KipSHeart Serene: Abu Dhabi I Dube! TAL Ain Ww ov Kicherer t cre “1 Presbyterian Kips CLINICAL NOTES tient Full Name: PRAGATH! Medical Phone No:971- Emirates 1D: 784, = SAKTHIVEL SAKTHIVEL GOVINDASAMY —No.: KAD20228 803146757 2020-4875735-9 Leah sie ‘Age & Sex:4 FEMALE Weight: 1535 Guastaaubuagi —Natlonalty: Inia tient Type: Insurance Company: Policy No: Policy Type: Card Wo: Date: 21-02-2024 CC: Delayed speech Referred by: Dr Emad Provious assessment: no ‘Age: 3 years 7 months (Gender: fomale Her: years 7 months female child brought by her parents as she falls in Kindergarten admission interview because of delayed speech rot answering simple questions moving around almlessly minimal eye contact she was enrolled in a nursery since 8 months ‘observations about echolalia participates in physical activities with other children but not in interactive play not yet tolle trained inconsistent response on calling her by name points and pulling the adult hand to reach the distal objects auditory sensitivity to ‘mixer and steam cocker inflexible adherence to particular toys. tactile issues has pretend play likes to play with water for ‘extended time no Tip toes walking no repetitive actions tantrums for no apparent reasons occasional spinning movements ‘selective in eating sleeping well can not talks in a conversation using back and forth exchanges can not asks who where or why ‘questions can not says first name when asked avoids touching hot objects Born by Cesarean section with birth weight of 21 kg antenatal type 1 diabetes mellitus on medications neonatal was uneventful ‘sat at 6 months crawl at 8 months walk at 12 months says baba mama at 10-12 months she is the 2" child parents are non consanguineous history of delayed speech her sibling + Duration: 4 months + Severity: moderate + Associated symptoms: hyperactivity, + Family language at home: English Pragathi arrived to the assessment room accompanied by hor parents she appeared to be well-groomed and dressed appropriately for her age and for the woather. Pragathi also appeared o be average in height and weight for her stated ag‘Administration of ADOS 2 MODULE 4 started which is a semi structured standardized assessment tool of communication, social interaction, play(or imaginative use of materials) and restricted and repetitive behaviors through presentation of various activities that elicit Behaviors which will be observed, coded and scored leading to diagnosis of Autism Spectrum Disorder for children above 21 months of age who do not consistently use phrase speech the assessment done in the presence of Pragathi parents and .the focus on social responses not on social initiations by the child like a shift in gaze, facial expressions or vocalizations LANGUAGE AND COMMUNICATION Pragathi was observed to have only few single words she can not point tothe distal objects. She can not use communicative Teaching gestures. She can not use emotional gestures even on prompting during balloon and bubbles activities RECIPROCAL SOCIAL INTERACTION AND PLAY Pragathi facial expressions toward the examiner and parents are appropriate and not directed to another person for the purpose of communicating enjoyment or frustration ‘she has fleeting gaze with the examiner. Pragathi is sharing enjoyment during physical activities. She is not seeking for Itvolvement of the examiner to play with her and when the examiner initiate she will not respond. She is occasionally showing ‘objects to the examiner and parents ‘STEREOTYPE BEHAVIOUR AND RESTRICTED INTERESTS, No odd intonation of vocalizations ‘No unusual sensory interest in play materlal/person No hand oF finger movementiposturing Repetitive and stereotyped behaviors during the assessment Came today for follow up assessment results and recommendations, RESULTS OF ADOS-2 MODULE 1 ALGORITHM FEW TO NO WORDS SOCIAL AFFECT (SA) COMMUNICATION Frequency of Spontaneous Vocalization Directed to Others 2 Gestures 2 RECIPROCAL SOCIAL INTERACTION Unusual Eye Contact ° clal Expressions Directed to Others 1 integration of Gaze and Other Behaviors During Social Overtures 4 -Shared Enjoyment in Interaction ° showing 1 Spontaneous Initiation of Joint Attention 2 -Response to Joint Attention 1 -Qualty of Social Overtures 1 SATOTAL 4 RESTRICTED AND REPETITIVE BEHAVIOUR (RRB)Intonation of Vocalizations or Verbalizations ° Unusual Sensory Interest in Play MateriaiPerson ° -Hand and Finger and Other Complex Mannerisms ° Unusually Repetitive Interests or Stereotyped Behaviors 1 RRB TOTAL 1 OVERALL TOTAL " CONVERTING THE OVERALL TOTAL TO THE ADOS-2 CLASSIFICATION AND ADOS-2 COMPARISON SCORE ‘ADOS-2 COMPARISON SCORE IS 4 (LOW LEVEL OF AUTISM RELATED SYMPTOMS) ‘ADOS-2 CLASSIFICATION AUTISM SPECTRUM (OVERALL TOTAL IS EQUAL TO OR GREATER THAN THE AUTISM SPECYTUM. CUTOFF BUT LESS THAN THE AUTISM CUTOFF )11-15 for few to no words algorithm OVERALL DIAGNOSIS Pervasive Developmental Disorder Continuing assessment by CARS2-STitis an observational standardized tool which covers 15 areas of behavior defined by a tunique rating system developed to assist in identifying individuals with Autism spectrum disorder and distinguishing them from individuals with other diagnoses CARS 2 ST ratings are made based not only on the frequency of behaviors but also on their intensity, peculiarity and duration RESULTS OF CARS-2.ST TOTALRAWSCORE 31.5, T-SCORE 2 PERCENTILE a ‘SEVERITY GROUP ‘Mild-To Moderate symptoms OF Autism spectrum disorder ‘Administration of PEP=R (Psycho-Educationa-Profle-Revised) provides information on developmental functioning in Imitation | Perception P Fine Motor FM Gross Motor GM EyetHand EH Cognitive Performance CP ev ‘Aso identities degrees of behavioral abnormality in Relating and Affect R Play and Interest in Material M Sensory Responses s Language LThe assessment consists of a set of toys and materials that are prosentod to the child within a structured play activities. The examiner observes evaluate and records the child responses during the assessment and the scores are distributed among the seven developmental and four behavioral areas. Besides the passing and falling scores the PEP-R provides a third score called Emerging that indicates some knowledge of what Is. required to complete a task but not the full understanding or skill necessary to do so successively Developmental score 53 Developmental age 22 month Vanderbilt Assessment Seale ‘Scored 7 out of 9 in attention symptoms Scored 7 out of 9 in hyperactivity symptoms Scored 7 out of 8 in performance scale Met the DSM.V criteria for Attention Deficit Hyperactivity Disorder combined type ‘Average performance score is 4.6 ASSESSMENT SESSION SESSION START TIME: 1001 HRS SESSION END TIME: 1101 HRS TIME CONSUMED: 60 MINUTES Impression: Developmental Disorder of Speech and Language Attention Deficit Hyperactivity Disorder combined type Pervasive Developmental Disorder PLAN: -agathi wil benefit rom ABA sessions 5 per week 2-Pragathi wil benefit from speech therapy sessions 3 per week focusing on receptive expressive and play skils 3-Pragathi will benefit from occupational therapy sessions 3 per wesk focusing on fine motor and eye hand coordination skils 4-Pragth will boneft from continuing enrollment in a mainstream nursery full day for § days a week 5-Pragathi will benefit from social ski {raining programs organized in nursery with her peors6- Family counselling 7 -Follow up after 6 months Pragathi needs support atthe nursery 4-Breaking skills down into smaller t ichable components 2.Visual schedules, modelling ,scripts social stories 3-Peer-tutoring 44 to 1 instructions to target specific skills, 2022024 1106 tn ‘This Document is Electronically signed by Dr, MOHAMED ELSAYED MOHAMED MASSRY SHARAN Genaral Pediatric License G08518 ids Hear Me ar, Po Box! 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