Protocol 1: Parent / Caregiver Questionnaire
People Present
- Names and relationships of all attendees
- Whether the child was present during the interview
1. Concerns
- Parent/caregiver’s primary concerns about the child
- Key symptoms, behaviours, or situations that prompted the assessment
2. Relationships – Family
- Who lives with the child at home
- How the child relates to different family members
3. Relationships – Peers
- Which children the child spends time with, ages, and types of activities
- Quality of peer interactions and any difficulties noted
4. Preference for Solitude or Company
- Whether the child prefers time alone or with others
5. Activities and Interests
- Favourite activities and areas of special interest or skill
6. Sensory Behaviours
- Food: preferences, aversions, textures, dietary restrictions, and any behavioural changes related to diet
- Clothing: preferences, sensory sensitivities (e.g., tags, seams, materials)
- Tactile: touch preferences, deep pressure vs. light touch, objects frequently held, skin/hair picking or mouthing
- Visual details: noticing or commenting on details others miss; reactions to changes in environment
- Noises: sounds that bother or distress the child; sounds the child seeks out
- Smells: odours that bother the child; objects explored by smell
- Sleep patterns: bedtime routine, sleep quality, difficulty falling or staying asleep
- Body boundaries: awareness of personal space; crowding reactions
- Crowded places: avoidance of or distress in crowded environments
- Transitions and routine changes: reactions to transitions or schedule changes; use of visual/written supports
- Response to pain: typical reaction to minor injury or discomfort
7. Emotions – Anger / Frustration
- Triggers for anger or agitation
- How the child expresses these emotions
- What helps the child calm down
8. Emotions – Fear / Anxiety
- Specific fears or anxious behaviours the child displays
9. Medications
- Current medications, purpose, duration, and any observed behavioural changes
10. Developmental Milestones
- Birth history and early developmental milestones
- History of delays in walking, talking, or toileting
- Early childhood interventions received (e.g., speech, OT, physio)
- Physical health conditions or injuries and treatment received
11. School Experience
- Current and past school experiences
- Supports that have worked or not worked
- Suggestions for beneficial changes
12. Current Understanding of Autism
- What the parent/caregiver has read or learned about autism
- Their thoughts about autism in relation to their child
13. Evaluation History
- Previous assessments: type, clinician, date, and results
14. Family History
- Family history of learning, social, behavioural, or other challenges
15. Three Words / Qualities to Describe Child
- Three words or qualities used by the parent/caregiver to describe the child
16–18. Closing
- Additional information not captured elsewhere
- What the parent/caregiver hopes to gain from the evaluation
- Specific questions about the evaluation process and clinician’s response
Protocol 2: Teacher Questionnaire
People Present
- Names, roles, and school details of all attendees
- Whether the student was present during the interview
1. Concerns
- Teacher’s primary concerns about the student
- Symptoms, behaviours, or situations leading to the referral
2. Organisational Skills
- Ability to manage class materials independently
- Current school supports in place
3. Relationships – Peers
- Social interactions with peers during free time
- Ability to interpret social cues (e.g., humour, sarcasm)
- Cooperative group work; peer correction or reporting behaviours
4. Relationships – Adults
- Preference for adult vs. peer interaction
- Awareness of teacher–student hierarchy
5. Communication Style
- Relevance of classroom contributions to the topic
- Formal, scripted, or unusual speech patterns
- Monologue vs. reciprocal conversation tendencies
6. Preoccupations / Skills / Interests
- Intense interests, highly developed skills, or eccentric preoccupations
7. Sensory Behaviours
- Tactile: touching objects, skin/hair picking, mouthing
- Visual details: noticing visual changes in the classroom or on their desk
- Noises: sounds that bother or are sought by the student
- Smells: aversions or exploratory smelling behaviour
- Body boundaries: personal space awareness and peer proximity issues
- Crowded places: reactions in crowded school environments
- Transitions and routine changes: transition difficulty, use of visual/written supports
- Physical movements: clumsiness, unusual gait, difficulties sitting, distress in PE or sport
8. Academic Abilities
- Areas of academic strength and challenge
- Handwriting difficulties or written expression issues
9. Behaviour During Unstructured Times
- Behaviour in hallways, at lunch, recess, or between periods
10. Emotional Qualities
- Anxiety triggers and presentation
- Emotional immaturity or acting younger than age
- Frustration and anger management; de-escalation strategies
11. Three Words / Qualities to Describe Student
- Three words or qualities used by the interviewee to describe the student
12–14. Closing
- Additional information not captured elsewhere
- What the interviewee hopes to gain from the evaluation
- Specific questions about the evaluation process and clinician’s response
Section 3: Summary Notes (All Protocols)
Psychometric Assessment
- Name and purpose of each test administered
- Quantitative results (scores, percentiles)
- Qualitative interpretation
- Clinical implications
Findings According to DSM-5-TR Criteria A: Social Communication and Interaction
- A1: Social-emotional reciprocity
- A2: Nonverbal communication
- A3: Developing and maintaining relationships
Findings According to DSM-5-TR Criteria B: Restricted Patterns of Behaviour
- B1: Stereotyped or repetitive movements, speech, or use of objects
- B2: Insistence on sameness, rigid routines, or ritualised patterns
- B3: Highly restricted, fixated interests abnormal in intensity or focus
- B4: Hyper- or hyporeactivity to sensory input or unusual sensory interest
Findings According to DSM-5-TR Criteria C
- Summary of how autism-related symptoms presented in the early developmental period
Findings According to DSM-5-TR Criteria D
- Statement of clinically significant impairment in social, family, educational, or other key areas
Findings According to DSM-5-TR Criteria E
- Comment on intellectual disability or global developmental delay; social functioning relative to developmental expectations
Risk
- Suicidal or self-harm risk, if any
- Risk of social isolation, bullying (victim or perpetrator)
- Protective factors
Recommendations and Next Steps
- Medication referral recommendations
- Non-pharmacological interventions or strategies
- Specialist referrals
- Plan for ongoing assessment, follow-up, and monitoring
- Safety plan details
- Education provided to interviewee about assessment, diagnosis, and treatment
- Details of the next scheduled appointment
Protocol 1 – Parent / Caregiver Questionnaire
People Present
- Emma Brown (mother) and David Brown (father)
- Lucas Brown not present.
1. Concerns
- Parents described significant difficulties with social communication, limited interest in peer play, and intense distress when routines are disrupted.
- Emma reported that Lucas rarely initiates conversation with unfamiliar adults and repeats phrases from television programmes when distressed.
2. Relationships – Family
- Lucas lives with both parents and his older sister Ella (aged 10). He has a warm relationship with Emma and seeks her out for comfort. He disengages from family activities involving noise or unpredictability.
3. Relationships – Peers
- Lucas prefers the company of one familiar classmate and avoids group play, particularly when activities involve physical contact or loud noise.
4. Preference for Solitude or Company
- Lucas strongly prefers solitary play with construction toys and trains. He tolerates company on his own terms and becomes dysregulated if others disrupt his play without warning.
5. Activities and Interests
- Lucas has an intense interest in trains and railway systems and can recite timetables and track layouts from memory. He also enjoys building with LEGO and watching nature documentaries about insects.
6. Sensory Behaviours
Food
- Lucas eats a narrow range of foods and cannot tolerate foods touching on his plate. He currently eats approximately eight preferred foods and becomes distressed if sauces or mixed dishes are presented.
Clothing
- Lucas insists on seamless socks and refuses clothing with tags. He is sensitive to tight waistbands and will only wear soft, loose-fitting fabrics. Dressing is a daily source of conflict.
Tactile
- Lucas seeks deep pressure input and dislikes light, unexpected touch. He frequently carries a small smooth stone in his pocket.
Visual Details
- Lucas notices minor environmental changes others do not register, such as a slightly tilted picture frame, and becomes anxious until corrections are made.
Noises
- Hand dryers, vacuum cleaners, and raised voices cause distress. He covers his ears in supermarkets and assemblies, but actively seeks out recordings of trains and railway stations.
Smells
- Strong cooking smells, particularly fish or eggs, cause Lucas to gag or leave the room. He occasionally smells unfamiliar objects before touching them.
Sleep Patterns
- Lucas requires a fixed bedtime routine involving a bath, two specific books, and set goodnight phrases. Variation causes distress and delayed sleep onset. He wakes once or twice nightly.
Body Boundaries
- Lucas becomes distressed when others stand close to him but has limited awareness of his own proximity to others, which has been raised at school.
Crowded Places
- Shopping centres, birthday parties, and school events are highly challenging. Emma prepares him with a schedule in advance, which partially reduces distress.
Transitions and Routine Changes
- Transitions away from preferred activities are a consistent source of dysregulation. Emma uses a visual timer and written schedule with partial success. Unexpected changes can trigger prolonged distress lasting up to an hour.
Response to Pain
- Lucas appears to have a higher pain threshold than expected but may react intensely to anticipated pain, such as before a needle.
7. Emotions – Anger / Frustration
- Triggers include transitions, routine changes, and perceived rule violations. Lucas typically responds with verbal protests, crying, and occasionally throwing objects. A quiet space and access to his train sets help him regulate.
8. Emotions – Fear / Anxiety
- Lucas displays anxiety related to loud environments, new social situations, and routine deviation. He has recently developed anxiety about school fire drills.
9. Medications
- Lucas is not currently taking any medications.
10. Developmental Milestones
- Pregnancy and birth were uncomplicated. Gross motor milestones were achieved within expected timeframes. First words appeared at approximately 18 months, primarily used to label objects rather than communicate socially.
- He received speech therapy for 18 months and occupational therapy for 12 months, now concluded. No significant physical health conditions or injuries were reported.
11. School Experience
- Lucas attends Year 2 with a part-time integration aide. Structured, predictable activities are where he performs best. He struggles during lunch, recess, and activities involving group work or timetable changes.
- The family has requested a personalised learning plan, currently being developed by the school.
12. Current Understanding of Autism
- Both parents are familiar with the neurodiversity framework and are open to a diagnosis if it accurately reflects Lucas’s experience. Emma requested that language in the report be strengths-based.
13. Evaluation History
- Speech pathology assessment at age three identified pragmatic language difficulties. OT assessment at age four identified sensory processing differences and fine motor delays. No previous autism assessment has been completed.
14. Family History
- David has wondered whether he may be autistic. A paternal uncle was diagnosed with Asperger Syndrome in adulthood. No known neurodevelopmental history on Emma’s side.
15. Three Words / Qualities to Describe Child
- Emma described Lucas as “curious, determined, and deeply loving.”
16. Closing – Additional Information
- Emma noted that Lucas has recently begun tracking rainfall in a notebook, which she wanted recorded as a strength.
17. Goals for the Evaluation
- Both parents hope the evaluation will confirm whether Lucas meets criteria for autism, deepen their understanding of his profile, and support school advocacy.
18. Questions About the Evaluation Process
- David asked whether a written report would be provided. The clinician confirmed a comprehensive report would be prepared and reviewed with the family at a follow-up appointment.
Section 3: Summary Notes
Psychometric Assessment
- No psychometric testing has been completed at this stage.
Findings According to DSM-5-TR Criteria A: Social Communication and Interaction
A1 – Social-Emotional Reciprocity
- Lucas’s language is primarily functional and label-based with limited use of conversation to share experiences or emotions. He does not initiate interaction with unfamiliar adults and uses scripted phrases under stress, limiting reciprocal exchange.
A2 – Nonverbal Communication
- Specific information about nonverbal communication behaviours was not detailed in the interview. Direct observation is indicated.
A3 – Developing and Maintaining Relationships
- Lucas restricts socialising to one familiar peer, engages in parallel rather than cooperative play, and becomes distressed when peers intrude on his activities. He shows difficulty adjusting behaviour across social contexts.
Findings According to DSM-5-TR Criteria B: Restricted Patterns of Behaviour
B1 – Repetitive Movements, Speech, or Use of Objects
- Lucas uses scripted echolalic phrases under stress and engages in repetitive sensory-seeking behaviour (carrying a smooth stone). He shows repetitive, focused engagement with train sets.
B2 – Insistence on Sameness and Rigid Routines
- Lucas requires a fixed bedtime routine and becomes significantly dysregulated by unexpected schedule changes. He insists on visual sameness in his environment and responds distressfully when objects are moved.
B3 – Restricted, Fixated Interests
- Lucas has an intense, enduring preoccupation with trains that significantly exceeds typical developmental interest in both depth and focus.
B4 – Sensory Reactivity
- Lucas shows marked hypersensitivity to auditory, tactile, and olfactory input, while actively seeking deep pressure. His sensory profile impacts daily functioning across home, school, and community settings.
Findings According to DSM-5-TR Criteria C
- Parental report indicates symptoms were present from early childhood. Pragmatic language differences were identified at age three and sensory processing differences at age four. Emma reported concerns beginning before age two.
Findings According to DSM-5-TR Criteria D
- Sensory sensitivities and rigid routines create daily difficulties at home. At school, Lucas requires one-to-one support and struggles significantly during unstructured times. Social participation is limited by his preference for solitude and difficulty with peer interaction.
Findings According to DSM-5-TR Criteria E
- No formal cognitive assessment has been completed. Intellectual disability does not appear probable given his functional academic progress, though formal assessment is recommended. Lucas’s social functioning is noticeably below age-expected norms.
Risk
- No suicidal ideation or self-harm was reported. Moderate risk of social isolation given limited peer connections. His close relationship with both parents is a significant protective factor.
Recommendations and Next Steps
- Cognitive assessment recommended to establish Lucas’s intellectual profile and inform school planning.
- Referral to OT recommended to reassess sensory profile and develop updated strategies.
- Family advised to request an updated school support plan incorporating sensory accommodations and transition supports.
- Follow-up appointment scheduled for Thursday, 12 March 2026 at 10:00 AM.
Protocol 2 – Teacher Questionnaire
People Present
- Ms. Sarah Hill (Year 3 classroom teacher) and Mr. James Nguyen (school counsellor) attended the interview. Both are employed at NovoNote Primary School.
- Oliver Green was not present.
1. Concerns
- Ms. Hill described Oliver as academically capable but struggling significantly with peer relationships, transitions, and sensory aspects of the classroom environment.
- Mr. Nguyen noted he frequently corrects peers and adults, becomes intensely distressed when the timetable changes, and has difficulty sustaining reciprocal conversation.
2. Organisational Skills
- Oliver manages personal materials independently and maintains his desk in a precise arrangement. He becomes distressed if items are moved.
- He receives no formal academic adjustments, though Ms. Hill provides verbal pre-warnings before activity changes as an informal strategy.
3. Relationships – Peers
- Oliver rarely seeks out peers during free time. In group activities he tends to direct or correct others rather than collaborate, causing friction with classmates.
- He frequently misinterprets playful teasing as genuine criticism, does not recognise sarcasm, and takes figurative language literally. He regularly reports peer behaviour to Ms. Hill.
4. Relationships – Adults
- Oliver consistently seeks adult over peer interaction and converses comfortably with Ms. Hill at length. He does not consistently recognise the teacher–student distinction and has corrected Ms. Hill on factual matters in front of the class.
5. Communication Style
- Oliver’s classroom contributions are detailed and often tangential. His speech is formal and precise — Ms. Hill described it as sounding like a documentary narrator.
- He can monologue extensively on his interests but has limited capacity for back-and-forth conversation and frequently redirects discussions to his own topics.
6. Preoccupations / Skills / Interests
- Oliver has an intense preoccupation with ancient Egypt and will steer conversations toward this topic regardless of context. His self-directed written work on this topic is well above grade level.
7. Sensory Behaviours
Tactile
- Oliver frequently runs his fingers along desk edges and book spines. He dislikes unexpected touch and has pulled away sharply when peers brush against him.
Visual Details
- Oliver immediately notices classroom changes. On one occasion he refused to settle to work until a moved bookshelf was returned to its original position.
Noises
- The school bell and assemblies cause distress; Oliver covers his ears and has requested to be excused from assemblies. He is drawn to the rhythmic sound of the air conditioning and taps along to it.
Smells
- Oliver has commented negatively on the smell of the school canteen on several occasions.
Body Boundaries
- Oliver becomes distressed when peers stand close uninvited. Conversely, he frequently enters adult personal space without apparent awareness.
Crowded Places
- Oliver avoids the canteen at peak times and requests to eat in the library or classroom. He becomes overwhelmed during large school events.
Transitions and Routine Changes
- Transitions are a significant area of difficulty. Oliver checks the written classroom schedule multiple times per day and becomes dysregulated when unexpected changes occur, sometimes taking up to 30 minutes to re-engage.
- Providing written advance notice of changes has been the most effective strategy to date.
Physical Movements
- Oliver sits in an unusual posture, often preferring to stand at his desk. Physical education is a source of anxiety; he avoids ball sports and has cried when required to participate.
8. Academic Abilities
- Strong reading comprehension and general knowledge, particularly in history and science. He struggles with open-ended writing tasks, and his handwriting deteriorates under time pressure. Maths performance is solid for structured tasks.
9. Behaviour During Unstructured Times
- Oliver typically walks the oval perimeter alone or reads near the school building. He appears content during solitary time but becomes dysregulated when peers approach unexpectedly or unstructured time extends beyond schedule.
10. Emotional Qualities
- Oliver displays high baseline anxiety around change, rule violations, and social unpredictability. His frustration responses resemble those of a younger child, and he can remain dysregulated for the remainder of the school day after a significant upset.
- A quiet space and access to a book on his preferred topic are the most effective de-escalation strategies.
11. Three Words / Qualities to Describe Student
- Ms. Hill described Oliver as “brilliant, earnest, and exhausting.”
12. Closing – Additional Information
- Mr. Nguyen noted that Oliver has attended a lunchtime chess club twice and appears more relaxed in this structured, rule-based social context.
13. Goals for the Evaluation
- Ms. Hill and Mr. Nguyen hope the evaluation will provide clarity about Oliver’s needs and inform the development of a personalised learning plan.
14. Questions About the Evaluation Process
- Ms. Hill asked whether she would receive a copy of the final report. The clinician confirmed this would be provided with written parental consent.
Section 3: Summary Notes
Psychometric Assessment
- No psychometric testing has been completed at this stage.
Findings According to DSM-5-TR Criteria A: Social Communication and Interaction
A1 – Social-Emotional Reciprocity
- Oliver does not sustain back-and-forth conversation with peers and redirects interactions to his own topics. He misinterprets humour and takes figurative language literally, limiting genuine reciprocal exchange.
A2 – Nonverbal Communication
- Direct observation has not been conducted. Teacher report indicates Oliver enters adult personal space without apparent awareness, suggesting difficulty reading nonverbal proximity cues.
A3 – Developing and Maintaining Relationships
- Oliver has no identified peer friendships and consistently chooses solitary activity. He has difficulty adapting behaviour across social contexts, corrects and directs peers, and has declined social invitations. His social functioning is significantly below age-expected norms.
Findings According to DSM-5-TR Criteria B: Restricted Patterns of Behaviour
B1 – Repetitive Movements, Speech, or Use of Objects
- Oliver engages in repetitive tactile behaviour (running fingers along surfaces) and rhythmic tapping. His speech is notably formal and scripted in quality.
B2 – Insistence on Sameness and Rigid Routines
- Oliver shows strong insistence on sameness in his classroom environment and becomes distressed when displays or furniture are altered. He checks the written timetable repeatedly and becomes dysregulated by unexpected changes.
B3 – Restricted, Fixated Interests
- Oliver has an intense, pervasive preoccupation with ancient Egypt that he redirects conversations toward across all contexts.
B4 – Sensory Reactivity
- Oliver shows hypersensitivity to auditory, tactile, and olfactory input and is distressed in crowded environments. He engages in some sensory-seeking behaviour (rhythmic tapping, surface touching). Sensory difficulties impact participation across multiple school settings.
Findings According to DSM-5-TR Criteria C
- Teacher report is based on current observations. Early developmental history will be gathered via the Parent/Caregiver Questionnaire to fully assess this criterion.
Findings According to DSM-5-TR Criteria D
- Oliver’s difficulties with transitions, sensory tolerance, and peer interaction affect his functioning across structured and unstructured school settings daily, representing clinically significant impairment.
Findings According to DSM-5-TR Criteria E
- Oliver’s academic performance in areas of interest is notably advanced, making intellectual disability an unlikely explanation. Formal cognitive assessment has not been completed and would strengthen the evaluation.
Risk
- No self-harm or harm to others reported. Moderate risk of social isolation given absent peer friendships. His tendency to correct peers may contribute to friction and potential rejection over time. Teacher supervision during unstructured time is a current protective factor.
Recommendations and Next Steps
- Personalised learning plan recommended incorporating transition supports, written schedule provisions, and sensory accommodations.
- Referral to OT for school-based sensory assessment and environmental modifications recommended.
- Parental consent will be sought to share the final report with the school.
- Follow-up appointment with Oliver’s parents scheduled for Thursday, 12 March 2026 at 10:00 AM.
