Profile of an NLD/ASD Child: Part 3

Occupational Therapy Evaluation

Child’s age: 4 years, 6 months

Reason for referral: Kira was referred for an occupational therapy evaluation as part of a full child study team evaluation. Kira was previously evaluated by this therapist last year. Concerns at that time centered around her social development and attention to task. Kira has attended preschool this year. While growth has been noted, concerns persist in the aforementioned areas.

Behavioral Observations: Kira entered the evaluation room with this tester, by herself, as her mother completed an interview with the social worker.  She was pleasant and friendly but announced that she did not want to play. Nonetheless, she was cooperative when asked to perform a variety of gross and fine motor activity.  While she preceded her performances with “I don’t want to” she could be encouraged to participate. This was Kira’s second evaluation on this morning.

Kira’s attentional behavior appeared to be diminished. Eye contact could be elicited but was fleeting in length and not offered frequently on her own initiative. Response time appeared to be notably delayed. Kira often appeared to be staring in to space. Sometimes she seemed to forget what she was supposed to do. On other occasions after a long delay, she would say “I don’t know how to do that.” While performing many gross and fine motor activities, Kira failed to watch what she was doing, which interfered with the accuracy of her work. Kira talked freely throughout the evaluation period: conversations were not always topical. Also noted was that Kira tended to hold her breath while concentrating, letting it out suddenly.

Gross Motor:  Kira displayed a full repertoire of primary movement patterns, with a fairly complete range of secondary, more integrated movement patterns. Active range of motion and muscle tone appeared to be generally within normal limits. Overflow observed last year (arms in midguard posture and hand flapping) seemed to have lessened. The quality of her movements in terms of speed and agility appeared to be within normal limits. Kira tended to move spontaneously, without careful regard to motor planning other directed movements.

According to the Michigan Preschool Profile, Kira functioned on a 4 year to 4 year 6 month level in gross motor development, with scattering of skills in the 3 year 6 month to 4 year 6 month level. Kira walked with heel to toe articulation.  She was able to walk backwards and in a heel to toe fashion.  She stood on one foot for one to two seconds. She jumped in a forward direction a distance of about twelve inches. By report, she pedals a riding toy, and uses the slide and swing, although she does not yet pump a swing. She was able to toss a ball, with inconsistent control.  Inattention interfered with her ability to catch the ball.

Perceptual/Fine Motor: Kira used her hands in a fairly coordinated, assistive fashion, displaying a preference for her right hand. Mild hypermobility of the joints of the hands was noted. Manipulation was usually performed in the fingertips, although when inattentive, palmar control was used. She displayed a wide range of grasp patterns with pincer grasps occasionally being lateral. Release appeared to be immaturely developed in both control and precision in placement, again being modified by inattention to task.

According to the Michigan Preschool Profile, Kira functioned on a 3 year 6 month level, with skills widely scattered in the 2 years 6 months to 4 year 6 month range. She stacked eight one inch cubes and duplicated building a four cube train and a three cube bridge using trial and error but did not build the five cube gate or six cube pyramid. She did not complete the rotated two piece puzzle but did complete the simple five piece puzzle. Again, Kira’s approach was not well organized, and she tended to retry the same piece in the improper place repeatedly. She placed six pegs in a pegboard in ten seconds.

Kira held a pencil in her right hand, in a digital supinated grasp. She copied a vertical and horizontal line and a circle and attempted to copy a cross.  She printed her name with some assistance. She drew a seven part man upon request. She attempted to trace within a square template. Kira attempted to cut on a line, with some success.

On the Ernhardt Developmental prehensile assessment, she functioned on a 3 year 6 month to 4 year level. On the design copying test from the SCSTI she achieved a standardized score of – 0.1 (where scores above + 1.0 SD and below -1.0 are considered increasing significant.)

Self Care: Mrs. Baker reported that Kira is completely toilet trained, including at night. She dresses and undresses herself. She can undo snaps and zippers. For feeding she uses a fork and spoon and can pour from a small pitcher.

Summary:  Kira was referred for an occupational therapy evaluation as part of a full Child Study Team evaluation. Her behavior was marked by inattentiveness and difficulty planning and organizing herself for movements and activities. Gross motor functioning was essentially within normal limits, although movements were spontaneous and not well planned. Perceptual/fine motor development was judged to be mildly to moderately delayed, with a wide scattering of skills up to age level. Inattention hampered her performance in all areas tested.

Profile of an NLD/ASD kid: Part 2

Occupational Therapy Evaluation

Child’s age:  3 years, 8 months

Background: Kira was referred for an occupational therapy evaluation by staff from Project Child’s Assessment service because of concerns with gross and fine motor development. Mrs. Baker originally brought Kira to Project Child because of concerns about her social abilities and questionable attention to task.

Kira is the product of a full term pregnancy, with delivery achieved through Cesarian section due to a breech positioning. Mrs. Baker reported her recollections of gross motor milestones being mildly delayed, although independent ambulation was achieved by one year. Medical history was remarkable in that Kira was born with congenital torticollis, which has since resolved. Health has been generally good. Kira attends nursery school.

Tests Administered: 

Michigan Early Intervention Developmental Profile

Michigan Preschool Profile

Ernhardt Prehensile Profile

Parent Report

Observation

Behavioral Observations: Kira entered the evaluation room with her mother, appearing fairly comfortable and interested in her environment. She sat at the table when directed to do so.  Eye contact could be elicited but was fleeting, particularly as language or task demands became more persistent. Kira was generally cooperative and happy, although she seemed to need to be encouraged to participate in dialogue. Mrs. Baker reported concerns that she needs to direct Kira’s play and that she frequently reverts to hand flapping episodes. Occasional episodes of hand flapping were observed during this assessment, but not in an uncontrollable fashion. She also held one hand in the air, while manipulating with the other hand.

Kira benefited from focusing prompters to direct and maintain her attention to task. She occasionally became fidgety in her chair. She seemed more distracted by her own movements and thoughts than by external stimuli.

Gross Motor: Kira displayed a full repertoire of primary movement patterns, with a fully complete repertoire of secondary more integrated movements. Active range of motion and muscle tone appeared to be within normal limits as well. Overflow was observed on occasion as noted previously, with shaking of the arms, as well as occasional fisting, and oral overflow. The quality of her movements was judged to be age appropriate.

According to the Michigan Preschool Profile, Kira functioned on a 3 year 6 month level. She walked with heel strike, and ran fairly smoothly. Mrs. Baker reported that Kira ascends and descends stairs in a reciprocal fashion. She was able to jump twelve inches in a forward direction and repetitively. She stood two to three seconds on one foot. By report, Kira uses the slide, climbing bars and swings on the playground. She pedals a riding toy as well.

Perceptual/Fine Motor: Kira could use her hands in a coordinated, assistive fashion, displaying a preference for her right hand. She manipulated objects comfortably in her fingertips. A very mild tremor was occasionally evident in the hands in unstable postures. Release appeared immaturely developed in both control and precision in placement. Kira had difficulty isolating the movements of her thumb and individual fingers imitatively.

According to the Michigan Preschool Profile and EDP, Kira functioned on a 30 to 32 month level in perceptual/fine motor development, achieving a basal score of 28 months and displaying a scattering of skills up to 3 years 6 months. She was able to stack 6 one inch cubes, and aligned the blocks. She did not actually duplicate building a 4 cube train. She completed the three piece formboard in a forward and reversed presentation. She did not complete the rotated two piece puzzle. She placed six pegs in a six holed pegboard in 19 seconds.

Kira held a marker in a static tripod grasp. She was able to copy a vertical, horizontal and diagonal line, and a circle. She drew an eye, an ear and some hair on a complete-a-man drawing. Kira held scissors in both hands, and is mastering snipping. Kira achieved a 3 year level on the Erhardt Prehensile Profile.

Self Care: Kira is toilet trained during the day, but not at night. She eats using a spoon, and occasionally fork. She spreads very little. She can take off her socks, shoes and underwear, and put on her underwear, and sweatshirts.  She is cooperative in dressing and not yet handling fasteners.

Summary:  Kira was referred for an occupational therapy evaluation because of concerns about hand flapping, difficulty involving herself in play, and delays in gross and fine motor development. Gross motor abilities were judged to be within normal limits. Perceptual/fine motor abilities are judged to be moderately delayed in both quality and skill achievement. Overflow, as noted by Mrs. Baker, was also observed. She will probably gradually outgrow this behavior.

Recommendations:

  1. Kira has been referred to the Perceptual/Motor Clinic. If vacancies are not available, she will be placed on the waiting list.
  2. Mrs. Baker may be able to gradually lead Kira to making her own decisions about play by providing two or three choices, start her on the activity, then encouraging her to play independently for increasing periods of time.
  3. Kira should be encouraged to give and maintain eye contact, by using the directive “Look” (point to eye) and delay speaking to her until she does look at speaker.
  4. Games that encourage Kira to follow directions, move slowly, or sit quietly may also help (i.e.-Giant Steps, Follow the Leader, Simon Says, etc,)