Reference no: EM134036271

Question

Four-year-old Noah was referred for a psychological evaluation two years ago after his parents and pediatrician became concerned about his significantly delayed language development. Noah's parents described him as an extremely fussy baby who was hard to settle. Unlike his older sister, he was not very cuddly and, much to his parents' dismay, actually seemed to become more distressed when he was held. Although Noah's motor milestones were all achieved at the expected times, his language and communications skills lagged far behind. Not only did he speak much later than expected, he seemed to show little interest in any kind of communication. For example, he did not respond to his name and did not seek his parents' attention.Noah is very dependent on fixed and predictable routines. He plays with only a few toys, and always in the same order. When playing, he often uses toys in unusual ways that do not fit their intended purpose, such as using a doll to hammer in a peg or repeatedly spinning a horse on its side. He becomes extremely upset if these favorite toys are moved or rearranged on the shelf in his room where he keeps them. Noah also has difficulty engaging in imaginative or pretend play. Even on Halloween, he had difficulty with the idea of pretending to be a character, finding the idea confusing and upsetting.When Noah speaks, which isn't often, his speech is atypical in rhythm and volume, and he frequently reverses his pronouns (saying, for example, "Would you like the ball?" when he wants someone to give him a ball). When his parents or the evaluators attempt to speak directly to Noah, he quickly looks away and sometimes even turns his back on them. Noah has always been extremely active and easily frustrated; at times when he is upset, he bangs his head against the wall. He is generally fearful and anxious in new situations and settings and has been observed engaging in lots of hand-flapping and other self-stimulating behaviors. Noah's parents are quite worried about his starting kindergarten in a few months, knowing that he will be reluctant to be away from home and does not seem at all interested in the school setting or in meeting or playing with other children.

1. What is the likely diagnosis of the patient?

2. What TR assessment tool will you use to assess the patient (after-referral)?

3. Simulate assessment data, assuming that you use the assessment tool in 2 above to gather assessment data from the patient.

4. Based on the assessment results in 3 above, develop 2 treatment goals for the patient.

5. Select an activity intervention using evidence-based practice for the patient, and the activity intervention should be aligned with the treatment goals in 4 above,

6. How will you evaluate the program for effectiveness of the activity intervention in achieving the desired outcome?