Kevin's Assessment Results

Well, we went and got the results to Kevin's psychological assessment on Thursday afternoon.  There were no surprises.  They told us pretty much exactly what I expected to hear. Here are some highlights from the report, with my comments/observations added in [ ].

• Kevin's presentation is consistent the diagnosis of an autism spectrum disorder [ASD], likely toward the milder [high-functioning] end. 
• It is also necessary to stress that Kevin is very young, and assessments at his age are not necessarily predictive of future functioning. [In other words, this is not necessarily a permanent diagnosis.  He could show improvement as he matures; he could have increased difficulties; he could remain the same.]

Here are some of their specific observations from the testing results:

Strengths

• Kevin's cognitive skills [I.Q.] are actually in the High Average range: Percentile=87. [That is, if 100 children Kevin's age took the test, he would perform better than 87 of them.]
• He had a particular strength when came it to Working Memory, performing at a significantly higher level than would be expected for a child his age: Percentile=99.  [This means he is particularly good at taking in, remembering, and using small amounts of verbal and non-verbal communication in the short term, i.e., repeating sentences or copying a sequence of blocks.]

Areas of Concern

• Kevin's Adaptive Functioning/Behaviour is in the Moderately Low range: Percentile=9. This involves 4 areas: Communication (how he understands and communicates with others); Daily Living Skills (practical skills needed to care for himself); Socialization (how he gets along with others and uses leisure time); and Motor Skills (how he is able to move and coordinate his limbs and manipulate objects using his hands and fingers).
• Socio-Emotional/Behavioural Functioning:--Autism Related Behaviours: Kevin's results for Communication and Total Score fell above the cut-off for autism spectrum disorder and his Reciprocal Social Interaction fell above the cut-off for Autism (higher scores). 
• Some examples of concerning behaviours and/or interactions that Kevin showed include limited attempts to direct others' attention to his interests, unusual vocal tone, repetitive use of words and phrases, limited use of gestures, eye contact that was not well integrated and coordinated with other forms of communication, social overtures that were limited to his own interests or demands, less social communication than would be expected, and interactions that were sometimes awkward and difficult to sustain.
• Kevin also showed some other behaviours associated with autism spectrum disorders including limited pretend play and play that was restricted to cause and effect (toys and cars); some unusual sensory interests (e.g. looking closely at objects and dragging head on floor during play); and somewhat repetitive interests (e.g., spinning wheels on cars, lining up cars in a specific order).
• Problematic aspects of Kevin's Socio-Emotional Functioning:  Kevin is a child that has difficulty making friendships; may be socially awkward, disinterested in social interactions, have difficulty reading others' social cues; his interests, behaviours, and language can be unusual and/or somewhat repetitive or rigid.  Emotionally, he is prone to internalizing challenges and may be anxious, fearful, easily frightened, clingy, irritable, and cry easily.  He is also externalizing behaviours at times and may be stubborn, defiant, and aggressive [e.g., hitting, throwing toys in frustration].
• Overall, these items "often" seriously affect his home life, interactions with other children, and learning.
• We were also already aware that Kevin has Sensory Processing differences, which also affect his perception and reaction to stimuli in his environment.

Recommendations

• Kevin will need support in his classroom [it's not yet clear what form this will take] to be successful, interact with other children, maintain a calm and alert state, and to feel good about himself.
• Kevin should start seeing a Speech and Language Pathologist to assist in his use of social language.
• Kevin will continue to see an Occupational Therapist to work on his fine motor skills and sensori-motor strategies to help him maintain a calm-alert state.
• Kevin needs specific interventions like social-skills groups, social stories and books related to friendship, social scripts, adult intervention and modelling of appropriate social skills, and play groups/playdates. Given Kevin's high intellectual skills, it is likely that he will learn steps for interaction easily, but will have difficulty applying them in real-life situations. Therefore, it is important to practice by role-playing these situations with an adult first, and then gradually have him implement these new skills with his peers.
• Given Kevin's challenges with anxiety, we need to introduce him to techniques focused on calming and emotional coping strategies (e.g. breathing, relaxation, a calm-down area, soothing sensory materials, and calming self-talk). 
• We need to help Kevin recognize and label his feelings, and build his confidence (e.g. through books, modelling, positive self-talk).
• In general, children like Kevin do best in environments that are nurturing and supportive as well as predictable and highly structured (e.g., picture calendars and schedules, predictable routines).
• Teaching materials for Kevin should use the different senses and non-verbal cues (different colours, visual  aids, touch, movement, smells, role playing, etc.); frequent shifts between discussion, listening, and hands-on materials may also be helpful.
• When giving him instructions it is important to have his eye-contact (physical contact like touching him on the shoulder may also be helpful). Keep instructions simple, break down tasks into smaller steps, and augment verbal communication with non-verbal cues such as gestures or pictures, and have him repeat the direction.
• We should, as a family, explore the types of services and resources that are available for children with a diagnosis of ASD (e.g., the Autism Society of Ontario).

***

Mommy's Closing Thoughts

Like I said at the start, there were no surprises for me here (except maybe the pleasant surprise of Kevin's cognitive strengths).  However, it was still a lot to take in, and that's why it took me a few days to organize my thoughts before I could get on here and summarize the results.  I say "summarize" because the official report was 13 pages long!  Now, we move forward, exploring the available resources, notifying Kevin's school, and seeing what we can do to improve his communication skills.

One thing that has hit me really hard is seeing that Kevin has been given this diagnosis, and he is high-functioning, I can't help but be overwhelmed by thoughts of what we will learn about Ryan in the next 6 months, as they begin his assessments for ASD.  At this point, Ryan is clearly much more profoundly affected than Kevin ever was, even at the same age. I can only hope that Ryan will make a major leap in his skills around the age of 2, like Kevin did. 

Finally, it's interesting that we are in the More Than Words communication program for Ryan, but now I am beginning to recognize many ASD characteristics and communication skills we discuss in that class that are helpful for high-functioning children like Kevin, too.  Looking on the positive side, I guess that's a bonus of these classes: we're getting two-for-the-price-of-one! ;)