchbox until she had the sandwich first.

3. Highly restricted, fixated interests that are abnormal in intensity or focus. This criterion is rated as met based on the below information:

Strong attachment to or preoccupation with unusual objects

• Mrs Smith reported Jane is obsessed with vents and now she has to scream at them. She’s scared of smoke detectors because of the noise and obsessed/scared of fans.

• Jane is obsessed with noisy objects i.e. toy phones, baby toys that plays music. She will repeatedly press buttons to continue the noise or use things like poles to make noise with and it can go on for an hour or so.

• She is obsessed with vents and smoke detectors. She will stand under a vent and squeal up at it. She likes to talk about vents and smoke detectors when she sees one and is hard to redirect to another subject. She will continue to come back to the subject. She also does this with several other things i.e. if an alarm goes off, if she sees an ambulance, police car or fire engine, generally things that make noise. If you take away something that she is obsessing about or try to change the top of conversation she will scream, hit, pinch and kick.

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4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment. This criterion is rated as met based on the below information:

Apparent indifference to pain/temperature

• Mrs Smith reported Jane presses her feet against others. She does this all the time and it is quite painful.

• Bangs her head on people. This is something she does when she is frustrated or confused. • Pinches self and others. She also bites herself and others. • Doesn’t want to wear warm clothes when it’s cold. • Does not feel pain like others. • Overheats very easily. Her overheating is getting worse. She overheats in winter because

everyone has heaters on. She is constantly on edge and when it’s too much she hits, screams and destroys her surroundings. She calms down once she is cooled down, but it doesn’t take much to set her off again.

• Scratches self and picks at skin. • She will seek out objects that she can kneel on or press into her skin to make marks i.e.

kneeling on Lego or pressing a pen into her skin. She also bites herself and leaves marks. Adverse response to specific sounds or textures

• Mrs Smith reported wind causes fear. • Always slams doors and cabinets. This is something she does a lot. • Afraid of vacuum cleaner, lawn mower, fans and toilet hand dryers. • Runs away from expected or unexpected loud noises. • TV/music has to be really loud. • Doesn’t like wearing pants, skirts etc (bottoms). Dislikes certain clothing. She doesn’t seem to

like tight clothes and she prefers soft material. She’ll wear jeans if they are pre-owned and worn in.

• Chews on everything. • Hates wearing shoes. • Hears every little thing. • Afraid of the car wash. • She is sensitive to the noise of babies/kids crying. • She’s scared of smoke detectors because of the noise and obsessed/scared of fans. • Distressed at mealtime mess. She can’t handle sitting in the same chair the whole meal

because she spills food on it. • School Teacher reported Jane is quite sensitive to loud noises, often yelling at students who

are crying to ‘stop it’. • Speech Pathologist reported she is extremely sensitive to noise and spends most of the time

asking “what’s that noise?” Excessive smelling or touching of objects

• Mrs Smith reported rubs zippers - If she's watching a show or concentrating on something she will start rubbing her zipper or the zipper on the couch. She doesn't seem to know she's doing it so I think it is sensory.

• She has been sniffing things for awhile, but in the last 6 months I have noticed she sniffs things that are a bit inappropriate. She has started sniffing the chair when I get up, then glass I drink out of or straw, my clothes.

• Standing/waiting in line is very difficult. She will constantly take off and touches everything.

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Visual fascination with lights or movement

• Mrs Smith reported craves fast spinning. She likes to spin herself on the swing and I spin her in the egg chair.

• Prefers big squeeze/bear hugs. • Head being tipped backwards is avoided. • Likes to stomp everywhere. • Loves being tickled and keeps asking for more. • Jane prefers the lights off. She will turn lights off at shops if she sees the switch, the doctors,

anywhere she goes even if it is pitch black. She can get aggressive and scream if they are turned back on. Sometimes she will stand there and just switch on and off repetitively but not often.

• School Teacher reported Jane displays some sensory seeking behaviours during play such as ramming into walls/other students when riding the bikes or throwing her body against other students. The frequency of this behaviour is reduced when a large crash mat is provided for her to gain the ‘jolting’ feedback from/in a more appropriate manner.

• Speech Pathologist reported she seeks constant movement and has a need for movement breaks after sitting at a table for more than five minutes.

• Occupational Therapist reported - Sensory Profile; • Sensory seeking - definite (more that others). Meaning that Jane is moving/seeking moving,

crashing, tastes, chewing more than other children her age. • Low registration - definite (more than others). Meaning that Jane responds very

quickly/strongly to small (sometimes tiny) amounts of certain types of sensory input, and her reaction can, at times, be considered extreme to some form of sensory input that most of us just ignore.

• Sensory avoiding - definite (more than others). Meaning that Jane is avoiding certain types of sensory input because she finds them (in even the smallest of doses) noxious.

• Sensory sensitivity - definite (more than others). Similar to above - Jane finds certain sensory inputs noxious, from movement to touch to different textures in food. The result is that she avoids these sensory inputs.

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APPENDIX 3 - 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 from 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.