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HomeMy WebLinkAbout06-26-12s • N ~CJ G ~~ ~~ ~ ~= ~' IN THE COURT OF COMMON PLEAS ~, BERLAND COUNTY, PENNSYLVANIA r` v~ r OF CUM ORPHAN'S COURT G ~ . ~, ~ ~-~' _ ~_ ~'' P OF THE No. -7.1- I ~ - ~ 1 ~ ~ - _,. ~" ~, IN RE: GUARDIANSHI ~ ._.. PERSON AND ESTATE OF r•? ~NNETH CAMPBELL FINE PETITION FOR AN ADJUDICATI IO.ANN OF THE PERSON AND APPOINTMENT OF A~~ATRuD AMPBELL FINE .David R. Fine and Beth. Campbell Fine ("Petitioners") .hereby petition the Court to adjudicate Kenneth Campbell Fine incapacitated and to appoint David R. Fine and Beth Campbell Fine as co-guardians of the person and estate of Kenneth Campbell Fine. In support of their petition, Petitioners assert the following: 1. Petitioners are the biological parents of Kenneth Campbell Fine. 2, As of the date on which this petition is filed, Kenneth Campbell Fine is 17 years of age (having been born on June 27, 1994). 3, As of the date on which this petition is filed, Kenneth Campbell Fine is unmarried. 4, As of the date on which this petition is filed, Kenneth Campbell Fine lives with Petitioners at 344 North 25th Street, Camp Hill, Cumberland County, Pennsylvania, 17011. 5, Kenneth Campbell Fine's next of kin are his parents, Petitioners David R. Fine and Beth Campbell Fine. Their address is 344 North 25th Street, Camp Hill, Pennsylvania, 17011. 6 Kenneth Campbell Fine has no financial estate and no income. C z 7. Kenneth Campbell Fine has never been a member of the Armed Services of the United States, and he is not receiving any form of veteran's benefits. g. Kenneth Campbell Fine is a person with autism, and his ability to receive and evaluate information effectively and communicate decisions is im aired to such a significant extent that he is totally unable to manage his P financial resources and to meet essential requirements for his physical health and safety. Specifically, a, Kenneth Campbell Fine has been diagnosed by qualified 'cal ersonnel as severely autistic and moderately intellectually disabled (a meth P condition formerly referred to as mentally retarded). See Affidavit of Michael J. Murray, M.D., at ¶ 9 (attached at Tab "A"); Psychological Evaluation Dated January see also, 16, 2012, of Jillian Buckley, M.A. (attached at Tab " 2" to the Murray Aff.); Ps chological Evaluation Dated March 28, 2003 (most recent IQ test) (attached at Y Tab " 3" to the Murray Aff.); b, Kenneth Campbell Fine is not verbal and, as a result of autism and intellectual disability, has limited ability to communicate his wants his and needs. Id. at ¶ 10. c. As a result of his autism and intellectual disability, complexity, including Kenneth Campbell Fine is unable to make decisions of any decisions regarding his personal care, safety, healthcare, finances and maintenance. Id. at ¶ 11. d, Because of his autism and intellectual disability, Kenneth bell Fine is unable to make decisions of the sort typically made by adults Camp without his autism and intellectual disability. Id. at ¶ 12. e, Kenneth Campbell Fine has the love and support of his her and father, which whom he lives, and they have made decisions regarding mot his care and well-being since his birth. Id. at ¶ 13. 2 £ Because of his ,autism and intellectual disability, Kenneth ine is in need of plenary guardianship of an undefined duration in that Campbell F his needs and ability to make decisions for his own care, safety, healthcare, finances and maintenance will not change. Id. at ¶ 14. g. Although his parents remain dedicated to providing him- eve meaningful opportunity to learn, make decisions for himself and enjoy with r3' endence, because of his autism and intellectual disability, Kenneth Campbell indep healthcare, Fine will never be able to make decisions for his own care, safety, n finances and maintenance without significant assistance, support and supervisio Id. at ¶ 15. g. Kenneth Campbell Fine is currently receiving the following services to support him: a. Kenneth Campbell Fine is a student at The Vista School, S rin board Drive, Hershey, Pennsylvania, 17011. The Vista School is an 1021 p g approved private school for children and young adults with autism. b. Kenneth Campbell Fine receives behavioral support rin board Drive, Hershey, 1021 Sp g services through The Vista Foundation, Penns lvania, 17011, a licensed partial-hospitalization program licensed by the y Pennsylvania Department of Public Welfare. c, Kenneth Campbell Fine receives services through berland/Perry Mental Health/Developmental Disability Programs, 16 West Cum 17013. High Street, Carlisle, Pennsylvania, bell 10. Petitioners propose that they be appointed as Kenneth Camp Fine's guardians. Specifically, a. Petitioners propose that they be given guardianship over the care, maintenance and custody of Kenneth Campbell Fine. 3 b. Petitioners propose that Kenneth Campbell Fine live with until such a time as they find what in their careful examination and analysis them ro riate care, is a suitable residential placement for him in which he will receive app he believe support and vocational opportunities in as independent a setting as t y appropriate for him. c. Petitioners agree that they will continue to assure that Cam bell Fine receives such training, education, medical and Kenneth P need. psychological services as he may d, Petitioners agree that they will continue to assure that eth Campbell Fine receives such social and occupational opportunities as he Kenn may benefit from and need. will rovide such consents e. Petitioners propose that they P or approvals as may be necessary for Kenneth Campbell Fine. £ Petitioners propose that they be given guardianship over both the person and the estate of Kenneth Campbell Fine. 11. Petitioners have no interests adverse to those of Kenneth Campbell Fine. 12. Petitioners have considered potential alternatives to the uardianship requested by this petition, and they have concluded that none of those g alternatives would adequately provide for the safety and well-being of Kennet Campbell Fine. 13. No other court has ever assumed jurisdiction in any proceeding to determine the competency of Kenneth Campbell Fine. a ointed over the 14. There is not and never has been a guardian pp person or estate of Kenneth Campbell Fine. 4 t 15. Petitioners have read the contents of this petition aloud to th Campbell Fine and explained to him its contents and the effect upon him if Kenne the Court grants this petition. 16. Petitioners pray that the Court issue a citation, directed to eth Campbell Fine and such other persons as the Court may direct, to show Kenn cause why Kenneth Campbell Fine should not be adjudged an incompetent person erson and his estate appointed. and a guardian of his p WHEREFORE, Petitioners David R. Fine and Beth Campbell Fine tfull request that the Court grant their petition, adjudge Kenneth Campbell respec Y Fine an incompetent person and appoint David R. Fine and Beth Campbell Fine as the guardians of the person and estate of Kenneth Campbell Fine. submitted, - .. Da id R.T~ 66742 Pa Supreme 34 North 25th reet Ca p Hill, PA 17 1 (71 231-5820 (o i e~- (717 975-0459 (mob le) Date: June 26, 2012 5 VERIFICATION I hereby verify that the assertions in the attached petition are true and correct to the best of my knowledge, or information and belief. I understand that this certification is made subject t the penalties 18 Pa.C.S. § 4904, relating to unsworn falsifications to authorities. June 26, 2012 June 26, 2012 avid R. ~~~ ~ J Beth Campbell EXHIBIT A AFFIDAVIT OF NIICHAEL J. MURRAY. M.D. Commonwealth of Pennsylvania ss. County of Dauphin The affiant, being duly sworn, deposes and testifies as follows: 1. I am a medical doctor licensed by the Commonwealth of Pennsylvania. 2. I was graduated from the Pennsylvania State University College of Medicine in 1993. 3. I participated in a residency and a fellowship in psychiatry at the Milton S. Hershey Medical Center. 4. I am now an associate professor of psychiatry at the Penn State College of Medicine and director of the Division of Autism Services at the Penn State Milton S. Hershey Medical Center. 5. I am attaching at Tab "1" a copy of my current curriculum vitae. 6. My area of practice and research is in persons with autism spectrum disorders. 7. Kenneth Campbell Fine has been my patient for more than four years. 8. I offer all opinions set forth in this affidavit to a reasonable degree of professional certainty and based on my clinical treatment and observation of Kenneth Campbell Fine. 9. Kenneth Campbell Fine has been diagnosed by qualified medical personnel as severely autistic and moderately intellectually disabled (a condition formerly referred to as mentally retarded). See Psychological Evaluation Dated January 16, 2012, of Jillian Buckley, M.A. (attached at Tab "2"; see also, Psychological Evaluation Dated March 28, 2003 (most recent IQ test) (attached at Tab " 3") I0. Kenneth Campbell Fine is not verbal and, as a result of his autism and intellectual disability, has limited ability to communicate his wants and needs. 11. As a result of his autism and intellectual disability, Kenneth Campbell Fine is unable to make decisions of any complexity, including decisions regazding his personal care, safety, healthcare, finances and maintenance. 12. Because of his autism and intellectual disability, Kenneth Campbell Fine is unable to make decisions of the sort typically made by adults without his autism and intellectual disability. 13. Kenneth Campbell Fine has the love and support of his mother and father, which whom he lives, and they have made decisions regarding his care and well-being since his birth. 14. Because of his autism and intellectual disability, Kenneth Campbell Fine is in need of plenary guazdianship of an undefined duration in that his needs and ability to make decisions for his own care, safety, healthcare, finances and maintenance will not change. 1S. Although his pazents remain dedicated to providing him with every meaningful opportunity to learn, make decisions for himself and enjoy independence, because of his autism and intellectual disability, Kenneth Campbell Fine will never be able to make decisions for his own care, safety, healthcare, finances and maintenance without significant assistance, support and supervision. Further the affiant sayeth not. Sworn to before me this ~_ day of June 2012 Public CAMMONWBALTH OF PENNSYLVANIA Notarial Seal Crystal S. Grebb, Notary Publk Derry TWp., Dauphin County Hly Commiseiorl t3cpiras Oct. T6, I014 MEMBER, PENNSYLVI11iiA ASSOCIATrON OF -2- 1 Michael J. Murray, M.D. Associate Professor of Psychiatry Director, Division of Autism Services Penn State Milton S. Hershey Medical Center Penn State College of Medicine Department of Psychiatry, H073 500 University Drive, P.O. Box 850 Hershey, PA 17033-0850 Tel.: (717) 531-1115 Fax: (717) 531-6250 mmurray2(a).psu.edu EDUCATION AND TRAINING Undergraduate: St. Joseph's University Philadelphia, PA August 1985- May 1989 B.S., Biology Medical School: Penn State Milton S. Hershey Medical Center Penn State College of Medicine Hershey, PA August 1989- .May 1993 M.D. Residency: Penn State Milton S. Hershey Medical Center. Penn State College of Medicine Department of Psychiatry Hershey, PA July 1993- June 1998 Chief resident July 1996-June 1997 Fellowship: Penn State Milton S. Hershey Medical Center Penn State College of Medicine Division of Child Psychiatry Hershey, PA July 1994-June 1996 Chief resident July 1995- June 1996 Professional Development: Penn State Milton S. Hershey Medical Center Penn State College of Medicine Junior Faculty Development Program 2003- 2004 Penn State Milton S. Hershey Medical Center Penn State College of Medicine Department of Public Health Sciences Clinical Research Training Program 2006-2007 Certificate in Clinical Research APPOINTMENTS AND POSITIONS Academic: 2003-Present Department of Psychiatry Assistant Professor Penn State College of Medicine Penn State M. S. Hershey Medical Center Hershey, PA Non-Academic: 2001-2003 Ephrata Behavioral Health Director of Child and Ephrata Community Hospital Adolescent Services Ephrata, PA 1999-2001 Ephrata Behavioral Health Contracted to Initiate Ephrata Community Hospital Child and Adolescent Ephrata, PA Services 1999-2001 Capital Area Intermediate Unit Psychiatric Sommerville, PA and various locations Consultant 1999-2001 Biever and Walker, P.C. Staff Psychiatrist Annville, PA 1998-1999 Coastal Psychiatric Group Staff Psychiatrist Lewes, DE Established Child and Adolescent Services CERTIFICATION AND LICENSURE 2004-Present American Board of Psychiatry Diplomate and Neurology 1997-Present Pennsylvania State Medical Board Licensed Physician 1998-2000 Delaware State Medical Board Licensed Physician HONORS 2004 The Child Psychiatry Fellows' Award for Teaching Excellence 2012 The Child Psychiatry Fellows' Award for Teaching Excellence PUBLICATIONS Murray, M.J., Mayes, S.D., and Smith, L.A. (2011) Brief Report: Excellent Agreement Between Two Brief Autism Scales (Checklist for Autism Spectrum Disorder and Social Responsiveness Scale) Completed Independently by Parents and the Autism Diagnostic Interview-Revised. Joumal of Autism and Develoamental Disorders, in press Mayes, S.D., Calhoun, S.L., Murray, M.J., Morrow, J.D., Yurich, K.L., Cothren, S., Purichia, H., Bouder, J.N., and Petersen, C.E. (2011) Use of Gilliam Asperger's Disorder Scale in Differentiating High and:Low Functioning Autism and ADHD. Psychological Resorts; 108:3-13. Mayes, S.D., Calhoun, S.L., Murray, M.J., Ahuja, M., and Smith, L.A. (2011) Anxiety, depression, and irritability in children with autism relative to other neuropsychiatric disorders and typical development. Research in Autism Spectrum Disorders, 5:474- 485. Murray, M.J. (2010) Attention-deficit Hyperactivity Disorder in the Context of Autism Spectrum Disorders. Current Psychiatry Resorts, 12:382-388. Mayes, S.D., Calhoun, S.L., Murray, M.J., Mon-ow, J.D., Yurich, K.L., Mahr, F., Cothren, S., Purichia., H., Bouder, J.N., and Petersen, C.E. (2009) Comparison of Scores on the Checklist for Autism Spectrum Disorder, Childhood Autism Rating Scale, and Gilliam Asperger's Disorder Scale for Children with how Functioning Autism, High Functioning Autism, Asperger's Disorder, ADHD, and Typical Development. Joumal of Autism and Devetosmental Disorders, 39:1682-1693. Rao, P.A, Beidel, D.C., and Murray, M.J. (2008) Social Skills Interventions for Children with Asperger's Syndrome or High-Functioning Autism: A Review and Recommendations. Joumal of Autism and Develoomental Disorders, 38:353-61. GRANTS RECEIVED Murray, M.J. (Principal Investigator). The Central Pennsylvania ASERT Center. $2,400,000. Pennsylvania Department of Public Welfare Bureau of Autism Services. 2011-2014. Murray, M.J. (Lead Investigator) Development and feasibility of an assistive technology mediated social awareness program for children with autism. $20,000. Children, Youth, and Families Consortium, 2011. $19,860 Hintz Children's Communicative Competence Endowment, 2011 Murray, M.J. (Principal Investigator). The Central Pennsylvania ASERT Center. $1,600,000. Pennsylvania Department of Public Welfare Bureau of Autism Services. 2008-2011. Murray, M.J. (Lead Investigator). fMRI Studies of Children with Asperger's Disorder and High-Functioning Autism Undergoing Comprehensive Social Skills Training. $23,500 Children, Youth, and Families Consortium, 2007. Beidel, D.C., and Murray, M.J. (Co-Principal Investigator). Enhancing Social Functioning Among Children with Asperger's Disorder and High Functioning Autism. $119,962 Autism Speaks, 2006-2007. PROFESSIONAL ACTIVITIES Administrative Responsibilities: •Director, Division of Autism Services 2009-present •Acting Division Director, Child and Adolescent Psychiatry 2005- 2008 and 11 /2010-present •Chair, Clinical Affairs Executive Committee 2004-2005 Clinical Responsibilities: • Director of Autism and Developmental Disorders Specialty Clinic 2003- present •Director of Child Psychiatry Inpatient Unit 2005-2008 •Director of Outpatient Services, Child and Adolescent Psychiatry Division 2003- 2005 • Medical Director, Child and Adolescent Psychiatry Division 2005- 2009 Educational Activities: •Associate Training Director, Child and Adolescent Psychiatry Residency 2004-2008 •Seminar Series for Child Psychiatry Fellows: 2003-present Autism and Developmental Disorders Introduction to Applied Behavioral Analysis Sensory Processing Dysregulation Social and Emotional Learning Anxiety Disorders in Children and Adolescents Evidence-Based Psychotherapy for Children and Adolescents Outpatient Evaluation of the Child and Adolescent Patient Case Collaboration Series •Seminar Series for General Psychiatry Residents: 2003-present Autism Spectrum Disorders Child Psychopathology •Third Year Medical Student Curriculum 2008-present Autism Spectrum Disorders • Second Year Medical Student Curriculum 2003-2010 Child Psychopathology Lecture Series PRESENTATIONS: Reducing Stress on Siblings The Vista Foundation Hershey, PA March 2012 Adolescence and Autism Spectrum Disorders. Keystone Autism Fair Chambersburg, PA August 2011 Autism Goes to College Pennsylvania Association of Developmental Educators Annual Meeting Lancaster, PA April 2011 The Role of "Cognitive Rigidity'° in the Diagnosis, Course, and Treatment of Pediatric Psychiatric Disorders/ Cognitive Rigidity: Social Impacts and the Autism Spectrum American Academy of Child and Adolescent Psychiatry Annual Meeting New York, NY October 2010 The Impact of Autism on Siblings Keystone Autism Fair Chambersburg, PA September 2010 Autism Grows Up: Adults on the Spectrum Central Pennsylvania Psychiatric Society April 2010 Autism Spectrum Disorders: Practical Considerations Penn State Hershey Pediatric Update Day January 2010 Autism: A Psychiatrist's Personal and Professional Journey in Understanding the Spectrum. Penn State: Research Unplugged State College, PA October 2009 "We're all in this together": The Impact of Autism on Siblings The Vista Foundation Hershey, PA May 2009 Learn and Engage in the Development of a Statewide Network through Three Regional Centers PAR Solutions Conference 2008: Extreme Makeover Pennsylvania Association of Resources for Autism and Intellectual Disabilities Harrisburg, PA October 2008 Effective Pharmacotherapy for Autism Spectrum Disorders: The Important Questions to Ask Before Considering Medications The Organization for Autism Research The Sixth Annual Applied Autism Research and Intervention Conference Arlington, VA October 2008 Adolescence and the Struggle with the Social World Autism Across the Lifespan Conference Penn State Milton S. Hershey Medical Center Hershey,. PA September 2008 The Role of the Physician in the Assessment and Treatment of Individuals with Autism Spectrum Disorders National Autism Conference State College, PA August 2008 An Update on Research Findings in Social Skills Development National Autism Conference State College, PA August 2008 The "Big Bang° and ASD: Facial Perception Deficits Department of Psychiatry Grand Rounds Penn State Milton S. Hershey Medical Center Hershey, PA April, 2008 Research Findings in Social Skills Development National Autism Conference State College, PA August, 2007 Autism and Asperger's Syndrome: Diagnosis and Intervention in Home, School, and Community Seminar for Lorman Education Services Bethlehem, PA February, 2006 Treatment Considerations in the Care of Children with Autism: What Does the Research Teach Us? Department of Pediatrics Grand Rounds Penn State Milton S. Hershey Medical Center Hershey, PA December, 2005 Neuromedical Aspects of Autism Central Pennsylvania Psychiatric Institute Lemoyne, PA October 2005 Obstacles and Opportunities in Cognitive Behavioral Therapy Supervision Presented with Robert Friedberg, Ph.D. American Academy of Child and Adolescent Psychiatry Annual Meeting Toronto, ON October 2005 Medical and Biologic Treatments for Autism Central Pennsylvania Psychiatric Institute Scranton, PA March 2005 Trauma, Stress and the Effects on Children 2005 Annual Social Workers' Seminar Series Hershey, PA February 2005 Medical and Biologic Treatments for Autism Central Pennsylvania Psychiatric Institute King of Prussia, PA October 2004 POSTER PRESENTATIONS The Multi-Meida Social Skill Project for Adolescents with Autism Spectrum Disorders: Improved Social Fluency and Increased Social Motivation Murray, MJ, Pearl, AM, Hillwig-Garcia, JM, and Smith,LA 2011 Annual Meeting of the American Academy of Child and Adolescent Psychiatry Toronto, ON The Multi-Media Social Skills Project for Adolescents: Improved Social Responsiveness Murray, MJ, Pearl, AM, Smith, LA, and Hillwig-Garcia, JM 2011 International Meeting for Autism Research San Diego, CA Adolescent Social Competence: No Differences between Mother and Father Ratings on the Social responsiveness Scale Laura Smith, Amanda Pearl, and Michael Murray 2011 International Meeting for Autism Research San Diego, CA A Preliminary Investigation of a Social Skills Training Program for Children with Asperger's Disorder Michael Murray, Patricia A. Rao, and Lindsay Scharfstein 2006 National Autism Conference State College, PA Training Child Psychiatry Residents in Cognitive Therapy Robert Friedberg, Stuart Kaplan, and Michael Murray 2005 AADPR7 Annual Meeting Tucson, AZ CDI Scores and Critical items in Pediatric Psychiatric Inpatients Brent Wilson, Robert Friedberg, Michael Murray, Stuart Kaplan, Susan Mayes, and Christopher Petersen 2005 Association for Behavior and Cognitive Therapies Annual Meeting Washington, D.C. Using popular visual media to teach social skills and distress tolerance to children and adolescents Robert Friedberg, Michael Murray, and Adam Biuckians 2005 Crossover Symposium Penn State University State College, PA COMMUNITY ACTIVITIES Central Pennsylvania Autism Education and Resource Center: The Vista School The Vista Foundation Hershey, PA •board member 2000-present 2 Jonathan M. Gransee, Psv.D. & Associates, P.C. Jonathan M Gransee, Psy D -Licensed Psycholo~stlPresident Psychological Associates: Jillian Blickley, M.A.; Michelle Cummings, M.Ed.; Shaun Loftus, MS; Blake DeMatteo, M.S. 313 W. Liberty St. Suite 113, Lancaster PA 17603 Phone: (717) 509-5151 Fax: (717) 509-6734 www jgevaluations.com Consulting -Evaluations -Therapy PSYCHOLOGICAL RE-EVALUATION KENNETH (KENNY) FINE JANUARY 16, 2012 Identifying Information Birth Date: 6.27.94 Age: 17 years, 6 months Gender: Male Address: 344 N. 25~` St. Camp Hill, Pa 17011 Parents (Married): Mother: Beth Fine Father: David Fine Custody: Parents Siblings: None School District: Camp Hill SD School: The Vista School Race: Caucasian Phone: 717.975.0459 Birth Date: 12.2.66 Birth Date: 3.10.65 Grade: Level II Competency Community Systems Involved: The Vista School: Occupational and Speech therapies Cumberland County MH/IDD: Erika Stark, Case Manager Capital Area Therapeutic Riding Association: Equine Therapy Fitness 4 Focus: Chris Russell, Personal Trainer ` Fine, Kenneth Reason for Referral 2 Kenny Fine was referred for a Psychological Re-Evaluation as part of a yearly requirement of The Vista School, due to his ongoing issues related to an Autism Spectrum Disorder. The purpose of this evaluation was to update diagnostic impressions and treatment recommendations, aswell as to note Kenneth's progress. Information for the current evaluation was provided by Kenneth, and his Mother, Beth Fine. His current treatment plan, prior evaluation, and IEP were also reviewed. Relevant Information Brief Update Kenneth, known as Kenny, is a 17-yeaz, 6-month-old Caucasian male whose STRENGTHS include that he is very social, follows directions well, enjoys being azound people, and is not aggressive. Further, he is of robust health, is of a happy nature, and is adept at reading people. With regards to FAMILY, he continues to reside with his family in Camp Hill. The household includes Kenny, and his Pazents, Beth and David. In terms of COMMUNITY AND PEER RELATIONSHIPS, the azea in which they reside is described as suburban and safe, and Kenny's maternal Crrandparents live neaz the home. Further, Kenny has friendly neighbors, but no one that he really plays with, and he has developed no friendships neaz the home. It is noted that Father is employed as an Attorney, and Mother is a homemaker. Regarding RELIGIOUS PREFERENCE, Mother notes that she is Presbyterian, and Father is Jewish. Mother and Kenny attend her church regulazly, and aze active. FAMILIAL STRENGTHS include that they aze loving towazd each other, the Parents aze very involved with the school, and everyone is very interested in and helpful towards Kenny, all of which contribute to his RESILIENCY. With regards to TRAUMA HISTORY, there were no indications that Kenny has been exposed to abuse, domestic violence, or trauma. He has never been an adjudicated delinquent or dependent. There has not been Children and Youth involvement. Familial history of substance abuse or involvement with law enforcement is denied. FAMILIAL HISTORY OF MENTAL HEALTH CONCERNS includes a maternal Crrandmother who was treated for Obsessive Compulsive Disorder, and members with depression on both sides. It is noted that Kenny was previously interviewed by associates from Jonathan M. Gransee & Associates, and information from that report was reviewed in developing the background of this evaluation. In terms of his DEVELOPMENTAL HISTORY, Kenny was the product of a normal pregnancy and delivery, though Mother had to be induced because he was 10 days overdue. He received adequate prenatal care and Maternal Substance abuse was denied. Kenny weighed 8 pounds, 12 ounces and the health condition at birth was "robust". Regazding developmental milestones, Kenny began walking at 15 months, used a few words by about 10 months, and then regressed, though Mother notes he would sing, but he also lost this skill. Toilet mastery was attained by age 7, though Mother notes Kenny continues to have issues with hygiene related to this concern. She also notes that he will have the occasional night-time accident from time to time, but this is not a regular ` Fine, Kenneth 3 occurrence. In terms of MEDICATIONS/MEDICAL HISTORY, Kenny continues to be healthy at this time. Testing was conducted regazding lead toxicity, but Mother notes there were not concerns. 'T'here is no report of head injury, surgery (other than 3 dental procedures), seizures, or loss of consciousness. He also had an eye exam while under anesthesia. It is noted that Kenny is ALLERGIC TO SEROQUEL. In terms of his HEIGHT/WEIGHTBMI, Mother notes that Kenny is approximately 6 feet, 1 inch tall, and weighs azound 280 pounds, indicating a BMI of 37.0. Mother was informed that Kenny's primary Gaze physician should be informed of his mental health treatment and after releases have been obtained, a copy of this evaluation should be offered for the purposes of collaboration. ACADEMICALLY and in regards to SCHOOL-BASED INTERVENTIONS/EFFORTS BY THE SCHOOL TO ADDRESS HIS NEEDS, Kenny continues to be enrolled in The Vista School, where he is participating in Level II programming. As noted, this is a specialized autistic support setting. A review of his treatment plan revealed goals related to having Kenny request items that he wants and accept a delay including first work then play or "not right now" when directed by an adult rather than engaging in undesirable behaviors; increasing participation in on-going classroom activities, responding to staff directions and completing tasks within a teacher and semi-directed condition; and increasing use of appropriate means of communication to express wants and needs, responding to social interactions by others, and increasing the specificity of his communication methods. Mother notes that school has been going very well, and that he loves attending school. He is noted to have an iTouch that he enjoys using, and that he also has a great team of teachers working with him as well. Mother states they aze working on communication and life skills now, and that Kenny is making progress. He is noted to "like to please", and will display communication skills to garner more attention and interaction from Pazents and staff. He is noted to get along well with peers and staff, and tantrums are not of concern in this setting. In terms of PAST IQ OR EDUCATIONAL TESTING, it has been noted that intelligence testing has been conducted, yielding a Full Scale score of 41. This report was available for review. In terms of a CER or IEP, Kenny does have an IEP. His attendance has been good, per Mother. Educational reports were provided for the current evaluation. In terms of SCHOOL-BASED EMOTIONALBEHAVIORAL INTERVENTIONS, as noted, this is a specialized, Applied Behavioral Analysis setting, and this technique is implemented throughout Kenny's interactions. He also receives Speech, Occupational, and Music therapies in this setting. Behaviorally and emotionally, Kenny has evinced a history of symptoms and behaviors thought to be related to an Autism Spectrum Disorder, including social and communication delays, sensory integration issues, stereotypical behaviors, and other issues. Concerning a LEGAL history, nothing was noted. With regazds to a DRUG AND ALCOHOL HISTORY, nothing was noted. Due to these concerns, Kenny was formally diagnosed with Autistic Disorder at 2 yeazs and 2 months old by Dr. Pellegrino at Children's Seashore House. Concerning SERVICE HISTORY, he has also been provided with various interventions. Kenny received Early Intervention services via Keystone, and also worked with United Cerebral Palsy. At the Polyclinic Hospital, he had Speech therapy, and also received Speech, Occupational, and Paly therapies with the local Intermediate Unit. Further, he was enrolled at Devereaux Cazes in Downingtown, J Fine, Kenneth 4 Pennsylvania for 2.5 years before coming to The Vista School. Kenny is also prescribed PSYCHOTROPIC MEDICATIONS by Dr. Murray at The Vista School in the form of Strattera (50 mg morning, 40 mg evenings), Abilify (20 mg, QAM), Trazodone (200 mg, PRN), and DDAVP (.6 mg, bedtime). A FUNCTIONAL BEHAVIORAL ANALYSIS HAS BEEN COMPLETED. As noted, Kenny has received NO DRUG AND ALCOHOL TREATMENT. IN TERMS OF EFFECTIVENESS OF TREATMENT, Mother notes that these have been his medications for some time, and that they are effective. Regarding community activities, Kenny is noted to participate in Equine therapy, and also recently began a program called Fitness 4 Focus, which is physical fitness training for children with special needs. Further, Mother notes that he also participates in Challenger Baseball. Natural supports include his immediate and extended families. Special needs and barriers to treatment were not reported to be of concern. Evaluation Procedures Clinical Interview Behavioral Observations Review of Records DAST-10 AND AUDIT Inte_rview_ Behavioral Observations Kenny was observed in his classroom at The Vista School. He again presented as a casually dressed youth of above average height and weight for his age. His hygiene was again appropriate. Kenny was working with staff in his classroom, and had just returned from lunch. He was using his PECS on his iTouch, and interacted well with peers and staff. He did not appeaz to notice the presence of the Evaluator, and did not engage her. Overall, based on the information gathered during the evaluation, it is deemed that the current report is reflective of this client's functioning. Mental Status Ezam During the course of the evaluation, Kenny appeared alert but again, due to his nonverbal status, it was not possible to discern his orientation. His affect was bright and her mood was level. Kenny's thought processes could not be discerned due to his nonverbal status, though Mother notes no concerns. It could not be determined whether there were any perceptual abnormalities, homicidal ideation, or suicidal ideation, but there were no suggestions of such, and again, Mother had no concerns. Kenny's intellectual functioning appeazed to be below average, based on his presentation during the evaluation. His insight appeazed to be limited, as he did not appear to be aware of any inherent behavioral difficulties. His judgment appeazed poor, based on the displayed behavioral difficulties. Uadate/Imuact of Services Fine, Kenneth Throughout this authorization period, Kenny has been provided with FIBS services via the Vista School involving Level II services (75% of the time, approximately 23 hours per week). A review of his treatment plan revealed goals related to having Kenny request items that he wants and accept a delay including first work then play or "not right now" when directed by an adult rather than engaging in undesirable behaviors; increasing participation in on-going classroom activities, responding to staff directions and completing tasks within a teacher and semi-directed condition; and increasing use of appropriate means of communication to express wants and needs, responding to social interactions by others, and increasing the specificity of his communication methods. Recommendations are for services to remain at this level for another yeaz. Mother is in agreement. Socially, Kenny continues to be very interested in others, and is very social overall. Mother notes that he will vocalize loudly to gain attention, but this is just making sounds, no words. His social skills remain significantly below age level, however. He will still tap too gain attention, but no longer taps Mother on top of the head. He now will sign "sorry" and will give a "kiss kiss" sign as well. Though not interested in games or toys, Kenny does enjoy his iPod and iPad, and will watch videos on this device. He is also very physically active. As noted, no imaginazy play is present at this time. There is some ability to "read" the social cues of others, but as noted, Kenny will often misinterpret these cues, thinking others are angry with him when they aze simply angry. He continues to be drawn to all age groups, and also loves babies. Kenny still needs prompting in order to share, cooperate, and take turns, though he has been working on not grabbing items from others. Eye contact is near adequate, per Mother. Empathy is present, but as noted, Kenny will apologize or try to help when he is not the person at fault. Remorse is also present, but again, he will apologize when he's not sorry, or will apologize when it's not his fault. Regarding communication, as noted, Kenny continues to be completely nonverbal, though he will make vocal noises to gain attention. He is able to sign, and is now using his iTouch to communicate as well. As noted, echolalia, delayed echolalia, and scripting aze not present. Mother notes that he is not completely literal in his interpretation of communication, and is able to comprehend some sarcasm and "joking around", and has a sense of humor. Mother also indicates that receptive communication is greater than expressive communication by faz. Regazding stereotypical behaviors, as noted, rocking and spinning is no longer present. Hand-flapping is present when Kenny is very excited, and he continues to very much enjoy summing with water, and watching the fluid drip from his fingers. Obsessive behaviors aze related to food, and Kenny continues to eat a preferred food items until it is gone, and will not be sated. Mother indicates that she has gotten a mini fridge and keeps the preferred items in there so Kenny is unable to get to them. Kenny also continues to be li is off. Self-stimulatory behaviors include obsessed with closing doors and turning gh playing with bubbles and water, and Kenny will watch the water drip from his fingers for a long period of time, as noted. 6 ` Fine, Kenneth Regazding issues related to sensory integration, auditory concerns remain, but aze minor, and Kenny will only startle if he cannot to h as~ reviously seen s Gustatory concerns are smelting people and food, but not as muc p present, but aze improving. Kenny is more ab1eT o~hlelcr Kenny con roues to d lik a t diet, but he is noted to dislike stronger flavors y and will not pet them, but he is noted to ~tlodo ~ tfho ong periods of timeAs noted previously, he loves playing vv~th water, and c Regarding other azeas of functioning, Kenny does well with transitions, and remains relatively easy-going. Tantrums aze present in the home at a RATE of 1-2 per month, lasting a DURATION of no more than 10 minutes. Mother notes Flo deand stomping INTENSITY. It is noted that tantrums include Kenny becominb if in ain, as if "to around. He is no longer grabbing others, and will now only gra P communicate to the person that he is in pain"• e ~ sues with enures s remain present, but he is allowed some independence m the hom accidents aze only occurring at a rate of 1-2 per month. As noted, he remains on DDAVP, and Mother indicates that this is helpful. Sexual behaviors are present and include masturbation, but Kenny is able to keep this private. Emotionally, Mother indicates that Kenny is generally happy and easy-going. Sleep behavior is usually good, and medicine is helpful in this area. He is noted to not have nightmazes. His appetite is very good, and as noted, he continues to seek to eat do se and items until they are gone. Excessive feazs continue to include vacuums, bazking g , cats. He will become anxious when presented with these items. No issues were noted related to depression, mania, other anxiety, or sadness. Crying and tearfulness are present related to pain, but Mother notes that this is not an emotional concern, as he has not cried in some time. No other issues were noted. In TERMS OF DRUG/ALCOHOL USE/ABUSE, there were no reports of Kenny using any alcohol, drugs, or tobacco, or of receiving drug and alcohol treatment. He was administered the DAST-10 and AUDIT, and he scored a "0" on each, indicating no concerns. Dia~ostic Impressions Kenny continues to present as a young male struggling with issues and symptoms thought to be related to an Autism Spectrum Disorder, including social and communication delays, self-stimulatory behaviors, stereotypical behaviors, and sensory integration issues. As such, it is felt that his previous diagnosis of Autistic Disorder remains appropriate at this time. Further, as reports of intelligence testing have been made available, and a Full Scale score of 41 was indicated, the diagnosis of Moderate Mental Retardation will be assigned at this time. In general, it appears that Kenny has significant issues that certainly warrant intensive intervention. His issues appear to be more significant than could be treated simply in weekly outpatient therapy. While his issues do not appeaz to warrant inpatient treatment, it seems that cont~e dataons follow. The Vista School remains appropriate. Specific diagnoses and recd Fine, Kenneth Diagnoses Axis I 299.00 Autistic Disorder Axis II 318.0 Moderate Mental Retardation Axis III Allergic to Seroquel, dental surgery by history. Axis IV Psvchosocial Stressors: social alienation due to behavioral and communication delays, educational limitations. Axis V Current GAF: 40 GAF Range in the Past Yeaz: 31-40 Prognosis Kenny's prognosis will continue to be listed as guardedly fair, in light of his pleasant demeanor and social interest. It is hoped that Kenny will begin to show verbal gains with further intervention. Recommendations Given Kenny's behavioral and emotional issues, it is recommended that he receive Case Management Services, in order to coordinate services among all providers involved in his care, and for the assessment, identification, facilitation, and monitoring of service needs. Ongoing communication between case managers, treatment providers, and family members is recommended in order to coordinate treatment interventions. 2. Given Kenny's behavioral and emotional issues, treatment options were discussed and explored with his Mother, including: outpatient therapy, in-school therapy, specialty groups, summer treatment programs, Behavioral Health Rehabilitation Services, Family-based mental health treatment, hospitalization, therapeutic out- of-home placement, or residential treatment. Of these options, it was agreed he receive EIBS Services, as specified below, to work in conjunction with other public and private services being provided, for the identification, assessment, development, facilitation, and monitoring of service needs. THE RATIONALE FOR CHOSING THIS PARTICULAR SERVICE, AMONG ALL OF THE CHOICES, IS it was felt to be the best, least-invasive choice for Kenny and his family, among the methods of treatment yet to be attempted, and success was shown in the past. Regulaz communication between family members, educators, and treatment providers would be beneficial. 3. Educationally, given Kenny's developmental, behavioral and emotional issues, it is recommended that he participate in the Vista EIBS program at Level II. This t Fine, Kenneth 8 would involve one-to-one staff contact at approximately 75% of the time or the equivalent of 23 hours per week. Services are medically necessary to enable Kenny to achieve socially significant improvements in behavior and to maintain achieved skills and functions. Services should be for a period of 12 months, from 2/29/2012 until 2/28/2013. 4. Medically, Kenny is receiving psychotropic medications. These interventions should remain monitored, and that all persons involved in Kenny's treatment should maintain contact vv~th the Prescribing physician to report his response to this medical intervention. 5. Regarding social and community needs, Kenny has significant need for social skill development. Involvement in age appropriate informal activities in the community is advisable. Natural supports appear to be very strong and will likely continue to be in Kenny's life. 6. Educationally, it is recommended that parents, treatment staff and educators remain in contact to address any issues that may arise. 7. It is recommended that Kennyss card t riOdetermine the necessity and nature of months, to assess lus progre , continued services. Respectfully submitted, . ~ '~ Jillian Blickley, M.A. Psychological Associate Supervised by, Reviewed by, and Submitted by, Jonathan M. Gransee, Psy. D. Licensed Psychologist Lic # PS-015106 January 23 2012 Date 3 e ` ~ENNSTATE The Milton S. Hershey Medical Center The College of Medicine Department of Psychiatry P3YCSOIAGIC'-AI- EVA~°iTIaN Penn State College nt' Medicine Tel: (717) 531-8338 The Milton S. Hershey Medical Center Fax: (7 f 7) 531-6250 Department of Psychiatry. H073 500 University Drive P.O. Box 850 Hershey, PA 1 703 3-08 50 PATIENT NAME: Kenneth Fine DOB: 6/27/94 CHgONOLO6ICAL AGE: 8 years DOg; 3/28/2003 TESTS A~IST~' - Stanford-Binet Intelligence Scale-IV Leiter International Performance Scale Developmental Test of Visual Motor Integration - 4 (VMI) Vineland Adaptive Behavior Scale (Parent Interview Version) Pediatric Behavior Scale Children Checklist for Autism in Young Early Intervention Developmental Profile (EIDP) Receptive One-Word Picture Vocabulary Test (ROWPVT) HISTORY: Kenny has previous diagnoses of autism and moderate menta retardation. Kenny is an only K and ~sdthe productoof alnormal parents. According to report, y estation with a birth weight was 8 pregnancy and was born at 40 weeks g lbs. 14 oz. The neonatal period was uncomplicated. Kenny is currently treated with Risperdal and Ritalin and is enrolled at the Vista School for students who have autism. TEST gEgAVIOR: leasure to evaluate. Kenny Kenny is a delightful 8-year-old who was a P $e smiled was very cheerful and cooperative throughout rou lof.his successes, readily, completed all tasks requested, was p ersonality. Mrs. Fine was present throughout the and has a charming p evaluation. Kenny and his mother clearly have a warm and affectionate relationship. Mrs- Fine has invVe~edkno ledg abledandfdedicated eeting Kenny's special needs and is a y social, and loving child parent. Mrs. Fine describes Kenny as a happy, who coma~tunicates well nonverbally, follows directions, and has good problem-solving skills. Kenny`s teacher at the Vista School reports that Kenny is a happy student who is great with matching, sorting, and assembling puzzles. AvTISM ANAissls: According to clinical observations, information pro continuesKtony,s mother and teacher, and a review of records, Kenny present with the symptoms of autism, as described under the following characteristics of autism: An Equrl Oppextunity University Problems with social interaction. Typical of autism, Kenny has limited peer interaction and difficulty establishing friendships, is at times socially withdrawn and in his own world, and has problems with eye contact and social skills. Perseveration. Kenny has many of the perseverative characteristics of autism including obsessive interests and repetitive play behaviors (e.g., swinging a stuffed snake around in front of his eyes), stereotypies (e.g., repetitive vocalizations and toe-walking), and fearfulness in new situations. Somatosensory disturbance. Kenny demonstrates many of the somatosensory characteristics of autism including hypersensitivity to sounds (e.g., noise made by a vacuum and drill), smelling objects, unresponsiveness at times to verbal input, fascination with repetitive visual movements (e.g., watching water drip from his fingers), tactile defensiveness (e.g., not liking to have his hair dried or to wear shirts with collars), love of movement, sleep disturbance (awaking early), and oral hypersensitivity to soft textures. Atypical developmental pattern. Kenny exhibits the atypical developmental pattern found only in children with autism including normal development till 18 months of age followed by a regression, nonverbal ability at a higher level than verbal skills, verbal dyspraxia, atypical vocal patterns (e.g., repetitive and self- stimulatory sounds), and a relative strength in visual skills {e.g., assembling puzzles and matching). Mood disturbance. Unlike many children with autism, Kenny is very happy and content unless he is frightened by something. Kenny has unusual fears, which are common in autism (e.g., fear of vacuum cleaners, hair dryers, and power drills). Problems with attention and safety. Typical of children with autism, Kenny can be hyperfocused on activities of interest to him {e.g., swinging and fixating on his stuffed snake), but is quite inattentive, impulsive, and fidgety at other times. Kenny's performance style was impulsive and his attention was fleeting during testing, but improved considerably with edible reinforcers. Kenny also exhibits the limited safety awareness common to autism. INTELLIGENCE TEST RE3ULT3: _. According to Kenny' performance on the Stanford-Binet-IV and Leiter, Kenny earned a mental age of 3-years-l0-months. This in relation to his chronological age of 8-years-9-months yields a ratio IQ of 44, placing Kenny in the moderate range of mental retardation. In contrast, language, graphomotor {drawing), and adaptive skills are significantly lower. Kenny earned the following age equivalents (AE) in years months and ratio IQs or standard scores (SS), with a standard score of 100 representing the average for Kenny's age: 2 ss AE Nonverbal Ability 44 3-10 Leiter (matching pictures based on appearance and concepts) 44 3-10 Stanford-Binet Nonverballe~in form boards) Pattern Analysis (comp g Copying (replicating block constructions} Bead Memory (copying bead patterns) Graphomotor skills encil) 29 2-6 VMI (copying geometric forms with a p Adaptive Skills 28 Vineland Adaptive Behavior Scale 1-4 Comanunication 2_7 Daily Living 1-4 Socialization Receptive Language - 19 1-8 ROWPVT (pointing to designated pictures) j_g EIDP Receptive Language Subscale Speech ~ a7 EIDP Speech Subscale gay: Kenny is a very likable 8-year-old who continues to present with autism and mental retardation. ggTla[~i8 1. Kenny is in need of continued intensive educational and behavioral intervention using specific strategies that have been empirically proven to be effective with children who have autism. Several carefully controlled research studies have shown that intensive one- on-one behavior therapy using the principles of applied behavior analysis can result in significant long-term gains for children with autism. The goals of such services for Kenny are to: (1) help keep Kenny meaningfully engaged socially, (2) foster social interaction and peer relationships, (3) teach social awareness and social skills, (4) reduce self-stimulation, (5) decrease repetitive and stereotyped behavior, (6) increase nonverbal communication, language comprehension, and vocal skills, (7) improve attention, listening, compliance, and task completion, (8} teach functional play skills, (9) improve adaptive functioning and academic skills, (10) increase safety awareness, and (11) desensitize Kenny to frightening sounds. 2. The following suggestions are offered to help keep Kenny meaningfully involved and attentive in school: (1) structure social situations and provide guidance to promote social skills and peer interactions, {2) use cues and reinforcement to help Kenny develop a less impulsive approach to tasks, 3 w p. (3) refocus Kenny on the activities at hand when he is inattentive, (4) help inhibit vocal stereotypies by using verbal and nonverbal cues and reinforcement, (5) ensure that one has Kenny's eye contact and full attention when initiating social interaction or giving instructions, (6) provide clear and consistent expectations, (7) give tangible and social reinforcement for participation, effort, and task completion, (8) offer frequent and specific feedback, (9) limit distractors, (10) break tasks into small, manageable segments, (11) use cues, redirection, repetition, and rehearsal, (12) provide hands-on activities that allow for active involvement, (13) alternate high and low interest activities, and (14) use computer learning activities to capitalize on Kenny's visual strength.._ _ _ _ ___ - _ _.--- __ 3. Given the significant disparity between Kenny's nonverbal ability and speech, Kenny is in need of continued augmentative comanunication using PECS and intensive speech and language therapy. 4. A primary goal is to increase external relatedness and social interaction while decreasing social isolation and self-absorption. One should continue to take advantage of activities Kenny enjoys (e.g., gross motor activities), and the reciprocal nature of these activities should be stressed (e.g., requiring Kenny to chase or tickle you before you again chase or tickle him). These activities should also be used to increase eye contact and communication (e.g., requiring Kenny to make eye contact and request more before you resume the game). 5. Typical of most children with autism, Kenny is very much a visual and not an auditory learner. Therefore, when the goal in school is cognitive and academic learning, it will be important to teach to Kenny's strength in visual perception and bypass his auditory-verbal weakness by emphasizing visual teaching strategies, activity schedules, communication systems, and computer learning activities. Auditory input should continue to be paired with visual cues to enhance-attention, learning, and language comprehensi-on. Susan D. Mayes, Ph.D. Certified PA School Psychologist Licensed Psychologist Professor, Department of Psychiatry 4