REASON FOR REFERRAL
Services were required by parents Suzanne and John who initially enrolled Alex due to concerns regarding limited diet, refusal to engage in required activities and picking his skin and nails. At present Alex’s behavior impacts his life in the following ways:
1. Prevents positive age appropriate social interactions with peers and adults.
2. Prevents accesses to wide variety of preferred items or activities or reinforcers.
3. Limits opportunities for developing functional skills.

Strength and Weaknesses
Strength.
Alex uses full sentences to communicate, though it is sometimes unclear what he is trying to communicate. He is willing to complete tasks to access reinforcers and he has a variety of preferred activities. Alex is great at drawing, video and computer games.
Weaknesses.
Alex does not seek out interactions from unfamiliar adults, or same age peers. He is inflexible about the language he uses and does not like when people use negative words such as no’, “do not”, ‘cannot’.

BACKGROUND INFORMATION
Alex is 12 years old boy who lives in Seattle with his mother Suzanne, his father John and his brother Ben. The family has lived in Seattle for the past 10 years. Alex was born in Mexico and lived there for a short period of time. Alex is Mexican and his family speaks both Spanish and English. Alex speaks and understands English and some Spanish and sometimes prefers to be given direction in Spanish. In school he is spoken to in English. Alex enjoys playing with Legos, watching videos and playing games.

Past psychiatric history: Alex’s parents became concerned when he stopped talking and would hide from people who he did not know. He was diagnosed with Autism when he was 3.5 years old at Seattle children’s autism center.

Chief Compliant and History of Present Illness (HPI)
Social communication. Alex uses full sentences and gestures to communicate. Sometimes he has trouble making eye contact and orienting his body when he is talking to people. He asks for item and information when he needs them and sometimes asks his brother to say certain phrases.

Behavior. Alex is selective with food and will only eat preferred foods on separate plates. His parents reported that Alex has seemed more anxious recently with the transition from elementary school to Middle School. He picks, bites and cuts his fingernails sometimes to the point of bleeding. At school he has

Using the recommendations on pp. 603–604 in the Cooper text as a gu...