Stand 10.11.09 Veröffentlicht Soziale Psychiatrie 1/10 Asmus Finzen Neuroleptika für Kinder? Ein Lehrstück Vorbemerkung Im Memorandum der Deutschen Gesel schaft für Psychiatrie zur Anwendung von Antipsychotika vom September 2009 heißt es im Abschnitt »Psychopharmaka bei »Die Verordnung von Antipsychotika bei Kindern und Jugendlichen steigt in Deutschland und in anderen we
Microsoft word - sc_zd_final.docxCONFIDENTIAL: PSYCHOEDUCATIONAL EVALUATION
City Community Schools
Name: Sam *
Date(s) of Evaluation: 11/18/2010
Date of Birth:
Age: 2 years, 10 months
Parent: Mrs. Mother
Examiner: Sarah Connolly, M.A.
Supervisor: Dr. Psychologist, Ph.D.
* Name and other information have been changed to protect the identity of the student.
REASON FOR REFERRAL
Sam was referred for a psychoeducational re-evaluation to determine eligibility for special
Social and Developmental History
Systematic Behavioral Observation
Learning Accomplishment Profile (LAP)
Vineland Adaptive Behavior Scales—2nd Edition, Parent Interview and Teacher Rating Scale
Sam is a 2 year, 10 month old Caucasian male who resides with his mother, Mrs. Mother, in
City, State. Mrs. Mother reported that Sam has diagnoses of Down Syndrome and autism, and
stated that “the autism effects are not as prominent as the Down Syndrome in his current
abilities.” He was reportedly diagnosed with autism by Dr. Physician in August 2009. Mrs.
Mother also reported that Sam has spina bifida occulta at the third and fourth lumbar vertebrae
and that his second and third vertebrae are fused. Mrs. Mother reported that Sam exhibits severe
hypotonia and torticollis. She also indicated that he is lactose intolerant and is currently not
eating most solid foods. Mrs. Mother reported that Sam has sleep difficulties. He is reportedly
taking the following medications: Synthroid .25 mg for hypothyroidism, Melatonin 6 mg for
sleep difficulties, Zytrec 1 tsp for allergies, and Miralax 8.5 mg for constipation.
Mrs. Mother reported Sam was able to sit alone at 16 months of age and was able to crawl at 18
months of age. Mrs. Mother indicated that Sam spoke his first words at 12 months of age and
began talking in 2-3 word sentences at age 32 months. Mrs. Mother stated that Sam is currently
saying 3-5 words consistently, and he is able to “imitate sound play back and forth.” At the time
of the evaluation, she reported that Sam was not able to walk independently and was not toilet
Regarding Sam’s social development, Mrs. Mother reported, “Sam loves to watch and be around
other children.” She indicated that Sam initiates eye contact and attempts to gain adult attention.
She reported that Sam reacts sympathetically to others’ crying. Mrs. Mother indicated that Sam
has difficulty in noisy social situations and that he becomes easily over-stimulated. Mrs. Mother
stated that Sam repeats the sound “eee-eee-eee” when he is “going to have a melt-down.” When
asked if Sam exhibits atypical or unusual behavior, Mrs. Mother indicated that Sam engages in
self-stimulating behavior, such as hand-flapping, humming to himself, and twirling objects.
A progress report from First Steps (dated 12/31/09) summarized Sam’s progress in the areas of
physical, cognitive, adaptive, and social development as measured by the Assessment,
Evaluation, and Programming System for Infants and Children (AEPS). At the time of the First
Steps evaluation, Sam was reported to perform two standard deviations below average for
children his age in all assessed areas. Sam’s fine motor skills (Fine Motor Raw Score = 9),
demonstrated that he was able to grasp pea-sized objects with his finger and thumb, though he
was unable to assemble toys that required putting pieces together. Sam’s gross motor score
(Gross Motor Raw Score = 5), reflected his ability to roll by turning segmentally from stomach
to back and from back to stomach; however, he was unable to creep forward using alternating
arm and leg movements. His adaptive skills (Adaptive Raw Score = 5) included the ability to use
his tongue and lips to take in and swallow solid foods and liquids, though he was unable to
successfully bite and chew hard and chewy foods. Sam’s cognitive skills assessment (Cognitive
Raw Score = 9) indicated that Sam was able to reproduce and continue part of an interactive
game (e.g., peek-a-boo), though he was unable to imitate a motor action that is not commonly
used. His social communication skills (Social Communication Raw Score = 6) reflected an
ability to engage in vocal exchanges by babbling; he did not demonstrate consistent word
approximations. Finally, Sam’s social score (Social Raw Score = 5) indicated that Sam was able
to initiate and maintain interaction with familiar adults but was unable to participate in
established social routines.
When asked about Sam’s strengths, Mrs. Mother reported that Sam is attentive, persistent, sweet,
and caring. She stated that Sam demonstrates strengths in problem solving skills and is willing to
do activities over and over until he has learned them. Mrs. Mother expressed concern that Sam is
behind in the areas of physical and cognitive development and indicated specific difficulties with
sleeping, feeding, and sensitivity to textures and noise.
Sam was systematically observed in two settings. Behavior was continuously coded for three
consecutive 15-second intervals and then noting comments for the 4th interval of each minute.
During the first observation, this resulted in 60 coded intervals during a 20-minute observation,
which occurred during a semi-structured activity in the speech room. Sam was observed sitting
on his mother’s lap, interacting with the speech teacher and his mother, and looking at a book.
Sam made vocalizations during 27 (45%) of the total intervals, and was quiet during 33 of the
total intervals. During the observation, Sam looked at and attended to a book. At times, Sam was
able to briefly interact with the speech teacher by making eye contact and playing peek-a-boo. A
frequency count was also maintained of the number of demands placed on Sam and the number
of times he responded appropriately. In total, eight demands (e.g, “Look at the book,” or “Point
to the bear”) were placed during the 20-minute observation, and Sam responded appropriately
50% of the time. Throughout the first observation period, Sam clung to his mother, began to cry,
and appeared reluctant to engage with the examiners.
The second observation consisted of 51-coded intervals during a 17-minute observation, which
occurred during an unstructured activity in a secluded area of the special education preschool
classroom. During this observation period, the special education teacher presented Sam with
sensory toys (e.g., beads, balls, and squishy toys). Sam sat independently on the floor and
eventually gestured and vocalized to his mother, indicating that he wanted to sit on her lap. Sam
made vocalizations during 21 (41%) of the intervals, and was quiet for 30 intervals. During
unstructured play activities, Sam was observed to play independently during 16 (31%) of the
total intervals, and he sat in his mother’s lap and resisted playing with toys for the remaining
69% of intervals. No demands were placed on Sam during the second observation; however, he
continued to show reluctance to interact with the examiners.
ASSESSMENT RESULTS AND IMPRESSIONS
During the current evaluation, the Learning Accomplishment Profile (LAP) was administered in
a checklist format to assess Sam’s academic abilities. Although reluctant to interact with the
examiners, Sam showed higher levels of interest when his mother presented toys and interacted
with him. Sam briefly interacted with the examiner by playing peek-a-boo or making eye-contact
when spoken to. Sam communicated with his mother by making unintelligible vocalizations and
lifting up his arms to be held when he was distressed. No intelligible speech was observed.
Throughout the testing session, Sam turned or looked away when presented with most toys.
However, when presented with sensory toys (balls, beads, or squishy toys), Sam was able to
grasp the toys with one hand, briefly hold objects using both hands, shake toys, and hand them to
his mother. Mrs. Mother stated, “at home he brings me toys all the time.” In assessing fine motor
skills, Sam was observed to remove pieces from a form board using one hand. Mrs. Mother
indicated that Sam is not yet capable of turning single pages of a book independently. Regarding
Sam’s gross motor skills, Mrs. Mother reported that Sam is not yet able to walk independently
but stated he is able to “cruise” by pulling himself to a standing position and using furniture as a
support. Mrs. Mother further reported that Sam is able to walk using a walker. Sam was able to
sit independently on the floor during testing. He briefly sat in a chair but showed preference for
sitting in his mother’s lap.
The Vineland Adaptive Behavior Scale—2nd edition (Vineland-II) is a valid and reliable rating
scale used to assess an individual’s skills in performing daily activities necessary in the home,
school, and community environments. Mrs. Mother completed a rating scale to evaluate Sam’s
present level of adaptive functioning. Average composite scores fall between 90 and 109, with
average scale scores ranging from 13-17.
Adaptive Behavior Composite
Daily Living Skills
Sam’s overall adaptive skills fell in the Low range (Adaptive Behavior Composite = 63) as rated by his mother. This indicates that Sam is likely to experience significant difficulties in daily functioning across a variety of tasks compared to his same aged peers. Mrs. Mother reported Sam’s overall communication skills as falling within the Low range (Communication Skills = 66). Mrs. Mother rated Sam’s receptive and expressive language skills to be in the Low range (Receptive = 8; Expresive = 9), suggesting that his current communication skills are below that of his age-matched peers. Mrs. Mother rated Sam’s daily living skills as falling the Moderately Low range (Daily Living Skills = 71). Specifically, Mrs. Mother rated Sam’s personal living skills to be in Low range (Personal Living Skills = 7), suggesting that Sam may experience difficulties with proper self-care (e.g., taking off clothing and feeding self). Mrs. Mother reported Sam’s domestic living skills as falling the in the Moderately Low range (Domestic Living Skills = 10), indicating that Sam is careful around dangerous household objects but has difficulty completing basic chores. Sam’s community living skills were rated by Mrs. Mother as falling in the Adequate range (Community Living Skills = 13), suggesting that Sam understands the function of a phone but has difficulty understanding rules. When rating Sam’s socialization skills, Mrs. Mother indicated that Sam’s social skills currently
fall in the Moderately Low range (Socialization = 84). Sam reportedly demonstrates mild
difficulties in interpersonal relationships (Interpersonal Relationships = 10). Specifically, Mrs.
Mother indicated that Sam shows a preference for familiar persons but demonstrates difficulty
expressing his emotions. Mrs. Mother reported Sam’s socialization skills during play and leisure
time as falling the Adequate range (Play and Leisure Time = 14), indicating that Sam is likely to
play with other children at an age-appropriate level. Sam’s reported coping skills fell in the
Moderately Low range (Coping Skills = 12), suggesting that Sam may experience mild difficulty
adapting from one activity to another.
Sam’s overall motor skills were reported by Mrs. Mother to fall in the Low range (Motor Skills =
62). Mrs. Mother rated Sam’s gross motor skills as falling in the Low range (Gross Motor = 9),
characterized by an inability to stand, walk, run, and jump independently. Sam’s fine motor skills
were also rated in the Low range (Fine Motor = 7), suggesting he is likely to demonstrate
difficulties in turning book pages, stacking objects, and opening doors.
Sam is a 2-year, 10-month old Caucasian male, currently living with his mother, Mrs. Mother, in
City, State. Sam was referred for the current evaluation to determine special education eligibility.
Sam was reported to have diagnoses of Down syndrome, autism, and spina bifida occulta. Sam
reportedly has sleep difficulties, feeding difficulties, and hearing loss. According to parent report
and a First Steps annual evaluation (12/31/09), Sam has a history of developmental delays in the
areas of cognitive, physical, and adaptive functioning, as well as speech and language delays.
Behavior observations indicated that, although Sam was reluctant to interact with unfamiliar
adults, he interacted with his mother by making unintelligible vocalizations and using expressive
gestures. He briefly attempted to interact with the examiners by making eye-contact and playing
peek-a-boo. Sam demonstrated interest in books and sensory toys and occasionally engaged in
The evaluation of present levels of academic functioning suggested that Sam resisted academic
tasks while in the presence of unfamiliar adults. Sam exhibited some pre-academic skills in the
areas of fine and gross motors skills (e.g., beating two objects together and sitting in a small
chair). Mrs. Mother reported that Sam demonstrates some pre-academic cognitive skills such as
obtaining toys that are out of his reach or handing toys to others.
A formal rating of Sam’s current adaptive functioning indicated that Sam exhibits overall
difficulty with adaptive skills as reported by his mother. Sam reportedly exhibits low adaptive
functioning in the areas of communication and motor skills. Mrs. Mother rated Sam’s
socialization skills during play and leisure time and his community living skills as falling in the
Adequate range, suggesting that Sam demonstrates personal strengths in these areas (e.g.,
playing appropriately with peers, understanding use of a phone).
RECOMMENDATIONS AND ACADEMIC/BEHAVIOR NEEDS
1. It is recommended that the case conference committee discuss the results of the present
2. Observations of Sam suggested that he attempts to communicate with his mother by making vocalizations and expressive gestures. Sam may benefit from continued pre-language skill building activities such as playing “peek-a-boo” (turn taking skills), listening to music and speech for lengthening periods of time (auditory skills), being presented with objects when spoken to (visual skills), and being encouraged to move his tongue and lips (tactile and oral motor skills). 3. Because children with Down syndrome typically demonstrate a personal strength in the area of visual-spatial processing skills, Sam may benefit from instructional tasks that involve visually presented information. To further develop these skills, Sam should be presented with tasks that involve visual concept formation and part-to-whole relationships (e.g., puzzles). 4. During unstructured play activities, Sam demonstrated a preference for sensory toys (balls, beads, and squishy toys). It may be beneficial for Sam’s parents and teachers to use these toys to promote academic participation and social interaction. 5. Mrs. Mother reported that Sam experiences significant delays in physical development. Sam may benefit from continued assistance and support to develop his gross and fine motor skills. 6. Sam reportedly has a history of speech delays and hearing loss. Continued speech therapy may be useful in enhancing Sam’s expressive and receptive language abilities, and the use of alternative communication, as deemed appropriate. 7. Mrs. Mother indicated Sam demonstrates sensitivity to noise and becomes easily over- stimulated. Noise-cancelling headphones may be useful for Sam during situations that are potentially noisy or over-stimulating. 8. Sam may experience difficulties in attending to academic tasks for long periods of time. In order to promote his learning capabilities, it may be important for teachers to break lessons into smaller parts and allow for frequent breaks. 9. Sam reportedly experiences mild difficulties in transitioning to unfamiliar situations and caregivers. Sam’s teachers and parents should consider helping him transition by establishing predictable structure where possible. A visual schedule, accompanied by simple verbal cues can sometimes be used to signal upcoming changes in structure or activity. Slowly preparing Sam for new preschool or classroom settings (e.g., frequent, short visits, meeting his teachers well in advance) will also be helpful. School Psychology Practicum Student Ball State University _____________________________________ Licensed School Psychologist (#XXXXXXX) Ball State University
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