Case 2

Attention Deficit / Hyperactivity Disorder

314.01 (F90.2)
 Case summary

M.A is a 9 years old boy who lives with his birth parents in a nuclear family system. The

concerned were raised when parents observed noticeable developmental delays, regression in

speech and language, limited reciprocal social interaction, difficulty to follow instructions in

a structured manner and sustaining attention for extended period with reports on short sitting

span. The mother reported that M.A frequently engages in repetitive behavior such as, hand

flapping, feet stomping, fidgeting and lining up objects when he gets overwhelmed or

overstimulation. The communication is limited to phrases, challenges while initiating and

maintaining conversation, interpreting non-verbal cues and engaging age-appropriate peer

interactions is quite evident. In the academic environment, M.A struggles with task

completion, organizational skills and is easily distracted by external stimuli. He also

demonstrates signs of emotional dysregulation, including frequent mood swings, difficulty

managing frustration, and low tolerance for unexpected changes in routine. These emotional

responses often manifest as tantrums, avoidance, or withdrawal during social or academic

tasks. The child underwent a formal assessment using standardized tools, specifically the

Conners' Parent/Teacher Rating Scale, Questions About Behavioural Functions and the DSM-

5 Checklist for Attention Deficit/Hyperactivity Disorder. Additionally, an informal evaluation

was conducted through behavioural observation and a clinical interview with the child's

teacher. A multidisciplinary intervention approach was sought to address these concerns and

provide M.A with the support needed to enhance his communication abilities, regulate his

emotions more effectively, and develop adaptive functioning skills both at school and at

home.
Demographic detail:

Name M.A

Age 9 years

Gender Male

Date of birth 13th May,2015

No. of siblings 3

Birth order 1st

Religion Islam

Father occupation Pak Army Officer

Mother occupation Housewife

Socio-economic status Middle class

Family structure Nuclear

Informant Mother

Reason and source of referral

The case was referred through a parent supporting group on the Facebook, where a mother

sought guidance after observing developmental and behavioral challenges such as speech

delays, use of nonsensical words and phrases, humming sounds, and babbling that lacks

communicative intent. She also reported concerns regarding short attention span and inability

to remain seated in a place where stillness is required like mealtimes.

Presenting complaints

As reported by the mother, the client is experiencing difficulties in following instructions,

attention span, impulsivity and hyperactivity that leads to self-destructive behavior such as

biting and self-hitting. Delayed speech, babbling, humming sounds, frequent irritability and

attempts to run away or escape from structured settings.

General appearance and behaviour

The child appeared in a casual clothing that was neither neat nor ironed during sessions

indicating a lack of proper attention towards personal hygiene or grooming. Multiple marks

were visible on the face and arms, consistent with a history of self-injurious behaviors such as

self-biting.

The child maintained intermittent eye-contact indicating positive engagement throughout

session. However, in the case of structured activity present like draw or cut semicircle, he

exhibited escape behaviors including attempts to run away from the setting. He has limited

verbal communication but functional in some instances as the phrase “green car” used to

request his favorite toy indicates expressive language command. The client also displayed the

excessive laughing and humming different sounds during the activity, followed by crying,

suggesting an overwhelmed emotional state.

History of the present illness

The concerns regarding the child's speech and language development were first noticed

around the age of 3 years. At that time, the child demonstrated limited verbal communication,

primarily engaging in babbling, creating his own words, and repeating them during play. The

child predominantly relies on gestures to communicate his needs and desires.

According to parental reports, one of the contributing factors to the delay may be limited

verbal interaction at home during early childhood, combined with excessive screen exposure.

The child began watching television at approximately 3 to 4 months of age and currently

exhibits signs of mobile phone addiction, which may further hinder language development.

A speech-language specialist initially assessed him at age 3 and indicated a developmental

delay with features of impulsivity and hyperactivity indicating Attention Deficient/

Hyperactivity Disorder. Since then, the child has been evaluated by multiple professionals,

including a psychologist, speech therapist, and psychiatrist.

Background Information

Childhood History

The client’s mother did not report any complications during pregnancy and it was full term 9

months pregnancy. The child was born through planned caesarean and his birth weight was

3.8kg.

Prenatal – No prenatal complications were noted. The pregnancy was reported to be healthy

and uneventful.

Postnatal – The child has little fever when he was 7 months old. No other significant

postnatal concerns were reported during infancy.

Medical History

There is no significant history of seizures, allergies, and major illness. The child has a record

of up-to-date vaccinations.
Educational History

The child academic sessions are conducted under the guidance of behaviour therapist to

ensure that learning environment is safe enough according to child’s individual needs and

challenges. The child has been introduced to the beginner level foundational math concepts

such as addition with the help of calculator, concept of money and counting till 100 to

enhance his engagement and confidence related to numerical task whereas in literacy early

reading skills are being developed through the introduction of simple three-letter words such

as "cat" and "ball." These sessions are structured to build phonemic awareness and word

recognition.

Family History

The child belongs to a middle-class family. He lives in a nuclear family system. His father is

a Pak Army Officer and mother is a housewife and they have healthy family relationship. The

child is the eldest son with younger two siblings and spends most of the time with his mother.

Family Psychiatric History

There is no history of any developmental, medical or psychiatric conditions in the immediate

family.

Social History

The child exhibits limited social interaction due to behavioural concerns such as hitting or

pushing other kids observed previously in group setting. At the moment he is not allowed to

have a direct peer interaction as behaviour therapy aimed to improve his social engagement

and emotional regulation to ensure safety and peaceful environment for everyone around him.

Medical History

The client is generally healthy and no medical history was reported.

Developmental Milestones History

The client presents a unique developmental profile that highlights both her achievements and

the areas of concern. The following table highlights the child’s functional abilities and

developmental milestones across various domains including motor skills, self-help skills, and

language development.

Table 1

Domain Age of achievement Child’s current status

Sit independently 6-8 months Achieved at 6 months (Within typical

range)

Walk independently 12-15 months Achieved at 1 year (Within typical

range)

Feed self 12-18 months Achieved (Within typical range)

Dress self (i.e., putting on clothes) 3-4 years Not achieved (Delayed)

Use single words (e.g., no, mom) 12 months Uses only when interested (Delayed)

Combine words (e.g., me go, 18-24 months Not achieved (Delayed)

daddy shoe)

Name single objects (e.g., car, 18-24 months Not achieved (Delayed)
tree,

Use simple questions (e.g., 2-2.5 years Not achieved (Delayed)

"Where’s doggie?")

Engage in conversation 3 years and above Not achieved; only phrases (Delayed)

Gross motor coordination (walk, 1-2 years No difficulties (Within typical range)
run, climb, etc.)

Fine motor coordination (use

utensils, grasp small objects) 1-2 years No difficulties (Within typical range)

Feeding and oral-motor skills By 1 year No difficulties (Within typical range)

(chewing, swallowing)
Preliminary investigation

Preliminary investigation has been done using two methods

i. Informal assessment (i.e., clinical interview and behavioural observation)

ii. Formal assessment (i.e., Conner Parent/Teacher rating scale, QABF)

Informal assessment

Clinical interview

An unstructured interview was conducted with child’s therapist to gather insights about his

academic performance, behavioural concerns and social interaction. A therapist reported that

child faced challenges in maintaining attention during activities and often requires

redirection. Lately, the foundational math concepts such as counting, simple addition and the

literacy three alphabet word (e.g., cat, bat) have been introduced but the home incompletion

with several missing home tasks considered ongoing concern which eventually hinder

progress.

A therapist also highlighted emotional dysregulation and impulsivity that is often shown in

the form of excessive laughing, humming sounds and crying, particularly when transitioning

between tasks or when his demands are not met. For example, when his demand for his

favourite green car toy has been delayed, he became frustrated and had a temper outburst. A

multidisciplinary approach has been applied comprising ABA techniques to manage

behaviour, Occupational therapy session for sensory regulation and Speech therapy sessions

for communication skills.

Behavioural Observation
 The following ABC (Antecedent-Behaviour-Consequence) behavioural observation table

documents the child’s responses across various situations over five consecutive days.

Frequency indicates how many times the behaviour occurred during the observed period,

while duration reflects how long the behaviour lasted. All interventions were implemented

with guidance from a behaviour therapist, tailored to reduce maladaptive behaviours and

support self-regulation.

Table 2

ABC (Antecedent-Behaviour-Consequence) behavioural observation

Day 1 Day2 Day 3 Day 4 Day 5

Antecedent Denied access Noisy room Jigsaw puzzle Maths activity Drawing and
to favourite presentation (addition cutting
(Triggers)
toy question) semicircle

Behaviour Fidgeting, Self biting, Threw puzzle, Crying, Screaming,

covering started screaming crying, self
(Actions) self hitting
ears laughing biting

Consequence Tantrum Continued Lost attention, Self-injurious Started

escalated with crying attempted to jumping, biting throwing room
(Outcomes)
crying run material

Function of Access to Sensory Task avoidance Escape from Sensory

Behaviour preferred item avoidance cognitively overstimulation
demanding task

Frequency 1-2 times 5-6 times 2-3 times 6-7 times 3-4 times

Duration 5-6 minutes 10 minutes 7 minutes 15 minutes 20 minutes

Intervention Visual cards Offered Redirected to Time out Introduced

Given (first/then) sensory simplified followed by rubber-band
strategy tools deep pressure snapping (mild-
 (brush, puzzle input aversion
playdough) strategy)

Response to Calmed after Stopped Showed brief Had difficulty Attempted self-
Intervention 10 minutes crying after engagement self regulating regulation by
a while and interest covering eyes

Table 3

Sensory Profile Assessment

Sensory Behavioural Observed Behaviour Notes/Response

Category Indicators

Tactile (Touch Sensitivity to Shows preference for Engages with tactile materials
Sensitivity) textures. certain textures (e.g., but may react negatively to
playdough). unexpected textures.

Proprioception Awareness of Difficulty with spatial Needs reminders to stay in

(Body body position awareness during personal space (e.g., “hands to
Awareness) activities self”)

Vestibular Movement Shows good balance; No major difficulties with

(Balance & sensitivity can skate with shoes balance-related activities;
Movement) and use a skateboard enjoys movement and responds
with minimal support well to active play like skating
or swinging

Auditory Response to Only responsive to Exhibits discomfort during

(Hearing sounds loud noises; may noisy environments; prefers
Sensitivity) cover ears quieter settings

Visual Reaction to Engages well with Visual tasks help maintain

Processing visual stimuli visually stimulating attention but may show
tasks (e.g., puzzles) frustration during complex
activities

Oral Sensory Seeking oral Engages in self-biting; Oral sensory exploration

Seeking stimulation. sucks/chews on items (mostly food) has been
introduced to reduce self-biting
 behaviour

Formal assessment

i. Conner’s Parent/Teacher Rating Scale-Revised (S)

The Conners Parent and Teacher Rating Scales—Revised (CPRS-R and CTRS-R) were

developed by Cecil R. Conners to provide a standardized method for assessing behavioural

and emotional problems in children, particularly for identifying

Attention-Deficit/Hyperactivity Disorder (ADHD).

These scales are typically filled out based on observations of the child’s behaviour over a

specific period, allowing for both quantitative and qualitative data to be collected. The

scoring of these scales involves rating behaviours on a Likert scale, with responses ranging

from 0 (never) to 3 (very often), reflecting the frequency of the observed behaviours. The

resulting scores are compared to normative data to determine if the child’s behaviour falls

within typical ranges or suggests the presence of a behavioural disorder, such as ADHD.

Quantitative Analysis

Table 4

Table showing severity level on Conner’s Parent Rating Scale -Revised (S)

Oppositional Inattention Hyperactivity ADHD Index

Raw score 16 15 15 32
T Score 83 73 88 77

Percentile 98+ 98+ 98+ 98+

Table 5

Table showing severity level on Conner’s Teachers Rating Scale -Revised (S)

Oppositional Inattention Hyperactivity ADHD Index

Raw score 13 14 20 31

T Score 90 75 81 75

Percentile 98+ 98+ 98+ 98+

Qualitative analysis

The qualitative analysis of the raw scores on the Conners Parent Rating Scale reveals

significantly elevated levels of concern across multiple domains. The client obtained the

following T-scores: Oppositional – 83, Inattention – 73, Hyperactivity – 88, and ADHD Index

– 77, with raw scores of 16, 15, 15, and 32 respectively. All scores fall within the 98 th

percentile and above, indicating markedly atypical behaviour and a clinically significant level

of symptom severity across these areas. Whereas the raw scores on the Conners Teacher

Rating Scale also indicates significant severity ratio across domains with the T-scores:
Oppositional – 90, Inattention – 75, Hyperactivity – 81, and ADHD Index – 75, with raw

scores of 13, 14, 20, and 31 respectively falling within 98th percentile.

ii. Questions about Behavioural Functions (QABF)

The Questions About Behavioural Function (QABF) is a standardized, indirect assessment

tool designed to identify the possible functions of challenging behaviours in individuals with

developmental disabilities, including autism spectrum disorder. Developed by Johnny L.

Matson and colleagues, the QABF helps clinicians and therapists understand the underlying

purpose or motivation behind specific behaviours by categorizing them into five functional

areas: Attention, Escape, Physical Discomfort, Tangible Reinforcement, and

Non-social/Automatic Reinforcement. The assessment is typically completed by someone

familiar with the individual’s behaviour such as a caregiver, teacher, or therapist based on

their observations in various settings. It consists of 25 items, rated on a Likert scale from 0

(never) to 3 (often), which are then scored to determine the most likely maintaining

function(s) of the behaviour.

Table 6

Table showing scoring obtained on QABF

Attention Escape Non- Social Physical Tangible

8 9 14 8 13
 QABF
16
14
12
10
Scores

8
6
4
2
0
Attention Escape Non-social Physical Tangible
Behaviour Function

Figure 1: Graphical representation of Questions about Behavioural Scoring

Qualitative Analysis

The scores obtained on the QABF were Non-Social (14), and Tangible (13) indicates that

child challenging behaviours are mostly driven by sensory needs and access to preferred item.

Moderate scores on Escape (9) and Attention 8 are prevalent but less dominant. The low

score on Physical (8) shows minimal influence. These results help in identifying what the

child may be trying to achieve or communicate through the behaviour.

iii. DSM-5-TR Checklist for Attention Deficit/Hyperactive Disorder

Check the column that best describes the child’s behaviour for the last 6 months.

Inattention Not at All Sometimes Frequently

1. Often fails to give close attention to details Yes

or makes careless mistakes in schoolwork,
work, or other activities.
2. Often has difficulty sustaining attention in Yes
tasks or play activities.

3. Often does not seem to listen when spoken Yes

to directly.

4. Often does not follow through on

instructions and fails to finish schoolwork,
Yes
chores, or duties in the workplace (not due
to failure to understand directions).

5. Often has difficulty organizing tasks and Yes

activities.

6. Often avoids, dislikes, or is reluctant to Yes

engage in tasks that require sustained
mental effort (such as schoolwork or
homework).

7. Often loses things necessary for tasks or Yes

activities (e.g., toys, school assignments,
pencils, books, tools).

8. Is often easily distracted by extraneous Yes

stimuli.

9. Is often forgetful in daily activities. Yes

Hyperactivity Not at All Sometimes Frequently

10. Often fidgets with hands or feet or squirms Yes

in seat.

11. Often leaves seat in classroom or in other Yes

situations in which remaining seated is
expected.

12. Often runs about or climbs excessively in yes

situations in which it is inappropriate (in
adolescents or adults, may be limited to
 subjective feelings or restlessness).

13. Often has difficulty playing or engaging in yes

leisure activities quietly.

14. Is often “on the go” or often acts as if yes

“driven by a motor.”

15. Often talks excessively. yes

Impulsivity Not at All Sometimes Frequently

16. Often blurts out answers before questions yes

have been completed.

17. Often has difficulty waiting turn. yes

18. Often interrupts or intrudes on others (i.e., yes

interrupts conversations or games).

Tentative Diagnosis

314.01 (F90.2) Attention-Deficit/ Hyperactivity disorder, Combined Presentation.

Case Formulation

4P’s Clinical Framework

This case formulation aims to provide a comprehensive understanding of M.A's

developmental and behavioural challenges, focusing on both the contributing factors and

potential therapeutic interventions. M.A a child with a tentative diagnosis of mild autism and

speech-language delays, presents a unique profile shaped by various predisposing,

precipitating, and perpetuating factors. By examining the impact of early developmental

experiences, social reinforcement patterns, and behavioural responses, this formulation will

draw on principles from behavioural theory, operant conditioning, and Applied Behaviour
 Analysis (ABA) to better understand M.A's behaviour and identify appropriate interventions.

The formulation also highlights key protective factors, such as early intervention, that may

improve M.A's cognitive, behavioural, and adaptive outcomes. This structured approach will

serve as the foundation for creating a tailored intervention plan to support M.A's

developmental needs.

Predisposing Precipitating Perpetuating Protective

(Underlying risk (Triggering (Maintaining (Supportive
immediate current problem) resilience factors)
factors)
cause)

Description Early screen Lack of family Continued use of Early intervention

exposure from 3–4 communication, preferred initiated by mother
months of age. minimal parental behaviours (e.g., at age 3, consistent
interaction, and obsession with therapy at centre,
excessive green card), with proactive steps by
unstructured therapy focusing parents toward
alone time on prompting and speech and
leading to screen fading to reduce behavioural
addiction. reinforcement therapy.
dependency

Relevant Behavioural Theory Operant ABA Principles Early Intervention

theory (Watson, 1913; Conditioning (Skinner, 1953; Model (Dawson &
Skinner, 1953) (Skinner, 1953) Lovaas, 1987) Rogers, 2010)
Theory Early exposure to Lack of social Unwanted Timely therapeutic
explanation screens can lead to reinforcement behaviours are support during
passive behaviour drives the child reduced by early development
patterns, with to seek removing improves cognitive,
attention shaped by stimulation reinforcement behavioural, and
repetitive stimuli. through screens. (extinction) and adaptive outcomes
encouraging
alternative
behaviours
(DRA).

Individualized Educational Plan (IEP)

Observed Relevant ABLLS-R ABLLS-R Task(s) Suggested Strategies

Behavior Domain(s)

Self-biting Self-Help (V: Eating), V1: Accepts a Introduce oral sensory tools
behaviour Motor Skills (Z: Fine variety of foods; (e.g., chewy tubes), provide
Motor) Z1: Uses hands crunchy/chewy foods (e.g., raw
appropriately carrots, apples), implement
brushing protocols (e.g.,
Wilbarger), use compression
garments for deep pressure
input.

Oral sensory Self-Help (V: Eating) V2: Chews food Offer safe oral alternatives
seeking appropriately (e.g., gum, chewy tubes),
engage in blowing activities
(e.g., bubbles, whistles), use
straws for drinking to provide
 deep oral input

Tactile Motor Skills (Z: Fine Z2: Manipulates Provide fidget toys, stress balls,
seeking (e.g., Motor) small objects putty, or textured objects to
fidgeting) keep hands engaged and reduce
self-injurious behaviours.

Difficulty Motor Skills (Z: Fine Z3: Uses scissors; Provide guided practice with
with cutting Motor) Z4: Pastes objects cutting shapes, use visual
and pasting outlines for pasting activities,
gradually increase complexity
of tasks.

Challenges Writing (S) S3: Colours within Start with simple colouring
with colouring lines tasks, use thick boundary lines,
within provide hand-over-hand
boundaries assistance as needed, gradually
reduce support.

Observed Relevant ABLLS- ABLLS-R Task(s) Suggested Strategies

Behaviour R Domain(s)

Difficulty with Receptive Language C50: Understands Use picture cards to practice 3-
story (C), Intraverbals (H) sequences; H10: and 4-step story sequences,
sequencing Answers questions encourage retelling of familiar
about stories stories, utilize visual aids to
support comprehension.

Limited use of Labelling (G) G34: Uses carrier Model descriptive language
adjectives in phrases with during play, prompt use of
requests adjectives adjectives in requests (e.g.,
"big car"), reinforce correct
usage with praise or rewards.

Challenges Receptive Language C52: Identifies Engage in activities that

locating (C) objects in pictures involve finding and naming
objects in objects in complex images, use
scenes "I Spy" games to enhance
visual scanning and
vocabulary.

Difficulty Labelling (G), G35: Labels Practice with preposition

using Receptive Language prepositions; C51: flashcards, set up physical
prepositions (C) Understands activities that involve placing
prepositions objects in, on, under, etc.,
reinforce correct usage through
repetition.

Limited Labelling (G) G20: Labels Encourage the child to describe

labelling of functions of items the function of common objects
item functions using full sentences (e.g., "This
is a spoon. We use it to eat."),
use real objects during practice.

Difficulty Receptive Language C53: Understands Use real-life examples to

understanding (C) concepts demonstrate concepts (e.g.,
concepts (e.g., filling and emptying
empty/full) containers), incorporate
concept vocabulary into daily
routines.

Summary of Therapeutic Intervention

Day Activity Purpose Therapeutic Approach

1 Jigsaw puzzle Improve attention span Cognitive Stimulation + ABA

verbal/gestural and problem-solving prompting
prompts

2 Cutting, Enhance fine motor Occupational Therapy + Sensory

colouring along skills and reinforce Reinforcement, Shaping
with playdough participation

3 Pom Pom Teach self-regulation Sensory Integration +

 breathing game through deep breathing Mindfulness

4 Brain gym + Promote bilateral Sensorimotor Therapy + Prompt

shape sorting coordination and visual Fading
discrimination

5 Story sequence Identify emotional ABA – Emotional Regulation,

cards (triggered triggers and teach shaping (reduce tantrums,
tantrum) coping strategies improve emotional responses)

6 Colourful Strengthen expressive Speech & Language Therapy,

semantics and receptive language ABA (Prompting Fading)
skills

Summary of sessions

Day 1- Initial rapport-building phase. Child exhibited continuous laughter, short attention

span, and self-destructive tendencies. Sessions focused on observation and gaining familiarity

through structured play and OT activities (i.e., colouring, pasting and cutting)

Day 2- Behaviour patterns became clearer. Communication limited to phrases. Noted

impulsivity and emotional outbursts. Behavioural strategies (e.g., rubber band technique-

positive punishment) and sensory tools were introduced to manage tantrums.

Day 3- More engaged in structured tasks like jigsaw puzzles. A strong emotional reaction to a

green car revealed obsessional tendencies. Intense tantrum allowed deeper insight into

triggers and regulation needs.

Day 4- Shift towards structured breathing and self-regulation activities (e.g., pom pom task).

Social behaviour strategies like silent treatment and differential reinforcement were

introduced to shape alternative responses.

Day 5- Improved participation in tasks such as brain gym and colour recognition. Observed

better regulation in some areas, though impulsivity and humming persisted. Continued focus

on motor coordination and sensory integration.

Day 6- Increased expression of self-soothing behaviours like repeating phrases and

requesting chin touch. Speech sessions revealed growth in understanding language cues. OT

continued to support sensory regulation and fine motor engagement.

Pre and post Intervention Assessment

Concerning areas Pre intervention Post intervention

Attention Span 1-2 minutes 5 minutes

Hyperactivity/ Impulsivity Very High High

Emotional Regulation Poor regulation Some improvement

Sensory Processing Over responsive Moderately responsive

Self care (dressing, feeding) Needs full assistance Partial assistance required

Communication Rarely initiate Use of phrases

Social interaction Minimal interaction Minimal interaction

Limitations

Limited parent contact and involvement: Consistent communication with the parent was

lacking, resulting in missed opportunities to share valuable insights and progress updates

regarding the child’s behaviour and needs.

Lack of strategy generalization at home: Parents have struggled to implement or practice

therapeutic strategies at home, reducing the consistency needed for behaviour change and

learning generalization.

Insufficient understanding of therapeutic importance: There appears to be a gap in

parental understanding regarding the importance of applying therapy-based techniques at

home. This has likely impacted the child’s rate of progress.

Neglect of dietary considerations: The child frequently brought sugary treats (e.g.,

cupcakes) from home, which may exacerbate symptoms of hyperactivity and impulsivity.

Apparent parental neglect: There are signs of inadequate attention to the child’s emotional

and behavioural needs at home, which has hindered consistent improvement.

Recommendations

Parent psychoeducation sessions: Conduct structured psychoeducational training to help

parents understand the significance of at-home follow-through and its impact on the child's

development.

Develop a home strategy journal: Encourage parents to maintain a simple behaviour journal

or checklist to track progress and reinforce therapeutic strategies at home.

Dietary monitoring and guidance: Recommend reducing high-sugar food items brought

from home to support better regulation of energy levels and behaviour.

Psychiatric evaluation for medication support: A psychiatric consultation is advised to

assess the need for pharmacological intervention, particularly to manage impulsivity and

hyperactivity.
Encourage parental involvement and attention: Emphasize the need for consistent parental

engagement, including active participation in therapy plans, emotional support, and

behaviour monitoring.

References

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708–713

Nikkelen, S. W. C., Valkenburg, P. M., Huizinga, M., & Bushman, B. J. (2014). Media use

and ADHD-related behaviours in children and adolescents: A meta-analysis. Developmental

Psychology, 50(9), 2228–2241

Lovaas, O. I. (1987). Behavioural treatment and normal educational and intellectual

functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1),

3–9.

Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., &

Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism:

The Early Start Denver Model. Paediatrics, 125(1), e17–e23

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental

Disorders (5th ed., text rev.; DSM-5-TR).

Partington, J. W. (2007). The Assessment of Basic Language and Learning Skills-Revised

(ABLLS-R).

Appendix