REASON FOR REFERRAL
Services were required by parents. At present Toby’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.

BACKGROUND INFORMATION

Past psychiatric history:
Toby has a documented diagnoses of Autism Spectrum Disorder and an intellectual disability.

Chief Compliant and History of Present Illness (HPI)

Social communication. Toby does not use vocalizations to communicate. He prefers to communicate through the use of simple gestures and through a basic Picture Exchange Communication System (PECS).
Behavior. Toby exhibits aggressive behavior that consists of hitting, slapping, pinching, biting, scratching, grabbing, and pulling the hair of other individuals. Aggression occurs on average 10 times per day at school and 3 times per day home. Toby engages in self-injurious behavior. This includes, but is not limited to, biting himself, hitting himself in the head, and putting his hands into very hot water. Self-injury occurs on average 17 times per day at school and 10 times per day home. Toby experiences problems with sleep. It typically takes his mother or father 2–3 hours every night to have Toby stay in his bedroom, until he falls asleep. The IEP team considers Toby’s aggression and self-injury the most significant barriers to Toby transitioning to a level restrictive educational setting.
Adaptive skills. Toby is capable of maintaining age appropriate personal hygiene and care.
Motor skills. Toby does not demonstrate any motor delays.
Education. Toby is attending Mrs. Ryan’s first grade, self-contained special education class. There are eight students in that class including him and two paraprofessionals. Toby has his Individual Educational Plan (IEP) to reduce aggression and self-injury. Toby’s IEP team assessed that Toby needs a behavior intervention plan to address behavior goals in EIP to support Toby in transitioning to a less restrictive educational setting.
Family history. No psychiatric history in the family. Toby lives with Mr. and Mrs. M., his parents, whom are very invested in addressing Toby’s educational and behavioral needs, even though they are both working professionals with busy work schedules. Toby lives with an older brother, 10 years old Miles.
Medical history: Mrs. M reported that her pregnancy was normal. Toby attends Mrs. Ryan’s first grade classroom and receives in-home/community services 20 hours a week. In addition, Toby is under the care of his neurodevelopmental pediatrician.
Active medical problems. None.
Current medication. Risperdal and Melatonin.
Allergies. Special diet. None.
He has never received ABA.

Intervention Goals

When defining goals and objectives, it is critical to consider social validity which was the main factor when defining the goals of intervention for Toby. The goals are listed below:
a) Long term objective: Toby will communicate his wants and needs. Toby will manage difficult situations appropriately.
b) Intermediate goal: Toby will use appropriate behavior skills instead of engaging in problem behaviors.
c) Short term goals:
a. Toby will decrease his aggressive behavior

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