Pilot Study - Homoeopathic Secretin

Score SHEETS, Section outlines etc.

Firstly, please copy all the forms, as this study should be completed over 2 months. As we do not have a base line assessment of behaviour prior to the start of taking HS, we assume a pre score of 5 as the average/normal as observed by carer/parent for the client. This scoring system is dependent upon the carer/parents observations of the client prior to the intake of HS. Once forms are completed (please make a copy for your own records) please send to Ainsworths Homoeopathic Pharmacy. (TP) 36, New Cavendish Street, London W1M 7LH. Below are examples only.
Sht. 1.1	Physical Self-stimulatory behaviour. Hand flapping – finger flicking – spinning – rocking – tip-toeing – tapping – tapping self – tapping objects – dangling string – (Comforting – stress reducing behaviours.)
Sht. 1.2	Self Injury Physical harm to self – biting hands – banging head – pulling fingers & toes Hair tugging etc.
Sht. 1.3	Aggression Aggressive physically to others or property. Throwing, hitting, etc. Aggressive posture and/ or vocal/verbal.
Sht. 1.4	Eye contact.
Sht. 1.5	Isolation Solitary periods – avoidance of others.
Sht 1.6	Ritualistic behaviour ‘Fixed’ routine – e.g. taps on certain object X times before commencing an activity – set order of things must happen before moving forward etc.
Sht. 2.1	Ability to handle changes in routine E.g. different route to shops, change of meal, bed time routine etc.
Sht. 2.2	Toileting (if using toilet): Working towards total independence, taking to and from, undressing/re-dressing – wiping/flushing, washing hands afterwards.
Sht. 2.3	Toileting (learning to use the toilet) Getting sensation of, or indicating need for etc.
Sht. 2.4	Emotion: Appropriate emotion exhibited towards people/events etc.
Sht. 2.5	Obsessive/ compulsive behaviour: Only eating or drinking certain things – need to finish/empty food/drink. Need for things to be in their expected place. Rigid control of their environment. Narrow focus on things i.e. weather, time, water, the same video over and over.
Sht 2.6	Stress / Anxiety: Vocalisations, body stiffening, tension, facial expressions i.e. wide eyed, fearful, repetitive movements.
Sht. 3.1	Body/facial expressions: Appropriate to situation. Fearful, sad, happy, anxious Loving etc.
Sht. 3.2	Social Interaction: Initiation and response to...... ease and comfort with…. Appropriate responses.
Sht. 3.3	Sleep pattern:
Sht. 3.4	Drink intake: More or less.
Sht. 3.5	Food intake: More or less.
Sht 3.6	Inclination to try new foods or drinks.
Sht. 4.1	Non-verbal communication In client gaining the attention of carer/parent attending to needs etc. (touch, gesturing, vocalisation/utterances etc.)
Sht. 4.2	Verbal communications:
Sht. 4.3	Isolated vocal communication: Client withdraws from immediate contact with people and vocalises with no obvious target for his vocalisation (not apparently trying to communicate with carer/parent or family member)
Sht. 4.4	Understanding communications from others Verbal or otherwise. E.g. responding appropriately to requests?
Sht. 4.5	Pointing / touch pointing: Pointing/gesturing to gain your attention – or to gain certain objects/desires (Food, drink).
Sht. 4.6	Sensitivity to sounds: Appropriate responses.
Sht. 5.1	General behaviour Changes from the ‘norm’.
Sht. 5.2	Behaviour swings frequency:
Sht. 5.3	Behaviour swings intensity.
Sht. 5.4	Possible cause of positive or negative behaviour: Can you pinpoint possible cause of change in behaviour?
Sht. 5.5	Was this behaviour (Q5.4) instant or delayed I= instant D=Delayed