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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
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
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)
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)
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