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Bio Data:

Name A.A.

Sex Female

D.O.B: 17th May , 2019

Age 5years 4months

Number of Siblings 2

Birth Order 1st

Examining Psychologist Z.S

Date of Assessment 7th November, 2023

Informant Mother

Purpose of Evaluation

N/A

Presenting Complaints

N/A

Background Information

A.A. resides in an extended/joint family system, which is common in Pakistani households

(Crozier & Davies, 2006). The household includes her grandparents, parents, and a younger

brother, all of whom are in good physical health. Her father, H.A., is a businessman, and her

mother, G.H., practices as a gynaecologist at Mayo Hospital in Lahore. According to the client,

she maintains healthy relationships with all family members, and they share a strong bond. I.A.'s

younger brother, I.A., attends an English-medium school and is currently in the 1st grade.
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The client was born through normal delivery, and no history of prenatal or postnatal

complications has been reported. Her physical health has been appropriate since birth, with no

history of trauma. She has achieved all developmental milestones at the appropriate ages

(Okunev, 2022). According to the client, her parents have been very loving. Being the first-born

child in the family, she has received extra care and attention. The client also mentioned her love

for reading storybooks.

The client started school at the age of three and a half years. Currently, She’s in 1 st grade. She

has been a brilliant student, consistently ranking first in her class. Her attitude towards her

studies is serious and dedicated. She attends an English medium school. The client's family

practices Islam and integrates Islamic values into their children's upbringing. She has learned the

recitation of the Quran and is familiar with all fundamental beliefs and practices. The client has a

strong bond with her teacher’s due to her obedience and intelligence. According to the client, she

is very conscious of her behaviour and her grades in class. She maintains friendly relationships

with her peers, and there have been no reported incidents of disputes. The client’s family resides

in an urban setting in Lahore, where they speak Punjabi and Urdu as their native languages but

are also fluent in English. The family's socioeconomic status is upper-middle-class. The financial

stability enables access to all the necessities and educational opportunities. Moreover, No history

of past medical or psychiatric illness was reported.

Behavioral Observations

A.A. was a healthy, pleasant, energetic, and compliant child with an average build. She was

adequately dressed and groomed. During the session, she maintained age-appropriate eye contact

(Shen et al., 2022), and establishing rapport with her was quick. She sat attentively, followed
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instructions, and responded appropriately before, during, and after the session. However, at

times, the psychologist had to repeat instructions.

It was evident that A.A. had no difficulty staying attentive; her attention span was consistent

with her age (Christopher, 2012). Throughout the session, she remained calm and patient,

refraining from interrupting or cutting off the conversation. It was also observed that A.A.

became tired during the evaluation, as her mother mentioned she did not get enough sleep.

Her speech, articulation, vocabulary, and sentence formulation were age-appropriate. The

evaluation results are believed to provide a fair representation of her current functioning. In other

words, the test results align with other information obtained or observed, and there are no

discrepancies between the child’s and parents' reports.

Procedures Used

Assessment was carried out with

1. Childhood Autism Rating Scale (CARS)

1. Childhood Autism Rating Scale (CARS)

The Childhood Autism Rating Scale (CARS) helps to identify children (2 years and older with

Autism, specifically, distinguishing them from developmentally handicapped children who are

not Autistic (Rellini, 2004) . In addition, it distinguishes between mild-to-moderate and severe

Autism. Its brevity makes it a very useful tool to help you recognize and classify Autistic

children. The simplicity of administration and scoring enhances its utility in diverse settings,

contributing to its widespread use in both clinical and research contexts. The scale has

demonstrated reliability and validity, providing a valuable means of recognizing and categorizing

individuals on the Autism Spectrum (Stevanovic,2021)

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Summary of Category Scores

The following table summarizes the category scores and gives general data about how ABC

compares to the group norms.

S.No. Categories Raw Behavior description

Score

1 Relating to people 1 Normal, age-appropriate level of

relating to people

2 Imitation 1 Normal, age-appropriate

3 Emotional Response 1 Normal, age-appropriate emotional

response

4 Body Use 1 Normal, age-appropriate body use

5 Object Use 1 Normal, age-appropriate object use

6 Adaptation to Change 1 Normal, age-appropriate level of

adaptation to change

7 Visual response 1 Normal, age-appropriate visual

response

8 Listening Response 2 Mildly abnormal Listening

Response; some lack of response to

name or instructions. Also,

distractibility was evident.

9 Taste, Smell and Touch Response Use 1 Normal, age-appropriate use of, and

response to Taste, Smell and Touch

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10 Fear or Nervousness 1.5 It lay between normal and mildly

abnormal because the child shows too

much nervousness at times. It was

also evident during the session.

11 Verbal Communication 1 Normal, age-appropriate verbal

response

12 Nonverbal communication 1 Normal, age-appropriate nonverbal

response

13 Activity Level 1 Normal, age-appropriate activity

level

14 Level and Consistency of Intellectual 1 Normal, age-appropriate level and

Response consistency of intellectual response.

15 General Impressions 1 No Autism

Interpretation

A.A obtained a total raw score of 16.5 on CARS which is indicative of No Autism .However, it

was imperative to note important observations in the categories of "Listening Response" and

"Fear or Nervousness." A comprehensive understanding of A.A.'s behavior required careful

consideration of both the strengths and potential challenges identified through the CARS

assessment.

Recommendations for (ABC, Atypical child ) who’s observered and reported with:
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- Moderately abnormal verbal communication (Score:3)

- Mildly abnormal relationships (Score:2)

- Moderately abnormal imitation (score :3)

- Mildly abnormal listening response (Score :2)

- Severely abnormal fear or nervousness (Score :4)

Recommendations for Parents:

- Speech and Language Therapy: Given the speech and communication difficulties,

contemplate enrolling ABC in speech and language therapy sessions. Consistency is

crucial for reinforcing skills and building communication abilities over time.

- Incorporate Speech Activities at Home: Work with the speech-language pathologist to

incorporate speech and language activities into daily routines at home. Consistent

practice in familiar settings can reinforce learning.

- Workshops and educating the parents: Websites: “www.autismspeaks.org” and books:

“Helping Your Child with Autism Spectrum Disorder” (Lockshin, Gillis, & Romanczyk,

2005) would educate the parents regarding the condition, behavior and symptoms of the

child.

- Promote Social Interaction: Encourage social interactions with peers and family

members. Social engagement provides opportunities for the child to practice

communication skills in different contexts (Carter et al., 2014)

- Strategies to increase imitation: Use response prompting (Rogers, Dawson & Vismara,

2012), patience and positive reinforcers (Losh , 2022).

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- Use Visual and Auditory Cues Together to increase the listening response: Combine

visual and auditory cues when giving instructions (Barzy, 2020). For example, say the

instruction aloud while also showing a corresponding picture.

- Consider Sensory Needs: Be mindful of your child's sensory preferences and sensitivities.

Understand how sensory factors may impact their ability to listen and tailor the

environment accordingly (Jones, Hanley, & Riby, 2020).

- Use Technology:Explore educational apps or assistive technology that supports listening

and communication skills. Some apps are specifically designed for children with autism

to enhance communication and learning.

- Establish Predictable Routines: Create and maintain consistent daily routines.

Predictability can help reduce anxiety by providing a structured environment that is easier

for the child to navigate (Goris,2020)

- Use Visual Supports: Visual supports, such as visual schedules, social stories, or visual

cues, can help autistic children understand and prepare for upcoming events or changes,

reducing anxiety (Arthur-Kelly,2009).

- Identify Triggers: Understand and identify specific triggers that may cause fear or

nervousness. This could be related to sensory sensitivities, social situations, or changes in

the environment. Once identified, work on minimizing or accommodating these triggers.

- Provide a Safe Space: Create a designated safe space where your child can retreat if they

feel overwhelmed. This could be a quiet room with sensory-friendly items where they can

self-regulate.

- Involve the Child in Decision-Making: Whenever possible, involve your child in

decision-making processes. Allowing them to have some control over their environment
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or activities can empower them and reduce anxiety.

- Regular Follow-ups: Maintain regular follow-ups with the school administration,

teachers, and the child’s therapist to monitor ABC's progress.

Recommendations for Teachers and School Administration:

- Individualized Education Plan (IEP): Please incorporate an individualized education plan

tailored to ABC’s specific needs.

- Classroom Accommodations: To support her attention and behaviour, consider

implementing classroom accommodations, such as shorter assignments or providing

frequent breaks.

- Promote Positive Peer Interactions: Foster positive peer interactions by creating social

opportunities during group activities.

- Professional Development: Consider organizing workshops or training sessions for

teachers and staff to enhance their knowledge and skills in supporting students with

autism spectrum disorder (Carter et al., 2014).

- Supportive Environment: Ensure that the school environment is sensory-friendly,

considering factors such as lighting, noise levels, and seating arrangements. Create spaces

where students, including ABC, can self-regulate when needed.

- Provide Professional Support: Consider offering additional professional support, such as

hiring support staff or aides, to assist in implementing strategies outlined in ABC's

support plan.
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- Facilitate Peer Understanding: Promote understanding and inclusion among ABC's peers.

Consider organizing awareness sessions or activities that help classmates better

understand and support ABC within the school community.

- Communication with Parents: If ABC is receiving help from speech therapy or a child

psychologist, please maintain regular communication with her parents to ensure

continuity of care and support.

References:
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Arthur-Kelly, M., Sigafoos, J., Green, V., Mathisen, B., & Arthur-Kelly, R. (2009). Issues in the use of

visual supports to promote communication in individuals with autism spectrum

disorder. Disability and rehabilitation, 31(18), 1474-1486.

Barzy, M., Black, J., Williams, D., & Ferguson, H. J. (2020). Autistic adults anticipate and integrate

meaning based on the speaker’s voice: Evidence from eye-tracking and event-related

potentials. Journal of Experimental Psychology: General, 149(6), 1097.

Carter, E. W., Common, E. A., Sreckovic, M. A., Huber, H. B., Bottema-Beutel, K., Gustafson, J. R., ...

& Hume, K. (2014). Promoting social competence and peer relationships for adolescents with

autism spectrum disorders. Remedial and Special Education, 35(2), 91-101.

Christopher, M. E., Miyake, A., Keenan, J. M., Pennington, B., DeFries, J. C., Wadsworth, S. J., ... &

Olson, R. K. (2012). Predicting word reading and comprehension with executive function and

speed measures across development: a latent variable analysis. Journal of Experimental

Psychology: General, 141(3), 470.

Crozier, G., & Davies, J. (2006). Family matters: a discussion of the Bangladeshi and Pakistani extended

family and community in supporting the children's education. The Sociological Review, 54(4),

678-695.

Goris, J., Brass, M., Cambier, C., Delplanque, J., Wiersema, J. R., & Braem, S. (2020). The relation

between preference for predictability and autistic traits. Autism Research, 13(7), 1144-1154.
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Jones, E. K., Hanley, M., & Riby, D. M. (2020). Distraction, distress and diversity: Exploring the impact

of sensory processing differences on learning and school life for pupils with autism spectrum

disorders. Research in autism spectrum disorders, 72, 101515.

Lockshin, S. B., Gillis, J. M., & Romanczyk, R. G. (2005). Helping your child with autism spectrum

disorder: A step by step workbook for families. Oakland, CA: New Harbinger.

Losh, A. E. (2022). The Impact of Positive, Supportive Classroom Environments for Young Autistic

Children: Positive Reinforcement and Student-Teacher Relationships (Doctoral dissertation,

University of California, Riverside).

Okunev, R. (2022). CDC and Medline Milestones and APA Factsheets Guidelines. In the Psychology of

Evolving Technology: How Social Media, Influencer Culture and New Technologies are

Altering Society (pp. 57-91). Berkeley, CA: Apress.

Rellini, E., Tortolani, D., Trillo, S., Carbone, S., & Montecchi, F. (2004). Childhood Autism Rating

Scale (CARS) and Autism Behavior Checklist (ABC) correspondence and conflicts with DSM-

IV criteria in diagnosis of autism. Journal of autism and developmental disorders, 34, 703-708.

Rogers, S. J., Dawson, G., & Vismara, L. A. (2012). An early start for your child with autism: Using

everyday activities to help kids connect.

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Shen, M. D., Swanson, M. R., Wolff, J. J., Elison, J. T., Girault, J. B., Kim, S. H., ... & IBIS Network.

(2022). Subcortical brain development in autism and fragile X syndrome: evidence for dynamic,

age-and disorder-specific trajectories in infancy. American Journal of Psychiatry, 179(8), 562-

572.

Stevanovic, Dejan, Floriana Costanzo, Elisa Fucà, Giovanni Valeri, Stefano Vicari, Diana L. Robins,

Maureen Samms‐Vaughan et al. "Measurement invariance of the Childhood Autism Rating Scale

(CARS) across six countries." Autism Research 14, no. 12 (2021): 2544-2554.