Profile of an NLD/ASD Child: Part 5

Psychological Evaluation

Age: 4 years, 7 months

Reason for Referral: Kira is being evaluated as part of a full child study team assessment. Parental concerns over perceptual-motor development and immature social/play behavior have persisted since Kira was first brought to the attention of Project Child one year ago. Currently there are questions about Kira’s readiness for Kindergarten.

Background Information: Kira was seen for screening by Project Child last year. Results at that time indicated possible deficits in gross and fine motor development, while age appropriate speech/language and cognitive skills were apparent. Kira demonstrates shy behavior in unfamiliar situations. An occupational therapy evaluation noted gross motor abilities within normal limits. However, delays in fine motor ability, including both quality of production and skill achievement were evidenced. Recommendations were made by the occupational therapist which were relevant to home and nursery classroom setting.

Currently behavioral concerns centering around socially reticent behavior, lack of peer relationships and immaturity are being noted by mother and classroom teacher. Delays in the fine motor area also appear to be hampering Kira’s development.

Observations: Kira is a very pretty 4 year 7 month old girl of average height and build. She was unwilling to separate from her mother and therefore Kira’s mother accompanied her throughout this assessment. Initially Kira remained seated on her mother’s lap but spontaneously moved to a nearby chair after approximately five minutes in to the session.

Kira was very interested in the testing materials and was cooperative with all tasks.  No spontaneous speech was apparent. Speech upon demand was sparse and not elaborate but effective in relaying information.

Kira’s attention was appropriate although she sometimes seemed to tune out. Kira interacted affectionately with her mother and was socially responsive with the examiners. Kira seemed quite interested in people but hesitance was noted in her interaction with them.

Results of Evaluation:

McCarthy’s Scales of Children’s abilities

Scale                             Scale Index               Scale Age Equivalent          Percentile

Verbal                                 60                                         5-6                                85th

Perceptual Performance  45                                    4-0                                 30th

Quantitative                       52                                   4-6                                  55th-60th

Memory                           55                                    5-0                                   70th

General Cognitive Index  105                            4-10                                  60th-65th

 

Results of this measure indicate overall cognitive development at the average level. Perceptual-Performance scores are an area of relative weakness, with scores at below average levels. Verbal and memory skills are at high average level.

Verbal: The verbal scale measures the child’s ability to express herself verbally and to measure the maturity of her verbal concepts. Age scores for subtests include: Pictorial Memory (4-6); Word Knowledge (4-6); Verbal Memory I: Words and sentences (5-6) Verbal Memory II: Story  (5-0); Verbal Fluency (6-6);  Opposite Analogies (5-6).

Kira recalled four out of six pictures. She identified or named nine out of nine pictures and defined the words “coat” and “tool”. She repeated a series of four unrelated words. Kira correctly completed five opposite analogies.

Perceptual Performance:  Kira achieved these subtest age scores in the perceptual performance area: Block Building (3-0); Puzzle Solving (4-0); Tapping sequence (3-6); Draw-a-design (4-0); Draw-a–child (4-0); Conceptual grouping (5-6). This scale evaluates reasoning ability through manipulation of materials. The child demonstrates skills of imitation, logical classification and visual organization which are generally below age expectations.

Kira copied block structures such as a 6 block tower and a 3 block chair. She correctly put together a three piece puzzle. Kira copied a circle, vertical and horizontal line and a right angle intersection. Her drawing of a person consisted of six scorable parts but the quality of her drawing was immature. Kira used the right hand for drawing tasks and a pincer grasp was inconsistent.

Kira identified the concepts of big/little, square-round and named nine colors. She was able to sort by three attributes.

Quantitative: The quantitative scale is designed to measure Kira’s number aptitude rather than the upper limit of computational skills. Kira’s understanding of quantitative concepts is judged to be at these age equivalents: Number Questions (4-0); Numerical Memory I: Forward Series (8-6);  Counting and Sorting (5-0).

Kira answered number questions such as “how many heads do you have?” to a 4-0 year old level. She repeated six digits, which is a notable strength for her age.

Kira was able to sort four and ten blocks by half. She correctly counted to five with one to one correspondence.

Memory: Visual and auditory memory are assessed by subtests on this scale. The following subtest age equivalents have been achieved: Pictorial Memory (4-6); Tapping Sequence (3-6); Verbal Memory I: Words and Sentences (5-6) ; Verbal Memory II: Story (5-0): Numerical Memory (8-6). Kira’s short and long term memories appear adequately developed.  A strength was noted in short term auditory recall.

Summary of Evaluation: Kira, a pretty and reticent 4 year 7 month year old girl, was cooperative and curious during this evaluation. She was able to maintain attention in a consistent manner for about fifty minutes.

Results of the cognitive assessment indicate functioning at approximately the 4-10 year level, with scatter to the 6-6 level. Perceptual-fine motor skills appear developed to the 4-0 level, which would be considered an area of notable weakness for Kira. Receptive language and expressive language appear well developed and were exhibited to the 5-6 level. Kira’s memory skills were demonstrated to the 5-0 level while qualitative skills appeared average.

These results suggest cognitive development at the average level overall.

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,)