NEUROLOGY REPORT

on

Neel JOSHI

by

DR GWILYM HOSKING

Diagnosis:

1. Autistic spectrum disorder

22 July 2005

RE: Neel Joshi DOB: 12 05 1998

THE REFERRAL This boy was seen here in London at the request of his family and on the recommendation of parents whose older child also attends the Integrated Neurocare services. It was agreed that a visit to London for this boy would be one in which there was a brief medical review but an in-depth speech and language and clinical psychological review by two colleagues with very significant experience of working with children and young people with autistic spectrum disorders. Neel was seen by me (and my colleagues) on the 4th July 2005 with both of his parents.

CLINICAL HISTORY Neel is the younger of two children of healthy, previously unrelated parents. Mother has some problem with arthritis and there is a second cousin in the maternal family who is diagnosed as having pervasive developmental disorder. The pregnancy in relation to this boy was normal as was birth at term with a normal birth weight. As an infant Neel was said by his parents to be a very quiet infant that very rarely cried. At between 12 and 15 months of age the babbling that he had seemed to stop and from having started to wave byebye this also stopped. He did not go on to interact with other children. At 2 years of age, Dr Merchant, paediatrician in Mumbai, diagnosed him as having an autistic spectrum disorder. Thereafter he had occupational therapy and speech and language therapy inputs, but progress was poor with this. He then went on to the Sunrise programme and this has remained since and has definitely been very helpful. Eye contact has increased, repetitive behaviour has decreased and parental bonding has definitely increased. He now has a 6 hour programme 5 times a week. In respect of daily living he dresses and undresses himself and feeds himself.

With toileting there is very significant progress being made. He is a very active boy that seems to need motion in any form most of the time. He isn’t particularly prone to tantrums but can have emotional outbursts at times. He is a boy that seems to fall sick rather readily and have coughs and colds. He has had a urinary tract infection and he has, in conjunction with this, had a circumcision. His hearing is thought to be normal but he is not that tolerant to noise. He has been taking, over the last 6 months, a homeopathic remedy which his mother feels may have been helpful. His language thus far is limited to statements of needs, such as I want …. Motor co-ordination, particularly fine co-ordination, is probably impaired.

CLINICAL EXAMINATION Neel was a very healthy-looking boy with good eye contact and no repetitive activity being seen. His weight is 18.5kg. For the most part he was on the go and into everything and a formal physical examination would have been inappropriate.

CLINICAL IMPRESSION This boy has a clinical picture entirely consistent with the autistic spectrum disorder.

COMMENTS I do not think there can be any reasonable clinical diagnostic questions here. Neel has, without doubt, made spectacular progress through the Sunrise Programme. This innovative programme of North American origin, if well followed, has a dramatic benefit on many children even with the most severe autistic spectrum disorder. I think Neel has certainly benefited from this. A further report will be made available from my two immediate colleagues, Mrs Jane Macer and Dr Sarah Lister Brook. I have already discussed Neel with both of my colleagues. The parents and I did discuss issues of specific medical treatment.

3

We talked a little about Ritalin. My thoughts are that Ritalin can be very helpful in a number of children with an autistic spectrum disorder if there is a major problem with hyperactivity. I don’t see this as being the case with Neel and I don’t think, at present, that medication with Ritalin is indicated. I talked a little about risperidone as sometimes being helpful in those autistic children that have severe emotional outbursts and tantrums. I don’t think this would be appropriate for Neel. He doesn’t have any major OCD type problems and I think medication for that area is not indicated.

FOLLOW UP I have made no arrangements for follow-up but would be very happy to keep in contact with his family and offer what advice may be thought appropriate.

Dr Gwilym Hosking MB FRCP FRCPCH FFPM Consultant Child Neurologist

cc:

Mr and Mrs Joshi Email: [email protected] Dr T Rajgopal Chief Medical Officer Hindustan Lever Ltd 165/166 Back Bay Reclamation Mumbai India Dr S Merchant C/o Breach Candy Hospital Bhula Bhai Desai Road Mumbai India Mrs Jane Macer Dr Sarah Lister Brook

4