Survey Date: Parent's Name:
5/31/05 Mrs. G.
Relationship: Email:
MOTHER xxxxxxxxxxxxxxxx
Phone: Child's Name:
xxx xxx xxxxx Roger
Date of Birth: Written by:
12/6/2000 Arnold Miller, Ph.D.
Sent: Age:
6/5/05 4 - 6

General Impression.

Roger seems to fall within the moderate range of children on the autism spectrum.

Sensory Reactivity, Body Organization, Problem Solving/Tool Use

Roger's sensory reactivity is entirely appropriate as is his ability to use his body in an organized manner. Except for toilet training - which is not yet fully established - he functions quite well. He understands spatial relations and can find his way home even when the house is out of sight. Roger's fine motor activity shows a bit of a lag. For example, when stacking blocks he seems to have some difficulty keeping in mind that he has to keep them balanced while stacking.

He shows good problem solving ability and understands the function of basic tools - as an extension of his reach - to get out-of-reach objects.

Social Contact

Roger has a strong bond with his mother. He certainly knows who to go to when he is hurt or needs the security of her presence. He reportedly sometimes has a buddy but, at the same time, rarely plays with other children. He delights in peek-a- boo as well as vigorous "Get you!" games. He can play a reciprocal ball game and is starting to "catch on" to the notion of turn-taking. He already grasps the concept of "mine" vs. "yours." There is also indication that he is starting to grasp the notion of competing with someone to get a desired object.

Factors which may be interfering with his social play with others is his decided preference for objects over people, his poor eye contact and his difficulty putting himself in the position of the other as when he allows a door to close in the face of the person following him.

Communication (Receptive, Expressive, Nonverbal)

Receptive. It is somewhat surprising to find a child as competent as Roger in problem solving to have such a limited grasp of the way spoken words relate to their objects. He certainly understands and can define familiar body parts (nose, mouth, etc.) on himself, on another and on a picture. And he will give an object in front of him to a person requesting it. However, his capacity drops as soon as he is asked to give an object that is a few feet from him. This same drop in capacity is evident when he is asked to bring a specific object from another room. It becomes even more pronounced when that object is in an unfamiliar place or when asked to get two objects. This suggests that Roger has not yet internalized spoken words and their meanings in a way that lets him "carry" the meaning outside their usual context. Children who are on the cusp of achieving this will often repetitively mutter the word as they look for the object it represents in another setting. The muttering or "self talk" allows them to keep in mind what they are looking for. This suggests that part of Roger's problem with communication is learning how to detach words and their meanings from their usual settings and carry them internally so they may be used everywhere.


This same dependence on words in their familiar contexts accounts, also, for Roger's difficulty expressing himself through words. He can sometimes initiate single words and can always complete a sentence when most of it is given to him. However, Roger rarely initiates a sentence on his own. Even when he does, he never varies the sentence structure. Roger's dependence on an immediate, familiar context in front of him, accounts also for his inability to use words to refer to events that happened elsewhere, had happened or will happen.

Examining Roger's communication further, I find that his communication is hampered by his echoing what is said to him, by his use of "air words" that have nothing to do with the other person and by his reversals of I and you.

Nonverbal Communication

However, the good news is that Roger's nonverbal communication is quite good and can be drawn on to help him maintain meaning outside of familiar contexts. He can signal his intentions with gesture, can pull a person by the hand to a desired object, can sometimes point at a desired object and share his pointing with another to make certain the other knows what he is pointing at. This suggests that incorporating manual sign language into his program can help him improve his receptive and expressive language by grounding spoken word meaning with the help of gestures. The Sign and Spoken Language Program to be referenced later can be of help in this regard.

Symbolic Functioning.

Except for scribbling and make believe play (which he is able to vary) Roger shows little inclination to get involved with symbolic activities. He rarely matches pictures to objects and seems not to understand that pointing to a picture can get him the object represented in that picture.

System Functioning.

Given Roger's preoccupation with objects and his difficulty with transitions, it is clear that his autism is of the closed system type. Our experience with such children is that they often make rapid progress in all sectors if there is a knowledgeable therapist available to help the child expand and complicate their action-object systems and learn how to make transitions from one activity or place to another.


It seems that the further Roger gets from active physical involvement with objects and events, the more difficulty he has. Clearly, one of his major issues is how to cope with a world that is largely unseen but that can be represented in a variety of ways. Roger has many strengths but clearly needs help making transition from things to the symbols which represemt things. This shows itself in his communication lag and in his difficulties with pictures and words. Promising, however, is his ability to represent reality - and to vary it - in his make believe play.


I recommend that Roger be introduced to manual sign language. This means that each verbal direction would be paired with a manual sign related to the object or event. Our experience with the Sign and Spoken Language Program which pairs spoken with sign language is that it triggers a rapid increase in the ability to process spoken language. It also results in the child communicating more effectively with both signs and spoken words. For Roger, sign language should be viewed as a temporary expedient, to strengthen his understanding and use of words. Ultimately, he should be able to use spoken language without sign support. You can view a description of this program on

With appropriate intervention, Roger's prognosis for significant gains is very good.