Posted: May 25th, 2022
Autism Spectrum Disorder
Gender — Male
Ben is currently being raised by a single mother who has two additional children. The mother has worked full time for a number of years while the biological father is absent and rarely offers support or sees his children. The mother currently reports high levels of stress that are in part due to Ben’s ASD symptoms and his behavior at home. These symptoms include requiring considerable amounts of attention, difficulties with communication, mood swings and frequent outbursts, and trouble with school and homework.
Ben has had many problematic behaviors since birth including poor sleeping habits. Currently, Ben has entered the first grade and is experiencing tremendous difficulties in school which has prompted the school to moving Ben to an individualized educational program (IEP). Although there are many problematic behaviors that have been reported at school, the primary problem that the teacher reports are near constant disruptive behaviors that make it difficult for other students to study.
The current family dynamics include the fact that Ben has a heavy reliance on the mother to communicate and few others can understand Ben’s language. Ben also requires constant attention from the mother which makes it difficult for her to care for Ben’s siblings. Although Ben does not typically bother his brother and sister, his symptoms make it difficult to have a normal home environment.
Case Study – Detailed
Client — Ben Johnson
Age — 7
Gender — Male
Family History — Ben is raised by single mother who originally requested an evaluation for her son. Ben’s mother works full-time in an administrative position in a local school and Ben’s biological father lives in Texas with minimal involvement or contact. The mother has been fully employed for roughly a decade and the father works construction but has irregular periods of employment with long stretches of unemployed periods. This has made it difficult for him to make regular support payments which has also added stress to the family’s finances. The family lives in an apartment and Ben has two other siblings — one brother and one sister who are both older.
As an infant it was reported that Ben suffered from difficulties with sleep and would only sleep for two or three hours at a time. In regards to language and gross motor development, there are obvious signs that the child is behind developmentally. Ben has low motivation for any of his school work (1st grade), has disruptive social behaviors, and difficulty participating in a classroom environment. There are some distinct characteristics Ben displays that are considered to be potentially harmful such as being nervous and with repetitive habits, being fidgety and restless and has the occasional dramatic mood swings. Severe mood dysregulation and problems (SMP) in otherwise typically developing youth are recognized as an important mental health problem with a distinct set of clinical features, family history and neurocognitive characteristics and some studies have found an increased likelihood of SMP in children and adolescents with ASD (Simonoff, et al., 2012).
At home, Ben typically distances himself from his other siblings and is reliant upon his mother for most things. The mother reports that is an issue because it heavily detracts from her ability to get anything done around the house and/or take care of the needs of the other children in the home. The challenges involved in raising a child with autism spectrum disorders (ASD) have been well-documented over the last several decades and parents of children with ASD typically report higher levels of parenting stress and higher affective symptoms when compared to parents of typically developing children and parents of children with other disabilities (Davis & Carter, 2008). In many cases, it is beneficial to provide counseling to the mother as well as the child with ASD in a more comprehensive treatment plan due to the fact that there are many related problems that also affect the family.
In terms of communication and language, although Ben does communicate with language regularly, he also heavily depends on non-verbal communication. Instead of asking for things, Ben almost always points to whatever object he wants as well as mutters some incoherent expressions. Although Ben’s mother seems to have an understanding of what he is trying to communicate, it is difficult for anyone else. Three main theories attempt to explain how the ASD brain functions and the implications on communication: lack of theory of mind, weak central coherence, and lack of executive function and children with ASD have difficulties in vocalic, kinesthetic, and proxemic aspects of communication; however, some simple adaptations to environment and style have been shown to make the communication between nurses and children with ASD easier and more effective (Brown & Elder, 2014)
Assessment — Ben’s communication was assessed with the SCERTS Assessment Process in the spring of 2015. As a criterion-referenced, curriculum-based tool, the SAP determines a child’s profile of strengths and needs based on his or her developmental stage in the domains of social communication and emotional regulation. Data was collected data in three contexts: school, home, and an intervention session in the clinic (Diehl, Wegner, & Rubin, 2010).
The Diagnostic Behavioral Assessment for ASD — Revised (DiBAS-R) is a DSM-5/ICD-10-based caregiver-report screening tool that consists of 19 Likert-scaled items that has also been shown to be a promising and psychometrically sound instrument for ASD screening of adults with ID (Sappok, et al., 2014). However, the diagnosis of children can have a special range of limitations due to their stage of development and this requires that alternative assessments be used that are more age appropriate.
Brown, A., & Elder, J. (2014). Communication in Autism Spectrum Disorder: A Guide for Pediatric Nurses. Pediatric Nursing, 219-225.
Davis, N., & Carter, A. (2008). Parenting Stress in Mothers and Fathers of Toddlers with Autism Spectrum Disorders: Associations with Child Characteristics. Journal of Autism and Developmental Disorders, 1278-1291.
Diehl, S., Wegner, J., & Rubin, E. (2010, January). Children with Autism Spectrum Disorders: Three Case Studies. Retrieved from ASHA Leader: http://leader.pubs.asha.org/article.aspx?articleid=2289534
Sappok, T., Gual, I., Bergmann, T., Dziobek, I., Bolte, S., Diefenbacher, A., & Heinrich, M. (2014). The Diagnostic Behavioral Assessment for autism spectrum disorder — Revised: A screening instrument for adults with intellectual disability suspected of autism spectrum disorders. Research in Autism Spectrum Disorders, 362-375.
Simonoff, E., Jones, C., Pickles, A., Happe, F., Baird, G., & Charman, T. (2012). Severe mood problems in adolescents with autism spectrum disorder. Journal of Psychology & Psychiatry, 1157-1166.
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