Case of Arthur

Intake Date: January xxxx

F84.0 Autism Spectrum Disorder, Level I “requiring support”

F95.1 Persistent Motor or Vocal Tic Disorder, with motor tics only

Z55.9 Academic or Educational Problem

Z65.8 Other Problem Related to Psychosocial Circumstances

Z72.810 Child or Adolescent Antisocial Behavior

IDENTIFYING/DEMOGRAPHIC DATA: Arthur is a 12-year-old male in 5th

grade who was brought in for services by his adoptive mother. He is very small in
stature, appearing to be only 8 years old. He also acts younger than his 12
years, carrying around toy cars in his pockets, which he proudly displays and talks
about in detail. Arthur was adopted at age 2 by distant cousins. His mother was a
single mom that had become involved with drugs. She knew she was unable to
care for Arthur and decided to give him a better home. The adoptive parents are
upper middle class and have three biological children (ages 9, 7, and 5).

CHIEF COMPLAINT/PRESENTING PROBLEM: Arthur hates any type of

transition and will get upset and have temper tantrums if she does not prepare him
for any changes in plans. He is reported to kick and hit both parents, and they have
had to restrain him at times to stop him from hurting himself and others. He
sometimes reacted when his lunch was packed differently within his lunch box for
school. He also seemed to pay less attention to teachers and often interrupted class
with his own comments.

HISTORY OF PRESENT ILLNESS: Initially Arthur’s parents were unsure

what to do about their son’s behaviors. His mother is the primary caretaker and his
father thought she should handle any therapy or problems related to school. His
mother reported that she was now “at the end of her rope” and was ready to give
her son up to foster care. Both parents are exhausted. Arthur’s mother shared her
frustration with Arthur’s father, who “just does not understand how hard it is to
care for him.” Arthur’s language and developmental skills were far less
developed than his age at the time of his adoption. When the adoption was

This study source was downloaded by 100000870334356 from CourseHero.com on 08-28-2023 18:40:04 GMT -05:00

https://www.coursehero.com/file/210641930/Week-3-Case-of-Arthur-Explanationdocx/
 completed and they brought him home, Arthur cried often and refused to sleep for
the first 2 days they had him. They tried holding him, but he would not quiet down.

Arthur is reported to often get upset with his siblings and hit or kick them. His
mother stated that Arthur has always had issues with jealousy, and when her other
children were younger, she had to closely monitor him when he was around them.
She reported several occasions when she found Arthur attempting to suffocate each
of his younger siblings when they were babies. Arthur’s mother explained this as
part of his “always being immature” and not good at explaining himself. Besides
this, his mother reported that he is not a “mean” child but tends to function
according to his own rules. He often needed reminders to use his “indoor voice”
and to “wait his turn to speak.”

The mother reported that Arthur often hides food in his room and gorges himself
when he eats. She said she does not understand this behavior because he always
has enough food, and she never restricts his eating. In fact, because of his small
size and weight, she often encourages him to eat more.

The parents have never sought help before, as Arthur managed to largely keep up
with his schoolwork. He does have an aide in the classroom to help with his work
and behavior. His mother said that he has always taken things literally, but up until
5th grade, he had attended school without major problems. They had not been
concerned about his grades or lack of friends. His mother said that he has always
been “very shy” and never had a “best friend.” He has always shown interest in
cars, trains, and trucks. Recently, behaviors at school changed and worsened. His
school has complained of his inability to focus and the increase in his disruptive
behaviors.

Collateral contact with his teachers confirmed that he struggles with school, has no
friends, and often has “meltdowns” when he does not get his way. One teacher
noted that in small group classroom activities, Arthur has trouble with restlessness
and will stumble over his words, pause excessively, and restart talking fairly
rapidly and loudly. His teachers noted a concern about occasional facial “tics” that
occurred at times. His teachers commented that he talks a lot about details of World
War II at times in school.

PAST PSYCHIATRIC HISTORY: Arthur had never had any official testing for
special education, nor had he ever received any counseling services. Since up to
know he was able to keep up with his school work with the help of the aide.

This study source was downloaded by 100000870334356 from CourseHero.com on 08-28-2023 18:40:04 GMT -05:00

https://www.coursehero.com/file/210641930/Week-3-Case-of-Arthur-Explanationdocx/
 SUBSTANCE USE HISTORY: None reported.

PAST MEDICAL HISTORY: Arthur was not initially immunized. After he was
adopted, his parents immunized him on the later age schedule.

FAMILY HISTORY INCLUDING MEDICAL AND PSYCHIATRIC:

Arthur’s biological mother was using drugs from an early age. There is no
information about Arthur’s dad other than he too was a drug user. Arthur was
adopted by distant relatives but there is no information about Arthur’s immediate
family.

CURRENT FAMILY ISSUES AND DYNAMICS: See history of present illness.

MENTAL STATUS EXAM: The school social worker met briefly with Arthur
alone. During this time, he was clearly restless, appeared anxious, and avoided her
in the room. He was very slow to engage with her and was distracted by his pocket
toys, which he continuously meddled with. He had pressured speech and some
facial tics and was unable to keep his legs still during the interview. When he did
engage, he chose to play a board game during his time in the session and he
talked in detail about World War II and each of the boats in the game. His hand was
in his pocket fingering toys at some moments. When asked how he knew so much
about all the warships, he stated that he often watched television documentaries on
the subject. Once on this topic he took less time to respond and spoke at length.
Arthur appeared oriented to time and place. His voice in this interview was
somewhat monotonic and repetitive of his interests. He was generally cooperative,
and the interview passed without incident although it was obvious that he was
eager to be “dismissed” from the meeting.

Diagnosis Explanation:

F84.0 Autism Spectrum Disorder, Level I “requiring support”

A. (must have all three)

1) Deficits in social-emotional reciprocity…..

2) Deficits in nonverbal communicative behaviors used for social interaction,

ranging……

This study source was downloaded by 100000870334356 from CourseHero.com on 08-28-2023 18:40:04 GMT -05:00

https://www.coursehero.com/file/210641930/Week-3-Case-of-Arthur-Explanationdocx/
 Arthur has trouble with restlessness and will stumble over his words, pause
excessively,
and restart talking fairly rapidly and loudly

3) Deficits in developing, maintaining, and understanding relationships,

ranging….

B. Restricted, repetitive patterns of behaviors, interests, or activites….two of the

following…

1) Stereotyped or repetitive motor movements, use of objects or speech

carrying around toy cars in his pockets, which he proudly displays and talks
about in detail.
2) Insistence of sameness………..

hates any type of transition and will get upset and have temper tantrums if she
does not
prepare him for any changes in plans
3) Highly restricted, fixated interests…………

that he talks more about this topic at other times at school.

4) Hyper- or hyporeactivity to sensory input

Not present

F95.1 Persistent Motor or Vocal Tic Disorder, with motor tics only

A, B, C, D, E

Other conditions that may be a focus of clinical attention

Arthur is having challenges in school as well as with friends and he had to be

watched for homicidal attempts which is why the antisocial behavior is noted

Z55.9 Academic or Educational Problem

Z65.8 Other Problem Related to Psychosocial Circumstances

Z72.810 Child or Adolescent Antisocial Behavior

This study source was downloaded by 100000870334356 from CourseHero.com on 08-28-2023 18:40:04 GMT -05:00

https://www.coursehero.com/file/210641930/Week-3-Case-of-Arthur-Explanationdocx/
Powered by TCPDF (www.tcpdf.org)