ASSESSMENT

Name: Rishi Anilkumar Tejwani D.O.B: 04.03.2002 Age: 8 yrs Sex: male Address: c-14, Swami harmamdas soc, bangla area, Kuber nagar, Ahmedabad. Ph. No: 079-22821577 (r) , 99984-45983 (m) School: Attending Chetan group. Referral Problem: Hyperactivity, Banging and hurting himself, eye contact is poor. Informant: Mother and Paternal Aunty.

History:

Developmental History: 1. 2. 3. 4. 5. Sitting within normal limit (8 month) Crawling- 10 month Walking- 13 month Toilet- control. Speaking- was able to speak small sentences, but stopped speaking after convulsion.

Social History: Father: Age: 37 yrs Education: SSC Occupation: Business Mother: Age: 30 yrs Education: SSC Occupation: Housewife

Brother: Age: 11 yrs Sister: Age: 2 yrs Medical History: R Birth was full term normal delivery at hospital. Delayed birth cry reported. Kept in incubator immediately After birth for hour he became whitish At age of 9 months fits were reported. Second fit was reported at age of 11month associated with fever. At age of 2 year, he was fallen from swing, not reported any major problem.

Cognitive Level: His IQ level = 40-45 range His Autistic rating score is 142 which falls under moderate severe category Autism. R is Moderate delayed developmental child with ADHD symptoms and Autistic features.

Cognitive Aspect: R milestones are age appropriate. He has concept of body, He can identify body parts. No concept of Time, Place and Money. He can recognize his family member and familiar faces He can speak 1 to 10 numbers. He doesn t have knowledge about shape, color, numbers, left right uses of body part, simple addition subtraction, object, etc. His concentration span is poor.

His paper pencil work is v.poor, just scribbles if in mood to hold pencil and write, else doesn t sit to write. He is not able to draw horizontal or vertical lines on paper.

Physical Examination: Fine motor: good Gross motor: good Grip strength : good Balance: good Gait: normal Co-ordination: good

Speech, Language and Hearing: He doesn t speak any word or sentence as such, but sings songs when he is in mood. Cannot communicate through language. He uses body language and gestures to communicate. Does screaming.

Interest (likes and dislikes), ADL: According to parental grandmother her present complain is stubborn by nature, not listen to anyone. Very moody and not mix with others. Excessive diet eater, He likes Maggi and panipuri v.much. While eating item 1st smell and then eat. Shout a lot and sometimes bangs his head and hurt himself. Avoid sitting in toilet, Need assistance in toileting. He see his brother peers, feel jealousy towards brother and sister. He has no friends and doesn t show empathy or share enjoyment with others. He is not interested in social interaction. He holds fingers of parents or others to show his desired object. Watching TV quietly otherwise wandering not listening, poor attention and concentration. He is not able to comprehend and follows simple test instruction. He is dependent on other person for ADL. Needs assistance while performing ADL activities. He can wear clothes, can wear shoes but doesn t tie his lace, eat nastas.

He doesn t like to wear shoes. He likes bathing and playing in water pool. He likes music.

Behavior Therapy: He is ADHD child With Autistic features, Sometimes he gets aggressive and throws tantrums. He is engaged in self injuring and harming behavior by hurting his head with his hand often. Engaged in stereotyped and repetitive mannerism. He has attachment toward Sensory Integration room in chetan specially the body part game. Any change in his daily routine and environment can disturb him. He is stubborn and remains isolated from others. Doesn t mix easily with all. He follows simple instruction.

Sensory Integration: Tactile Sensation: hyposensitivity in lower limb, very poor sensation in foot Visual Sensation: good Auditory Sensation: good Vestibular and proprioceptive Sensation: good Olfactory Sensation: good Gustatory Sensation: good

Treatment Plan: He is a Trainable boy. Behavior therapy is needed. He is needed to move in all different environment so that he gets adjusted. The activities which he does in same place should be change to different room as he is adapted to the routine and place. Should avoid isolated activities. Group therapy is required. Play therapy is also beneficial. Sensory Integration is needed. Physical exertions like jumping, dancing, swinging, running is needed to reduce his hyperactivity. After that learning activities are taught so that

he can pay attention on his task. Activity with the help of music therapy can be very beneficial as the child is interested in music. Physical activities, such as stringing beads or doing puzzles, to help a child develop coordination and body awareness. Play activities to help with interaction and communication. Developmental activities, such as brushing teeth and combing hair. Adaptive strategies, including coping with transitions He needs special education programme. Vocational training is taught later on as the child understands and learns basic concepts. His family member needs counseling, as the child needs support, love and care from his mother and father. Thus, the main treatment plan is to make the child independent as much as possible.

OT role in Autism: Since people with autism often lack some of the basic social and personal skills required for independent living, occupational therapists have developed techniques for working on all of these needs.
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Provide interventions to help a child appropriately respond to information coming through the senses. Intervention may include swinging, brushing, playing in a ball pit and a whole gamut of other activities aimed at helping a child better manage his body in space. Facilitate play activities that instruct as well as aid a child in interacting and communicating with others. For the OT specializing in autism, this can translate specifically into structured play therapies, which were developed to build intellectual and emotional skills as well as physical skills. Devise strategies to help the individual transition from one setting to another, from one person to another, and from one life phase to another. For a child with autism, this may involve soothing strategies for managing transition from home to school; for adults with autism it may involve vocational skills, cooking skills and more. Develop adaptive techniques and strategies to get around apparent disabilities (for example, teaching keyboarding when handwriting is simply impossible; selecting a weighted vest to enhance focus; etc.)

Skills which Occupational therapy may fosters are: -Daily living skills, such as toilet training, dressing, brushing teeth, and other grooming skills

-Fine motor skills required for holding objects while handwriting or cutting with scissors -Gross motor skills used for walking or riding a bike -Sitting, posture, or perceptual skills, such as telling the differences between colors, shapes, and sizes -Visual skills for reading and writing -Play, coping, self-help, problem solving, communication, and social skills

By working on these skills during occupational therapy, a child with autism may also do the following:
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develop peer and adult relationships learn how to focus on tasks learn how to delay gratification express feelings in more appropriate ways engage in play with peers learn how to self-regulate

Assessed By: Dehuti Gajjar (BOT) Ph: 09428073842

Guided by:

Dr. Mrinjan (BOT)