Sample report for Nathan, age 4, thought to be seriously emotionally disturbed by teachers and parents; NOT SO!
Nathan is a little guy who arrived at his PreK classroom receiving speech therapy for stuttering. The educational treatment plan that my team and I developed for Nathan focused on empowering his mother to serve as his advocate as he worked his way through the educational system. Most kids have a new teacher every year. It is more or less accepted that every school year, the children’s new teachers spend six weeks getting to know regular students. Think about this: how much time do you expect it to take the teacher to get up to speed on what works with a child who learns a little (or a lot) differently from the average student?
Educational Treatment Plan for Nathan, age 4
Learning Disability in Oral Expression
Demographics/Student History: Nathan, age 4 years 10 months, is a PreK Student. English is the language spoken in the home. Both parents are employed, mother works as a bank teller, Dad as a truck driver. Nathan lives with both parents and his brother. His mother was 22 years old when he was born and his father was 27 years old. His grandparents care for him when parents are at work. There is no significant health history. Vision and Hearing were screened at school on 12/13/12 and Nathan passed both screenings.
Nathan’s teachers report concerns regarding speech (by parental report stutters, not observed at school) and behaviors (aggressive and noncompliant). At the Child Study Meeting held with Nathan’s mother, teachers, and Ms. Arnold, educational diagnostician, Nathan’s mom signed consents for testing in the areas of suspected disability: speech, language, and specific learning disability.
Meeting Notes from initial CST meeting: We discussed my opinion that Nathan’s behaviors were unlikely to be related to significant emotional disturbance as defined in an educational setting. We also discussed how children who have a difficult time ‘getting words out of their mouths’ frequently develop many avoidance behaviors that can be extremely disruptive at home and at school. Mom noted that she had been concerned about Nathan all year and that she was dismayed that it had taken the school so long to do something. At that point in the meeting, we revisited the TIER 1 and TIER 2 teacher classroom data, and pointed out that through ‘luck of the draw’ Nathan had been enrolled in a CoTeach Classroom and had had the benefit of both regular and special education teachers in his classroom this school year. (i.e., despite parental impression, school had not ‘done nothing’)
Nathan had a targeted TIER I strategy Plan that includes this information regarding his academic and social competencies: Nathan can sing the alphabet, but can’t identify the letters in his name. His academic and behavioral progress is sporadic: one day he can count to 11 and the next day he can only count to 5. Nathan receives speech at home 2X weekly and has a significant stutter, but hardly ever talks at school. His behavior has improved during the school year and Nathan has perfect attendance.
TIER 2 Documentation is as follows: Services are documented from 10-22-12 thru 3-25-13. Goals included letter naming, counting blocks, letter and number recognition, rote counting, identifying, extending, and creating patterns, and letter names and their related sounds. Classroom testing (C-PALLS, beginning of the year and middle of the year data) noted that Nathan is making acceptable progress in 5 of the 8 areas assessed in phonological awareness and in 1 of 1 area on the math screener, however, there was insignificant progress in rapid letter naming and rapid vocabulary naming.
Teacher Information on the Student Support Plan: Below average in pre-reading skills, math skills, and reasoning skills. Average in written expression. Below average in: listening, oral expression, attention, memory, and working style.
Significant Information Gained from the Psychoeducational Assessment with recommendations for educational strategies and materials suggested by Nathan’s assessment profile: An evaluation of specific learning disability (SLD) requires that the assessment team document that a disorder in one or more basic psychological processes is the primary cause of an academic skill or weakness. Nathan does appear to demonstrate a SLD in the area of oral expression.
Exclusionary Factors that were ‘ruled out’ as the primary cause of Nathan’s learning disability in oral expression:
Vision: screened at school 12/13/12
Hearing: screened at school 12/13/12
Motor Functioning: average on written expression in classroom performance, no problems in regular activities in the gym or playground
Cognitive and Adaptive Functioning: Fluid Crystallized Index (verbal) score on KABC-2: 91 Nonverbal Index Score on KABC-2: 79 (both scores above a score indicative of ‘sub-average intellectual functioning of 75 or lower)
Social-Emotional/Psychological Factors: Nathan’s ‘behaviors’ all appear to be related to strategies that he has developed to deal with the severe anxiety he feels about stuttering disorder. In a one on one environment with adults who are supportive, he becomes visibly relaxed, smiles, works for examiners, and ‘loses’ the noncompliant behaviors that characterize his ‘public behaviors’. A child who can turn the behaviors off and on to that extent does not meet educational criteria as a student who is seriously emotionally disturbed.
Environmental/Economic Factors: Mom is concerned and supportive, but doesn’t understand the extent to which the cause of Nathan’s disruptive ‘behaviors’ is his attempts to hide his stuttering problem.
Cultural/Linguistic Factors: None that apply in Nathan’s case
Physical/Health Factors: None that apply
Instructional Factors: None that apply
Determination of Primary and Contributory Causes of Academic Weaknesses and Learning Difficulties: Nathan’s academic weakness in oral expression appears to be primarily related to these significant and unexpected cognitive processing deficits (narrow abilities) in an otherwise ‘average’ ability profile:
Crystallized Intelligence (Gc) / Lexical Knowledge: the breadth and depth of a person’s acquired knowledge of a culture and the effective application of this knowledge / extent of vocabulary/correct word meanings: DAS-2 Naming Vocabulary Subtest Score 31st percentile (lower than other related skills due to the verbal manner in which Nathan had to demonstrate his knowledge); on the KABC-II Expressive Vocabulary that measures the same narrow ability Nathan’s score fell within the average range; however, due to his age, he only had to produce one word responses or point to the correct answer to obtain an ‘average’ score: 50th percentile; Preschool Language Scale-5 Auditory Comprehension standard score of 94 vs the PLSC-5 standard score of 79 on Expressive Communication. This 17-point difference is clinically significant and provides support for the conclusion that the stuttering is significantly impacting Nathan’s ability to perform adequately in the PreSchool Classroom. As Nathan has been enrolled in a remedial program at school and has had speech therapy for about 5 months now, examiner impression is that this pattern of strengths and weaknesses is indicative of a specific learning disability and that the frustration and embarrassment attendant to the stuttering is the primary cause for Nathan’s (likely anxiety triggered ‘behaviors’)
Crystallized Intelligence / Listening Ability: the ability to listen and comprehend oral communications as seen on the DAS-II Verbal Comprehension subtest where Nathan can point to indicate correct response: 86th percentile
Crystallized Intelligence / Verbal Knowledge: range of general knowledge as measured on the KABC-II Verbal Knowledge subtest: 75th percentile;
Crystallized Intelligence / Lexical Knowledge AND Language Development: KABC-II Riddles; 16th percentile (Nathan does very well in demonstrating what he knows and understands age appropriate curriculum ONLY when he doesn’t have to produce words or sentences to demonstrate what he knows)
Fluid Intelligence / Induction: The deliberate but flexible control of attention to solve novel, on-the-spot problems that cannot be performed by relying exclusively on previously learned habits, schemas, and scripts / the ability to observe a phenomenon and discover the underlying principles or rules that determine its behaviors as measured on the DAS 2 subtests: Matrices (42nd percentile) and Picture Similarities (76th percentile).
Long-term Storage and Retrieval (Glr) / Associative Memory: The ability to store, consolidate, and retrieve information over periods of time measured in minutes, hours, days, and years / the ability to recall one part of a previously learned but unrelated pair of items when the other part is presented as measured on the KABC-II subtest Atlantis where Nathan scored at the 91st percentile as he only had to point to the correct response although he had to remember made up names for pictures in three categories. On the KABC-2 Associative Memory subtest Rebus, Nathan’s score fell to the 25th percentile, as he had to produce verbal responses.
Short-Term (Gsm) / Memory Span: the ability to hold information in immediate awareness and then use it within a few seconds / The ability to attend to and immediately recall temporally ordered elements in the correct order after a single presentation as seen on the KABC-2 Hand Movements Subtest Score which fell at the 5th percentile
Short-Term Memory (Gsm) / Memory Span as measured on the KABC-2 subtest Number Recall which measured within the average range at the 37th percentile and the subtest Word Order which also fell at the 37th percentile
Visual Processing (Gv) / Visual Memory: The ability to make use of simulated mental imagery (often in conjunction with currently perceived images) to solve problems / the ability to remember complex visual images over short periods of time (less than 30 seconds) as measured on the KABC-II Face Recognition subtest (37th percentile)
Visual Processing (Gv) / Visualization (Vz): The ability to perceive complex patterns and mentally simulate how they might look when transformed (e.g., rotated, changed in size, partially obscured) as measured on the KABC-II subtests: Conceptual Thinking: below average 9th percentile; Triangles: below average 9th These scores suggest that Nathan also had a processing weakness in the narrow ability of visualization. As Visualization abilities are not directly related to Oral Expression skills, examiner impression is that visualization skills may be low average, but this is likely due to all of the anxiety that this child feels whenever he is presented with academic tasks. If we can reduce Nathan’s anxiety at school and at home and enable him to relax by providing him with both therapy to address the stuttering and modifications and classroom accommodations for alternative ways to express what he knows, once he internalizes the fact that he can count on these supports to be in place for him, it is highly likely that he will be able to produce average level academic work.
During the testing sessions, examiners were able to get some really significant work product from Nathan suggesting that his actual ‘intelligence’ is average to above average, however he will not be able to ‘show’ this ability nor can he use his abilities at the present time in a general education kindergarten without alternatives in teaching style and methods of collecting information about his mastery of skills.
General Recommendations for Nathan’s Kindergarten Program:
Speech therapy at school as well as at home
Counseling support at school
Modify the way in which Nathan is able to respond both to questions that are directed toward him as well as to group responses
Use class sets of response cards whenever possible for large group learning. It appears likely to this examiner that as soon as Nathan realizes that when teacher asks a question every child can hold up a card to respond he will relax and begin to develop consistent mastery of curriculum. All indications are that his listening skills and understanding of language is above average, and his visualization and long-term retrieval skills are average to above average. There’s no reason this child can’t succeed EXCEPT for the fact that he’s so afraid that he’s going to stutter his response that he is rendered unable to attend to the questions that are presented to him whether they be visual or verbal.
When asking questions of Nathan individually, prompt his response with a verbal and visual cue. For example, if you want him to name a bench, show him the picture and immediately produce the first sound of the word. When examiners used this technique with Nathan in a safe secure setting, he was able to complete the words at an above average level of comprehension. In other words, it’s not that Nathan doesn’t know the answer, the problem is that Nathan is unable to speak fluently. He needs a home and learning environment that will reduce that anxiety level.
Whenever possible, provide a set of cards or test item responses such as multiple choice rather than fill in the blank test questions. Teachers who are interested in viewing a curriculum that emphasizes the types of teaching techniques suggested for Nathan might want to look at Open Court’s Breaking the Code curriculum for children who have been unable to learn to read using traditional methods.
Emotionally, Nathan is a very anxious little boy. His behaviors throughout his testing sessions are highly indicative of the current state of his level of comfort with himself and others around him. He did not like the idea of going for testing at all. The first time he met me he worked for less than one minute before he began to produce his avoidance behaviors. (Has to go to the bathroom, is hungry, wants to go back to room, wants to play with toys now). Even asking him to work on one subtest and then play for a timed period only got him through one additional subtest. Longer test items such as those that are found on the KTEA-2 were attempted but not completed due to complete shutdown and work refusal. Subsequent test sessions went only marginally better. Nathan’s body language continued to be: slumped in the seat, dragging feet when forced by teacher to ‘go and play games with Mrs. Arnold’, breaking test items, etc.
At the point where Ms. White (speech therapist) and I had been going back and forth with Nathan for over a week, one day we were approaching his lunchtime, and we weren’t getting a huge amount of cooperation from him, so I looked directly into Nathan’s eyes and said something along these lines: “you’re a really smart little boy.” Then I named some of the specific tasks that he had completed at levels significantly higher than either his teachers or parents had predicted that he would be able to do. “Ms. White and I were so amazed that you knew those answers. Now we realize that you have a problem getting words to come out as fast as you can think of them, and we think that a big part of the stuttering problem is precisely because you are such a fast thinker. You understand many words that other little boys your age haven’t learned yet. So we need for you to point and answer our questions to the best of your ability so together we can help your teachers figure out the best ways for you to show what you know while you get better and better at talking.”
That morning, Nathan worked a bit more for us and then told us in a paragraph of sentences that he needed to go to lunch and then he had to go to recess, but after that he would come back and work some more! He never stuttered once. Later that day I saw Nathan in the hall, and he gave me a big smile and said, “Hi!” which was the first time that he’d ever acknowledged my presence in any way whatsoever.
Conclusion: Nathan is a sweet little boy underneath all of that pugnacious ‘exterior’. Hopefully, we can get together with his teachers and therapists before school starts next year and organize his learning environment so that he can get off to a much better start than he did this year. His best chance for success lies in continued therapy and special and general education staff working together to modify what he has to do to demonstrate knowledge in the general education classroom. I cannot over emphasize that Nathan is a very SMART little boy. His behaviors reflect anxiety over stuttering, NOT inability to understand and master grade level curriculum. Once he learns to read and write, he should be much more able to relax at school and at home as he realizes that he can read with comprehension and respond on paper even if he continues to stutter (prognosis not great on that front as their is a strong family history of stuttering). However, Nathan is at risk almost certainly in the areas of reading comprehension and written expression in coming years if the level of anxiety is not significantly reduced within the regular classroom environment. If everyone involved works together with this little guy, my best bet is that by third grade he will be on or above grade level in all subjects!
Summary of The Type of Testing and Consulting that I Do
In addition to developing educational treatment plans that accompany my assessment reports, I create video documentation of the assessment to illustrate each individual student’s strengths and weaknesses. The focus of all of the testing that I do is to design an educational program that will facilitate the development of the language, behavioral, and social skills an individual child needs to be successful in a specific educational setting. I assess in these areas:
- Autism Spectrum Disorders
- Early Childhood Evaluations
- Learning Disabilities (emphasizing connecting specific processing deficits with academicweaknesses in order to recommend specific treatment strategies and methods for monitoring progress)
- Intellectual Disabilities (again the focus is on assessment of strengths and weaknesses rather than simply testing to document disability)
- Adaptive Behavior Assessments (focus is the determination of existing communication abilities prior to working with the educational team to find adaptive devices and techniques that facilitate child’s ability to express his/her wants and needs)
It is difficult to grasp the significance of the increased number of children who are arriving in our kindergartens each fall with undiagnosed and untreated autism spectrum disorders. Autism is a brain-based condition (many professionals now include brain and gut issues as primary body systems upon which we need to focus with developing effective educational and life strategies for individuals living with an ASD)
March 2014: CNN reported that 1 in 68 U.S. children has an autism spectrum disorder (ASD), a 30% increase from 1 in 88 two years ago, according to a new report released Thursday by the Centers for Disease Control and Prevention. The report went on to note that it is difficult to find professionals who can work with children as young as 2, but that it is imperative that we move toward early diagnosis and treatment. I’ve seen the number of children with ASDs increase exponentially since I began working as an educational diagnostician. I’ve also seen many children fortunate to have been diagnosed and treated in early childhood education programs progress to the point where once they are kindergarten age, all they need to succeed in school is support and continuation of communication strategies that they’ve learned during the key language acquisition years that comprise the period from infancy to age 4. The longer we wait to understand that a child with an ASD processes and produces language differently from an average learner, the poorer will be that child’s educational and social outcome as he or she enters ‘the real world’ and seeks to participate in a developmentally appropriate program . There is a saying those of us who work in the area of autism often repeat: ‘Remember, we say, if you’ve seen one child with autism, you’ve seen one child with autism’. While there are commonalities that contribute to the diagnosis, each child who is diagnosed with an ASD is indeed, a unique individual and requires a very individualized approach to the curriculum needed at each grade level throughout the educational process.
Difficulties arise when children with Autism Spectrum Disorders misunderstand what is being said to them. Unlike typically developing children, boys and girls with ASDs do NOT understand significantly more language than they can produce. This in part explains the presence of echolalia. These little guys don’t understand that the ‘gestalt’, the whole phrase or sentence, is made up of separate words. Typically, their receptive and expressive language is restricted to nouns or object labels. Temple Grandin reports that ‘if you can’t make a picture in your head of the words, then the child with ASD is going to have difficulty understanding the term. Nouns that are concrete are relatively easy, abstract concepts much less so’. Never assume that a child who can use a word actually comprehends the meaning of the word. Remember that much of the language the child produces is repetitive rather than functional. Many times we assume that a child ‘understands’ because he’s complied with a directive previously, ignoring the fact that we use visual cues or that there is a model present for the child to imitate. If we constantly remind ourselves that children with ASDs are making PICTURES in their heads, we will become much better at understanding these little guys.
Sample Report for James, age 9, Home Schooled, Atypical Learning, AUTISM suspected
Tests that we administered as part of James’ Autism assessment:
Psychoeducational Profile-3rd ed.
Childhood Autism Rating Scale-2nd ed.
MIGDAS (Montiero Interview Guidelines for Diagnosis of High Functioning Autism)
August 2013: Assessment Results Conclusion: James demonstrates symptomology consistent with the behavioral and language patterns of others who have been diagnosed with High Functioning Autism Syndrome. To summarize, in students similar to James, who do present with significant ASD symptomology, what we are looking for is:
A pattern of differences in development
The levels of the child’s current skills and competencies
The extent to which this child’s pattern of differences interfere with the individual’s ability to master academics at a developmentally appropriate rate
MIGDAS Interview Results:
Language skills have developed but include these atypical features
During the assessment, there was a drop off in James’ ability to produce words in response to questions when the topic was not organized around James’ areas of interest. He frequently responded to questions with related facts and was unable to respond to verbal prompts and cues without visual supports. Often he produced a related but inaccurate word when asked to name a picture (table for chair). When prompted with cues and extra wait time, he was able to retrieve accurate terms for familiar objects (toothbrush). His language was very repetitive and much of the language that he produced consisted of he delayed echolalia (repetition of phrases and sentences from previous instances)
James does not understand that sounds make up separate words in specific sequences so even phrases that he uses all the time have to be interpreted within context, as they are not intelligible.
The burden of reciprocity, the task of keeping a conversation going, fell exclusively on the adults. James initiated conversation in the form of statements such as ‘I want an iPad.’ James displayed a limited repertoire of topics and was unable to respond appropriately to conversations with topics introduced by others. Even when asked about what he had done over the weekend, which his mother reported had fascinated him, James was unable to produce any statement or facts to tell about what he had seen or done. His mother often had to tell us what James said or wanted, and James would then indicate that her statements were correct.
James used and responded to nonverbal cues (hand out to signal ‘stop’), but displayed limited nonverbal behaviors (shoulder shrug, head nod, specific phrase with precise head or hand movement). Nonverbal communication behaviors are not well-integrated fashion into conversations.
Language is not fluid and is characterized by poor articulation, especially in connected speech
Fluency and flow become disrupted when James responds to questions
Language production becomes most fluent when James is in charge of the topic
James ‘tells’ information to others or talks at people
James doesn’t factor in the responses that he gets to his words to formulate phrases and sentences in response to conversational overtures
James has preferred topics such as sharks, Legos, iPad games
James is not interested in others’ areas of interest
When playing alone or talking to others, James appears to be repeating details for himself rather than sharing information for social interaction
James’ longer responses to questions are actually non responses as he tells what he knows about a related topic rather than responds to the questions or comments of the examiner
Conversationally, James does not often initiate interactions, as he prefers to play alone with materials or electronics
When he is engaged in conversation, the task of keeping the flow of the conversation going falls very much upon the adult
James functions best in very structured predictable situations, and his expressive language typically keeps working for him longer than does his ability to process others’ speech and gestures (receptive language)
Social Relationships and Emotional Responses
James is more able to converse with his mother than with other adults. He reports that he ‘fights’ with his brother. James primarily labels objects and repeats information, words, or phrases in a rote or scripted fashion.
When James talks, he does so without seeming to direct his words and phrases toward another person (with the exception of his mother, and then the words often appear to be part of well-established routines, as opposed to spontaneous creations). James’ expressive language continues even as it becomes apparent that his receptive language is non-functional. I.e., James will talk, repeat, use words, but won’t take in verbal responses to his words. This ASD characteristic helps us to understand why visual/tactile prompts are still needed on a regular consistent fashion even with children who are able to integrate completely into a mainstream classroom. This also accounts for the fact that these children will start out doing pretty well and then ‘melt down’ after a while. In more structured classes such as math, the child may be fine, but have trouble in the hall while changing classes or in seminar type classes where there is lots of discussion and the language is likely to be more imaginative and figurative as opposed to linear and literal. We can see this happening with James in his current school environment, which consists of 1-1 teacher/student ratio 3 hours a day with a special education teacher. James is picking up and using numbers, but still cannot identify the letters that make up his name. Math, in essence, is much easier to make both concrete and multi-sensory than are the subjects of Language and Literacy.
James’ most common facial expression is neutral and somewhat flat
James gets more expressive when he understands what is going on around him, but it is apparent that it is ‘hard work’ for James to make sense of how the words and nonverbal communications of his teacher and other adults relate meaningfully to their deeds and actions
James looks directly at others when interacting with them, however this social skill/behavior (as well as many of James’ social skills have been extensively developed and continue to be prompt by parental coaching). James’ mother reports that James is heavily dependent upon the interventions of his younger brother when the boys play together and/or with others.
James demonstrates a preference for looking at materials or slightly over the shoulder of the person with whom he is interacting
During testing sessions James begins to act silly and ‘entertain’ when the material grows difficult
James’ body language and verbalizations skills become most relaxed when he is playing alone.
James is ‘sweet and placid’ and is consistently compliant and anxious to please.
James’ ability to process language declines simultaneously as he loses his ability to be flexible in making choices. As his anxiety level escalates, James begins to repeat himself, saying the same thing over and over again.
When stressed (such as when trying to identify letters), James retreats to self-soothing behaviors and is unable to access previously observed communication skills (looking at the parent and following a familiar verbal request).
Sometimes the trigger (for an anxiety response such as repeating familiar action or word non-communicatively) can be an activity that James can do, however if he’s already done three ‘hard for him’ things, the fourth demand, even if it is familiar and comfortable, will push his stress level over the top and trigger a non-compliant or sensory-seeking behavior.
In James’ case, playing with Legos would be an example of a ‘sensory-seeking behavior’. He demonstrates awkward body postures and movements, and when he plays with the timer or perseverates with the call bell, he is attempting to organize information with additional predictable sensory input.
Sensory Use and Interests:
When we discuss ASD stereotyped interests and restricted interests (often called sensory-seeking routines), we are describing actions and words that help a student with these particular brain differences ‘organize’ information/input; these routines persist because they also feel good/comfortable to the child.
James walks with a awkward, stilted gait.
James is rule bound and controlling in the way that he plays with toys alone and with other children.
James, like many children with ASD, displays few of the typical AU behaviors such as pacing or hand posturing.
Sensory-driven quality to speech; James repeats details for himself rather than sharing information for social interaction. He produces repetitive phrases such as ‘I know that’. He has some variety in tone, but it is limited. He often speaks in a monotone, or a silly teasing tone. He runs words in a phrase together in a manner that suggests that he doesn’t see words as separate grammatical units.
James understands information that comes in through his eyes and through touch much better than verbalizations (oral directions and speech).
James displays limited awareness of others and/or demonstrates limited interest in others.
The PSYCHOEDUCATIONAL PROFILE-3 (PEP-3) assesses the developmental level of young children with autism, who may be non-verbal, have limited attention skills and poor concentration, and who are not accustomed to a formal testing situation. The PEP-3 provides norm-referenced comparisons for children between 2 and 7 1/2 years of age. It also provides developmental age equivalents for children functioning between 6 months up to 7 years of age. As James is functioning below the 7-year age level, examiners determined that this was the most appropriate instrument to determine his unique learning profile. The profile resulting for the PEP-3 graphically charts uneven and idiosyncratic learning development, emerging skills and autistic behavioral characteristics. The PEP-3 was primarily designed for planning an educational program based on a child’s identified developmental profile and behavior. Because it is true that all children with ASD look both similar (in learning styles and social behavioral patterns), it is equally true that children with ASD are individually unique. This fact largely accounts for all of the confusion about ‘diagnosis’. In actual point of fact, the ASD diagnosis is much less important that the educational services and strategies that are employed. The big question we need to ask ourselves is not does James’ have a disability, the question we need to be talking about is this: Is James making any, adequate, or average educational progress? And if our answer is ‘not really’, then we need to ask ourselves: How can we alter the educational environment to facilitate learning?
PEP-3 test information is drawn from two complementary sources. The first is a standardized norm-referenced scale designed to assess the development of Communication and Motor skills and the presence of maladaptive behaviors of children suspected of having autism and other pervasive developmental disorders (PDD’s). The second source is a Parent/Caregiver Report form, which is completed prior to the assessment of the child and asks the parent/caregiver to estimate the age at which their child is functioning in key developmental areas of communication, motor and social, adaptive behavior functioning and thinking. The items on the Maladaptive Composite score (completed by the examiner during the assessment) and the Problem Behaviors and Adaptive Behavior subtests (caregiver reported) parallel the criterion domains for autism of the DSM-IV-TR, and support the inclusion of parents in the child’s assessment and educational programming. It seems likely to this examiner that Dr. Harkins actual report should have read that James has no significant maladaptive behaviors that interfere with his ability to interact with adults, however he does not have the receptive, expressive, or pragmatic language functioning, skills, and abilities to allow him to participate in appropriate social interactions with peers and/or adults.