The results of Noah’s evaluation last month.

Psychological Assessment

Age: 2 years, 10 months

Background:
Noah lives with his parents and 3 siblings. He was born at full term with no complications. His mother indicates that he has fluid in his right ear and will be evaluated to determine if tube placement in necessary. He does not take ongoing medication.
Noah participates in the Early Start program at Casa Colina for 6 hours a week.

Intellectual Assessment:
An estimate of Noah’s cognitive functioning was obtained using the Bayley Scales of Infant Development- 3rd edition. His cognitive composite score of 95 falls within the average range of nonverbal cognitive ability. Noah was able to focus on and attempt most of the items that were offered to him. He demonstrated the ability to assemble puzzles consisting of 2 pieces and pretended to lick the ice cream cone puzzle. He engaged in simple pretend play using a doll. Noah fed the baby and used a cloth for a blanket while saying “night night”. He matched pictures correctly on two out of three trials and was able to identify a previously viewed picture. He was able to match color disks to the appropriate colors. Noah sorted by color but did not show interest in the task requiring him to identify objects by color. He did not identify objects by size but is reported to be working on this skill. He imitated a two-step action. While his counting was inconsistent, he did assign one number to each block in attempting to count them.

Adaptive Functioning:
Noah feeds himself using utensils with some spilling. He is learning to remove clothing items and can take off shoes, socks and diaper. He cooperates with dressing. Noah is in the process of toilet training and will sit on the toilet. He brushes his teeth with help. He wipes his face and nose. Noah requires assistance to complete bathing. He will pick his toys up with the clean up song. He also takes things to the trash upon request. He was noted to have good coordination in the visual-motor skills required for him to hit a ball with a bat.

Social/Emotional/Personality Functioning:
Noah’s behavioral presentation was evaluated through parent interview and observations of his behavior during evaluation. His mother was asked to complete the Gilliam Autism Rating Scale- 2nd edition (GARS-2). The examiner administered the Autism Diagnostic Observation Schedule (ADOS). His rating scores fell within the possibly autistic range on the GARS-2 and within the non-autistic range on the ADOS. Noah’s behavioral presentation does not meet the DSM-IV-TR criteria for Autistic Disorder.

Noah demonstrates a good level of social interaction. He is affectionate with his parents and extended family. He plays with his older sister. His mother indicates that Noah likes to do songs with gestures and will participate in circle time activities with other children. He will become “instant friends” with other children at the park. He plays well with his two cousins who are near his age. Noah looked when his mother called his name. He would give things and showed toys to others. He participated in playful activities initiated by the examiner.

He has a history of a significant delay in language development. Noah first used single words at 18 months and phrases around two years old. His mother notes that for a long time he would not repeat words spoken by others unless he could say the word perfectly. An occupational therapist has pointed out that some possibly difficulties related to the mouth muscles which may affect his ability to produce words. He is reported to drool, chew on many objects and to often hold his mouth open. Noah has much improvement in his communication skills within the last month. He is now able to produce spontaneous meaningful sentences. There were no autistic-like oddities such as echolalia observed. His mother notes that Noah’s language has always been meaningful. He does continue to have articulation difficulty. He understands and follows directions. Noah demonstrates an appropriate use of gestures such as pointing, waving and sign language for “please.” His use of eye contact was inconsistent which seemed to be related to him being active. He is reported to have good eye contact with family members.

Noah engages in functional and pretend play with toys. He likes to stack blocks and knock them down. When asked about repetitive activities, his mother reported that he watches the wheels on cars and trains move at eye-level. Noah will pinch his finger when excited. He is also reported to be overly active. He likes to turn in circles, walk on his toes and put objects in his mouth.

Summary
Noah is a delightful child. He has the benefit of having loving parents who are interested in learning new ways to facilitate his development. He currently demonstates nonverbal cognitive abilities that fall within the average range at the level that would be expected for his age. He does have a history of delay in language development. His behavioral presentation is inconsistent with a diagnosis of Autistic Disorder. Noah demonstrates a level of social interaction which exceeds the level that is typically seen in a child with a diagnosis of Autism. He also has meaningful use of sentences and gestures used to communicate with others. It is recommended that he be evaluated to determine the appropriateness of special education preschool services with a formal speech and language evaluation. He should continue to participate in occupational therapy interventions as appropriate.

Diagnostic Impressions:
Axis I: Rule out 315.32 expressive and receptive language disorders
Axis II: v71.09 No diagnosis on Axis II

Bayley Scales of Infant Development- 3rd edition
Cognitive Composite Score – 95
Gilliam Autism Rating Scale – 2nd edition
Autism Index Score = 79
Autism Diagnostic Observation Schedule
Communication = 0
Social = 5
Total = 5 (Autism cut off =12)

Recommendations:
1. Ineligible for IRC services under the criteria of mental retardation or autism.
2. Assessment for appropriate special education services with a formal speech and language evaluation.
3. Consider continued participation in occupational therapy services as appropriate.

Who me? I don’t know what they’re talking about.
(insert evil laugh here)