Case Report 1

Autism spectrum disorder

 Case Summary

The client was 9 years old and was studying in Army Specail Education with the complaints of lack of

interest, hyperactive, excessive touching of objects, lack of eye contact ,lack of on set behavior. The client

was in formally assessed with the help of clinical interview and behavioral observation. He was formally

assessed with the help of CPM corner's teacher/parents rating scale_revised(S).on the basis of

assessment,client was given the diagnosis autism spectrum disorder.

Case Report
Demographic information
Name

Hamza

Age

9 years

Education

specail

Gender

Male

No of siblings
3

Birth order

1st

Parental status

Residence

Rawalpindi

Informants

Place of assessment

Army Specail Education

Academy

Source and reason of referral

ABC was referred by the clients aunt who is also a lecturer of clinical psychology at NUML university, at
the age of 3 ABC was diagnose as ASD . The reason is that he didn’t maintain an eye contact with the
people around them, lack of interest, hyperactive. Deficit in non verbal communicative behavior and
repetitive motor movements.

Presenting complains

According to his mother ,

‫اس کی والدہ کے مطابق میرے بیٹے کی اسکول کی کارکردگی بہت خراب ہے اور سماجی میل جول میں بھی۔ وہ زبانی‬
‫رابطے میں بھی کمزور ہے اور کسی چیز پر توجہ نہیں دیتا۔‬
History of present illness

ABC was suffering from above mentioned complaints from the past 4 weeks. He has symptoms of
deficiency in giving attention to the people around them and the objects. Having lack of interest ,
hyperactive ,deficits in non verbal communicative behavior and repetitive motor behavior.

Background History

The father of ABC is an engineer. When he was at the age of 3 her mother noticed that he didn’t give
attention to us whenever we called him, he didn’t give response to us so her aunt who is also a clinical
psychologist lecturer at NUML university she give advise to us that he has ASD due to which they
admitted his child in a center that is Autism resource center when his age is 3 year. He was there for
about 1 year. After this he was brought to another center that Kreative kinderhaus for 1 year. After this
he was brought to another special center that Bolta Pakistan for 2 years. Her mother saw some
improvements in his behavior as academically he is able to grip a pencil. But this is not the result his
parents wants so his aunts refers his child to ASEA.

Personal History

Abc is 9 year old boy. He has 3 siblings 1 is his twin that is his sister and the other one is his brother. He
was born in a hospital, his birth was normal. He is belonged from a middle class family. He has a nuclear
family. His father is an engineer. He has a very good relation with his father. But is attached to his
mother. His presenting complaints was giving no attention to the people and to his work. His attention
span is very low. He do aggressive at a little thing and gets shouted and sometimes weeping. His pencil
griping is quite good and IQ level is understable.

Educational History

When ABC was 3 years he got admitted to special center that was Autism resource center for at least 1
year. After that he got admitted to another center that is Kreative Kinderhaus for 1 year. In this 1 year
his parents seems no improvements in his child so they decided to admitted to the other center that is
Bolta Pakistan for 2 years but they seems no improvement in his child. Now they decided to admit his
child to a new center that is Army special education academy. His teacher reported that he has no
attention span at all. He respond to objects quickly but didn’t have attention for this object for too long
tym. He is intellectual able to read alphabets and is good in counting.

Family History
He belongs from a middle class family. He lives in a nuclear family and have 8 members in his family. His
father is an engineer and mother is a house wife. He has 3 siblings 1 sister and 1 brother.
Past medical/surgical history
There is no past medical history but the client is suffering from pollen allergy.

Psychological assessment

Inforrmal assessment

● Behavioral observation

● Clinical interview

● Portage Guide to Early Education

Behavioral Observation
Client is a 9 years old Boy. He does not pay attention to what spoken to him directly. He appears little bit
irritable. His attention shifts from one thing to other in a room. His posture was appropriate but he does
not maintain eye contact and has a smile on his face. He does not following our instructions and touches
everything. Motor skills was poor but gross motor skills was fine. Many times he stand up from the chair
and want to leave the room without any instruction to do so. During the entire session he remain irritable
and did not answer any single question verbally. Client speech is delayed. During the entire session she is
shouting, repeating word and seeing here and there. His attention was so poor and he is unable to
concentrate.

On-seat Behavior

Session On-seat Off-seat On-seat Off-seat On-seat Off-seat Average Average

on-seat off- eat

04 5minutes 3minutes 6minutes 4minutes 7minutes 5minute 6minutes 4minutes

s

The child shows that the on-seat and off-seat of the client during the 4 sessions. The average on-
seat of the client during the session was 6 minutes and off seat was 4 minutes.
Average attention= 2 minutes.
It was observed that he was maintaining attention only for 2 minutes on average. Overall observation of
the client shows that client exhibit inattentive behavior in all task even he was interested initially but later
got bored.

Clinical interview
The purpose of conducting clinical interview in the present case was to obtain information regarding the
history and previously seek treatment of client's problem.The client's mother was interviewed in this
regard.She was very concerned and wanted to improve client's problematic behaviors of lack of
interest,hyperactive, Deficits in nonverbal communicative behavior,lack of eye contact ,non talkative,lack
of on seat behavior,repetitive motor movement's and deficit in developing,maintaining and understanding
relationship's .She knews the problem of the client and had accepted that he has special need's.

Portage Guide to Early Education

Portage guide to early education was administered in order to assess whether the child language, motor
skills, social skills, cognitive and self-helping skills were developed or not. It also tells about client
developmental deficit. With the help of clients motor cognitive area of the portage guide were directly
administered on the client. It takes almost an hour.

Chronological age: 9
Quantitative scoring

Quantitative scoring of portage guide to early education

Quantitative Scoring

The result of the portage guide to early education (PGEE) showing that the client's developmental
age is lagging behind in all the areas of the Portage Guide to Early Education as compared to his
chronological age. His language abilities is least developed and is not properly functional. Because
he isn't allowed to go out and only interacts with people he knows, his social skills are also lacking.
he acquires self-help abilities at age 5 years, 9 months, thanks to his mother's preparation. In
addition, the client's motor and cognitive abilities are also falling behind for his age.
Formal assessment

● Childhood autism rating scale (CARS)

● DSM 5 TR Checklist

Childhood autism rating scale

ABC rating on the CARS was 32, suggesting mild to moderate symptoms of an Autism Spectrum
Disorder.

1.5 1.5 1.5 2.5 1.5 1.5 2.5 1.5 1.5 2.5 2.5 2.5 2.5 2.5 1.5
32

I. II. III. IV. V VI VI VIII IX X XI XII XIII XIV XV Total

I

Qualitative Score
The client obtained score were 32 which is mild and moderate Autism. According to childhood
autism rating scale the score are higher on two items verbal communication and activity level and the
scores are 3.5. The client score 2.5 relating to people, emotional responses, objective use, non-verbal
communication, level of consistency of intellectual responses and general response. The items like
imitation, body use, visual responses adoptive change, taste touch and smell responses, listening

responses and fear of nervousness are scored 1.5

DSM V CHECK LIST

Status of symptoms
Diagnostic criteria

Criteria A 1. Deficit in social emotional reciprocity Present

Present
 2. Deficit in non-verbal communicative behavior

Present
3. Deficit in maintaining developing
relationships

1. Inflexible adherence to routine

Criteria B
Present

Present
2. Fixated interest that are abnormal

Present
3. Hyper or hypo-reactivity to sensory input or
unusual interest

Tentative Diagnosis
299.00 (F84.0) Autism spectrum disorder

Specifier: Moderate

Case conceptualization
Client was identified as having Autism Spectrum Disorder (ASD), which the biopsychosocial model
explains well.
Biological model
Biological variables may have a role in the emergence of any illness. In this specific instance, the
mother also reported birth problems, and the researchers also discovered that having several
complications at birth increases the risk of autism by 34% in comparison to having none.
Additionally, there is a 44% higher risk for children who had problems both before and during birth
(Peltier, 2017).
According to current estimates, 40–80% of autism susceptibility is hereditary. Numerous potential
environmental factors, such as older parents or maternal difficulties or infections during pregnancy,
have been proposed to increase risk (Rylaarsdam, 2019). There was a family history of down
syndrome from her father side. One possible explanation for the client's condition is that both the
mother and the father were older than average at the time of conception.
The results of an MRI revealed overactive brain tissue in several regions. Women who become
pregnant later in life and fathers who are older than average may experience autistic symptoms.
According to the stated theory, the following theories can be observed. Shelton and colleagues
(2001),conducted study at the University of California in the United states and the results were later
published in the medical journal Autism study.

Psychological model
Moving on to psychological aspects, we can see how theory of mind develops in typical children by
noting that children learn the foundational abilities/skills they will use to subsequently create their
theory of mind during their early years. These skills includes the ability to
• • Pay attention to other people and copy them..
• • Recognize others' emotions and use language to convey them (e.g., "happy," "sad," or
"mad").
• • Are aware of their uniqueness and the fact that they have diverse likes and dislikes from
other people
• • Understand that people behave as they would like to be treated.
• • Understanding the cause and effects of emotions (Mom will be upset if I chuck my toy).
• • When playing, pretend to be someone else (such as a doctor or a cashier).
• • Children begin to start think about other people's thoughts and feelings around the age of 4-
5, which is when true theory of mind begins to develop.
The client's history during infancy indicates that she has developed mind skills in a different order
than typical development, as reported by the researcher who found that children with autism
spectrum disorder develop theory of mind skills in a different order than in typical development
(Kimhi, 2010). She doesn't pay attention to the voices even after repeated attempts, doesn't make eye
contact, doesn't engage in any kind of play behaviour, and has a limited and unusual range of
interests.
Social factors
According to the mother of the client, she experienced stress during her pregnancy and was exposed
to a stressful environment for eight months.
A research was conducted at the University of Missouri–Columbia (2016), and it revealed that stress
during pregnancy can lead to a variety of problems in the offspring, including characteristics of
autism. The client's diagnosis could be du e to any of the factors listed above

Report building
According to Roger (1995), rapport is the quality of a connection that "makes communication
possible or easy" and is particularly "characterized by agreement mutual understanding, or empathy."
In order to establish a trusting relationship and start therapy with child and her mother, rapport has to
be created. By attentively listening with empathy and demonstrating sincere concern, it was formed
with the mother. It was created by spending quality time with the child and involving her in
enjoyable activities that would keep her interest in the therapist.
Psychoeducation to parents
The parents of such a child are typically unable to handle the circumstance and believe that the
child's life is unpleasant. On occasion, they may also become overly protective of their child. Parents
of the client gave her all the fundamental details about her issue as well as some basic management
advice, such as not paying attention when the client throws tantrums will make her realize that she
needs to alter her behavior and always rewarding the child when she completes a task correctly.

Social skills training

The child was encouraged to socialize with at least one new person each week. It can happen
anywhere, such at school (where kids and teachers are present) or at a relative's house (where cousins
are present). Due to his lack of friendship and social engagement, this was intended. He can benefit
from positive reinforcement in social situations as well.

Speech therapy
The child's speech may improve with daily speech therapy. PECS (Picture Exchange Communication
System) would enhance nonverbal communication. Additionally, it would be beneficial for other
daily tasks. In order to interact with him and learn about children's communication styles, the
therapist will watch his speech session and interact with him appropriately during the session

Short term goals

To increase his compliance and the effectiveness of the therapeutic interventions, rapport-building
was done.

Socialization: The client was given permission to take part in activities for 5-10 minutes, with the
time and numbers of children gradually increasing. Then he was taught to ask for help when needed
and given permission to share the objects..

In IEP sessions, cognitive skills and academic learning focused on counting, English alphabets, fruit
names, and colour names using flashcards, pointing, and picking.

By increasing his responses to name his family members, combine two words, use words for
bathroom needs, and demand food items rather than crying, his receptive and expressive skills were
improved.

Long term goals

Continuation and maintenance of short-term objectives to assist client in effectively reproducing the
acquired functional, academic, linguistic, and motor skills.
Generalization of learned skills in discrete learning trials to assist the client in interacting with the
world normally.
To help the client become more socialized and academically capable so that he can function
independently in daily activities and attend regular schools
ABA therapy
Positive reinforcement was the main component of the client's applied behavior analysis (ABA)
therapy, which was used to enhance behavioral, social, communication, and learning skills and deter
inappropriate behavior. On reaching the set objectives, participants received a favorable reward, such
as time to play with blocks.
Individual education plan
IEP plans were formulated on the basis of Portage Guide for Early Education’s scoring. They are
made according to client’s need of development.

Individual education plan

Goals Methods Achieved outcomes Expected outcomes
Colors; By coloring objects, The goal is achieved Partial achievement
Red, yellow, blue, green flash cards and pointing with 70% accuracy with with 4-5 times
with verbal, visual and by repeating and giving repetitions.
tactile prompt prompts.
Shapes;. By flash cards and The goal is achieved Partial achievement
Rectangle, triangle and coloring objects and with 30% accuracy by with 4-5 times
pentagon pointing with verbal, repetition and giving repetition.
visual and tactile prompt.
prompt
Animals; By flash cards, coloring The goal is achieved Partial achievement
Cow, sheep. tiger objects and pointing with 20% accuracy by with 4-5 times
with verbal, visual and repetition and giving repetition
tactile prompt. prompt.
Fruits; By flash cards and The goal is achieved Partial achievement
Apple, banana, grapes coloring objects and with 50% accuracy by with 4-5 times
pointing with verbal, repetition and giving repetition.
visual and tactile prompt.
prompt.
By flash cards and The goal is achieved Partial achievement
coloring objects and with 30% accuracy by with 4-5 times
Parts of body; repetition.
Shoulders, hands, neck,

Limitation
Time restrictions can be seen as a limitation because more time would have increased the chances of
the client making more improvements and teaching her more coping mechanisms for the difficulties
she faces on a daily basis.
References