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language, which is a significant improvement. He is not yet able to
engage in a conversational exchange, but this is an area that should now
be worked on in therapy, as he has the capacity to talk about events and
objects not present, and answer questions and offer information about
his interests. Imagination is another area that Jason has clearly made
strides in; he now engages in a variety of spontaneous pretending,
including representational play, which is a higher form of creativity.
However, when left to choose, he still has some tendency to prefer more
repetitive forms of play, such as pressing buttons on cause and effect
toys. Although he exhibits less repetitive activities than he did in the
past, this is still an area of interest for him. We suggest limiting
opportunities for this type of play in order to steer him toward more
imaginative and creative play. Finally, we observed that Jason still
engage in some repetitive motor mannerisms ( hand flapping, toe walking),
although less than in the past. We concern that this is not a behavior
that warrants any attention in therapy, as it is brief and does not
interfere with his ability to engage; it will most likely continue to
decrease on its own. Jason continues to demonstrates average receptive
language skills, below average expressive language skills, and very low
visual reception and fin motor skills. Although the pattern of his
performance has not changed, the consistency of the standardized scores
indicated that he is continuing to make development progress in all
areas assessed. However, he is not closing the gap in areas of delay. At
home, Vineland results suggest good pre-academic skills, but moderate
difficulty using expressive and receptive language skills to communicate.
Daily living skills, social skills, and motor skills were also moderate
to severely impaired. It is possible that his scores on today's testing
are influenced by efforts and motivation, but it is also possible that
this pattern of cognitive strengths and weakness will continue as he
gets older. Another important factor in his performance on visual tasks
is the impact of his nystagmus on his ability to sustain effort on
visual activities. The effort required to focus on visual details
( particularly in larger visual displays, or with small details) might