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OPD : 03-Jul-2026 05:03PM Demographic Details Child's Name: Denish Singh Age: 1 Year 11 Month 8 Days Gender: Male DOB: 2024-07-25 Mother’s age (years): 37 years Mother’s occupation: Homemaker Father’s age (years): 38 years Father’s occupation: Bank Type of family: Nuclear Address: Guna Contact: 8981591600 Referred By: Doctor Informant: Parents Presenting Concerns Chief concerns: Speech delay Interaction history: Eye contact: Fleeting Quality of Interaction: limited Behavioral history: Repetitive behaviors (RRBs): stimming, running to and fro Patterned behavior or activities: Hyperactivity Inattention Object obsession Temper tantrums Stubbornness Sensory Concerns: Auditory: Hyposensitive Visual: Seeks visuals Proprioception: Seeks pressure Details:: Doesnt cooperate for haircut and nailcut Birth & Perinatal History: Antenatal History Consanguinity: No Type of conception: Natural Natal and Postnatal History: Place of Birth: Institutional Mode of Delivery: NVD Gestational Age: 37 weeks Birth Weight: 2.5 Kg Cry at birth: Cried immediately after birth Resuscitation required: No NICU stay: No Past history: Hospitalization: No Seizures: No Investigations done- Hearing assessment: Done Details: BERA- normal B/l Vision assessment: Not done Family history: Neuropsychiatric condition: Yes Others: 1st cousin has psychiatric issue Developmental History: Gross Motor Neck holding: Achieved Age of attainment: 4 months Roll over: Achieved Age of attainment: 5 months Sitting without support: Achieved Age of attainment: 6 months Standing without support: Achieved Age of attainment: 9 months Walking without support: Achieved Age of attainment: 12 months Running: Achieved Age of attainment: Climbing upstairs: Achieved Age of attainment: Fine Motor Bidextrous grasp: Achieved Age of attainment: 4 months Unidextrous grasp: Achieved Age of attainment: 6 months Pincer grasp: Achieved Age of attainment: 12 months Language Receptive:- Joint attention: Not achieved Pointing: Not achieved Understanding gestures: Not achieved Following commands: Not following Expressive:- Cooing: Achieved Age of attainment: 12 months Babbling: Achieved Age of attainment: 18 months Meaningful words: Not achieved Expressive:- Cooing: Achieved Age of attainment: 12 months Babbling: Achieved Age of attainment: 18 months Meaningful words: Not achieved Communication & Language Assessment Non-Verbal Communication Grading:- Need-based communication: Emerging Drag for needs: Emerging Joint attention: Absent Pointing: Absent Understanding gestures: Absent Following commands (gesture + verbal): Nil Answering Questions:- Echolalia: Present Social Social smile: Achieved Age of attainment: 3 months Stranger anxiety: Achieved Age of attainment: 12 months Waving bye bye: Not achieved Comes when called: Not achieved Response to Name Call Details: 3/10 Sitting tolerance- (in minutes) For interaction: Doesnt sit For tasks: 1-2 minutes ADL Skills (Age-appropriate)- Eating: 1. Dependent Bathing: 1. Dependent Dressing: 1. Dependent Undressing: 1. Dependent Academic History: Is child enrolled in school: No Diet History: Food preferences: Mixed Food allergies: No Junk food intake: Nil Sleep History Total sleep duration (night): 9 hours Afternoon nap: Yes Duration of Afternoon nap: 2 hours Sleep disturbances: Daily Screen Time Duration: Zero Examination a. Vitals: b. Anthropometry: Weight: 12 Kg Height: 85 cm Head circumference: 47 cm c. General Examination Dysmorphology: ab Neurocutaneous markers: ab d. CNS: Higher Mental Functions Sensory Examination Cranial Nerves (1–12) Neuromuscular Concerns Oromotor Examination Drooling: No Chewing: Proper Swallowing: Proper CVS examination: NAD Respiratory System examination: NAD Per abdomen examination: NAD Impression: ?ASD. M chat- 17 Advice Intervention plan: IDP 2/week + PMT 1/week General recommendation- Zero Screen Time Physical interactive play No Junk food

OPD : 03-Jul-2026 05:03PM Demographic Details

Child's Name: Denish Singh
Age: 1 Year 11 Month 8 Days
Gender: Male
DOB: 2024-07-25
Mother’s age (years): 37 years
Mother’s occupation: Homemaker
Father’s age (years): 38 years
Father’s occupation: Bank
Type of family: Nuclear
Address: Guna
Contact: 8981591600
Referred By: Doctor
Informant: Parents

Presenting Concerns

Chief concerns: Speech delay

Interaction history:

Eye contact: Fleeting
Quality of Interaction: limited

Behavioral history:

Repetitive behaviors (RRBs): stimming, running to and fro Patterned behavior or activities: Hyperactivity Inattention Object obsession Temper tantrums Stubbornness
Sensory Concerns:

Auditory: Hyposensitive
Visual: Seeks visuals
Proprioception: Seeks pressure

Details:: Doesnt cooperate for haircut and nailcut

Birth & Perinatal History: Antenatal History

Consanguinity: No
Type of conception: Natural

Natal and Postnatal History:

Place of Birth: Institutional
Mode of Delivery: NVD
Gestational Age: 37 weeks
Birth Weight: 2.5 Kg
Cry at birth: Cried immediately after birth
Resuscitation required: No
NICU stay: No

Past history:

Hospitalization: No Seizures: No

Investigations done-

Hearing assessment: Done Details: BERA- normal B/l Vision assessment: Not done

Family history:

Neuropsychiatric condition: Yes Others: 1st cousin has psychiatric issue

Developmental History:

Gross Motor

Neck holding: Achieved

Age of attainment: 4 months
Roll over: Achieved

Age of attainment: 5 months
Sitting without support: Achieved

Age of attainment: 6 months
Standing without support: Achieved

Age of attainment: 9 months
Walking without support: Achieved

Age of attainment: 12 months
Running: Achieved

Age of attainment:
Climbing upstairs: Achieved

Age of attainment:

Fine Motor

Bidextrous grasp: Achieved

Age of attainment: 4 months

Unidextrous grasp: Achieved

Age of attainment: 6 months

Pincer grasp: Achieved

Age of attainment: 12 months

Language

Receptive:-

Joint attention: Not achieved
Pointing: Not achieved
Understanding gestures: Not achieved
Following commands: Not following

Expressive:-

Cooing: Achieved

Age of attainment: 12 months

Babbling: Achieved

Age of attainment: 18 months

Meaningful words: Not achieved

Expressive:-

Cooing: Achieved

Age of attainment: 12 months

Babbling: Achieved

Age of attainment: 18 months

Meaningful words: Not achieved

Communication & Language Assessment

Non-Verbal Communication Grading:-

Need-based communication: Emerging
Drag for needs: Emerging
Joint attention: Absent
Pointing: Absent
Understanding gestures: Absent
Following commands (gesture + verbal): Nil

Answering Questions:-

Echolalia: Present

Social

Social smile: Achieved

Age of attainment: 3 months
Stranger anxiety: Achieved

Age of attainment: 12 months
Waving bye bye: Not achieved
Comes when called: Not achieved

Response to Name Call

Details: 3/10

Sitting tolerance- (in minutes)

For interaction: Doesnt sit
For tasks: 1-2 minutes

ADL Skills (Age-appropriate)-

Eating: 1. Dependent
Bathing: 1. Dependent
Dressing: 1. Dependent
Undressing: 1. Dependent

Academic History:

Is child enrolled in school: No

Diet History:

Food preferences: Mixed
Food allergies: No
Junk food intake: Nil

Sleep History

Total sleep duration (night): 9 hours
Afternoon nap: Yes
Duration of Afternoon nap: 2 hours
Sleep disturbances:

Daily Screen Time

Duration: Zero

Examination

a. Vitals:

b. Anthropometry:

Weight: 12 Kg Height: 85 cm Head circumference: 47 cm

c. General Examination

Dysmorphology: ab Neurocutaneous markers: ab

d. CNS: Higher Mental Functions

Sensory Examination

Cranial Nerves (1–12)

Neuromuscular Concerns

Oromotor Examination

Drooling: No
Chewing: Proper
Swallowing: Proper

CVS examination: NAD
Respiratory System examination: NAD
Per abdomen examination: NAD

Impression: ?ASD. M chat- 17

Advice

Intervention plan: IDP 2/week + PMT 1/week
General recommendation-
1. Zero Screen Time
2. Physical interactive play
3. No Junk food

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