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PSYCHOLOGICAL ASSESSMENT REPORT

(CONFIDENTIAL)
PERSONAL INFORMATION
Name :
National ID Card No :
Date of Birth :
Test Date :
Age at Testing :
Gender :
Source of Information :
Test Administered :
Report Date :

REASON FOR REFERRAL

Naya was referred for a psychological evaluation by her parents to understand her current
psychological functioning.
According to her parents, Naya doesn’t speak and has a speech delay with a limited vocabulary
of about 50 words. Her parents stated that she sometimes appears as if she cannot hear them and
lacks eye contact although they state that this is a bit better than before. They note that she only
wants to wear certain clothes and does not like colorful clothes. And that she enjoys playing with
wheels on her toys. They report that she is an easy going and active child who babbles a lot now.
But this isn’t so when they take her outside. They state that Naya gets overwhelmed, distressed
and cries in all social situations outside of home and they usually have to come back home
immediately as she is inconsolable until they do so. They report that she has an irregular sleep
pattern where she tends to stay awake during the night and sleep during day time. They state that
she eats only a specific set of limited food items.

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BACKGROUND INFORMATION
Developmental History
Naya’s mother had a normal pregnancy although due to her being diabetic, she was on insulin
throughout the pregnancy. Naya was delivered at full term by caesarean delivery. Her birth cry
was present and her birth weight was 3.7kg. Her developmental milestones were reported to be
slow for gross motor and fine motor development. Her language and speech development were
significantly delayed.
Past/Medical
At 3 months old, she had three epileptic seizures during which she foamed at her mouth. Parents
noted that it took a year for her to recover from this and was back to normal physically.
She has also been in speech therapy since she was 2 years old.
Family History

33 32

Naya lives with her parents and sister in Male’. Her father works full time and her mother is
a stay-at-home mother. She enjoys spending time with her family and gets along well her
sister although she prefers playing by herself mostly when at home rather than with her sister.
Schooling
Naya will be attending baby nursery later this year.

BEHAVIORAL OBSERVATIONS
Naya was assessed over one day. At the time of assessing, she failed to maintain adequate eye
contact, was unable to engage and rapport was not established. She was playful, babbled and was
active with her parents. Throughout the session, she was mostly did not take notice of the
examiner.
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EVALUATIVE PROCEDURES
1. Pediatric Symptom Checklist -17
2. Autism Screening Instrument for Educational Planning – 3
3. Gilliam Autism Rating Scale 3rd Edition
4. ADHD Rating Scale IV – Preschool Version
5. Vineland 3 – Comprehensive Parent/Caregiver Form

TEST RESULTS AND INTERPRETATIONS

1. PEDIATRIC SYMPTOM CHECKLIST -17 (PSC-17)
The Pediatric Symptom Checklist-17 (PSC-17) is a psychosocial screening tool designed to
facilitate the recognition of cognitive, emotional, and behavioural problems so that appropriate
interventions can be initiated as early as possible. Naya’s scores are as below:
Raw Score Cutoff
Score

Internalizing 5 5
Attention 6 7
Externalizing 1 7
Total Score 12 15

2. AUTISM SCREENING INSTRUMENT FOR EDUCATIONAL PLANNING 3RD

EDITION (ASIEP-3)
The Autism Screening Instrument for Educational Planning- Third Edition (ASIEP-3) is a valid
and reliable measure of autism and related behaviors. It was designed to identify individuals
with autism; assist in planning appropriate educational programs for those individuals; monitor
performance and progress; and research autism. Naya’s mother Niuma Ismail, was administered
the Autism Behavior Checklist which provides a checklist of 47 behaviors typical of autistic
individuals. Following are Naya’s score on the ASIEP-3 Autism Behavior Checklist:

Raw Score %ile Rank Standard Score Probability of

Autism
ABC Total Score 22 58 103 Very Likely

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2. GILLIAM AUTISM RATING SCALE-THIRD EDITION (GARS-3)
The GARS-3 is a norm referenced screening instrument that is designed to identify individual’s
ages 3 through 22 years of age who have severe behavioral problems that may be indicative of
autism. The GARS-3 is divided into six subscales that describe specific, observable, and
measurable behaviors. These behaviors are related to the Autism Society’s (2012) definition of
autism spectrum disorder and based on the diagnostic criteria for autistic disorder published in
the DSM-5.
GARS-3 Parent
Subscales %ile Ranks Scaled Score
Restricted/Repetitive Behaviors 16 7
Social Interaction 37 9
Social Communication <1 2
Emotional Response 37 9
AUTISM INDEX (4 Scores) 7 27

Results of ratings from Naya’s mother reveal notably elevated scaled score in the subscale areas
of Social Interaction, Restricted/Repetitive Behaviours and Emotional Response. Social
Interactions refer to social behavior such as showing little or no interest in others people, not
initiating conversations with others, and showing minimal expressed pleasure with peers or
others. Restricted/Repetitive Behaviors may include stereotyped behaviors, or fixated interests,
routines, or rituals. Parent ratings reveal that Naya is demonstrating behaviors associated with
the Autism Spectrum Disorder at Very Likely levels in the home setting, and that these behaviors
are limiting her academic and social interactions. Results include an Autism Index standard
score of 78, with the probability of ASD being Very Likely with a DSM-5 Severity Level for
ASD of Level 2 – Requiring Substantial Support.

3. ADHD Rating Scale IV – Preschool Version (ARS IV – Preschool Version)

The ADHD Rating Scale-IV obtains parent ratings regarding the frequency of each ADHD
symptom based on DSM-IV criteria. Parents are asked to determine symptomatic frequency that
describes the child’s home behavior over the previous 6 months. The scale consists of 2

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subscales: inattention (9 items) and hyperactivity-impulsivity (9 items). Following are Naya’s
score on the ARS IV – Preschool Version:
Score Cut off Score
Inattention 9 14
Hyperactivity/Impulsivity 9 17
Total Score 18 32
Naya’s scores are not indicative of symptoms for ADHD.

4. VINELAND 3 – COMPREHENSIVE PARENT/CAREGIVER FORM

The Vineland-3 is a standardized measure of adaptive behaviour--the things that people do to
function in their everyday lives. Whereas ability measures focus on what the examinee can do in
a testing situation, the Vineland-3 focuses on what he or she actually does in daily life. Because
it is a norm-based instrument, the examinee's adaptive functioning is compared to that of others
his or her age.
Naya’s evaluation for the Vineland-3 Comprehensive Parent/Caregiver Form was completed by
Niuma Ismail, her mother.
Below are Naya’s ABC and Domain Scores and her subdomain scores:

ABC and Domain Score Profile

Based on Mean of 100, SD of 15

Adaptive Behavior Composite 67

Motor Skills Communication Daily Living Skills Socialization
85
51
76
72

10 20 30 40 50 60 70 80 90 100 110 120 130 140

Standard Score

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 Subdomain v-Scale Profile
Based on Mean of 15, SD of 3

COM - Receptive 3
COM - Expressive COM - Written DLS - Personal DLS - Domestic
2 DLS - Community
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SOC - Interpersonal Relationships
SOC - Play and Leisure SOC - Coping Skills MOT - Fine Motor 13
MOT - Gross Motor 10
12
10
9
9

11
14
12

1 2 3 4 5 6 7 8 9 101112131415161718192021222324
v-Scale Scores

Adaptive Behavior
The Adaptive Behavior Composite (ABC) provides an overall summary measure of Naya’s
adaptive functioning. Her ABC standard score is 67, with a 95% confidence interval of 64 to 70.
Communication Domain
The Communication domain measures how well Naya exchanges information with others. Her
Communication standard score is 51, with a 95% confidence interval of 41 to 56. This
corresponds to a percentile rank of <1.
Naya’s Communication domain standard score is based on her scores on three subdomains:
Receptive, Expressive, and Written. The Receptive subdomain assesses attending, understanding,
and responding appropriately to information from others. Naya’s Expressive score reflects her
use of words and sentences to express herself verbally. The Written subdomain score conveys an
individual's use of reading and writing skills.
Naya's v-scale scores are 3 for Receptive, 2 for Expressive, and 13 for Written. Pairwise
difference comparisons among these scores show that the Written score is significantly higher
than the Receptive and Expressive score.
Daily Living Skills Domain

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The Daily Living Skills domain assesses Naya’s performance of the practical, everyday tasks of
living that are appropriate for her age. Her standard score for Daily Living Skills is 76, with a
95% confidence interval of 71 to 81 and a percentile rank of 5.
Naya’s Daily Living Skills domain standard score is derived from her scores on three
subdomains: Personal, Domestic, Community. Her Personal subdomain score expresses her level
of self-sufficiency in such areas as eating, dressing, washing, hygiene, and health care. Her
Domestic score reflects the extent to which Naya performs household tasks such as cleaning up
after herself, chores, and food preparation. The Community subdomain measures an individual's
functioning in the world outside the home, including safety, using money, travel, and rights and
responsibilities.
Naya received v-scale scores of 10 for Personal, 12 for Domestic, and 10 for Community.
Pairwise difference comparisons among these scores show that the Domestic score is higher than
the Community and Personal score.
Socialization Domain
Naya 's score for the Socialization domain reflects her functioning in social situations. Her
Socialization standard score is 72, with a 95% confidence interval of 68 to 76. The percentile
rank is 3.
Naya’s Socialization domain standard score is based on her scores on three subdomains:
Interpersonal Relationships, Play and Leisure, and Coping Skills. Interpersonal Relationships
assesses how an individual responds and relates to others, including friendships, caring, social
appropriateness, and conversation. Naya’s Play and Leisure score reflects how she engages in
play and fun activities with others. Her Coping Skills score conveys how well she demonstrates
behavioural and emotional control in different situations involving others.
Naya’s v-scale scores are 9 for Interpersonal Relationships, 9 for Play and Leisure, and 11 for
Coping Skills. Pairwise difference comparisons among these scores show that the Coping Skills
score is higher than the Interpersonal Relationships and Play and Leisure score.
Domain-Level Strengths/Weaknesses
Naya's three domain standard scores were compared to her mean domain standard score of 71 to
determine possible areas of strength and weakness. The results show that Motor Skills is a
relative strength for Naya, and that Communication and Socialization is a relative weakness.

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Maladaptive Behavior
The Maladaptive Behavior domain provides a brief assessment of problem behaviors. The
domain includes brief scales measuring Internalizing (i.e., emotional) and Externalizing (i.e.,
acting-out) problems. These scales are reported using v-scale scores, which are scaled to a
mean of 15 and standard deviation of 3. Higher Internalizing and Externalizing v-scale scores
indicate more problem behavior. Scores of 1 to 17 may be considered Average, 18 to 20
Elevated, and 21 to 24 Clinically Significant.
Naya received v-scale scores of 15 for Internalizing and 11 for Externalizing which indicates the
scores are Average.
The Maladaptive Behavior domain also includes a set of Critical Items covering more severe
maladaptive behaviors. The Critical Items for which Naya received a score of 2 (Often) or 1
(Sometimes) on 2 of the 20 items.

SUMMARY
On the Pediatric Symptom Checklist-17, Naya’s cognitive, emotional, and behavioural
functioning is within the normal range.
On the ASIEP-3, Naya’s behaviors were consistent with features of Autism and indicated that it
was Very Likely.
On the Gilliam Autism Rating scale Naya scored 78, with the probability of ASD being Very
Likely with a DSM-5 Severity Level for ASD of Level 2 – Requiring Substantial Support.
On the ADHD Rating Scale IV – Preschool Version (ARS IV – Preschool Version) Naya’s
behaviors were inconsistent with symptoms of ADHD.
Lastly, on Vineland 3 Comprehensive Parent/Caregiver form, Naya portrayed relative strengths
in Motor Skills, relative weakness in Communication and Socialization domains.

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M. Nalahiya Manzil, 8th Floor, Fareedhee Magu
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DIAGNOSIS
Based on the assessments conducted on Naya along with the diagnosis intake information
collected from her parents, the possible diagnoses could be 299.00 (F84.0) Mild Autism
Spectrum Disorder, with accompanying language impairment, requiring substantial
support for deficits in social communication and restricted, repetitive behaviors.

It is highly recommended that Naya receives speech therapy as it will help her to communicate,
help her academically in being able to listen and understand her lessons, play and relate to others
and also help her to regulate her own emotions.

RECOMMENDATIONS
1. Psycho-educate the parents on the nature of Naya’s problems.
2. Inform her school about Naya’s challenges.
3. Let Naya know what will happen next in situations. Such as, “After you finish your
homework, it is time to have dinner”.
4. Give Naya choices on things. Such as, “Would you like to eat bread and Nutella or an
omelet for breakfast?”
5. Plan a schedule for Naya’s day so she knows how her day will go.
6. Distract and redirect problematic behavior instead of saying “stop” or “no.”
7. If Naya seems over stimulated from sensory input, such as in a large crowd, bring her to a
quieter place to de-stress.
8. Preferential seating (front of class, near teacher, away from distractions).
9. Repeat and simplify directions: Oral directions simple and clear, give examples,
periodically ask Naya to repeat instructions, demonstrate how to approach tasks.
10. Give regular breaks while studying.
11. Positive reinforcement: Positive verbal or written feedback, reward systems and
incentives, specify tangible goals and reinforce with incentives.
12. Teach self-monitoring strategies.
13. Firm, consistent, predictable limits, rules and consequences.

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14. Consistent bedtimes, scheduled mealtimes, structured quiet time for homework & support
for academic related work.
15. Promote independence and self-help skills.
16. Allocate downtime and playtime for Naya to pursue and explore her own interests and
hobbies.

Assessed and report written by: Checked by:

Rishfa Abdul Sattar

Fathimath Maeesha
Licensed Provisional Psychologist
Licensed Psychologist
M. Clin Psych
MSc. Applied Psych (Clinical)

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