Developmental assessment Social Autism 1. friends of his age 2. reciprocal play (interactive)/ parallel 3. imaginative play 4.

fascination with certain objects/ things 5. aversion to certain noises/ things (flushing) 6. object labeling (what does the cat do?) 7. stereotypical, repetitive action (hand flapping) 8. rigidity/ routine 9. eye contact 10. joint references/ gaze (look) Assessment Observe - fascination on certain objects/ circumscribed interest - stereotypical movement - unimaginative play Interact - eye contact (poor/ variable) - interaction unreciprocal - What is your name? - How old are you? - Are you a boy? - Where is mummy? Brick building - can you build me a tower of bricks? - what colour is this? - Can you give one to mummy? (simple command) - Can you put one under the table? (preposition) Imaginary play (spontaneous/ taught) - teapot party - figurine Reading - what is this? - Where is the duck? - What does it do? (object labeling) Gaze - joint references - Look - Where is the light

Point to body part - where is your eyes, nose, ears, mouth, hand Impairment social interaction Impairment communication Stereotypical behaviour Autistic spectrum disorder If speech is normal, consider asperger Might underestimate developmental milestone in autistic as not cooperative Poor eye contact Do not initiate communication Single words Pointing to objects Persistence echolalia

The CHAT
To be used by GPs or Health Visitors during the 18 month developmental check­up.  Section A: Ask Parent:  1. Does your child enjoy being swung, bounced on your knee, etc?  2. Does your child take an interest in other children?  3. Does your child like climbing on things, such as up stairs?  4. Does your child enjoy playing peek­a­boo/hide­and­seek?  5. Does your child ever PRETEND, e.g, to make a cup of tea using a toy cup and teapot, or pretend other things?  6. Does your child ever use his/her index finger to point, to ASK for something?  7. Does your child ever use his/her index finger to point, to indicate INTEREST in something?  8. Can your child play properly with small toys (eg cars or bricks) without just mouthing, fiddling or dropping them?  9. Does your child ever bring objects over to you (parent) to SHOW you something?  Section B: GP or HV Observation:  i. During the appointment, has the child made eye contact with you?  ii. Get child's attention, then point across the room at an interesting object and say 'Oh look! There's a (name of  toy!)' Watch child's face. Does the child look across to see what you are pointing at?  iii. Get the child's attention, then give child a miniature toy cup and teapot and say 'Can you make a cup of tea? '  Does the child pretend to pour out tea, drink it, etc.?  iv. Say to the child 'Where's the light?', or 'Show me the light'. Does the child point index finger at the light?  v. Can the child build a tower of bricks? (If so how many?) (Number of bricks:.............) 

Management 1. communication therapy 2. speech and language therapy 3. behavioural a. occupation therapy b. psychologist (structured teaching) 4. education placement (supported)

Speech 1. receptive 2. expressive Delayed speech 1. isolated speech delay 2. global developmental delay 3. hearing impairment 4. autism spectrum Assessment of speech 1. fine motor 2. receptive/ expressive speech 3. play Fine motor Receptive/ expressive Building blocks Name/ sex/ age Color/ objects/ body part Tell story from book Sing Follow simple command Follow command with preposition Articulation problem Qualitative impairment in communication Discrepancy btw receptive and expressive speech May have been taught (not spontaneously acquired) Lack of symbolic play Global developmetal delay Hearing problem (need assessment)

Play

Teapot party figurine

Autistic spectrum Isolated speech delay

Hello, how are you Offer object (puzzle) Look at this Lets try to do this If able to put in (visual-perception) What is this shape (recognize colors and shape consistently 4 years) Where is the circle (show) Give me the circle Put it in now

Offer doll house Where is the window Is this the door Play to sex of child Girl Cooking What are you cooking Is it hot/ready Are you hungry Is it for me (listen for echolalia) Dolls Lets put the doll to bed Boy cooking

Figurine/ cars Roll the car to me (watch whether look at car or me)

Well thriving girl. Clinging to mother She is shy in participation and engagement with me However on language assessment She has a few single words vocabulary up to 20-30 words Forming short phrases She is able to name colors But unable to name shapes But she is able to identify shapes She is also observe to communicate with mother With a minimal of 4 words In terms of language, I would put her Receptive language at 4 years old Expressive language at 3-3 ½ years old 18 months 2 years 3 words (use functionally) Besides specific papa/ mama 20-30 single words Phrase of at least 2 words Mama, come Mama, see (but not come here, thank you which is learned as one word) 3 words sentence including a verb I want to go out (I want is learned as one word) To and fro conversation What do you do in school Alphabet / number concept

2 ½ -3 years 4 years 5 years

Motor Gross motor Lie down Pull to sit - good neck control - poor truncal tone - sit with support with rounded back Pull to stand - bear weight Ventral suspension Put prone - lift chest off couch on elbow (5 month) - lift chest off couch with elbow straight (6 month) Turning Crawling/ creeping Cruising along table edge (with toy on other end) Independent steps - tip toe (tight Achilles tendon/ use of walker; able to put feet down) Pull toys - walk forward - walk backward Offer ball to kick Steps to walk up (2 years) Fine motor Offer a toy (not present more than one toy) - left hand preferences - right hand fisting - reach out to grasp with index approach - no transfer Entice with another block to right hand (leaving block in left hand) Look for mouthing (5-9 months) Look for banging (8 months) Offer small objects (use bright object as might have problem with visual) Object permenance Find hidden object Reach Poke

Index approach Immature pincer Matured pincer Drop into bottle (12-13 months) Crayon to scribble Books pointing to ball /car (15 month) Stacking cubes (18 month) His best motor skill is at 10 months as he is able to stand with support However there is variable motor discrepancy as he has poor truncal tone and is unable to sit and prop up. His fine motor is more consistent with 5-6months. However he might be limited by right fisting He shows signs to point to right hemiparesis pattern However I would need to do a full neurological assessment He is a well looking child who is not dysmorphic. He is lying supine on the bed. There is no obvious facial asymmetry He is able to fix and follows my face He is also actively moving all his limbs. On gross motor examination, He has good head control on pulling to sit. He is able to sit with support with a straight back. He is also able to bear weight. On ventral suspension, he is able to hold his head above the horizontal plane. On prone position, he is able to lift his chest off the couch on elbows. He is able to turn from supine to prone and vice versa. However he has not demonstrated creeping or crawling. This puts his gross motor development at 5months On fine motor examination, His fists are unclenched and meeting in midline He is mouthing. He is able to hold the rattle momentarily placed in hands However, I am unable to get him to reach for objects. And he has not demonstrated transfer. This puts his fine motor skills at 3 months. ADHD 1. Hyperactivity 2. Impulsiveness 3. Inattention Persist in 2 skills Present < 7 years old (when first present symptoms) Cause functional difficulties

Affect functional skills 2/3 untreated cause learning disability Majority normal intelligence Main management is medication Behavioural therapy only supportive

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