Autism Assessment Report

Background Information

Leo Vance (DOB: 14/05/2018, Medicare: 3294 81023 1) was referred for multidisciplinary autism assessment following recommendation by his paediatrician and school learning support team. Developmental differences were first observed at 18 months regarding delayed expressive language and atypical motor patterns (persistent toe-walking). Current strengths include strong visual-spatial recall, advanced numeracy, and an affectionate nature with immediate family. Primary concerns involve peer interaction difficulties, rigid adherence to routines, sensory sensitivities, and gross motor coordination challenges (frequent tripping, poor ball skills). Family Hx is significant for ASD (maternal cousin) and ADHD (paternal uncle).

Family Situation

Lives in Perth, WA with mother (Sarah), father (David), and older sister (Maya, 9 yo). Parents are supportive and cohesive. Maternal grandmother lives locally and provides regular respite and childcare support. Maya has no diagnosed neurodevelopmental conditions.

Medical Background

Uncomplicated pregnancy; SVD at 39+2 weeks, BW 3.4 kg. Nil neonatal complications. Current medical conditions: mild asthma and idiopathic toe-walking. Allergies: NKDA. Regular medications: salbutamol (Ventolin®) 100 mcg INH PRN and melatonin (Circadin®) 2 mg PO nocte. Audiology (12/08/2023) and optometry (04/09/2023) assessments both NAD.

Developmental History

Sat unsupported at 7 months, crawled at 10 months, walked independently at 16 months (immediately displaying persistent toe-walking). First words at 24 months; phrase speech at 36 months. Toilet trained for bladder by 4 years; continues to require prompting for bowel movements. Currently independent with feeding (restricted diet) but requires physical assistance and verbal prompting for dressing (buttons, zips) and grooming due to fine motor delays and tactile sensitivities.

Behavioural History

At home, exhibits intense emotional dysregulation (meltdowns lasting 30–45 minutes) when routines are altered or demands are placed abruptly. Displays high activity levels and constantly seeks proprioceptive input (crashing into furniture, jumping from heights). At school, tends to withdraw during unstructured periods, hiding under desks or in the reading corner when classroom noise levels escalate.

Educational History

Attends Pre-Primary at Subiaco Primary School (4 days/week). Educator questionnaire completed by classroom teacher, Ms. Karen Jenkins. Academic performance is above average in numeracy and letter recognition, but below expectations in fine motor tasks (handwriting, scissor use) and group participation. Currently receives 0.2 FTE Education Assistant support via school-funded allocation while awaiting formal diagnosis.

Previous Assessments and Interventions

Reviewed by Dr. A. Patel (Paediatrician) on 15/10/2023, who identified global motor clumsiness and social communication differences. Speech Pathology CELF-P3 assessment (11/2023) indicated receptive language within normal limits and mild-to-moderate pragmatic language impairment. Physiotherapy assessment (12/2023) noted bilateral gastrocnemius tightness (dorsiflexion -5 degrees bilaterally), core hypotonia, and scores <5th percentile on the Movement ABC-2. Currently accessing fortnightly private Speech Pathology and Physiotherapy; NDIS access request pending.

Social Communication Differences

A1: Social Approach and Interaction

Initiates interactions with adults primarily to have needs met or to share facts about trains. Rarely initiates social approaches with peers. At social gatherings, remains on the periphery or engages in parallel play. Conversation is largely one-sided, struggling with turn-taking and reciprocal back-and-forth exchange unless centred on his specific interests.

A2: Nonverbal Communication

Eye contact is fleeting and poorly modulated during social interactions. Uses instrumental gestures (pointing to objects he wants) but rarely uses descriptive or emphatic gestures. Facial expressions are flat or incongruent with the social context, and he struggles to interpret peers' body language or facial cues (e.g., failing to notice when a peer is bored or frustrated).

A3: Play Style and Friendships

Prefers solitary, constructive play (lining up toy trains, building specific LEGO schematics) over cooperative or imaginative play with peers. Has not yet formed reciprocal friendships at school; interacts briefly during structured physical games (chasey) but struggles when rules change fluidly, often walking away when peers deviate from his play script.

Restricted and Repetitive Behaviours

B1: Repetitive Behaviours

Exhibits frequent hand-flapping and bilateral toe-walking, particularly when excited or dysregulated. Engages in delayed echolalia, frequently repeating scripts from Thomas the Tank Engine. Repetitively spins the wheels of toy vehicles close to his peripheral vision rather than rolling them functionally along the floor.

B2: Routines and Transitions

Insists on taking the exact same walking route to school daily; roadworks forcing a detour recently triggered a 40-minute meltdown. Requires visual schedules and countdown timers to transition between preferred and non-preferred activities at home and school. Struggles significantly when relief teachers are present.

B3: Special Interests and Collections

Demonstrates an intense, circumscribed interest in metropolitan train networks and locomotives. Memorises Transperth train timetables and collects plastic train models, which he carries in his backpack at all times. Becomes distressed if prevented from discussing trains or accessing his collection.

B4: Sensory Processing Differences

Auditory hypersensitivity: covers ears and cries in response to hand dryers, vacuum cleaners, and loud classroom environments. Tactile defensiveness: distressed by clothing tags, seams in socks, and hair brushing; restricts diet to crunchy, beige foods. Proprioceptive and vestibular seeking: constantly rocks on his chair, walks on toes, and crashes into crash mats during physiotherapy sessions. Hypo-responsive to pain (rarely cries after falls).

Autism Quotient Scoring

Autism Spectrum Quotient – Children's Version (AQ-Child) completed by parents:

• Social Skills: 24
• Attention Switching: 26
• Attention to Detail: 21
• Communication: 25
• Imagination: 22
• Overall Score: 118

Clinician interpretation: The overall score of 118 is well above the clinical cutoff of 76, indicating a high level of autistic traits across all measured domains.