AUTISM SPECTRUM DISORDER

CASE STUDY

I. HISTORY

This is a case of Lyndsay, a 10.10 year old female from Rosario, Batangas.
It has been 7 years already (way back 2010) when Lyndsay has been referred to a Developmental
and Behavioral Pediatrician. The Center is named children’s Developmental & Intervention Center of
Lipa located in Rizal St., Lipa City, Batangas. As much as I wanted to have a full access to the data
of her first check-up evaluation, I was not able to have it since the parents were not furnished of
the first evaluation report and the same was no longer retrieved at the Center.

Due to these reasons, I have provided my own data presentation which somehow would
reflect some of the needed information way back then, a checklist inventory and an interview with
the parent of the client, most especially of the mother (Appendix A). Based on the summary of
the developmental assessment dated November 8, 2011, the test administered was Griffiths Mental
Development Scales – Extended Revised. Unfortunately, I was not able to get a copy of the test
result due to confidentiality. Instead, I have included a brief outline to give us an idea on the
appropriateness of the test, how it is being administered, scored and interpreted (Appendix B)

The following details below were gathered based on a consolidated data collected from the
interview with Lyndsay’s mother (who is my eldest sister) and his father, my observation when she
was a child and most importantly from the evaluation reports.

According to her parents, Lyndsay, was a full-term baby delivered with no complications.
Her mother reported that as a baby and toddler, she was healthy and her motor development was
within normal limits for the major milestones of sitting, standing, and walking. At age 3, she was
described as low tone with inconsistent imitation skills. Her communication development was
delayed; she began her vocalization at 12 months of age but had developed no words by 3 years.
Also, at this time, she developed sleep difficulties and extreme tantrum behaviors including pulling

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her hair. By 4 years of age, she was no longer talking, no socialization and appeared to be "in her
own little world."
At the time of her diagnosis, Lyndsay had no speech and was not pointing or gesturing to
indicate her needs. Her parents would need to hold things up and give them to her to try to
determine what she wanted or what was bothering her. She made little eye contact and her
parents reported that if they held her chin to try to force her to look at them, she would look away.
Lyndsay did not offer comfort to others and would not accept comfort. She had a limited range of
facial expressions (smiling, glaring, and a "blank" look). She had no interest in and did not respond
to the approaches of other people. She often takes her mother’s hand and lead her to what she
wanted and put her hand on it. She used her hand as a tool in other ways as well (e.g., when he
would be upset and crying, she would use her hand to pull her hair). Lyndsay shows repetitive
behaviors being fixated in doing the same thing like tearing flowers/leaves, cutting papers, turning
pages of the magazine. She was also frequently observed to walk on her toes while flapping his
hands and spinning in circles. She did not receive special services prior to 3 years of age.

II. DIAGNOSIS
Axis I: 299.00 Autistic Disorder
To receive a diagnosis of autism, a person must have (1) significant qualitative
impairment in social interactions, (2) significant qualitative impairment in communication,
and (3) engage in restricted repetitive and stereotyped patterns of behavior, interests, and
activities.
Differential Diagnosis: To receive a diagnosis of Asperger’s, a person must have delays
in areas (1) and (3), but not area (2), and must have at least an average intelligence .
Axis II: V71.09 No Diagnosis
Axis III: Mild Asthma
Sensory Processing Disorder
Axis V: 31 – 40 Impairment in speech and communication, school functioning,
interpersonal relationships, judgment, thinking, or mood.

She was not able to engage in standardized assessment of her intellectual ability
at that time. A nonverbal measure was attempted but rather than using the response cards
to provide responses to test items, she became fixated on them.

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Summary of PDD issues or other psychological issues (Axis I issues):
Lyndsay demonstrates many clear signs of having autism based on DSM-IV TR, which is a
type of Pervasive Developmental Disorder (PDD) or now called Autism Spectrum Disorder under the
Neurodevelopmental Disorder as per DSM-5. Specially, a person with autism has difficulties in
three major areas: their social skills, language skills, and stereotyped/repetitive behaviors or
interests. In Lyndsay’s case, her social difficulties are evidenced by her minimal social eye contact
and inappropriate sharing of facial expressions, limited interest in peer interactions, and lack of
sharing his interests or achievements with others. These difficulties do not appear due to just her
language delays or shy personality, because even when comfortable or engaging in nonverbal play,
she chooses to be on her own rather than engage others. Lyndsay’s language development is also
more typical of a child with autism compared to a child who has strictly language delays, as she
uses few gestures to compensate for her delays.

Additionally, Lyndsay does not engage in conversations appropriate to her language level,
she engages in some repeating of others for no apparent reason (echolalia), and she has limited
make-believe or social imitative play. Lyndsay’s tendency to become overly focused on certain
topics and engages in self-stimulatory behaviors (such as hand-flapping, cutting papers, tearing
flowers/leaves) is also very typical of a child with autism. More specifically, when reviewing these
behaviors in light of the DSM-IV-TR, Lyndsay meets 9 out of 12 criteria for autism, when only 6
are required for a diagnosis of autism. (Annex Quantitative measures appear to support this
diagnosis, as seen by Lyndsay’s developmental profile based on the test results in Griffiths Mental
Development Scales- Extended Revised. On the 2 nd, 3rd and 4th evaluation of a Behavioral and
Developmental Pediatrician dated November 11, 2011 and June 6, 2012, (Annex D & Annex F)
results showed that during her 3rd evaluation, her chronological age is 5.7 but her capacity is for 4.
10 years old (locomotor), 24 months old (personal-social), 8 months old (hearing & language), 14-
16 months (eye-hand coordination and 22-24 months old for non-verbal performance) respectively.
Thus, her approximate age was far or lower than her chronological which explains her delayed
development in all aspects.

III. ASSESSMENT PROCEDURES

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The following are the assessment procedures that have been made to which I also added the
review of DSM IV-TR aside from the evaluation reports collected from the different practitioners.

a. Review of Prior Records

b. Collection and Review of Relevant History
c. Test Administered: Griffiths Mental Development Scales – Extended Revised
d. Behavioral Observations
e. Clinical Interview with Mr. Lyndon Alday and Mrs. Vicky Alday
f. Review of DSM-IV-TR Criteria for Autism and A-2sperger’s (Additional
g. School observation of Lyndsay
h. Review of DSM-IV-TR Criteria for Autism and A-2sperger’s
i. Evaluation Reports (Behavioral & Developmental Pediatrician, Speech therapist, Occupational
therapist, SPEd teacher)

Marizel R. Pulhin-Dacumos, MD., DPPS, FPSDBP, M.S., Developmental and Behavioral

Pediatrician, completed a a 2 nd and 3rd evaluation report when Lyndsay was 4 years old. During the
assessment, she was reported to be “very impulsive” and “sometimes needed extra time to respond
to requests.” Lyndsay was administered the Griffiths Mental Developmental Scales-Extended
Revised.

A Speech and Language initial evaluation was completed on December 10, 2011, by Marie
Aileen Ignacio-Lantin, CSP, MRS-SP as cited in the Progress Report dated May 2012 of Michael
Cavaldez ,CSP-PASP, Speech and-Language Pathologist. After gathering and analysis of results from
the evaluation, the child was diagnosed as having speech and language delays secondary to
Autism.

IV. RECOMMENDATIONS:

The following were the recommendations based on the different evaluation reports
conducted:
1. Autism intervention: Given Lyndsay’s diagnosis, she would benefit from an evaluation for
enrollment in a program for children with a pervasive developmental disorder. Such programs

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 typically emphasize social skills training, speech therapy, and structured behavioral
interventions.
2. Occupational therapy: 2x-3x a week to improve work behavior/pre-learning skills.
3. Speech therapy: To improve her receptive-expressive language skills, may continue with a 2x
a week speech therapy to improve identification of objects by use/language formation/reading
with comprehension.
4. Social Skills Class & SPED Program: To enroll in social skills class for autism in preparation
for SPED Program but if possible may have mainstreaming in Music, Arts, PE, Kinder Level for
socialization.
5. Reevaluation: Regular check-up and monitoring with the developmental pediatrician, speech
therapist, occupational therapist, and studying in SPED Program.
6. Other resources: The parents may benefit from becoming involved with organizations that
focus on children with special needs. Such organizations can provide parents with support
groups, behavior management techniques, education about autism, and other valuable
resources that may support a family with a child who has autism.
7. Record tracking: Parents are encouraged to create a system for tracking the numerous
reports and paperwork that will most likely accumulate throughout Lyndsay’s life. Bringing
these reports to their various meetings will help ensure goals are more reliably tracked and
information is provided in the most expedient manner. They should obtain a copy of each
assessment and place it chronologically within its appropriate section. It is important they keep
a permanent copy for their records.

V. TREATMENT/INTERVENTION

A. Speech Therapy
Shortly after her diagnosis, at the age of 6.1 years old, she started working with her
speech/language therapist last December 2011 & May 2012 (Annex E), among the
recommendations are the following:
1. Provision of a regular speech and language therapy sessions, on a 2x a week basis
following on the following goals:
a. Increasing vocabulary and concepts to further widen child’s repertoire
b. Expanding child’s content categories, form and language use;
c. Improving child’s ability to comprehend and answer yes/no and what questions;

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 d. Target mastery of integrative thinking skills of association and categorization.
2. Strict follow-up of speech and language management be done at home to provide
consistency and continuity of intervention.
3. Undergoing occupational therapy assessment and intervention focusing on possible
presence of sensory integration issues and work behaviors in different settings.
4. Speech and language re-evaluation after two months after progress

B. Social Skills Training/Enrollment in School for Special Children

Lyndsay was enrolled in Growth and Intellectual Nourishment Learning Center, when she
was 7 years old and continued until she’s 8 years old. She spent 2 years in a school for special
children as Kinder 1. There her general behavior, gross motor skills, fine motor skills, cognitive
skills, communication skills, activities of daily living and social and emotional skills were focused and
addressed. She was assessed to determine her progress and current academic and achievement
level. Based on the result, Lyndsay should be in SPEd Program. There is a need for provision of
small group’s instruction and partial mainstreaming targeting functional communication skills,
classroom achievement level and educational performance. Specific recommendations for
individualizing and small group intervention for Lyndsay were hereto attached (Annex G).

C. SPEd Program

Lyndsay also enrolled in Sto. Nino Formation School, a private school last 2014 – 2015, for

6 months as Kinder 2 mainstreaming. There were 20 students in class and it was not a class for

children with autism. The teacher could not handle Lyndsay well since she has special needs. Then,

it was recommended to transfer the student in a SPEd Program, for children with autism.

From 2015-2016, Lyndsay is attending the SPEd program at Rosario East Elementary School

for more than a year. They were only three in class and of the same case (with autism). At present,

she reports regularly from Monday, Wednesday and Friday, twice a week simultaneous with

occupational therapy. There she learns about nursey rhyme, basic educational lessons, social

interaction, communication skills and others.

D. Occupational Therapy

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 Lyndsay began participating in occupational therapy last August 2016, twice a week
(Tuesday & Thursday), to address all aspects such as work behavior, sensory processing skills,
visual-perceptual skills, fine motor skills/graph motor skills, receptive and expressive
communications skills/cognitive skills and self-help skills, with emphases on work behavior and
communication skills. (Please see Annex H, for more details).

VI. RE-EVALUATION
Due to busy schedules and unavailability of the attending behavioral and developmental
pediatrician, Lynsday was not able to return after the year 2012, for almost 5 years. However, she
is continuously attending the required interventions for her. The pediatrician was no longer
connected to the center where she was first diagnosed.
Fortunately, her present occupational therapist has referred a new behavioral and
developmental pediatrician and will have the next check-up on April 5, 2017. The evaluation report
will also be submitted to the SPEd teacher for reference and further evaluation on Lyndsay’s
present developmental status.

VII. CURRENT STATUS

Based on the OT Progress report, after 8 months of intervention, Lyndsay showed some
improvements on most areas gathered from the initial evaluation (See Annex H). It is
recommended to continue her OT to improve her emerging skills. This would further Lyndsay’s
present skills with appropriate behavior modification techniques in dealing with her behavioral
issues. Moreover, the recommendation for inclusion to a small group school setting has been
already complied since she is simultaneously attending a small class SPEd program. Lyndsay should
be consistently given BMT’s that would bring forth in increase in the capability of the child to
perform effectively to any tasks she is doing.
She has done well with the support of her family, SPEd teacher, and therapists. Lyndsay’s
parents noted improvements with regards to her ability to participate and attend to tasks as well as
decreased tantrum behaviors, which had been a frequent response to frustration or to sensory
issues. A change in working behavior and fine motor skills has also been noted. She find difficulty
expressing her needs and wants at times. She’ll just cry or point but was not able to tell what she
needs during her occupational therapy. But at home, she says little words like when she wants

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water, fries. Unlike before, she can also exhibits eye contact functionally and meaningfully. She is
now able to respond on her name. But selective attention is still noted. Lyndsay enjoys playing on
the computer. It was also observed that Lyndsay has more facial expressions and always smiles
when she’s happy playing with her younger sister. She can now even follow simple-complex
commands. She demonstrates good motivation towards intervention.
When it comes to self-help skills, Lyndsay is independent in doing Activities of Daily Living
(ADL). She can eat, dress/undress, takes shower and go to toilet alone.

Prepared by:

_____
Raquel D. Cantos
Student No. 2015-20067