Name: Czarina B.

Angeles

Age: 6 years 8 months

Gender: Female

Birthday: 8 September 2010

Date of screening: 4 August 2017

BACKGROUND HISTORY:

Czarina is a 6 ½ years old child diagnosed with Autism Spectrum Disorder (ASD) at 5 years old. She had
history of language delay both in expressive and receptive areas, difficulties relating to others, and repetitive
behavior. She had occupational therapy and speech and language therapy sessions for 1 year and was
discontinued. She spent one year at Daet Elementary School (SPED Center) and is currently enrolled in DSSD
since June 2017. Pertinent family history showed an 11-year-old sister with ADHD (Attention Deficit
Hyperactivity Disorder)

Present skills observed are as follows: echoing and repetitive speech, inconsistent response to name
calling and difficulty in following instructions, likes to draw and color her creations using her right hand, able
to explore surroundings and can pedal a bicycle with trainer wheels, hyperactive, difficulty in relating with her
peers, and is independent with feeding and needs minimal help with dressing and toileting.

Current concerns include: slow progression of language skills, difficulty with social relatedness,
repetitive behaviors and sensory issues (e.g. nail biting, ear plugging to particular sounds).

SCREENING TOOLS:

 PEDS (Parental Evaluation of Developmental Status) – PATH A; (4 Predictive concerns: Expressive

language and articulation, Receptive, Fine motor, School; 2 Non-predictive concerns: Behavior,
Social-emotional)
 PSC (Pediatric Symptom Checklist) – significant scores in total, attention and externalizing
Subscales)
 Vanderbilt ADHD Diagnostic Parent Rating Scale – predominantly inattention and
hyperactive/impulsive symptoms and ODD symptoms

IMPRESSION: Autism Spectrum Disorder; At risk of attention deficit hyperactivity disorder

RECOMMENDATIONS:

1. Refer for Occupational Therapy to address work behavior, sensory issues and fine motor skills.
2. Refer for Speech Therapy to address language delays and work on vocabulary building, requesting
and sentence structure.
3. Continue SPED placement with implementation of individualized education program to address
academic difficulties.
4. Advised yearly evaluation.

Prepared by:

OLIVIA D. ALIMAN, MD, DPPS

School Physician