After Visit Summary-1

Tredonn J. Harris DoB: 2/18/2020 7/12/2023 10:00 AM Jeff Hwy - Peds Psychology Boh Ctr 504-842-3900 Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 1 of 34 AFTER VISIT SUMMARY Your personalized instructions can be found at the end of this document. Ambulatory referral/consult to Applied Behavior Analysis (ABA) Therapy Expires: 7/12/2024 (requested) Ambulatory referral/consult to Boh Child Development Center Expires: 7/12/2024 (requested) You were seen on Wednesday July 12, 2023. The following issues were addressed: Speech delay, Suspected autism disorder, and Autism spectrum disorder. JUL 26 2023 Virtual Visit with Social Worker Mallory, LCSW Wednesday July 26 9:30 AM It is almost time for your virtual visit with your provider! Your virtual visit can be performed on the MyOchsner app on your smart phone or tablet; or via the MyOchsner website on a computer/laptop with webcam and microphone capabilities on a Chrome, Edge, or Safari web browser. Download the MyOchsner mobile app from the Apple App Store or Google Play Store . You will need the latest version of the MyOchsner app if using a smart phone or tablet. Watch a video tutorial about how to prepare for your virtual visit. View additional instructions on how to prepare for your virtual visit. To ensure that your devices are compatible, please click here to test your hardware . If you experience any issues while preparing for your virtual visit, please send a MyOchsner message to MyOchsner Support or call the MyOchsner Patient Support line at 1-877-339-2637. To join your Virtual Visit: 1. Login to your MyOchsner account via the mobile app or the website . 2. Select the box that shows your upcoming virtual visit appointment. 3. Complete ePre-Check prior to starting your virtual visit. 4. Join up to 10 minutes prior to your scheduled appointment time. To join, click the green button that says "Begin Visit". Referrals made today What's Next Today's Visit Instructions

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 2 of 34 What's Next (continued) • • • • • • Please note: If you begin your visit and you don't see your provider right away, please wait patiently as they may be finishing up with another patient. Minimum Version Requirements: Platforms: Windows® version 10 and later macOS® version 10.14 and later iOS/iPad OS version 15.5 and later Android™ version 8 and later Supported Browsers: Google Chrome™ 83 and later Safari® 13.1.1 and later Please note: We will process a claim with your insurance for this virtual visit. Prepay due: $49.00 AUG 16 2023 Well Child with Nikita R Patel, MD Wednesday August 16 11:00 AM Lapalco - Pediatrics 4225 Lapalco Blvd Marrero LA 70072-4338 504-391-7337 Please arrive approximately 15 minutes before your scheduled appointment time and ensure that you have a valid government issued ID and your insurance card. ePre-Check is available and completion prior to your arrival will assist with a quicker registration process. Two Options to Check-In for Your Appointment With MyOchsner Mobile Check-In simply complete ePre-Check before your appointment and click "I'm Here" in the app when you park Or, visit the registration desk to check-in for your appointment Prepay due: Estimate unavailable Guidelines for General Prevention of COVID-19 Take steps to protect yourself from COVID-19. Perform hand hygiene frequently. Wash your hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer, covering all surfaces of your hands and rubbing them together until they feel dry. Avoid touching your eyes, nose, and mouth with unwashed hands. Avoid close contact with people and stay home if you’re sick, except to get medical care. Cover coughs and sneezes with a tissue, or use the inside of your elbow. Immediately wash your hands or use hand sanitizer. For more information, see CDC link below: https://www.cdc.gov/coronavirus/2019-ncov/your-health/index.html COVID-19 Prevention

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 4 of 34 suggestion Always use your most recent med list. cetirizine 1 mg/mL syrup Commonly known as: ZYRTEC Quantity: 120 mL Signed by: Nikita R Patel, MD Take 2.5 mLs (2.5 mg total) by mouth once daily. for 14 days nystatin 100,000 unit/mL suspension Commonly known as: MYCOSTATIN Quantity: 56 mL Signed by: Nicole Mae S Mercado, PA-C Use dropper to place 1 mL in each side of mouth (2 mL total) QID for 7 days. Avoid feeding for 5 to 10 minutes after application as of July 12, 2023 11:59 PM Your Medication List

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 5 of 34 . Psychological Evaluation Autism Assessment Clinic IDENTIFYING INFORMATION Tredonn Harris is a 3 y.o. 4 m.o. male who lives with his mother and father and older brother and baby sister, and has a history of developmental delay. Tredonn was referred to the Autism Assessment Clinic at Michael R. Boh Center for Child Development at Ochsner by Dr. Yelena Johnson, PhD due to concerns relating to a possible diagnosis of Autism Spectrum Disorder. According to Tredonn's caregiver, concerns began at approximately 1.5 years of age. Guardian is seeking a developmental evaluation in order to clarify the diagnosis and inform treatment recommendations. This child participated in a multi-disciplinary clinic to assess for a possible diagnosis of Autism Spectrum Disorder. The multi-disciplinary clinic includes a psychological evaluation, speech therapy evaluation, occupational therapy evaluation, and a medical evaluation. This psychological evaluation should be considered along with the other components of the evaluation. BACKGROUND HISTORY: Name: Tredonn Harris Date of Birth: 2/18/2020 Parent(s): Harveyell Banks Age: 3 y.o. 4 m.o. Date(s) of Assessment: 7/12/2023 Gender: Male Examiner: Lee Ann Annotti, Ph.D. FAMILY INFO 6/11/2023 Type your name: Harveyelle Banks How many caregivers provide care to the child? 2 What is the Primary Caregiver's name? Harveyelle Banks Is the Primary Caregiver the Legal Guardian of the child? Yes What is the Primary Caregiver's relationship to the child? Mother What is the Second Caregiver's name? Trevon Hardis Is the Second Caregiver the Legal Guardian of the child? Yes What is the Second Caregiver's relationship to the child? Father How many siblings does the child have? Two What is Sibling #1's name? Trevon Harris What is Sibling #1's age? 4 What is Sibling #1's gender? Male What is Sibling #1's relationship to the child? Brother Is Sibling #1 living with the child? Yes What is Sibling #2's name? Tyleah Harris Instructions

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 7 of 34 Has the child ever had any thoughts of harming him/ herself or others? No Has the child ever been hospitalized for a psychiatric/ behavioral reason? No Has the child ever been under the care of a mental health provider (psychiatrist, psychologist, or other therapist)? No Did the child pass their hearing test at birth? Yes What were the results of the child's most recent hearing exam? Unknown Does the child use corrective lenses? No What were the results of the child's most recent vision test? Unknown Has the child had any medical evaluations, such as EEGs, MRIs, CT scans, ultrasounds? Unknown Please list any allergies (environmental, food, medication, other) that the child has: No allergies Please list all medications, vitamins, & supplements that the child takes- also include dose, frequency, and what it is used to treat. Vitamins Gummys for immune system Please list any concerns about the child’s sleep (i.e. trouble falling asleep or staying asleep, snoring, night terrors, bedwetting): Trouble falling asleep, night terror and bedwetting Please list any concerns about the child’s eating (i.e. trouble with chewing/swallowing, picky eating, etc) Trouble with personal space and picky eater Hearing: No Ear, Nose, Throat: No Stomach/Intestines/Bowels: No Heart Problems: No Lung/Breathing Problems: No Blood problems (anemia, leukemia, etc.): No Brain/neurologic problems (seizures, hydrocephalus, abnormal MRI): No Muscle or movement problems: No Skin problems (eczema, rashes): No Endocrine/hormone problems (thyroid, diabetes, growth hormone): No Kidney Problems: No Genetic or hereditary problems: Yes Please give us some additional information about this problem. Speech impairment Accidents or Injuries: No Head injury or concussion: No Other problem: No FAM HX 6/11/2023 ADHD: Father Alcoholism: None Anxiety: Mother Autism Spectrum Disorder: Other

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 8 of 34 Which family member had this problem? On his grandfather and nephews Bipolar: Father Birth defect None Criminal Behavior: None Depression: Mother Developmental Delay: Father Drug addiction None Genetics/Hereditary Issue: Father Heart disease: None Intellectual Disability: None Language or Speech problems: Mother Learning Problems: Father Obsessive Compulsive Disorder: None Pain Problems: None Schizophrenia: None Seizures: None Suicide attempt: None Suicide: None Tics or other movement problem: None CURRENT COMMUNICATION SKILLS & BEHAVIORAL HEALTH HISTORY 6/11/2023 Your child communicates, currently, by which of the following (select all that apply) Crying, Playful sounds How much of your child's speech is understandable to you? Some How much of your child's speech is understandable to others? Some What are Some things your child says currently (give examples of speech) Number 1-10 color red blue green pink, chicken, animal sounds Does your child have any problems understanding what someone says? Yes My child has unusual behaviors: Repeats the same behavior over and over, Plays with toys in unusual ways (lines things up, counts them), Flaps his/her hands, Is interested in unusual things (paper clips, bottle caps, stop signs, string, Has trouble with change or transitions My child has behavior problems: Is easily frustrated, Is aggressive, Runs away, Does not obey, Has temper tantrums My child has trouble with attention: Has trouble concentrating, Has a short attention span/is very distractible, Is often forgetful I have concerns about my child’s mood: Seems depressed or unhappy, Seems too irritable, Has sleep or appetite changes, Is moody or has mood swings, Has extreme happiness My child seems anxious or nervous: Is too shy, Feels driven to do things over and over (wash, check, count, confess, arrange, even, collect, etc.), Has trouble separating from parents/loved ones, Has unusual fears or phobias My child has social difficulties: Is not interested in having friends, Is mean to other children, Has poor eye contact

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 10 of 34 Cognitive/Learning Skills : Cognitive ability at this age represents how your child uses early abstract thinking and problem- solving skills. These formal skills were assessed using the Mullen Scales for Early Learning, Second Edition (Mullen-2). The non-verbal problem-solving domain referred to as the Visual Reception domain has been considered a better representation of “IQ” for young children with autism, given ASD deficits in language (Luyster & Lord, 2009). Donny's performance resulted in an age equivalency of 22 months. Tredonn weaknesses in social communication and engagement in restricted/repetitive behaviors somewhat impacted his ability to show his current levels of cognitive functioning. Cognitive functioning should be re-assessed after receiving interventions to target these maladaptive behaviors and should continue to be monitored over time. The CARS (Childhood Autism Rating Scale) Examiners used the Childhood Autism Rating Scale 2 nd Edition, (CARS-2) to assess your child's features of autism. The CARS-2 gathers information about an individual's development and behavioral characteristics that are often associated with autism spectrum disorders. Some of these behaviors include: relating to others, imitation, emotional responses, unusual use of the body or objects, adaptation to change, and sensory responses. The examiners complete the CARS-2 based on caregiver report and observations of your child's behaviors during the evaluation. Tredonn's parents served as the respondent during the CARS-2 interview. The CARS uses a 4 point likert scale to assess the child's behaviors. 1 being normal for your child's age, 2 for mildly abnormal, 3 for moderately abnormal and 4 as severely abnormal. Scores range from 15 to 60 with 30 being the cutoff rate for a diagnosis of mild autism. Scores 30-37 indicate mild to moderate autism, while scores between 38 and 60 are characterized as severe autism. Based on observation and guardian report, Tredonn earned a total score of 43, which falls in the Very Elevated range of symptoms for Autism Spectrum Disorder. Communication : Tredonn's speech throughout the observation primarily consisted vowel sounds and some consonant- vowel sounds. Some single words with notable articulation challenges when he labels colors, alphabet, and shapes. Reciprocal Social Interaction : One important feature to evaluate is the extent to which a child can coordinate nonverbal and verbal/vocal features strategies to send a message to another person. Nonverbal means include eye contact, gaze shifting, facial expressions, pointing, and other gestures. Donny's eye contact was inconsistent and improved during tickle activities. Although Donny showed aloofness to social overtures for play, he smiled and giggled while the examiner tickled him and sang nursery rhymes to him. He allowed the examiner to hold his hands and move his arms to make the gestures that go along with the Wheels on the Bus song and the Itsy Bitsy Spider song. He did not imitate play or other behaviors. At times he showed some an inappropriate degree of emotions, especially when items such as the telephone were removed. He threw himself to the ground and cried. Stereotyped Behaviors and Restricted Interests : Repetitive behaviors fall into the categories of stereotyped behaviors such as whole body behavior (spinning, rocking, flapping hands) and seeking certain visual stimulation (spinning wheels, watching the TV for certain visual sights, looking in the mirror repeatedly, holding objects in side visions), and needing to do things the exact same way every time. Repetitive behaviors can also take the form of highly restricted interests, such as in numbers, letters, shapes, puzzles, vehicles, and characters. He enjoys spinning toys and lining toys up. He likes to flip the light switches on an off, repetitively. He flaps his hands, shakes his head and rolls his neck, he spins in a circle, repetitively shrugs his shoulders and postures his fingers. He enjoyed opening and closing doors and exploring a box. He tended to mouth objects as opposed to playing with objects. He is under responsive to pain, he does not react when he hits his head by bumping into objects. He also periodically visually examined objects by holding them close to his eyes or looking out the corner of his eyes. QUESTIONNAIRE DATA: PARENT/CAREGIVER REPORT

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 11 of 34 • • • • • • • • • In addition to direct assessment, multiple rating scales were used as part of today's evaluation. Tredonn's Biological Mother completed the following rating scales to provide more information regarding his daily living skills, social communication abilities, and overall behavioral and emotional functioning. Adaptive Skills Assessment Adaptive Behavior Assessment System, Third Edition (ABAS-3) The Adaptive Behavior Assessment System, Third Edition (ABAS-3) provides information about Tredonn's adaptive development across a variety of practical domains. Adaptive development refers to one's typical performance of day-to-day activities. These activities change as a person grows older and becomes less dependent on the help of others. At every age, however, certain skills are required for the individual to be successful in the home, school, and community environments. Tredonn's behaviors were assessed across the Conceptual (measures communication, functional academics, and self-direction), Social (measures leisure and social), and Practical (measures community use, home living, health and safety, and self- care) Domains. In addition to domain-level scores, the ABAS-3 provides a Global Adaptive Composite score (GAC) that summarizes Tredonn's overall adaptive functioning. Standard Scores on the ABAS-3 are categorized as Extremely Low (≤70), Low (71-79), and Below Average (80-89), indicating Tredonn has significantly more difficulty than other children his age preforming skills in a given area. Standard Scores in the Average (90-109), Above Average (110-119), and High (≥120) range indicate age-appropriate abilities as reported by the rater in a given domain. Specific scores as reported by Tredonn's caregiver on the ABAS-3 are included below. Descriptions of the individual scales measured by the ABAS-3 include: Communication (skills used for speech, language, and listening) Functional Pre-Academics (the foundational skills needed for academic performance) Self-Direction (independence, responsibly, and self-control) Leisure (recreational activities such as games and playing with toys) Social (interacting appropriately and getting along with other children) Community Use (ability to navigate the community and environments outside the home) Home Living (appropriate use of the home environment such as location of clothing, putting away toys) Health and Safety (skills needed for preventing injury and following safety rules) Self-Care (eating, dressing, bathing, toileting) Domain Subscale Standard Score / Scaled Score Percentile Rank / Age Equivalent Descriptor Conceptual 54 0.1 Extremely Low Communication 1 0:04 Extremely Low Functional Academics 3 1:10-1:11 Extremely Low Self-Direction 1 0:11 Extremely Low Social 51 0.1 Extremely Low Leisure 1 0:04 Extremely Low Social 1 1:2-1:3 Extremely Low Practical 51 0.1 Extremely Low Community Use 1 1:10-1:1 Extremely Low Home Living 1 1:2-1:3 Extremely Low Health and Safety 1 0:00 Extremely Low Self-Care 1 0:06 Extremely Low General Adaptive Composite 53 0.1 Extremely Low

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 13 of 34 • • • • • • • • • • The following scales fell in the Clinically Significant range according to caregiver report: Hyperactivity (engages in many disruptive, impulsive, and uncontrolled behaviors) Aggression (can often be augmentative, defiant, or threatening to others) Depression (presents as withdrawn, pessimistic, or sad) Attention Problems (difficulty maintaining attention; can interfere with academic and daily functioning) Atypicality (frequently engages in behaviors that are considered strange or odd and seems disconnected from his surroundings) Withdrawal (often prefers to be alone) Adaptability (takes much longer than others his age to recover from difficult situations) Social Skills (has difficulty interacting appropriately with others) Functional Communication (demonstrates poor expressive and receptive communication skills) Activities of Daily Living (difficulty performing simple daily tasks)

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 14 of 34 • • • • • • Scales included below fell in the At-Risk range according to caregiver report: Anxiety (often appears worried or nervous) Somatization (often complains of aches/pains related to emotional distress) Autism-Specific Rating Scale Autism Spectrum Rating Scale (ASRS) The Autism Spectrum Rating Scale (ASRS) is used to gather information about an individual's engagement in behaviors commonly associated with Autism Spectrum Disorder (ASD). The ASRS contains two subscales (Social / Communication and Unusual Behaviors) that make up the Total Score. This Total Score indicates whether or not the individual has behavioral characteristics similar to individuals diagnosed with ASD. Scores from the ASRS also produce Treatment Scales, indicating areas in which an individual may benefit from support if scores are Elevated or Very Elevated. Finally, the ASRS produces a DSM-5 Scale used to compare parent responses to diagnostic symptoms for ASD from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Standard Scores on the ASRS are presented as T-scores with a mean of 50 and a standard deviation of 10. T-scores below 40 are classified as Low indicating an individual engages in behaviors at a much lower rate than to be expected for his age. T-scores from 40 to 59 are considered Average , meaning an individual's level of engagement in the behavior is expected for his age. T-scores from 60 to 64 are classified as Slightly Elevated indicating an individual engages in a behavior slightly more than expected for his age. T-scores from 65 to 69 are considered Elevated and T-scores of 70 or above are classified as Clinically Elevated . This final category indicates Tredonn engages in a behavior significantly more than others his age. Despite the presence of the DSM-5 Scale, results of the ASRS should be used in conjunction with direct observation, parent interview, and clinical judgement to determine if an individual meets criteria for a diagnosis of ASD. Specific scores as reported by Tredonn's caregiver on the ASRS are included below. Common characteristics of individuals who score in the Very Elevated, Elevated, or Slightly Elevated range on a given subscale include: Social/Communication (has difficulty using verbal and non-verbal communication to initiate and maintain social interactions) Unusual Behaviors (trouble tolerating changes in routine; often engages in stereotypical or sensory-motivated behaviors) Peer Socialization (limited willingness or capability to successfully interact with peers) Adult Socialization (significant difficulty engaging in activities with or developing relationships with adults) Scale Subscale T-Score Descriptor ASRS Scales/ Total Score 85 Very Elevated Social/ Communication 84 Very Elevated Unusual Behaviors 77 Very Elevated Treatment Scales --- --- Peer Socialization 85 Very Elevated Adult Socialization 82 Very Elevated Social/ Emotional Reciprocity 85 Very Elevated Atypical Language 55 Average Stereotypy 81 Very Elevated Behavioral Rigidity 69 Elevated Sensory Sensitivity 82 Very Elevated Attention/Self-Regulation 82 Very Elevated DSM-5 Scale 85 Very Elevated

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 16 of 34 1. 2. 3. 1. behaviors that are associated with Autism. After a period of treatment for behaviors associated with Autism, cognitive functioning should be re-assessed. DIAGNOSTIC IMPRESSION: Based on Tredonn's history, clinical assessment and the tests completed today, Tredonn meets the Diagnostic Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria for Autism Spectrum Disorder (ASD) and global developmental delay. Tredonn has deficits in social communication and social interaction as well as restricted, repetitive patterns of behavior or interests. These symptoms are causing significant impairment in his daily functioning. So "where are they on the spectrum?" Severity levels listed in the DSM-5 (e.g., level 1, 2, 3) are less clinically useful or appropriate compared to understanding your child's particular presentation, their strengths, and the identified areas in need of supports for your child listed below under recommendations. This understanding can include their cognitive and language ability, adaptive and academic functioning, social communication abilities compared to other children of similar age and developmental level, restricted and repetitive behaviors, and any internalizing or externalizing behaviors impacting functioning. Recommendations: Please read all the recommendations carefully: Therapy 1. Tredonn would benefit from an intensive behavioral intervention program based on the principles of Applied Behavior Analysis (ABA) conducted by an individual who is a board certified behavior analyst (BCBA), a licensed psychologist with behavior analysis experience, or an individual supervised by a BCBA or licensed psychologist. School Recommendations Because the results of the current assessment produced a diagnosis of Autism Spectrum Disorder, Tredonn may qualify for special education services under the category of Autism Spectrum Disorder in accordance with the Individual's with Disabilities Education Improvement Act's disability categories for special education. It is recommended that the family share copies of this report and request a full educational evaluation with the public school system. You can request this through Tredonn's teacher or principal. It is recommended that school personnel consider the results of this evaluation when determining appropriate placement and educational programming options. Tredonn will benefit from intensive educational and behavioral interventions. Research has consistently demonstrated that early intervention significantly improves the prognosis for children with an Autism Spectrum Disorder (ASD). Specifically, intervention strategies based on the principles of Applied Behavior Analysis (ABA) have been shown to be effective for treating symptoms and developmental skill deficits associated with ASD. ABA services can be offered at the individual (e.g., Discrete Trial Instruction), small group (e.g., social skills groups), or consultation level (e.g., parent/ teacher training). Consultation strategies are essential for maintaining consistency among caregivers for implementation of techniques and interventions that target the individual needs of the child and his or her family. As individuals with ASD and communication deficits may have difficulty with understanding verbally presented material and complex, multiple-step instructions, parents and/or caregivers are encouraged to provide concise, simple instructions to Tredonn in combination with visual cues and demonstrations to assist with him understanding of what is expected and assist with teaching new skills. Further Evaluation It is recommended that Tredonn be re-evaluated at a later date (e.g., at least three calendar years) to determine levels of functioning following intervention. It should be noted that assessment of intellectual ability may be complicated in individuals with Autism Spectrum Disorder as social-communication and behavior deficits inherent to ASD may interfere with adhering to testing procedures; therefore, any standardized testing results should be interpreted within the context of adaptive skill level when estimating ability.

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 17 of 34 2. 3. 1. 2. 3. The American Academy of Pediatrics and the American College of Clinical Genetics recommend that the families of children diagnosed with Global Developmental Delay and/or Autism Spectrum Disorder consider genetic testing to see if an etiology (cause) can be found. The usual genetic testing is chromosomal microarray and Fragile X testing. It is recommended that Donny have his vision and hearing checked. Family can schedule this with their pediatrician. Social Skills Training Tredonn would benefit from social skills training aimed at enhancing peer interaction in the school environment. The use of a small play-group (2-3 other children) would facilitate Tredonn's positive interactions with peers. Skills should include sharing, taking turns, social contact, appropriate verbalizations, expressing emotions appropriately, and interactive play. Modeling, prompting, and corrective feedback should be used as well as strong rewards (e.g., treats he likes, access to preferred activities). The teacher could reward your child for appropriate interactions with other children. The teacher could also pair Tredonn with a variety of other students to help model conversations, turn taking, waiting, and interacting with peers. Visual and verbal prompts may be necessary when helping Tredonn learn a new skill. Social stories may also be beneficial to teaching coping skills and social skills. Strategies to encourage social-emotional development and peer interaction in early childhood Engage your child in child led play while working to get in their attention spotlight. This looks like positioning yourself in their spotlight or gaze, reduce distractions in the room, play your child's favorite activity or with your child's favorite toys, describe his behaviors (like a sportscaster), provide praise when he smiles, gestures, shows, or looks to you, reflect his vocalizations, imitate his actions with similar toys, and show enjoyment. This also looks like following what your child is focused on in play or place a toy your child is interested in near you face and wait to see if he will respond, asking "where did it go?" Or "what do you want me to do now?". Additionally, make comments about the object. Attempt a back-and-forth type of interaction, and then perhaps encourage Tredonn to solve a problem. For example, if he is rolling a truck back and forth, pretend your hand is a hill that he needs to drive over. Encourage him to drive over the hill and continue to praise him for engaging with you. Encourage play with a child about the same age for increasingly longer periods of time. Set up a well-liked task with a carefully chosen peer, on with whom Tredonn relates comfortably. Find an activity for yourself that allows you to be present but not directly involved. For example, you could be reading a book or folding laundry, but not watching TV or listening on the radio. Later, you can begin to withdraw from the area for gradually increasing lengths of time. Let this learning stretch over many weeks and a number of play sessions, and do not hurry to leave the children alone too quickly. If Tredonn feels abandoned, frightened by the other child, or upset by the situation, it will be harder to learn independent peer play. A sensory social routine is a joint activity in which each partner focuses on the other person, rather than on objects. It is a dyadic joint activity routine (partner and self) in which two people engage in the same activity in a reciprocal way: taking turns, imitating each other, communicating with words, gestures, or facial expressions. Typical sensory social routines involve lap games like “Peekaboo,” “Itsy Bitsy Spider, “Ring Around the Rosy,” and movement routines like “Airplane,” “Chase,” and “Swing.” These routines teach children that other peoples' bodies and faces “talk” and are important sources of communication. Therefore, it is crucial that children face adults during the activity. Furthermore, these activities teach children to communicate, initiate, and maintain social interactions. The following are helpful tips for developing a sensory social routine: --Find something he will smile about --Get in front of Donny --Create fun routines from songs, physical games, and touch --Accompany him with lively faces, voices, and sounds

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 19 of 34 1. 2. 3. book could be presented and paired with the words, “First bath, then book.” This type of visual support can also be used to encourage Tredonn to engage with a new task prior to a preferred task. The following visual schedule would be an example of a visual support during Tredonn's day. A schedule such as this would serve as a reminder to Tredonn of what she should be doing and allow her to independently transition from activity to activity. These types of supports can be created using photographs, pictures from Boardmaker or Google Images http://images.google.com/ During times of transition, it may be beneficial to use visual time warnings for five minutes prior to the transition in order to allow Tredonn to see time elapsing. The Time Timer is a clock that has a visual time segment and an optional auditory signal when the time is up as well. There are several free visual timer apps for tablets and smartphones available as well. Resources for Families It is recommended that parents contact the Louisiana Office for Citizens with Developmental Disabilities (OCDD) for resources, waiver services, and program information. Even if Tredonn does not qualify for services right now, it is recommended that parents have Tredonn added to a Waiver waiting list so that they are prepared should the need for services arise in the future. Home and Community-Based Waiver Services are funded through a combination of federal and state funding. The waivers allow states to waive certain Medicaid restrictions, such as income, so individuals can obtain medically necessary services in their home and community that might otherwise be provided in an institution. The waivers allow states to cover an array of home and community-based services, such as respite care, modifications to the home environment, and family training, that may not otherwise be covered under a state's Medicaid plan. Tredonn's caregivers are encouraged to contact their regional chapter of Families Helping Families (FHF) . This non-profit organization provides education and trainings, peer support, and information and referrals as part of their free services. The FHF Centers are directed and staffed by parents, self-advocates, or family members of individuals with disabilities. The Autism Speaks “100 Day Kit for Newly Diagnosed Families of Young Children” was created specifically for families of children ages 4 and under to make the best possible use of the 100 days following their child's diagnosis of autism. https://www.autismspeaks.org/tool-kit/100-day-kit-young-children

Tredonn J. Harris (MRN: 12053983) • Printed at 7/13/2023 10:06 AM Page 20 of 34 4. 5. 1. 2. The Autism Speaks “100 Day Kit for Newly Diagnosed Families of Young Children” was created specifically for families of school aged children to make the best possible use of the 100 days following their child's diagnosis of autism. https://www.autismspeaks.org/tool-kit/100-day-kit-school-age-children The Autism Society of Greater New Orleans https://www.asgno.org/ provides resources, support groups, and social skills groups Book resources for parents: Autism Spectrum Disorders: What Every Parent Needs to Know by Alan Rosenblatt and Paul Carbonne Autism and the Family by Kate E. Fiske _______________________________________________________________ Lee Ann Annotti, Ph.D. L icensed Psychologist Coordinator, Autism Assessment Clinic Michael R Boh Center for Child Development Ochsner Hospital for Children 1315 Jefferson Hwy. | New Orleans, LA 70121 Louisiana's Only Ranked Pediatric Hospital