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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 Poor eye contact


Do not initiate communication
Impairment communication Single words
Pointing to objects
Stereotypical behaviour Persistence
echolalia

Autistic spectrum disorder


If speech is normal, consider asperger

Might underestimate developmental milestone in autistic as not cooperative

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 Building blocks Global


developmetal delay
Receptive/ Name/ sex/ age Articulation problem Hearing problem
expressive Color/ objects/ body part (need assessment)
Tell story from book Qualitative impairment
Sing in communication
Follow simple command Discrepancy btw
Follow command with receptive and
preposition expressive speech
May have been taught
(not spontaneously
acquired)
Play Teapot party Lack of symbolic play Autistic spectrum
figurine 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 Boy
Cooking cooking
What are you cooking
Is it hot/ready
Are you hungry
Is it for me (listen for echolalia)
Dolls Figurine/ cars
Lets put the doll to bed 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 3 words (use functionally)


Besides specific papa/ mama
2 years 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)
2 ½ -3 years 3 words sentence including a verb
I want to go out
(I want is learned as one word)
4 years To and fro conversation
What do you do in school
5 years Alphabet / number concept
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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