River from European Union

River was born premature in October 2015 to a mother with history of varicella. He has been diagnosed with bilateral sensorineural hearing loss for which he wears a cochlear implant in the right ear, non-allergic asthma, strabismus, inguinal hernia, and moderate cognitive delays with autistic characteristics. He has been living with a foster family since four months of age. River is a generally positive and obedient boy, particularly within the foster home where he feels comfortable with the setting and routine and is surrounded by those who know him best. He is well attached to his foster mother and father and enjoys physical affection. River seeks the attention of his foster parents as well as of the staff at the daycare center he attends and has developed ways to communicate his basic needs. Nonetheless, River shows many symptoms of autism, including toe-walking, being nonverbal, not responding to his name or carrying out instructions, resisting change, inadequate social and emotional responses, low eye contact and imitation skills, and a preference for solo activities. River’s attention is chaotic which negatively impacts any attempts at group or educational tasks. He does not seek interactions with peers, does not play meaningfully with toys, and does not show imagination. River still requires assistance with dressing, hygiene, and feeding and is not yet potty-trained. He sleeps well, albeit often in the foster parents’ bed. He works regularly with a multi-disciplinary team of therapists to aid his continued development which is progressing at a slow pace. Despite his attendance at a specialized daycare center, River has not acquired any academic knowledge typical for most children of his age and shows little interest in activities that would further such understanding. River enjoys being on the playground where he can confidently navigate the equipment. He also likes watching cartoons.