ASSESSMENT GIVING AND RECOMMENDATIONS
Mr. and Mrs. Muller attended the assessment giving sessions on October 4, 1985. This session was conducted by Dr. Any Psychologist and Ms. Any Assistant. Dr. Any Psychiatrist also provided input on the issue of medication.
Mr. and Mrs. M. expressed a desire to know the diagnosis appropriate to their son's difficulties, as well as to receive recommendations for further skill development.
We explained that Daniel's difficulty in communication and in understanding the world around him, accompanied by self-stimulatory behaviours, meet the criteria for a diagnosis of early infantile autism, and explained in more detail how in fact, Daniel's characteristics relate to the diagnosis. Subsequently, we proceed with sharing our findings with the parents.
According to information that Mr. and Mrs. M. provided in response to questions on the Alpern and Boll Development Profile, Danny is currently functioning in the physical and self-help areas at around the 5-1/2 to 6 year level. He is thus, pretty good in these two areas. We did recommend, however, that Mr. and Mrs. M. ensure that Danny in as much physical exercise as possible to increase his skill in the physical area as well as to help him channel his energy level somewhat. Furthermore, although Danny seems to be pretty good at taking care of himself, we suggested that Mr. and Mrs. M. further encourage him to do more for himself, that they treat him as a child of 11 years in this area, in order to help him to be more independent.
In the social area, according to parents, as well as in the communication area, Daniel's skills are more delayed, and are at approximately the 2 to 2-1/2 year level. We explained that this difficulty in these two areas is typical of the children we see in the Autistic Clinic, and strongly recommended that parents use sign language with Danny to enhance his ability to communicate with others, and that they encourage him to sign in order to obtain things he wants. We emphasized that everyone involved with Danny must learn sign language and use it consistently, including his siblings and special need worker. We provided Mr. And Mrs. M. with an outline on sign language resources and materials that they may find helpful. Daniel has been already exposed to sign language but we felt that a systematic and concentrated effort should be made in this key area of functioning at the present time.
In the academic area, as reported on the Alpern and Boll, Danny is functioning at the 4-1/2 to 5 year level. This corresponds with the result of formal testing where Danny was able to comprehend and manipulate materials on a nonverbal test at around 4-1/2 year level. On a task which involved a language component, however, Danny scored at a lower level, at about 2 years, again corresponding to parent's perceptions of his language capabilities. Danny was able to understand the relationship between cause and effect, and was also very good at imitating actions performed by the examiners. He was attentive and motivated to copy those actions, again indicating a good potential for learning to imitate others and likely to communicate with signs.
Danny was also able to relate certain miniature objects to one another, indicating an appreciation at the way things relate to each other in his environment. We encouraged Mr. and Mrs. M. to continue working with Danny in this area of symbolic play and provided them with an outline on how to promote Danny's symbolic play abilities.
A concern of the M. and our own is Danny 's smearing of saliva. We recommended that parents deal with this socially difficult behaviour using the procedure of overcorrection, whereby every time Danny engages in that behaviour, he would be required to clean himself and the area where he smeared with (including tables and chairs) thoroughly with a solution of warm water and Lysol. Everyone, including mother, father, siblings and special needs worker, must follow this procedure consistently in order to eliminate the behaviour as quickly as possible, The procedure must also be followed in a matter of fact manner without emotionality or punitiveness, particularly since any additional stress or excitement may serve a reinforcing function and inadvertently increase the behaviour. We recommended that a hand-over-hand approach may be necessary at first to encourage Danny to follow through. The parents expressed interest in trying this approach.
In order to eliminate any additional excitement in the home and to assist to provide structure which Danny so much needs, we suggested that Mr. and Mrs. M. may consider having fewer guests in the home at a given time, as other children may provide too much additional stimulation and unpredictability which Danny may find confusing. The M. are apparently already taking care of this issue.
Further, we encouraged Mr. and Mrs. M. to try to keep Danny busy with classification, seriation, and number tasks, such as sorting beans, macaroni or leaves according to size, shape and colour or to request that he help them around the house or during family outings.
Medication was suggested as another possibility to help reduce Danny's activity level and improve concentration. Dr. Any Psychiatrist discussed a number of medications and their potential side effects with the M., and provided them with a prescription for Stelazine, as parents were particularly concerned about Danny's ability to concentrate at school and Stelazine is considered to be helpful in this respect. Mr. and Mrs. M. will contact Dr. Any Psychiatrist in 6 days to keep him informed as to it's effectiveness with Danny.
We briefly discussed Danny's present school placement, which we feel is meeting his needs well at this time. For the future, we encouraged Mr. and Mrs. M. to consider placing Danny's name on the waiting list at both (group home's names) in the event that they may wish to place him there when he becomes older. We also suggested that they visit both placements in the meantime to become familiar with the facilities available there.
Finally, we briefly discussed issues related to family functioning, and encouraged parents to continue, as they have been, spending time with all the of their children and to continue be sympathetic to their individual needs, including discussing the children's concerns with respect to Danny. Furthermore, we encouraged them to spend time by themselves.
We invited Mr. and Mrs. M. to feel free to contact us should they have any concerns regarding Danny and asked that they contact us in 10 months to set up an appointment to have Danny reassessed.
15/Oct/85 #4RR-13 16/Oct/85 #5RR-1-2 dictated 11/Oct/85.vdc
Signatures of Psychometrist Research Assistant & Project Coordinator Child and Family Studies Centre and of Psychologist Head Autistic Clinic Child and Family Studies Centre.
