Diagnóstico ARANGO Gabriel

Name: Gabriel M.
Arango
Date of Birth: 04/18/2020
Chronological Age: 2 years old
Grade: Pre-K 2
School: Bright Minds International Academy
Date of Evaluations: 10/25/2022, 11/22/2022
REASON FOR REFERRAL:

Gabriel Arango is a 2-year-old male who was referred for a psychological evaluation due to
emotional and behavioral concerns. According to Gabriel’s mother, Mrs. Andreina Arango, he
currently presents with the following challenges: Deficits in social-emotional reciprocity, deficits
in nonverbal communicative behaviors, deficits in developing and maintain relationships,
restricted, repetitive patterns of behavior, interest, or activities and limited social skills. Gabriel’s
parents seek to acquire the most impactful learning and therapy methods in order to better
understand him and learn to treat any challenges he is facing. The purpose of the current evaluation
is to assess Gabriel’s overall functioning for diagnostic clarity and treatment planning, such as
appropriate academic accommodations for successful navigation through school.
BACKGROUND INFORMATION:
The following information was obtained from a clinical interview with Gabriel and his parents.
DEVELOPMENTAL AND MEDICAL HISTORY:

Mrs. Arango reported that Gabriel was born at thirty-six weeks of gestation, via caesarean delivery,
weighing approximately seven pounds, ten ounces. Complications during the pregnancy reported
included excessive swelling and high blood pressure. Any post-natal complications were denied.
Developmental milestones for language and motor functioning were reportedly delayed. Gabriel
is currently receiving speech therapy and occupational therapy. Reportedly, Gabriel has a limited
diet and is described to be a picky eater. Gabriel was reported to have regular sleeping patterns.
He is followed regularly by Dr. Anthony Martell and is reported to be in good health. An
unremarkable medical history was noted for Gabriel. Gabriel’s hearing is within normal limits. His
vision is significant for astigmatism. Gabriel has received neurological services provided by Dr.
Jaime Baquero and he was provided a diagnosis of Autism Spectrum Disorder (ASD). Concerns
related to self-harm were denied for Gabriel.
FAMILY AND SOCIAL HISTORY:

Gabriel was born in Coral Springs, Florida and is being raised by his biological parents. Gabriel’s
mother is an IT project manager and his father, Mr. Martin Arango, is a sales manager. Gabriel is
an only child and does not have any siblings. In terms of discipline, both parents are responsible
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for disciplining him. Gabriel is disciplined with redirection. With regards to social and
interpersonal abilities, Mrs. Arango reported that Gabriel’s peer relations require some
improvement, as he has difficulty interacting with other children.
TRAUMA/ABUSE HISTORY:
Mrs. Arango denied any history of trauma including physical, sexual, or emotional abuse for
Gabriel.
EDUCATIONAL BACKGROUND:
Gabriel is currently enrolled in pre-k 2 at Bright Minds International Academy. He reportedly
experiences difficulty interacting with other children and lacks participation in activities such as
painting and drawing.
BEHAVIORAL OBSERVATIONS:
Gabriel presented as a boy of average weight and stature. He was dressed appropriately and
appeared well-groomed. Gabriel usually did not respond when his name was called. Eye contact
was limited. Gabriel's speech was significantly delayed as Gabriel is nonverbal. He did not present
with any hearing or vision difficulties. Gabriel presented with a cheerful mood and displayed a
limited range of affect. Gabriel did not engage in joint attention. Unusual licking of objects was
observed throughout the evaluation. No self-injurious behaviors were observed. Of note,
evaluations of children younger than seven years old should be evaluated with caution as future
assessments may reveal different results. Gabriel presents with developmental delays; however,
significant gains can be achieved through participation in several therapies and may lead to
improvements in emotional, behavioral and social functioning. Overall, these results appear to be
a valid and reliable estimate of Gabriel’s functioning at this time.
EVALUATION PROCEDURES:
Clinical Interview
Screening Tool for Autism in Toddlers and Young Children (STAT)
Autism Diagnostic Interview - Revised (ADI-R)
Pervasive Developmental Disorder Behavior Inventory (PDDBI)
Autism Spectrum Rating Scales (ASRS)
ASEBA for Ages 1 12-5 (CBCL 1.5-5)
Developmental Profile-3 (DP-3)
Vineland Adaptive Behavior Scales-Third Edition (VABS-3)
TEST RESULTS AND INTERPRETATION
AUTISM DIAGNOSTIC MEASURES

Screening Tool for Autism in Toddlers and Young Children (STAT) is an interactive screening
tool comprising of twelve activities that assess play, communication, and imitation. Scores of 2 or
greater suggest the examinee is at-risk and follow up assessment is recommended. Gabriel
obtained a score in the At-Risk range.
Domain Domain Score

Play 1

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Requesting 1
Directing Attention 1
Imitation 0.5
Total Score 3.5
The Autism Diagnostic Interview - Revised (ADI-R) is a semi-structured, standardized

assessment of social interaction, communication, and restrictive and repetitive behaviors for
individuals who have been referred because of possible autism spectrum disorder. Scores at or
above the cutoff indicate a higher likelihood of an ASD. Higher scores reflect a combination of
autistic-type characteristics and their severity. Ratings are based on the client’s most abnormal
behavior and the diagnostic algorithm (ages 2.0 to 3.11) was used to calculate Gabriel’s scores.
A. Qualitative Impairments in Reciprocal Social Interaction Score

A1 Direct gaze, social smiling, and range of facial expressions 4
A2 Imaginative play, interest in and response to approaches from 1
children, group play, friendships
A3 Attention to others, offering to share, seeking shared enjoyment 2
A4 Using other’s body to communicate, offering comfort, quality of 6
social overtures, facial expression, and social responses
Total A: 13 (cutoff 10)
The social interaction domain measures Gabriel’s social relationships. Gabriel’s score on this
domain of behavior is above the specified cutoff.
B. Qualitative Impairments in Communication Score

B1 Pointing, nodding, head shaking, gestures 4
B4 Spontaneous initiation of actions, imaginative and imitative social 6
play
Total B: 10 (cutoff 7)
The communication domain focuses on features of language and communication that characterize
Autism Spectrum Disorders. Gabriel’s score on the communication domain is above the specified
cutoff.
C. Restricted, Repetitive, and Stereotyped Patterns of Score

Behavior
C1 Unusual preoccupations, circumscribed interests 0
C2 Verbal rituals and compulsions/rituals 0
C3 Hand and finger mannerisms, other complex 2
mannerisms/stereotyped body movements
C4 Repetitive use/circumscribed interest in parts of objects, or 2
unusual sensory interests
Total C: 4 (cutoff 3)
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The restricted, repetitive, and stereotyped patterns of behaviors scale is concerned with the
presence of restrictive and repetitive behaviors, interests, and activities. Gabriel’s score on this
section exceeded the specified cutoff.
D. Abnormalities of Development Evident at or Before 36 Age

Months
D1 Age parents first noticed difficulties 1
D2 Age Gabriel first spoke single words 1
D3 Age Gabriel first spoke phrases 0
D4 Age when developmental delay was first evident 1
D5 Abnormalities first manifested, as judged by examiner 1
Total D: 4 (cutoff 1)
This section rates Gabriel’s development at or before 36 months in order to determine if early
manifestation of developmental problems were present by 3 years old. Gabriel’s score is above
the cutoff range.
Items of concern include: overall level of language; use of other’s body to communicate; nodding;
head shaking; spontaneous imitation of actions; imaginative play; social smiling; offering to share;
offering comfort; quality of social overtures; range of facial expressions used to communicate;
appropriateness of social responses; imitative social play; response to approaches of other children;
repetitive use of objects or interest in parts of objects; unusual sensory interests; hand and finger
mannerisms; and gait.
The Pervasive Developmental Disorder Behavior Inventory (PDDBI) is a rating scale used to
assess children at risk for autism spectrum disorder (ASD). A T-score of 50 (with a SD of 10) is
typical of children with autism of a given age. The average child with autism will have domain as
well as composite scores that range between 40 and 60. In the Approach/ Withdrawal Problems
section, higher domain T scores indicate increasing levels of severity. In the
Receptive/Expressive Social Communication Abilities section, higher domain scores indicate
increasing levels of competence. The average child with autism will score in the moderate range
in these domains.
Mrs. Arango endorsed concerns on the following items as occurring “sometimes” or “usually” for
Gabriel: Licks or mouths objects; Licks or mouths hands; Chews on objects; Makes odd or unusual
finger movements; Holds fingers, hands, or arms in odd or unusual postures;; Ignores the social
approaches of people his own age; Is inappropriately abrupt and dismissive of others; Actively
avoids (e.g., runs away, turns away) other people who are his age when approached by them.
Approach/ Withdrawal Problems T Score 90% CI

Sensory/Perceptual Approach Behaviors (SENSORY) 47 41-53
Ritualisms/Resistance to Change (RITUAL) 50 42-58
Social Pragmatic Problems (SOCPP) 50 43-57
Semantic/Pragmatic Problems (SEMPP) 48 43-53
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Repetitive, Ritualistic, and Pragmatic Problems Composite 48 43-53
(REPRIT/C)
Receptive/expressive Social Communication Abilities T Score 90% CI

Social Approach Behaviors (SOCAPP) 55 50-60
Expressive Language (EXPRESS) 34 30-38
Expressive Social Communication Abilities Composite (EXSCA/C) 45 41-49
Composite T Score 90% CI

Autism Composite (AUTISM) 52 47-57
Cluster Raw Score Percentage Classification

range
Approach/ Withdrawal Problems
Sensory/Perceptual Approach Behaviors (SENSORY)
Visual Behaviors 0 ≤ 33 Low
Non-Food Taste Behaviors 9 75-94 High
Touch Behaviors 1 34-74 Moderate
Proprioceptive/Kinesthetic Behaviors 5 34-74 Moderate
Repetitive Manipulative Behaviors 2 ≤ 33 Low
Ritualisms/Resistance to Change (RITUAL)
Resistance to Change in the 4 75-94 High
Environment
Resistance to Change in 1 ≤ 33 Low
Schedules/Routines
Rituals 2 34-74 Moderate
Social Pragmatic Problems (SOCPP)
Problems With Social Approach 0 ≤ 33 Low
Social Awareness Problems 1 ≤ 33 Low
Inappropriate Reactions to the 6 34-74 Moderate
Approaches of Others
Semantic/Pragmatic Problems (SEMPP)
Aberrant Vocal Quality When Speaking 0 ≤ 33 Low
Problems With Understanding Words 2 34-74 Moderate
Verbal Pragmatic Deficits 0 ≤ 33 Low
Receptive/Expressive Social Communication Abilities
Social Approach Behaviors (SOCAPP)
Visual Social Approach Behaviors 12 ≥ 95 Very High
Positive Affect Behaviors 12 75-94 High
Gestural Approach Behaviors 5 34-74 Moderate
Responsiveness to Social Inhibition 1 ≤ 33 Low
Cues
Social Play Behaviors 11 ≥ 95 Very High
Imaginative Play Behaviors 2 ≤ 33 Low
Empathy Behaviors 0 ≤ 33 Low
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Social Interaction Behaviors 9 75-94 High
Expressive Language (EXPRESS)
Vowel Production 0 ≤ 33 Low
Consonant Production at the Beginning, 0 ≤ 33 Low
Middle, and End of Words
Diphthong Production 0 ≤ 33 Low
Expressive Language Competence 0 ≤ 33 Low
Verbal Affective Tone 0 ≤ 33 Low
Pragmatic Conversational Skills 0 ≤ 33 Low
The Autism Spectrum Rating Scales (ASRS) measures behavior associated with autism
spectrum disorder. On the Autism Spectrum Rating Scales (ASRS) administration-Parent Report,
Mrs. Arango responses resulted in a Total score that falls in the Average range, which suggests the
extent to which Gabriel's behavioral characteristics are similar to the behaviors of children
diagnosed with Autism Spectrum Disorder. Additionally, Mrs. Arango ratings resulted in an
Average DSM-5 Scale score and indicates how closely Gabriel’s symptoms match the DSM-5
criteria for Autism Spectrum Disorder. Classification of scores: Slightly Elevated (60-64),
Elevated (65-69) and Very Elevated (≥70)
The Social/Communication scale measures Gabriel’s ability to use verbal and nonverbal
communication appropriately to initiate, engage in, and maintain social contact. Ratings on this
scale yielded a score in the Elevated range.
Concerns noted on the Social/Communication scale suggest that Gabriel usually: Does not
understand how someone else felt; Does not point to objects when asked to; Does not understand
the point of view of others; Have trouble talking with other children; Does not use make believe
play; Does not care about what other people think or feel; Use language that was immature for his
age; Does not start conversations with others; Does not keep a conversation going; Does not notice
social cues; Does not respond when spoken to by other children; Does not seek the company of
other children; Does not show an interest in the ideas of others; Does not understand age-
appropriate humor or jokes; Does not show good peer interactions; Fail to make his needs known.
The Unusual Behaviors scale measures Gabriel’s level of tolerance for changes in routine,
stereotypical behaviors, and overreaction to certain sensory experiences. Ratings on this scale
yielded a score in the Average range.
No items were scored below average on this scale.
The Peer Socialization scale measures Gabriel’s willingness and capacity to successfully engage
in activities that develop and maintain relationships with other youth. Ratings on this scale yielded
a score in the Very Elevated range.
Concerns noted on the Peer Socialization scale suggest that Gabriel usually: Have trouble talking
with other children; Does not respond when spoken to by other children; Does not seek the
company of other children; Does not understand age-appropriate humor or jokes; Does not show
good peer interactions.

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The Adult Socialization scale measures Gabriel’s ability to successfully engage in activities that
develop and maintain relationships with adults. Ratings on this scale yielded a score in the
Average range.
The Social/Emotional Reciprocity scale measures Gabriel’s ability to provide an appropriate

emotional response to another person in a social situation. Ratings on this scale yielded a score in
the Elevated range.
Concerns noted on the Social/Emotional Reciprocity scale suggest that Gabriel usually: Does not
understand how someone else felt; Does not understand the point of view of others; Does not care
about what other people think or feel; Does not notice social cues; Does not show an interest in
the ideas of others.
The Atypical Language scale measures Gabriel’s ability to utilize spoken communication in a
structured and conventional way. Ratings on this scale yielded a score in the Average range.
The Stereotypy scale measures purposeless and repetitive behaviors. Ratings on this scale yielded
a score in the Average range.
The Behavioral Rigidity scale measures Gabriel’s ability to tolerate changes in his environment,
routines, activities, or behaviors. Ratings on this scale yielded a score in the Average range.
The Sensory Sensitivity evaluates Gabriel’s tolerance for certain experiences sensed through
touch, sound, vision, smell, or taste. Ratings on this scale yielded a score in the Average range.
The Attention/Self-Regulation assesses Gabriel’s ability to focus attention, resist distraction and
demonstrate control of his behavior and thoughts. Ratings on this scale yielded a score in the
Average range.
Scale Score Percentile Classification

Total Score 55 69 Average
ASRS Scales
Social/Communication 67 96 Elevated

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Unusual Behaviors 43 24 Average
DSM-5 Scale 59 82 Average
Treatment Scales
Peer Socialization 73 99 Very Elevated
Adult Socialization 40 16 Average
Social/Emotional Reciprocity 68 96 Elevated
Atypical Language 42 21 Average
Stereotypy 50 50 Average
Behavioral Rigidity 44 27 Average
Sensory Sensitivity 48 42 Average
Attention/ Self-Regulation 37 10 Average
SOCIAL, EMOTIONAL AND BEHAVIORAL FUNCTIONING

The Child Behavior Checklist for Ages 1 1/2-5 (CBCL 1.5-5) was completed by Mrs. Arango
to obtain her perception of Gabriel's problems.
On the CBCL 1.5-5 problem scales, Gabriel's Internalizing Problems, Externalizing Problems,
Total Problems and Stress Problems scores were all in the normal range for boys aged 2 years.
Scores on all rated syndrome scales were in the normal range.
On the CBCL/1.5-5 - DSM-Oriented Scales, Gabriel's scores on all rated scales were in the normal
range.
On the CBCL/1.5-5 - Language Development Survey for Ages 18-35 Months, Gabriel's
Vocabulary score for 24-29 months was at or below the 15th percentile, which suggests delayed
vocabulary development for children aged 24-29 months.
T-Score Percentile Classification
Emotionally Reactive 51 54 Average

Anxious/Depressed 50 ≤ 50 Average
Somatic Complaints 50 ≤ 50 Average
Withdrawn 56 73 Average
Sleep Problems 56 73 Average
Attention Problems 50 ≤ 50 Average
Aggressive Behavior 51 54 Average
Internalizing Problems 47 38 Average
Externalizing Problems 48 42 Average
Total Problems 50 50 Average
Depressive Problems 56 73 Average
Anxiety Problems 50 ≤ 50 Average
Autism Spectrum Problems 58 79 Average
ADHD Problems Problem 51 54 Average
Oppositional Defiant Problems 51 54 Average
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DEVELOPMENTAL FUNCTIONING
The Developmental Profile-3 (DP-3) evaluates potential developmental delays in children from
birth through age 12 years, 11 months. The DP-3 utilizes input from parents or caregivers in an
interview or checklist format to provide scores in five key areas of Adaptive Behavior, Social-
Emotional, Cognitive, Communication, and Physical development.
Gabriel’s General Development Score according to the DP-3, indicates that he is functioning
within in the Below Average range.
The Physical scale measures physical development by determining the child's ability with tasks
requiring large- and small-muscle coordination, strength, stamina, flexibility, and sequential motor
skills. Gabriel obtained a standard in the Average range.
The Adaptive Behavior scale measures competence, skill, and maturity for coping with the
environment. It evaluates the child's ability with tasks such as eating, dressing, functioning
independently, and utilizing modem technology. Gabriel obtained a standard score in the Average
range.
The Social-Emotional scale measures interpersonal relationship abilities, social and emotional
understanding, and functional performance in social situations. Specifically, the scale assesses the
manner in which the child relates to friends, relatives, and adults. Gabriel’s standard score is in the
Below Average range.
The Cognitive scale measures cognitive abilities in an indirect manner, that is, not by actually
measuring intelligence and achievement but by assessing the development of skills necessary for
successful academic and intellectual functioning. Specifically, measures perception, concept
development, number relations, reasoning, memory, classification, time concepts, and related
mental acuity tasks. Gabriel obtained a standard score within the Below Average range.
The Communication scale measures expressive and receptive communication skills with both
verbal and nonverbal language. The use and understanding of spoken, written, and gestural
language are assessed by this scale, as is the ability to use communication devices (e.g., telephone,
computer) effectively. Gabriel obtained a standard score in the Delayed range.
Index Standard Percentile Age Description

Score Equivalent
Physical 104 61 2-6 Average
Adaptive Behavior 86 18 2-1 Average
Social-Emotional 76 5 1-8 Below Average
Cognitive 73 4 1-8 Below Average
Communication 62 1 1-0 Delayed
General Development 70 2 -- Below Average

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ADAPTIVE FUNCTIONING:
Gabriel’s adaptive functioning ability was assessed utilizing the Vineland Adaptive Behavior
Scales-Third Edition (VABS-3). The Adaptive Behavior Composite (ABC) score summarized
Gabriel’s overall level of adaptive functioning (i.e., the ability to independently perform basic
daily living tasks). This score fell within the Low range of development. Gabriel’s adaptive
abilities are discussed individually in greater detail below.
In the Communication domain, Gabriel’s mother indicated that Gabriel demonstrates adaptive
communication skills that fall within the Low range. Gabriel reportedly exhibits Low receptive
language skills (e.g., listening and understanding, following directions, etc.) and Low expressive
language skills (e.g., talking, expressing needs and wants, etc.).
Gabriel’s mother reported overall adaptive Daily Living Skills falling within the Low range of
development. Gabriel’s mother indicated that Gabriel’s personal care skills (e.g., hygiene,
toileting, feeding, etc.) fall within the Low range.
Gabriel’s overall adaptive Socialization Skills reportedly fell within the Low range of development
in comparison to same aged peers. Gabriel’s interpersonal relational skills (e.g., seeking out
relationships, sharing, showing pleasure in others company, etc.), were rated within the Low range
of development. Gabriel’s play and leisure skills (e.g., engaging in fun activities with others, etc.)
were rated in the Moderately Low range. Gabriel was noted to demonstrate Low coping skills
(e.g., adapting to changes in the environment, adapting changes in routines, and using social
pleasantries) in comparison to same aged peers.
Gabriel’s overall Motor Skills fell within the Moderately Low. Gabriel’s gross motor skills (e.g.,
skills such as running, throwing, and jumping that involve the large muscles in the body) fell in
the Moderately Low of development when compared to same age peers. Gabriel’s fine motor
skills (e.g., skills such as grabbing, squeezing, and manipulating objects that involve the use and
coordination of smaller muscles such as the fingers and wrists) fell within the Adequate range of
development.
Domain/Subdomain SS/ v-Scale Percen Adaptive Level Strength or

tile Weakness
Communication Domain 48 <1 Low Weakness
Receptive 6 Low Weakness
Expressive 4 Low Weakness
Written -- -- --
Daily Living Skills Domain 57 <1 Low Weakness
Personal 7 Low Weakness
Socialization 67 1 Low --
Interpersonal Relationships 8 Low --
Play and Leisure Time 10 Moderately Low Strength
Coping Skills 9 Low --
Motor Skills 83 13 Moderately Low Strength

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Fine Motor 14 Adequate Strength
Gross Motor 11 Moderately Low Strength
Adaptive Behavior Composite 61 <1 Low --
SUMMARY:
Gabriel’s overall intellectual and developmental functioning was assessed using Developmental
Profile (DP-3). Gabriel obtained a general developmental score in the below average range of
functioning. Gabriel scored in the average range on the physical domain. Gabriel scored in the
average range on the adaptive behavior domain. Gabriel scored in the below average range on the
social-emotional domain. Gabriel scored in the below average range on the cognitive domain.
Gabriel scored in the delayed range on the communication domain. The obtained results should be
interpreted as a valid estimate of Gabriel’s current level of functioning. However, standardized
assessment of children younger than seven years old is subject to potential problems with
reliability and validity and cannot be considered a stable predictor of future performance. More
specifically, future assessments may yield different results. These results may be higher or lower
due to a disability of the child; the availability of tests that are more reliable and valid for older
children, developmental changed over time, and/or other intervening factors.
Additional information was gathered to evaluate the presence of social and communication
deficits, particularly as they relate to an autism spectrum disorder (ASD). As standardized
measures of autism findings suggest, Gabriel presents with deficits in social communication and
social interaction as well as restricted, repetitive patterns of behavior. Therefore, Gabriel meets
criteria for Autism Spectrum Disorder. Gabriel will need outside intervention such as ABA
therapy to improve his overall functioning. Without therapy, these negative symptoms and
behaviors are likely to continue or worsen Gabriel’s ability to function adequately.
Adaptive functioning was assessed using the Vineland. Gabriel described adaptive functioning
as low. Adaptive skills in the areas of communication were within the low range (Communication
domain). Gabriel’s daily living skills are within the low range (Daily Living Skills). Gabriel’s
social skills are in the low range (Socialization domain). Gabriel would benefit from speech and
occupational therapy services to improve his communication skills and daily living skills in order
to improve his ability to function to his maximal potential in all areas of daily living.
RECOMMENDATIONS:
Gabriel is recommended to participate in an Early Intervention program such as Early Steps
for children under 3 or Florida Diagnostic and Learning Resources System (FDLRS) for
children ages 3-5. Gabriel should be evaluated by the local public school district when he enters
school in order to formulate an Individualized Education Program (IEP). The Early Intervention
program also helps children transition into appropriate preschool programs when they turn three.
Gabriel’s parents are encouraged to share this report in order to formulate an Individualized
Education Program (IEP) as well as to implement effective instructional strategies at school.
Due to Gabriel’s diagnosis of ASD, it is imperative that his educational plan comprehensively
addresses social skills deficits. In addition, it is strongly recommended that an autism specialist
and behavioral therapist are consulted in development and implementation of this plan.

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Gabriel is recommended to participate in applied behavior analysis (ABA), which is an
evidenced-based approach to teach new skills and behaviors, decrease challenging maladaptive
behavior and increase socially appropriate desirable behavior.
It is recommended that Gabriel work with a Speech and Language Pathologist who specializes
in ASD to improve his verbal abilities as well as to teach him how to use language for social
purposes. Gabriel’s parents should be involved in sessions so they may utilize similar strategies at
home to provide maximum stimulation.
Gabriel would also benefit from Occupational Therapy services to improve his self-help skills,
adaptive behaviors, attention, social skills, motor skills, self-regulation and sensory modulation.
In terms of his education program, educational instruction should be organized around relatively
brief periods of time (e.g. 15-20 minute intervals) with a sufficient amount of adult attention
provided in one to one or very small group instruction to maintain meaningful engagement and
meet specified individualized goals.
Ideally, Gabriel would likely benefit most from the least restrictive placement, i.e., the general
education setting. An integrated class placement, if available, would be another good option to
consider. In deciding on a placement, there are many factors to consider including, but not limited
to: the training, experience and personal qualities of teaching staff, available curriculum, therapies
and learning activities; amount of time provided for individualized and small group and
instruction, and teacher to student ratio. The less restrictive educational setting offers advantages
for Gabriel, including greater opportunity for interaction with non-disabled peers (who can serve
as important role models for social learning as well as more academic and learning challenge.
Predictability and routine is critical to enhancing student engagement and understanding of what
is being taught. It is also important that teacher to child ratios assure an intensive level of
instruction to fit Gabriel's needs. Teachers and therapists working with Gabriel should not assume
a typical sequence of learning for him. While structure and consistency is needed, flexibility and
creativity on the part of teachers and therapists will be of great value.
Use of Direct Instruction and Discrete Trial Training (DTT) as intervention and teaching strategies
may be helpful. With both approaches, tasks are broken down into short and manageable steps,
with a high level of student engagement and contingent rewards for appropriate behavior and
participation. For children with Autism are not as motivated to work for social rewards as other
children, attempts to build this motivation by rewarding performance of desired behaviors and
completion of tasks with tangible or external reinforcement (food, toys, time to play, etc.) are often
very helpful. That external reinforcement is paired with social praise with the hope that eventually
praise will become as reinforcing as the treats, etc. Also with these approaches, presented stimuli
or instructions are clear and relatively consistent. Eventually, the child is taught to apply the
learned skills and behaviors across other environments and situations. These intervention
approaches teach skills and behaviors very explicitly which is of great benefit to children with
autism who typically have difficulty "just picking things up", i.e. acquiring skills and behaviors
through observation of the world around them. Communication skills and behaviors (such as

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imitating verbal prompts, sorting objects by classification, etc.) can also be taught in this way
although naturalistic approaches which are more effective at leading to generalization of language
gains are also needed. Instructions given in discrete trials are simple, concrete, and clearly provide
only the most salient information, especially at first. As the child progresses and receptive
language becomes stronger, verbal instructions can become more complex.
Natural Environment teaching strategies such as "Incidental Teaching" and "Pivotal Response
Training," are also recommended to be incorporated into an overall strategy for working with
Gabriel. These approaches which target global deficits such as motivation, initiation, engagement,
and attention to multiple and relevant cues, as well as individual skill sets are child-directed and
target language skills within naturally contrived opportunities throughout the day. These
methodologies have been shown to be very effective for many children with autism spectrum
disorders:
• A natural environment is arranged to attract children to desired materials and activities
• The child initiates the teaching process by indicating an interest in an item or activity
• The teacher uses the child's initiation as a teaching opportunity
• The child's response results in a natural consequence, contingent access to the item or
activity of interest.
Visual supports are recommended for teaching specific skills at home and in the classroom as well
as for providing support and increasing level of comfort, understanding and independence in
functioning. Incorporation of structured teaching (aka TEACCH) strategies i.e. highly structured
visual-based systems into Gabriel's classroom is recommended. Examples of strategies in this
regard would be: visual schedule; visual cues or prompts that delineate personal and group space;
numbered/ labeled boxes or compartments that hold assigned and finished work; activity and
choice picture displays, and use of a visual elapsed time timer (see example at App store or at
www.timetimer.com) to assist with increasing on-task behavior and task completion.
Critical attention should be paid to consideration of goals for Gabriel, each of which needs to be
defined in observable, measurable terms. Plan should be put in place for ongoing data collection
and review to monitor progress on the effectiveness of the identified learning plan and
interventions that are being provided so that modifications can be introduced into Gabriel's
intervention plan as needed in order that identified goals can be accomplished. Develop a hierarchy
or prioritization of needs and goals (so that instructional time can be planned to emphasize goals
of the highest priority). Furthermore, in evaluating mastery of goals, consideration needs to be
given to whether or not acquired skills have been generalized and are being demonstrated in a
natural settings and contexts.
Teachers and therapists should provide instruction that blends knowledge of learning
characteristics of autism and best educational practices for students with autism. It is recommended
all teachers and school personnel working with Gabriel have formal training in the area of autism
and experience in working with students who have autism, including knowledge and understanding
of how to implement best practice educational interventions. Multiple exposures to children with
autism as well as opportunities to practice skills and build on the knowledge of teachers with
experience in this area are needed. [This can be added to the IEP, under the section "Supports
Needed for School Personnel.]
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Providing frequent opportunities for instruction in meaningful communication throughout the day
and outside of school is crucial. Communication instruction should be a primary focus across all
educational environments. In regard to further development of communication skills, continued
speech and language therapy is recommended.
Strategies that are adopted for teaching communication skills should be coordinated among the
various therapists and teachers working with Gabriel and his family. That is: if Gabriel is going to
have two speech and language therapists working with him, ideally, there should not only be a
sharing and coordination of strategies and approaches between these individuals, but also
identification of mutual goals and priorities for intervention. It is also crucial that therapists consult
on a regular basis with his teachers and parents so that the same strategies and techniques can be
used across settings and so that desired responses and behaviors are appropriately reinforced.
Ongoing (daily) home-school communication is critical for Gabriel and needs to be a priority for
all concerned. Ideally, whatever strategy or plan is developed should be incorporated into his IEP.
Home-school communication strategies can be extremely helpful in enhancing children's
communication abilities. Children are more easily able to ability to talk about things they can see
and hear or actions taking place in their immediate environment but have much more difficulty
talking about past or future experiences. By creating a picture diary or communication book,
Gabriel can be aided in talking about things that happened during the school day or at home. As
the parent or teacher looks at the communication display provided from home or school, both adult
and child can comment on what is seen. Picture diaries and communication books help children
remember and know what to talk about without the adult having to ask numerous questions.
Those working with Gabriel need to be aware of the potential for sensory reactivity which may
interfere with his availability for learning. Children with autism related disorders often have
atypical sensory profiles and need to be carefully observed for potential signs and symptoms of
distress related to sensory needs or stimulation. They may need to be offered more frequent breaks
or rest periods as a result of this. They may also need at times an alternative (modified
environment) for learning activities, time away from other students to "regroup" especially if they
become overly stressed or frustrated, and/or incorporation of "prescribed" sensory activities in
their daily routine.
It is necessary for Gabriel to receive one-to-one direct instruction when teaching specific skills. A
paraprofessional may be needed in the classroom to provide him with assistance in practicing
previously learned skills, evaluating and monitoring his progress, and assisting teachers with his
curriculum. School staff will require training from a behavior analyst/therapist in basic Applied
Behavior Analysis (ABA) principles (e.g., positive reinforcement, pivotal response training,
functional behavior assessments to help identify appropriate replacement behaviors), identifying
his primary focus and goals, how to adapt their current program to meet his needs, how to modify
language to facilitate comprehension and behavior, and how to measure his progress and success.
An ABA therapist should go to his school and train/supervise his paraprofessional.
It is strongly suggested that Gabriel be provided with opportunities to interact with peers. These
exchanges should be closely supervised by an adult in order to model appropriate behaviors as

P: (305) 697-8997 • F: (305) 517-5377
well as redirect inappropriate expressions. This can be accomplished by arranging for play dates
with peers with whom he is familiar (i.e. students in his class, children in his neighborhood), and
arranging for the children to meet in a non-threatening, familiar environment (i.e. park).
Children with autism frequently have difficulty anticipating events and often experience anxiety
when schedules are changed without sufficient notice. Gabriel should therefore be informed of the
activities planned for each day, particularly those activities which deviate from the typical
schedule. This should be done at the start of the day and can be accomplished by making an
announcement to the entire group. When changes cannot be explained in advance, it is important
to carefully explain the reasons for the changes to Gabriel. A visual representation of the day’s
activities may help Gabriel organize his day and anticipate events.
Utilize visual supports such as the Picture Exchange Communication System (PECS) across
settings to increase Gabriel’s understanding of rules, expectations, and routines. Visual supports
throughout the classroom can be used to facilitate the creation of routines, and remind children of
behavioral expectations. Use visual choice boards for Gabriel to communicate what he wants to
do, or a reward he wants after completing a task. These can be low-tech such as a choice board or
high-tech. Use visual schedules to communicate order of activities to Gabriel, and help him
understand structure within and between activities.
Therapeutic Family Support/Education
Parents may wish to pursue additional training in ways to assist Gabriel's progress at home.
Organizations and resources which may be helpful include:
• Center for Autism and Related Disorders (CARD) is a valuable resource that offers
multiple supportive services to families with children and adolescents diagnosed with
ASD. The CARD provides parent mentoring, support group services, and referrals to
community-based services. Gabriel’s parents will need to become fully educated about
ASD, and treatments/strategies for intervention in order to maximize Gabriel’s progress.
Gabriel intervention has been evidenced to be critical in increasing a child’s potential while
their brain is still developing. Parents should contact the CARD promptly and are
encouraged to take advantage of the center’s parenting classes, support groups, lending
library and other educational opportunities. The CARD can be reached
at: http://www.umcard.org.
• Gabriel and his parents should visit Parent to Parent of Miami, Inc. (PTOP), as Gabriel
may additionally benefit from services provided by this agency. PTOP can be reached
at: www.ptopmiami.org.
• Autism Speaks also provides additional information on advocacy programs, after-school

programs, health providers, schools, support groups, treatments & therapies. Autism
Speaks has also created several toolkits to assist or guide individuals with Autism and their
families throughout the lifespan. Autism Speaks can be reached
at: www.autismspeaks.org.

P: (305) 697-8997 • F: (305) 517-5377
• Florida Agency for Persons with Disabilities support people who have developmental
disabilities and their families in living, learning, and working in their communities. APD
identifies the service needs of people with developmental disabilities, and those individuals
may receive social, medical, behavioral, residential, and/or therapeutic services. APD can
be reached at: http://apd.myflorida.com/.
• The Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)
programs provide assistance to people with disabilities. This page provides detailed
information to help you understand what to expect from Social Security during the
application process:
https://www.ssa.gov/benefits/disability/ & www.ssa.gov/applyfordisability/child.htm
Gardiner Scholarship Program provides eligible students a scholarship that can be used to
purchase approved services or products in order to design a customized educational program for
the student. Scholarships can be used for specialized services such as speech or occupational
therapy, instructional materials, tuition at an eligible private school, contributions to a college
prepaid account and more. The program is directly administered by state-approved nonprofit
scholarship funding organizations. For more information visit: www.stepupforstudents.org
The Mckay Scholarship Program provides scholarships for eligible students with disabilities to
attend an eligible public or private school of their choice. Students with disabilities include K-12
students who are documented as having or autism spectrum disorder may qualify for this
scholarship. Visit: http://www.fldoe.org
Referral to a neurologist for an evaluation and to rule out any neurological concerns and provide
additional recommendations, if considered necessary.
It is recommended Gabriel receive genetic testing conducted by a neurodevelopmental

pediatrician or a medical geneticist that could potentially explain the possible cause of autism and
possible future medical conditions. One of the benefits of genetic testing includes identifying a
particular genetic variant that might be linked to another health condition, in order to access
treatments to improve daily quality of life.
It is highly recommended that Gabriel participates in extracurricular activities such as formal

enrollment in community clubs, sports, and organizations that he enjoys and where he can feel a
sense of accomplishment, as his participation will help reinforce positive qualities. It will also be
beneficial that Gabriel has many opportunities to interact with other children to promote peer
relationships.
FOLLOW-UP:
It is recommended that the results of this evaluation be shared with other service providers
(e.g., pediatrician, neurologist, school, ancillary therapists) that may benefit from this information
in order to best coordinate care.

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Gabriel would benefit from a follow-up evaluation in two years to document changes in overall
functioning and to provide additional recommendations at that time.
It was a pleasure working with Gabriel and his family. If I can be of further assistance, please
contact me at Dr.MeganLavado@gmail.com
________________________________
Megan Michelle Lavado, Psy.D.
Licensed Psychologist (FL PY9725)

P: (305) 697-8997 • F: (305) 517-5377

Diagnóstico ARANGO Gabriel

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Diagnóstico ARANGO Gabriel

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Name: Gabriel M.

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DEVELOPMENTAL AND MEDICAL HISTORY:

FAMILY AND SOCIAL HISTORY:

TEST RESULTS AND INTERPRETATION

AUTISM DIAGNOSTIC MEASURES

Domain Domain Score

800 SE 4th Ave. Suite 816B • Hallandale, Florida 33009

The Autism Diagnostic Interview - Revised (ADI-R) is a semi-structured, standardized

A. Qualitative Impairments in Reciprocal Social Interaction Score

Total A: 13 (cutoff 10)

B. Qualitative Impairments in Communication Score

C. Restricted, Repetitive, and Stereotyped Patterns of Score

D. Abnormalities of Development Evident at or Before 36 Age

Approach/ Withdrawal Problems T Score 90% CI

Receptive/expressive Social Communication Abilities T Score 90% CI

Composite T Score 90% CI

Cluster Raw Score Percentage Classification

No items were scored below average on this scale.

800 SE 4th Ave. Suite 816B • Hallandale, Florida 33009

No items were scored below average on this scale.

The Social/Emotional Reciprocity scale measures Gabriel’s ability to provide an appropriate

No items were scored below average on this scale.

No items were scored below average on this scale.

No items were scored below average on this scale.

No items were scored below average on this scale.

No items were scored below average on this scale.

Scale Score Percentile Classification

800 SE 4th Ave. Suite 816B • Hallandale, Florida 33009

SOCIAL, EMOTIONAL AND BEHAVIORAL FUNCTIONING

T-Score Percentile Classification

Emotionally Reactive 51 54 Average

Index Standard Percentile Age Description

800 SE 4th Ave. Suite 816B • Hallandale, Florida 33009

Domain/Subdomain SS/ v-Scale Percen Adaptive Level Strength or

800 SE 4th Ave. Suite 816B • Hallandale, Florida 33009

800 SE 4th Ave. Suite 816B • Hallandale, Florida 33009

800 SE 4th Ave. Suite 816B • Hallandale, Florida 33009

800 SE 4th Ave. Suite 816B • Hallandale, Florida 33009

Therapeutic Family Support/Education

• Autism Speaks also provides additional information on advocacy programs, after-school

800 SE 4th Ave. Suite 816B • Hallandale, Florida 33009

It is recommended Gabriel receive genetic testing conducted by a neurodevelopmental

It is highly recommended that Gabriel participates in extracurricular activities such as formal

800 SE 4th Ave. Suite 816B • Hallandale, Florida 33009

800 SE 4th Ave. Suite 816B • Hallandale, Florida 33009

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