14 point autism kids improvements monitoring sheet english and hindi : www.myautismguru.com by dr Kondekar for teaching purpose only
The 14-point follow-up format associated with Dr Santosh V. Kondekar is best understood as a longitudinal developmental monitoring framework: it aims to move follow-up consultations beyond the general statement “no improvement” and toward specific gains, persistent difficulties, and measurable goals for the next review.
The important distinction is between monitoring change in a child’s functioning and measuring the core features of autism itself. The two are related, but they are not interchangeable.
1. The 14-point follow-up criteria
The material available on Dr Kondekar’s websites describes a follow-up approach that records developmental gains and next goals, alongside behavioural and functional concerns. The website also links to a follow-up format and monitoring chart.
The following is a structured reconstruction of the 14 domains from the follow-up criteria previously associated with Dr Kondekar. It is an analytical presentation, not a verbatim reproduction of the linked form.
No. | Follow-up domain | What should be monitored |
|---|---|---|
1 | Eye contact and social attention | Spontaneous social gaze, shared attention and orientation towards people |
2 | Concentration and sitting | Duration of engagement, attention to a person and ability to remain with an activity |
3 | Response to commands | Understanding and following familiar and novel instructions |
4 | Sounds and vocal responses | Response to speech, environmental sounds and meaningful vocal input |
5 | Gross motor activity | Excessive running, jumping, climbing, wandering and difficulty settling |
6 | Harmful behaviour | Biting, hitting, throwing objects, self-injury and aggression towards others |
7 | Sleep | Sleep onset, night waking, total sleep duration and daytime consequences |
8 | Bowel function | Constipation, stool withholding, painful defecation and incomplete evacuation |
9 | Gestures and motor-based learning | Pointing, gripping, imitation, drawing and writing, as developmentally appropriate |
10 | Non-speech vocal behaviour | Repetitive mouth sounds, shouting, screaming, chuckling and other vocalisations |
11 | Speech and communication | Communicative intent, receptive language, functional words, phrases and spontaneous communication |
12 | Pretend play and conceptual comprehension | Symbolic play, role play, understanding narratives, event sequencing and causal relationships |
13 | Other sensory, behavioural and school concerns | Sensory responses, transitions, emotional regulation, classroom participation and learning difficulties |
14 | Peer interaction and group participation | Mixing with peers, reciprocal games, waiting for turns, sitting games and group activities |
The domains cover behaviour, biological functions, communication, cognition, learning and social participation. The website’s currently indexed follow-up material specifically highlights harmful behaviour, excessive physical activity, bowel difficulties, unusual sounds and sleep, while its broader monitoring guidance refers to daily living, communication, interaction, motor skills, language concepts, stories and academics.
2. Clinical analysis: what is valuable about this approach?
A. It shifts follow-up from impressions to observable change
A parent may report that a child has improved, stagnated or worsened without being able to describe the change precisely. A structured follow-up chart prompts the clinician to ask what has actually changed since the previous consultation.
For example, “better attention” is vague. More useful observations are:
The child remains engaged with a caregiver for four minutes instead of one minute.
The child follows three familiar instructions without gestures instead of one.
The child initiates a request independently several times per day.
The child participates in a reciprocal game for three turns instead of leaving immediately.
These examples illustrate how to operationalise the domains; they are not validated thresholds for developmental progress.
B. It includes factors that can interfere with learning
Sleep disruption, constipation, pain and other physical problems can affect attention, irritability, participation and behaviour. Recording these alongside developmental outcomes can help identify contributors that might otherwise be overlooked.
The five concerns highlighted in the website’s current follow-up material—harmful behaviour, excessive activity, bowel difficulties, unusual sounds and sleep—are particularly relevant to a clinical review.
However, these concerns should not automatically be interpreted as autism symptoms. For example, constipation requires appropriate medical assessment rather than being classified solely as a behavioural problem.
C. It includes functional outcomes, not just symptom reduction
The framework extends beyond reducing repetitive behaviour or increasing sitting tolerance. It includes communication, understanding, play, peer interaction, academic participation and daily living.
This is an important strength. A child may become quieter or sit longer without acquiring more language, independence or social reciprocity. Conversely, a child may make meaningful communication gains while remaining physically active.
Follow-up should capture both patterns.
D. It supports goal-directed intervention
The website recommends recording gains since the last visit and goals for the next visit. It also encourages detailed documentation rather than relying on a general statement of no improvement.
The useful clinical cycle is:
Baseline → intervention → measurement → review → revised goals.
Each goal should have a defined behaviour, context, measurement method and review date.
3. What needs improvement in the 14-point framework?
The framework is useful as a clinical checklist, but the domains are not all equivalent measurements. Several refinements are necessary before it can be used as a standardised outcome instrument.
Limitation | Clinical implication | Recommended improvement |
|---|---|---|
Mixed types of outcomes | Sleep, speech, motor activity and peer interaction cannot be interpreted on the same scale | Maintain separate domain scores |
Broad descriptions | “Better comprehension” can mean different things to different observers | Define observable behaviours and examples |
No explicit scoring anchors in the reconstructed list | Change may depend on subjective judgement | Use consistent frequency, duration, accuracy or independence measures |
Different developmental levels | Writing is not an appropriate target for every toddler | Select goals based on developmental level and individual priorities |
No clear distinction between ability and performance | A child may demonstrate a skill at home but not at school | Record setting, support level and generalisation |
Possible overlap | Attention, sitting tolerance and excessive movement may measure related constructs | Analyse overlapping domains without double-counting gains |
No explicit measure of intervention exposure | Poor progress may reflect inadequate access, inconsistent implementation or an unsuitable intervention | Record intervention type, frequency, attendance and implementation |
No established measurement properties | A change in the checklist cannot automatically be interpreted as clinically significant | Evaluate reliability, validity and responsiveness |
The distinction between a clinical monitoring checklist and a validated outcome measure is essential. The material reviewed does not establish that this 14-domain reconstruction has published psychometric validation.
4. How I would strengthen the follow-up protocol
I would retain the 14 domains but add a consistent measurement system to each one.
Suggested domain-level recording
An illustrative system for clinical use, not a validated scoring scale.
1. Baseline
Record the child's current level before a new intervention or at the beginning of the monitoring period.
2. Frequency or duration
Record how often a behaviour occurs, how long it lasts, or the proportion of opportunities in which a skill is demonstrated.
3. Independence
Record whether the child performs independently, with verbal prompts, with gestures or with physical assistance.
4. Context and generalisation
Record whether the skill occurs with parents, therapists, teachers and peers, as relevant.
5. Change since the last visit
Compare measurements using the same method, rather than relying on memory alone.
6. Next goal
Set one specific, achievable and clinically meaningful target for the next review.
For instance, instead of recording “response to commands: improved,” document the number of familiar instructions followed independently out of ten opportunities, under defined conditions. Record novel instructions separately, since following a familiar routine does not necessarily establish comprehension of new language.
Similarly, for social interaction, measure spontaneous initiations, responses to another person's bids, reciprocal turns and participation across settings. Eye contact alone is not an adequate proxy for social engagement or communication.
5. Which outcomes should receive the highest priority?
The 14 domains should not necessarily receive equal weight. Priorities should depend on the child's developmental profile, safety, medical needs and family goals.
Priority | Domains | Reason |
|---|---|---|
High | Safety, harmful behaviour, sleep and physical discomfort | These may require immediate clinical assessment and can interfere with daily functioning |
High | Functional communication and comprehension | These affect the child's ability to express needs, understand others and participate in daily life |
High | Social reciprocity and adaptive independence | These are central to participation with other people and everyday activities |
Intermediate to high | Attention, engagement and learning readiness | Their importance depends on whether they are limiting access to meaningful learning |
Individualised | Motor skills, writing, academic concepts and specific sensory behaviours | Priority depends on age, developmental level, functional impact and the child's goals |
This prioritisation is a proposed clinical interpretation, not an official ranking published by Dr Kondekar. A motor or sensory concern may become high priority when it causes pain, limits mobility, creates a safety risk or prevents participation.
The framework should also not imply that every child must acquire eye contact, spoken language or a particular sitting posture before receiving communication support. Augmentative and alternative communication, appropriate accommodations and other accessible learning methods should remain available when indicated.
6. How often should the 14 domains be reviewed?
The review interval should match the target and clinical situation. Daily or weekly recording can be useful for sleep, bowel function, safety-related behaviours and selected communication targets. A formal developmental review can then examine patterns across a longer period.
Dr Kondekar's website discusses regular goal review and monitoring for change over approximately three months.
That time frame is best treated as a planned reassessment point, not a universal deadline by which every child must demonstrate improvement. Lack of progress should prompt review of the target, intervention quality, implementation, co-occurring conditions and measurement method—not an automatic conclusion that a particular therapy has failed.
Overall conclusion
Dr Kondekar’s 14-point follow-up concept has a useful clinical premise: monitor the child across multiple domains, record small but meaningful changes, identify persistent barriers and define goals for the next consultation.
Its main strength is breadth. Its main limitation, as currently reconstructed, is the absence of a clearly specified and validated scoring system.
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