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CONFIDENTIAL

20 November 2014
Mr. & Mrs. Everybody
Adress here
Dear Mr. & Mrs. Everybody

Re: Almost Everybody

Biographical Information
Name : Almost Everybody
Sex : Male
Date of Birth : 6 December 2010
Chronological Age : 3 years 10 mths.
Age at assessment : 3 yrs 10 mths 15 days
Assessment period : 05/08/2014 – 11/10/2014
Home Language : English

Reason for referral

Almost was referred to UCLIN by the psychologist at Dora Nginza Hospital (DNH) in Port
Elizabeth. The Psychologist queried the presence of developmental delays as well as hyperactivity
and aggression.

Background Information
Almost’s mother, Mrs Everybody, reports that her pregnancy with Almost was healthy; she
carried Almost to full-term, and he was born via natural birth with no complications. Mrs
Everybody further reports that Almost’s met all his developmental milestones after the time
expected for his age.
Almost is the younger of two children. He currently lives with his parents and an older brother.
The family share a warm and close relationship.
Mrs. Everybody reports that she became concerned about delays in Almost’s development at
around the age of two, hence taking him to DNH. Almost currently attends Kiddies Corner Edu-
care. His mother reports that when he comes home from school he is generally irritable. He
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refuses to allow her to unpack his schoolbag and becomes agitated and will throw items around
the house. She reports that he has poor impulse control, and is unaware of potentially dangerous
situations, such as crossing the road without looking for oncoming traffic or playing with sharp
objects.
Mrs Everybody furthermore reports that Almost is not able to sustain attention to a task, like
listening to a story for longer than 5 minutes or complying with requests or instructions after 5
minutes has elapsed.

Mrs Everybody indicates that Almost has one friend, who she describes as acting as Almost’s
voice at times i.e. when something has happened at school, Mrs Everybody says that she asks
the friend for the information as Almost does not volunteer information. Almost likes playing
with electronic items e.g. computer games, rather than engaging with others.

No medical concerns are noted. Almost’s hearing has been assessed by an Audiologist who
confirmed that Almost’s hearing is intact. Mrs Everybody notes that one of Almost’s cousins has
been diagnosed with Autism.

Assessment Battery
 Vinelands Adaptive Behaviour Scales, Second Edition Survey Interview Form (Vinelands)

Clinical Observations
Almost was assessed over four sessions. In all testing sessions, Almost refused to engage with
me. He was withdrawn and volunteered no speech. He offered no language expression at all.
The Griffiths was administered to him. During sessions Almost was unable to cooperate with
tasks required of him and became frustrated. He was emotionally labile, crying or becoming
angry, and showed poor impulse control, taking test items and throwing them around the room
or kicking the chairs. Almost was unresponsive to encouragement from me. He would not
comply with sensitive coaxing by his mother and physically hit her when he could not get his
way. Almost was also clinging, and did not want to separate from his parents. He buried in face
behind his parents and was disinterested. Due to his inability to comply with tasks, the
administration of the Griffiths was discontinued. Thus, the findings of this report are based on the
completion of the Vinelands in combination with clinical observations, and collateral provided by
Mr and Mrs Everybody.
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Assessment and Results

Vinelands Adaptive Behaviour Scales, Second Edition Survey Interview Form
(Vinelands)

The Vinelands was used to assess Almost’s adaptive behaviour in the four broad domains
measured by the test, namely, Communication, Daily Living Skills, Socialisation, and Motor
Skills, which each contain various subdomains. The test also provides an Adaptive Behaviour
Composite score which is an indication of overall adaptive functioning.

During sessions Almost’s performance on all the domains and subdomains had age equivalents
that ranged from between 1 year 5 months to 3 years 1 month, which are all below what would
be expected for his age. Each of the domains and subdomains will be examined:

Communication Domain
The Receptive language subdomain measures attention, and how the individual understands
language, communication and instructions. Here Almost obtained a score that falls within the
low range and produced an age equivalent of 1 year 5 months. Almost’s receptive language is 2
year 5 months below his chronological age.
The Expressive language subdomain is used to measure how words are used to gather new
information and to provide explanations. Almost obtained a score which fell into the low range
and produced an age equivalent of 2 years 1 month. Almost’s expressive language is
approximately 1 year 9 months below his chronological age.
The Written subdomain tests how letters make words and how written communication is
understood. Here Almost’s score fell into the adequate range, and produced an age equivalence
of 3 years and1 month. This is 9 months below his chronological age.
The total domain score for Communication fell at the 2nd percentile rank. This means that
Almost’s communication can be described as better than 2 percent of children his age. His
communication score falls into the moderately low adaptive level.
Daily Living Skills Domain
The Personal subdomain measures how an individual eats, dresses and engages in personal
hygiene. Here Almost’s score fell within the moderately low range, and produces an age
equivalence of 2 years and 10 months. This is one year below his chronological age.
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The Domestic subdomain measures what household tasks the individual can perform. Almost’s
score here fell within the low range. This score is equivalent to 7 months of age, and is 3 years
and 3 months below his chronological age.
The Community subdomain measures an understanding of how to use computers and
communication devices, and adaptive skills. Almost’s score fell within the moderately low
range, and produced an age equivalence of 2 years 10 months. This is 1 year below his
chronological age.
The total domain score for Daily Living Skills fell at the 5% percentile rank. This means that
Almost’s daily living skills can be described as better than 5 percent of children his age. His
daily living skills fall into the moderately low adaptive level.

Socialisation Domain
The Interpersonal Relationships subdomain measures how individuals interact with other
people. Almost’s score falls within the moderately low range, and produces an age equivalence
of 2 years and 5 months. This is 1 year 4 months below his chronological age.
The Play and Leisure Time subdomain looks at how individuals use play and free time. Here
Almost’s score fell within the moderately low range, and produces an age equivalence of 2 years
and 6 months. This is 1 year 4 months below his chronological age.
The Coping Skills subdomain tests how individuals demonstrate responsibility and sensitivity to
others. Here Almost’s score fell in the moderately low range, and produces an age equivalence
of 2 years 2 months. This is 1 year and 8 months below his chronological age.
The total domain score for Socialisation fell at the 13th percentile rank. This means that Almost’s
socialisaiton skills can be described as better than 13 percent of children his age his age. His
socialisation skills fall into the moderately low adaptive level.

Motor Skills Domain

The Gross Motor Skills subdomain measures how individuals use their arms and legs for moving
around and coordinating their movements. Almost’s score here fell within the moderately low
range, and produces an age equivalence of 2 years 7 months. This is 1 year 3 months below his
chronological age.
The Fine Motor Skills subdomain assesses how individuals use their fingers and hands to
manipulate objects. Almost’s score fell within the low range, and produces an age equivalence
of 2 years and 10 months. This is 1 year below his chronological age.
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The total domain score for Motor skills fell at the 3rd percentile rank. This means that Almost’s
motor skills are better than 3 percent of child his age. His score here falls into the moderately
low adaptive level.

Adaptive Behaviour Composite

Overall adaptive functioning is indicated by the Adaptive Behaviour Composite score. This score is
made up of all the scores on the above mentioned domains; it measures skills that are essential for
everyday living, and whether they can be performed when required. Almost’s score here is
representative of a mild deficit and can be described as falling within the moderately low range.
This score means that Almost performs poorer than most children his age.

Conclusions
1. Almost’s functioning is below that expected for his age in all the domains and subdomains
measured by the Vinelands. His Adaptive Behaviour Composite indicates a mild deficit.
2. Almost seems to show particular difficulties in the areas of mood lability, impulse control,
verbal expression and social engagement. He frequently becomes agitated and aggressive.

Recommendations
1. Almost should be referred to Quest school for Autism for a multi-disciplinary assessment
to query the presence of Autism or an Autistic spectrum diagnosis.
2. Almost should be placed at a school that caters for children with special needs. The
outcome of his assessment at Quest may inform which school will be suitable.
3. The family should be referred to a psychologist for assistance with regards to
understanding and equipping them to deal with Almost’s needs.

We trust you will find the information useful. Should you require any further information please do
not hesitate to contact us on 041- 504 2330.

Kind Regards,