Received the Assessment report from Education Psychologist. This is a summarised report and the reason I am sharing this confidential report is to give those interested an insight of the process and perhaps able to help those with a similar problem.
Background Information
Alex was given a diagnosis of Autistic Spectrum Disorder (ASD) in April 2007 by Dr Irani (Consultant Paediatrician) and this was confirmed in the May, following a multi-professional assessment at the Margaret Wells-Furby Children’s Resource Centre. Subsequently, he was referred to the TASS Pre-school service and Neel Wilson began working with him. She referred Alex to the Educational Psychology Service in October 2007.
Neel Wilson wrote to the SEN Section in December 2007 to request a statutory assessment of Alex’s special educational needs. The request was agreed and this report is provided as the statutory psychological advice for that assessment.
Assessment
I discussed Alex with staff at the Teddies Nursery on 23.11.07, and with his mother Ms Hoh during a home visit on that day (Alex was ill and so not at the Nursery). I learned from the staff that initially he had been receiving five hours 1:1 support funded from the Early Years Support Grant. More recently, Amanda Waistell (Inclusion Assistant) had started working with Alex for one session per week (2½ hours) with the staff being funded for the rest. He had been isolated when he started at the Nursery but this had improved, as had his eye contact. He had begun to acknowledge the other children but was not yet interacting meaningfully with them. Alex was not yet toilet trained and was wearing nappies and training was to begin at home and in the nursery. His expressive and receptive language development were delayed and he communicated through pointing with noises, some limited use of signs, and some use of words (e.g. car, more, thank you). When I visited the home, Alex gave good eye contact to me, later accepted my tickling his tummy, said “Bye, bye” and shook my hand when I held it out to him. Given the ASD diagnosis, I formed the view that he had appropriate skills in some aspects of his social interaction.
I visited Teddies Nursery again on 7.2.08. I discussed Alex with the staff (particularly with Catherine Wood, his Key Carer), observed him over a two-hour period, reviewed his East Sussex Curriculum Based Developmental Profile (CBDP) and carried out some 1:1 assessment to try to gauge the current level of Alex’s cognitive abilities.
Alex continues to attend for three mornings per week but currently also attends on Thursday afternoons while his parents are on the Early Bird course. I learned Angie Brown (Special Needs Assistant with the Speech and Language Therapy service) was working with Alex and staff for one session per week and as a consequence, Amanda Waistell had withdrawn to allow this to happen. She will resume her support once Angie Brown’s sessions have ended. The staff had received Makaton training and all the children were now learning one sign each week. Alex is still easily distracted and so at times the staff work with Alex 1:1 both in the main room and away from it. These sessions include daily work using Jolly Phonics and work on activities provided by Angie Brown. They have also set up small group games to develop Alex’s social skills and encourage contact with his peers. They had tried picture cards for use in a visual timetable but these had not worked well so they were preparing photos of Alex doing things for this purpose instead. Toilet training had been started and been quite successful, to the extent that Alex is now wearing pants rather than nappies to the nursery. Staff were preparing a photo of the toilet so Alex could have a toilet card to communicate when he needed to go. I learned later from his mother that his training at home has also been going well and he can stay dry, but currently still wears nappies at night as he can still be wet.
Alex looked at me and smiled back when he came into the room. I walked over and held my hand out and again he shook it. He went over to the carpet to join some other children who had arrived much earlier and had been playing with cars. I noticed he sat and agitated his hands and legs (‘stimming’). This happened at several points in the morning but it was not frequent or overly intrusive.
Alex was told the cars were finished, accompanied by the Makaton sign for finished, and he immediately put the car in the tray. There were many other occasions across the morning when I was clear that Alex is compliant and biddable. All the children then arrived to form a circle for registration. When Catherine said: “Morning Alex” he immediately said: “Uh-uh” (his version of morning) in reply. Alex was aware of me and regularly made good eye contact and sometimes smiled when I smiled at him. After registration, the children were asked one by one to get their coats, ready to go outside. Catherine asked a girl to take Alex to get his coat and he went off holding her hand, seemingly happily enough. When he returned, he stood outside the circle as there was no gap to allow him to enter. He stood passively and made no attempt to communicate with the children in front of him or to step through them. Similarly, when he was asked to line up, his route was partly blocked by a boy on the floor and Alex stood back passively and looked at him, rather than moving forward and so encouraging the boy to move, or moving to one side to walk round him. Catherine said she feels Alex can seem over-passive at times; for example, when he is on a bike and another child requests it, she feels he gets off because he follows instructions passively, rather than because he has finished riding it.
All the children went outside and Alex was given a large ball which he threw with signs of pleasure. He did not look at the ball or the carer when given it. He then got onto a bike with pedals but used his feet to scoot it around. I understand from Catherine he is not yet able co-ordinate his feet when pedalling. He took a different ball from me when I held one out. He made a sound and pointed towards a slide, as if trying to show / tell me something, although he did not make eye contact with me to indicate he was establishing shared attention. I encouraged him to join me at the slide and a carer helped him climb up, saying she felt he was unable to do this yet. He then slid down the slide. When prompted via the word “more?” and the Makaton sign, he went behind the slide to climb again and I loosely supported him, as he was climbing it well. On a third occasion, he climbed up entirely by himself. I asked the carer to do nothing when he slid down and he got up and stood passively. He needed organising / encouraging to find another activity. This was the case throughout my visit, in that during this period of observation, Alex never initiated an activity for himself or engaged in spontaneous play and needed to be supported to do this. At these times, he appeared to withdraw within himself.
Throughout the time I observed Alex, there was little interaction with his peers; he did not initiate contact and the others did not initiate it with him. He went over and stood on the edge of a group playing at one point, as if interested in what was going on, but there was no contact between him and group members. Not surprisingly given the ASD diagnosis, Alex’s social skills will continue to be an area for development.
Alex’s Curriculum Based Developmental Profile (CBDP) shows his achievement so far in the six areas of the Foundation Stage i.e. Personal, Social & Emotional Development, Communication, Language & Literacy, Mathematical Development, Knowledge & Understanding of the World, Physical Development and Creative Development. On the basis of the information supplied, it was clear he had made some progress since the CBDP was started, and Alex’s current achievements are within P Levels 1 – 3. That is, he is working at levels similar to those expected for children aged from birth up to 2½ years at age 3:11 years. Of course, this evidence of delayed development needs to be set in the context of the effects of his autism.
I also assessed Alex using some scales from the British Ability Scales (second edition) (BASII). Such testing is dependent on the child having an understanding of the formality of the situation, good attention and concentration and so on, so not necessarily features present in children with autism. As such, I used the tasks in an exploratory way. However, I learned Alex can be willing to sit with relatively unfamiliar adults and co-operate. He can attend but his attention span is short and he often needs focussing, for example with verbal and visual prompts. He does not yet always look with intent and understand which aspects of a task to attend to. Not surprisingly in the context of the effects of his autism, Alex’s scores were well below average.
During our discussion on 23.11.07, Ms Hoh said she felt Alex is quite social and might manage mainstream schooling at some stage. Her main concern was his expressive language as she felt there were no issues with his understanding. She and Mr Green had scheduled visits to Holly Spring Infants, the Rainbow Resource and Kennel Lane. In a phone call I made on 3.1.08, Mr Green told me he and Ms Hoh had made these visits and that their preference was for initial placement at the Rainbow Resource. During a brief conversation with Ms Hoh at Teddies on 7.2.08, she confirmed that both she and her husband would like Alex to have place at the Resource. One reason for this choice was that the speech and language therapy input would be more intensive. As this would be part time, she would also like him to continue attending at Teddies Nursery for the rest of each day.
Educational Needs
Alex has been diagnosed as having ASD. As such, he shows developmental delay across the six areas of the Foundation Stage.
Recommended Provision
Alex would benefit from:
· Full access to the Early Years Foundation Stage curriculum, adapted to take account of his particular needs;
· On-going monitoring of his progress across the Early Years Foundation Stage curriculum at a detailed level (the CBDP will continue to be a key aid for this and when planning his learning objectives);
· Specialist nursery placement for children with ASD with opportunities for inclusion within a mainstream setting when appropriate;
· Access to staff with specialist knowledge and experience of planning and delivering educational programmes for children with ASD;
· Activities to develop his gross- and fine-motor skills;
· Activities to develop his attention and concentration spans across a range of activities;
· Activities to develop his expressive and receptive language;
· Activities to develop his social & communication skills;
· Access to advice for staff, monitoring and direct input as needed, from a speech and language therapist.
Note from mummy: I agree with most of what is written but because he was only with Alex for 2.5 hours, he hasn't seen all of Alex. Perhaps, this will help to get what we needed for Alex.
