Jake is a 3-year, 4-month-aid male referred for an evaluation by his parents at the suggestion of the family physician. The primary concern is Jake's lack of talking. The parents questioned the possibility of Autism Spectrum Disorder. This evaluation was conducted at the Regional Child Development Clinics office with his mother present.
Jake was born a full term baby although there were a few complications at his birth (e.g, difficult birth, cord around neck). He has generally been healthy since then. Jake's communication skills (e.g., cooing) was described as developing normally until approximately 6 to 8 months of age. At that time, he simply stopped with his progression in the communication area. He still does not say any words or word approximations. He responds to very few verbal instructions. While his motor skills are generally appropriate for his age, he will not walk up or down stairs. Such a behavior appears to be more of a behavioral concern (e.g., fear or sensory integration difficulty) than a motor delay.
Based on my observations, parent report, and the results of the rating scales, Jake meets all criteria for classification as having an Autistic Disorder.
The following recommendations are made:
1) Local public school personnel should be notified and given a copy of this report right away. (The special education director's name and phone number were given to Ms. Case.) Jake will qualify for preschool and additional services (e.g., speech-language therapy) through the school system. School personnel need to be made aware of Jake's needs so they can plan for his educational services starting in August. Enrollment in the school's preschool is strongly encouraged to help Jake develop communication and socialization skills.
2) Jake's communication skills are severely delayed. Enhancing his communication skills will be the key to general developmental improvement. His parents are encouraged to obtain private speech-language therapy services for Jake right away (i.e., not wait for the school to start providing such services) and even keep such services going on top of whatever is provided by the school.
3) Therapy services from an Applied Behavior Analyst are encouraged as well. Applied Behavior Analysis (ABA) methods are research-based methods that have been demonstrated to be effective for young children with autism. In particular, "Verbal ABA methods will be very helpful to improve Jake's communication skills. Such methods focus on getting Jake to verbalize and sign (use sign language) "mends" first as a way to get him to talk. Mande are requests (think of "demands") for things he wants. He is much more likely to start using mends because he will be reinforced with whatever he wants. (There is little to no motivation for him to label objects or receptively point at things at this point in time.) Verbal behavior techniques encourage more language development. Challenging behaviors (e.g., his hair pulling) is likely to increase if such techniques are not implemented correctly, which is why an Applied Behavior Analyst is recommended.
4) Because Jake is showing a number of sensory sensitivities, an evaluation by an Occupational Therapist familiar with young children and sensory sensitivities is recommended. The school system may be able to provide such an evaluation.
A follow-up interview with the family confirmed that intervention services have been initiated and Jake is making progress.