I'm sorry to hear that your daughter's application for an autism assessment was rejected. I'd be happy to help you improve the application to increase the chances of acceptance next time. Below, I will go through each question, critique the responses, and suggest specific improvements, explaining why these changes might help.
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Provide Specific Examples: Wherever possible, include specific incidents or behaviors that illustrate your concerns. Concrete examples help professionals understand the extent and nature of the difficulties.
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Use Comparative Language: Highlight how your daughter's behaviors differ from typical developmental milestones for her age group.
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Complete All Sections: Ensure that all questions are answered thoroughly. Missing sections might lead assessors to conclude that there's insufficient evidence.
1. Describe and give examples of any concerns about the child/young person’s talking or understanding. How is it compared to other children their age?
Original Response Critique:
- The response provides some information about limited vocabulary and understanding but lacks specific developmental comparisons.
- It would be helpful to reference developmental milestones and specify how your daughter differs from typical expectations.
Suggested Improvements:
- Begin by stating that at 20 months, most children can say around 50 words and begin to combine words into simple sentences, but your daughter can only say a few basic words like "cup," "bye," "no," and "yeah."
- Mention that she does not form two-word phrases, which is expected at her age.
- Explain that she does not understand most of what is said to her, struggling with following new directions, which is atypical for her age.
Why This Helps:
- Comparing her development to typical milestones provides assessors with a clearer picture of her delays.
2. Describe and give examples of the child/young person misinterpreting or misunderstanding what someone means. Literal understanding, sarcasm, humour.
Original Response Critique:
- Good examples are provided but could be more specific.
- Consider adding instances where she misunderstands or does not respond to non-literal language or gestures.
Suggested Improvements:
- State that she does not understand pointing; for example, when you point to a toy and say, "Look at the teddy," she doesn't follow your gesture.
- Mention that she doesn't grasp simple games like "peekaboo" or "pat-a-cake," which involve imitation and shared attention.
- Note that she cannot answer yes or no questions appropriately, giving both answers or shaking/nodding her head inconsistently.
Why This Helps:
- Specific examples of misunderstandings highlight difficulties with receptive language and social cues, which are important in ASD assessments.
3. Describe and give examples of how the child/young person communicates with you. How do they get your attention, share what they like, ask for help?
Original Response Critique:
- The response indicates limited communication but could include more on non-verbal communication.
- The mention of hitting or scratching to get attention is significant and should be emphasized.
Suggested Improvements:
- Explain that she does not use gestures such as pointing, waving, or nodding to communicate.
- Mention that she doesn't bring you objects to show them or share interests.
- Describe instances where she may pull you toward an object or place to get what she wants, or if she doesn't do this, state that as well.
- Highlight that she primarily communicates through crying and doesn't use words or gestures to express needs or desires.
Why This Helps:
- Detailing her lack of both verbal and non-verbal communication emphasizes her communication difficulties, which are key indicators for autism.
4. How do they let you know how they are feeling? Consider different emotions not just obvious ones like sadness/happiness.
Original Response Critique:
- Provides some examples but could include more about how she expresses emotions across different situations.
Suggested Improvements:
- Explain that she doesn’t use facial expressions or body language typically expected at her age to convey feelings.
- Mention that when she's happy, she may engage in self-stimulatory behaviors (e.g., flapping hands, rocking) rather than looking at you or smiling.
- Include that she doesn't seek comfort from caregivers when distressed, which is atypical.
Why This Helps:
- Illustrates difficulties with emotional expression and social-emotional reciprocity, relevant in ASD assessments.
5. Describe and give examples of how the child/young person engages with others. Children, adults, strangers, family members.
Original Response Critique:
- Good information is provided but can be expanded with more examples.
Suggested Improvements:
- State that she avoids eye contact with others, including family members.
- Mention that she does not initiate interactions or play with siblings or peers.
- Provide examples of situations where she becomes upset when approached by others, even familiar people.
Why This Helps:
- Highlights social interaction difficulties, a core characteristic of ASD.
6. Describe and give examples of how the child/young person responds to others’ thoughts and feelings.
Original Response Critique:
- The response is partially repeated from previous sections and lacks specific examples.
Suggested Improvements:
- Explain that she doesn't notice when others are sad or happy; for instance, if a sibling is crying, she does not show concern or try to comfort them.
- Mention that she doesn't engage in pretend play, such as feeding a doll or mimicking household activities, which demonstrates understanding others' perspectives.
Why This Helps:
- Shows deficits in empathy and understanding social cues, important in identifying ASD.
7. What social relationships does the child/young person have? Friendships, siblings, peer groups, community groups.
Original Response Critique:
- Contains some information but can be more detailed.
Suggested Improvements:
- Elaborate on her interactions with her siblings: Does she play alongside them or ignore them altogether?
- Mention if she has any interest in other children at all, even if it's just observing from a distance.
- If applicable, state that she prefers to be alone and does not seek out others for play or interaction.
Why This Helps:
- Provides insight into her ability to form relationships, a key area assessed in ASD evaluations.
8. Describe and give examples of how the child/young person plays/spends their leisure time. Consider what they play with, who, and how.
Original Response Critique:
- Describes some repetitive behaviors but could provide more on the type of play.
Suggested Improvements:
- Highlight that she engages in repetitive activities rather than imaginative play.
- Mention if she lines up toys, focuses on parts of objects (like spinning wheels on a toy car), or has unusual attachments to objects.
- Explain that she doesn't engage in cooperative play with others or participate in interactive games.
Why This Helps:
- Emphasizes restrictive and repetitive patterns of behavior, interests, or activities, which are characteristic of ASD.
Sections Missing:
- The sections on "Describe and give examples of any unusual or intense interests," "How the child copes if things change in their routine or environment," "Sensory interests or aversions," and "Unusual body movements" are provided but could be expanded.
Suggested Improvements:
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Unusual or Intense Interests:
- Describe any fixations she has, such as with specific objects like strings, lights, or spinning objects.
- Mention the intensity and how difficult it is to redirect her attention.
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Coping with Change:
- Provide examples of meltdowns or distress when routines change, such as a different route home or a change in daily schedule.
- Explain how she reacts to transitions between activities.
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Sensory Interests or Aversions:
- Expand on sensitivities to sounds, lights, textures.
- Mention if she seeks sensory input, like spinning or certain textures, or avoids it.
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Unusual Body Movements:
- Include any repetitive movements like hand-flapping, toe-walking, spinning, or other self-stimulatory behaviors.
- Describe their frequency and situations in which they occur.
Why This Helps:
- These details provide evidence of the restrictive and repetitive behaviors associated with ASD.
How do all the difficulties you described impact the child/young person or family’s day-to-day life?
Original Response Critique:
- This section could be more detailed to convey the significance of the impact.
Suggested Improvements:
- Explain how her communication difficulties lead to frustration for both her and the family.
- Describe challenges in taking her to public places due to sensory sensitivities or behavioral outbursts.
- Mention the strain on family routines and the need for constant supervision to ensure her safety.
Why This Helps:
- Illustrates the functional impairment caused by her behaviors, which is important for assessors to understand the need for support.
Original Response Critique:
- The response addresses delays but could benefit from specific examples.
Suggested Improvements:
- Provide details on cognitive abilities: Does she engage with puzzles, stack blocks, or show interest in cause-and-effect toys?
- Mention if she can follow simple instructions or imitate actions, which are important learning indicators.
Why This Helps:
- Offers insight into her developmental level across different domains.
Original Response Critique:
- States she has no independence skills but could be more specific.
Suggested Improvements:
- Clarify that she is not yet feeding herself with utensils, cannot dress or undress herself, is not toilet trained, and has difficulty with skills that are typically emerging at her age.
- Mention any skills she does have, even if delayed, to provide a complete picture.
Why This Helps:
- Details the extent of her developmental delays and areas where she may need additional support.
Original Response Critique:
- Briefly mentions that parents understand autism and have older children diagnosed with ASD.
Suggested Improvements:
- Elaborate on this by stating that you recognize similar signs in your daughter as you did with your older children.
- Mention any strategies you've tried at home and how they've impacted her behaviors.
Why This Helps:
- Demonstrates that you have experience with ASD and strengthens the case for assessment due to familial patterns.
Original Response Critique:
- Two points are provided but seem to be incomplete and repetitive.
Suggested Improvements:
- Highlight her strengths, such as persistence in activities she enjoys.
- Mention her enjoyment of watching animals, which could be a positive area to build upon in therapy.
- Include any moments when she shows affection or connects with family members.
Why This Helps:
- Providing strengths gives a balanced view of your daughter and can help in planning interventions that build on her interests.
- Before resubmitting, ensure that all sections are thoroughly completed.
- Use clear, concise language and provide as many specific examples as possible.
- It might be helpful to keep a diary for a few days to capture specific incidents that you can include in the application.
- Consider attaching any reports or observations from professionals who have worked with your daughter, if available.
Why These Changes Will Help:
- Detail and Specificity: More detailed information allows assessors to better understand your daughter's behaviors and the extent of her developmental delays.
- Alignment with ASD Criteria: Highlighting behaviors that align with diagnostic criteria for autism spectrum disorder strengthens the case for assessment.
- Demonstrating Impact: Explaining how her difficulties affect daily life demonstrates the need for support and intervention.
I hope these suggestions help you refine the application and effectively communicate your concerns. Wishing you and your daughter the best in getting the support she needs.