It is becoming increasingly difficult to ignore the fact that various mental health disorders can be addressed through different approaches in treatment and creation of respective social setting. Moreover, treatment of a certain mental health disorder depends heavily on specific circumstances in which an individual is present, including background, environment, social status, accessibility of mental health assistance, etc. Understanding the most favorable approach to addressing a particular mental health disorder requires a detailed analysis of all factors and circumstances, which affect an individual and his/her condition. Therefore, case study is one of the most effective ways of analyzing mental health disorders. One of such cases discusses a study of a Caucasian boy with autism spectrum disorder at early school years. Thus, the following paper provides a profound account of the case study and contains detailed analysis of the patient and the disorder.
To be more specific, the case study describes the following scenario. A Caucasian boy named Tommy is diagnosed with autism spectrum disorder after numerous complaints of parents, teachers, and school psychologist regarding his behavior and obvious poor learning potential. The boy hardly responds to teachers’ and parents’ requests, behaves aggressively towards other children, especially those, who are trying to touch him or his toys. In addition, the boy has difficulties dressing and conducting other functions. Teachers report about Tommy’s aggressive behavior and stress he experiences during the switch between activities. All these facts suggest that Tommy experiences autism spectrum disorder, and he needs an immediate assistance of mental health professionals. That is why the following study contains a background information regarding DSM-V criteria for ASD and respective legal regulations. Moreover, the study includes a description of basic screening and assessment procedures, recommendations concerning accommodation and rehabilitation, and prognosis for the future.
Concerning DSM-IV criteria and genetic factors triggering autism spectrum disorder, first it is important to admit that ADS develops because of genetic mutation in chromosomes Y, which are inherited generally by males from their mothers. Beyond a doubt, incidence of ASD among females is also present, but males face a higher probability of genetic mutation (Kaufman, Raiford, & Coalson, 2016). Genetic mutation itself occurs due to numerous still unproved causes, so the following assumptions are potential hypotheses. Age difference between a mother and a father can be a determinant of genetic mutation; also, a presence of a genetic predisposition for gene mutation in sequential generations (Kaufman, Raiford, & Coalson, 2016). In such case, the patient’s father was likely to have the same disorder or at least was predisposed to it because of inborn factors that can result in ASD. Nevertheless, environmental factor should be not disregarded. Exposure of mothers to chemicals, unclean and humid air, and even a different climate during prenatal and perinatal periods can also cause mutation of genes and development of autism spectrum disorder. It is worth mentioning that the patient of the case study is Caucasian, which is why a potential climate change from mountain environments to urban area might have been a cause of the disorder.
Regarding abnormalities observed during MRI of the head, ASD could be identified at early years of children, as long as the following signs were explicit. First, reduced cerebral volumes at TEA are the observable sign, but such evidence as cystic lesions in the cortical white matter as well as smaller cerebella have to be also considered (Ure et al., 2016). Similarly, small deep nuclear grey matter and increased prefrontal regions of TEA are a distinct evidence of autism spectrum disorder (Ure et al., 2016). It is becoming increasingly apparent that MRI or any other brain screening is required to prove clinically ASD, since absence of social reciprocity and other signs congruent with DSM-IV can evidence a similar mental health disorder, since ASD is often present with various mental-related disorders (Ure et al., 2016). That is why Tommy is recommended to undergo an initial MRI screening to reveal the presence of accompanying disorders and identify further course of interventions and treatment.
There is no surprise that the most significant law related to autism spectrum disorder is Combat Autism Act enacted in 2006. The act is aimed to raise public awareness regarding ASD and establish a nation-wide program for research, insurance discount, and tolerant social acceptance for U.S. citizens with autism spectrum disorder. To be more exact, the law includes the following statements (The White House, 2006). First, research of ASD under a program of NIH is authorized to address the entire scope of autism spectrum disorder. Subsequently, this act initiates the creation and spread of centers aimed to excel research and epidemiology of ASD, so that the disorder can be studied on each level of its incidence in U.S. environments (The White House, 2006). On a separate note, activities aimed at raising public awareness have to happen by spreading information and education regarding ASD, promoting early screening of individuals with suspicion for ASD, searching for specialists in the related area, and offering education for parents/relatives of individuals diagnosed with ASD (The White House, 2006). In such a way, the government provides an extensive support for citizens with ASD, which is why a needed professional and counseling assistance has to be provided to the patient described in the case.
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Speaking about assessment and screening of Tommy for identification of specific symptoms of ASD and related mental deficits, a wide array of tests has to be conducted:
Digit-symbol Test. Tommy will be required to make correspondence between digits and respective symbols according to the initially provided instructions. Correctness and speed of cognitive activities are the main metrics, which determine type and severity of autism spectrum disorder (Kaufman, Raiford, & Coalson, 2016). This is a basic test, and children of Tommy’s age with a similar disorder usually pass this test with ease and a common degree of concentration.
Block assembly. The patient will have to arrange blocks with specific color/symbol/letter/etc according to the initially provided instructions. It is informative to note that instructions are provided once prior to the actual test (Kaufman, Raiford, & Coalson, 2016). This type of assessment measures memory potential of an individual with autism spectrum disorder. In addition, correctness and speed of task completion will determine possible related conditions of Tommy. There has been a little agreement on whether this type of test should be practiced, since arrangement tantrum activities are typical for ASD children (Kaufman, Raiford, & Coalson, 2016). However, identification of this evidence will prove a presence of autism spectrum disorder in Tommy.
Differential Ability Scales. This assessment involves numerous subtests, which measure cognitive skills, memory, social reciprocity, and other mental abilities of the patient. Generally speaking, the screening includes such tests as pattern construction, word definition, identification of similarities, matrices solving, sequential and quantitative reasoning, recall of design, recognition of pictures, etc. (Kaufman, Raiford, & Coalson, 2016). This test is especially applicable to Tommy’s case, since educators and school psychologist report on various abnormalities in Tommy’s behavior, especially regarding difficulties to switch between tasks, respond to the requests, dress up, and interact with other children. That is why this screening has to specify a certain tendency in the boy’s ASD.
Boston Name Test. The test is based on a requirement to name a particular object or group of items. The main goal of this test is to measure speed of reaction and general reciprocal potential of the patient. The test itself is not complicated but tracing a particular behavior of Tommy can be an important knowledge to identify further treatment and interventions needed for rehabilitation and social integration (Kaufman, Raiford, & Coalson, 2016). It is worth saying that BNT is a supplementary test, which is why positive outcomes will not necessarily mean a healthy condition of the boy; however, it is still mandatory.
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NEPSY. Neuropsychological test should be conducted to measure respective development of Tommy. Hence, the test includes subtests, which evaluate different aspects of neuropsychological development. To be more specific, the test format suggests such sub-assessments as attention and executive functions, language and communication, sensorimotor functions, visuospatial functions, and learning and memory (Kaufman, Raiford, & Coalson, 2016). The outcomes of these subtests distinguish potentially underlying mental deficiencies, so that a particular area of ASD can be detected, and hence the doctors can identify the basis for subsequent treatment, counseling, and rationale for a special education. Thus, this test plays an important role in the treatment process of Tommy.
Vineland Adaptive Behavior Scales. It is becoming abundantly clear that children with autism spectrum disorder need to adjust to particular patterns of social, communicative, and personal behaviors. Therefore, measuring potential for adaptation determines an extent to which counseling and psychiatric assistance is required (Kaufman, Raiford, & Coalson, 2016). The test presupposes basic functional skills assessment, behavior problems screening, and functional behavior test. The scale is divided into two groups. The first group includes such metrics as communication, daily living, and socialization. The second group involves conceptualization, practice, and behavior (Kaufman, Raiford, & Coalson, 2016). Overall, appliance of tests described is mandatory, as distinctiveness of Tommy’s ASD development should be clarified for further treatment.
The description of the patient suggests that the boy is having a certain difficulty with handwriting and other study related tasks, as he loses concentration and gets stressed during the switch between the tasks. Therefore, the primary requirement for Tommy’s accommodation is to establish a certain sequence of activities. The boy has to be aware of them, which is why the creation of special signs or pictures, which represent a particular task, is an effective way to framework Tommy’s daily activities and provide a less stressful transition between the activities at home and school (Cardon, 2016). To add to the educational setting of the patient, the boy is expected to start attending special education school with a more ASD-friendly environment (Cardon, 2016). Special education schools can provide a wide range of reading techniques including the use of digital means and gadgets as well as counselors offer appropriate interventions aimed at children and parents (Cardon, 2016). It is no surprise that children with autism spectrum disorder comprehend system of signs much faster; therefore, incorporation of encoded meanings into educational activities will facilitate Tommy’s comprehension of reading skill, thereby creating a foundation for the further learning and academic process.
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In any case, functional skills of Tommy need to include his abilities to operate basic technologies. This factor is justified with preexisting ability of ASD patients to recognize systematic logical sequences. Moreover, there is a practical need to enable ASD children to serve themselves in a number of daily routines. Hence, setting for Tommy in that regard is also essential, and his parents are recommended to ensure that a chosen special education school contains all needed instructions and counseling in its curriculum (Cardon, 2016). Overall, Tommy’s accommodation is not likely to involve any considerable obstacles, since his case is well studied and, therefore, can be adequately addressed even though the Metropolitan area lacks special education schools.
Concerning rehabilitation of Tommy, a commonly practiced TEACCH model can be applied. The model includes three main domains such as physical structure, individualized daily schedule, and activity visual structure (Riva, Bulgheroni, & Zappella, 2013). To begin with, physical structure should be considered in detail. It is pivotal to provide a satisfactory physical environment for learning and education for the boy with ASD. In fact, such environment is characterized by the provision of less open space, absence of external noises, and even arrangement of furniture inside the room that provides the boy with a feeling of safety and comfort, so that his behavior does not promptly change.
As for individualized daily schedules, this domain is particularly focused on the optimization of the boy’s cognitive activities related to external schedule. In other words, a smooth transition between regular schedule and specific appointments, changes, or unexpected activities is the main objective of TEACCH, as it is an indispensable aspect of social life, and Tommy has to be trained to recognize such shifts as a normal experience (Riva, Bulgheroni, & Zappella, 2013). As long as randomized external schedule is perceived as an irritator, it is necessary to provide a specific framework for the organization of a daily schedule. In fact, it can be a specific sign or command, which signifies that it is okay to leave a regular sequence of activities, and switch to another task.
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Activity visual structure is an independent dimension of TEACCH model, as it provides a methodological foundation. Structured learning is the easiest way of comprehension for students with autism spectrum disorder, and, therefore, Tommy’s rehabilitation has to include deployment of such learning (Riva, Bulgheroni, & Zappella, 2013). Making visualized instructions, their explained sequencing, and even modeled completion of a certain task on a video can simplify and boost Tommy’s comprehension of educational material and functional skills, since such form of teaching is the most acquirable by the children with ASD.
It is becoming abundantly clear that early diagnosis and intervention will drastically change the further condition and development of Tommy. That is why making predictions should not go beyond the scope of present treatment and interventions focused on the boy. Early diagnosis of ASD is a key factor in this case; therefore, a choice of appropriate interventions is focused on regular counseling and psychotherapeutic aspects as well as special education institutions (Eriksson, Fernesll, & Gillberg, 2013). Depending on timely intervention of psychotherapists and special education professionals, Tommy’s future cognitive, social, and cultural integration to a normal social life can be determined. Early interventions provide short and long-term adaptively of a patient with autism spectrum disorder, since appliance of specific cognitive models and learning frameworks enables individuals with ASD perceive the objective reality through a less stressful methodology (Eriksson, Fernesll, & Gillberg, 2013). As a result, sufficient social, cognitive, and cultural development provide full-scale intelligence and hence normal social life. This goal can be achieved if the boy’s parents refer to special education assistance and counseling right now until Tommy’s developmental potential is amended (Eriksson, Fernesll, & Gillberg, 2013). Decision-making of parents largely determine the further development of Tommy as well as his ability to integrate into social life in the future.
In order to achieve such positive results, an early placement of the boy in ASD-friendly environment is a vital consideration. A common practice suggests that provision of regular ASD-friendly settings for education, learning, and cognitive as well as functional development of a child makes autism spectrum disorder at least a treatable and adjustable condition. Aforementioned TEACCH model also places an emphasis on the physical environment of the boy. If fact, this model suggests that the future development of Tommy is also determined by favorable conditions for gaining large-scale intellectual potential.
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At a current stage, the boy has obvious problems with communicative and social reciprocity, and the disorder is likely to develop in the future if appropriate intervention is not performed. Difficulties in interaction with peers and almost complete disregard of teachers/parents during completion of certain tasks are the central concerns, which have to be specifically considered during the entire treatment, accommodation, and rehabilitation processes of the boy (Tustin, 2013). Tommy has the most typical signs of autism spectrum disorder, which is why a choice of interventions and learning methodologies should be respectively standard, otherwise the boy’s condition may worsen. Appliance of learning and counseling models is essential, since Tommy has to realize concepts of achievement and learning (Tustin, 2013). Even though the boy is given sufficient special education assistance and counseling, his cognition should be developed towards understanding the objective reality through his perception peculiarities. In case this consideration is neglected, Tommy will develop aggressive behaviors and irritative states even though his intellectual deficit is addressed (Tustin, 2013). Henceforth, adequate education and counseling are the most pivotal determinants of success in addressing autism spectrum disorder, and active participation of his parents is a respectively crucial factor.
Overall, Tommy is likely to adjust to normal social life, as long as his parents are particularly concerned with his autism spectrum disorder and its subsequent treatment. The main difficulty at this stage is selection of suitable special education school, but this issue is not a considerable problem in spite of the fact that Metropolitan area is reported to lack schools with special education. Henceforth, standard interventions and learning methodologies should be applied with a close attachment to socio-functional development of Tommy (Tustin, 2013). Due to the immediate and relevant intervention of mental health professionals, Tommy is predicted to adapt to normal social life in the future.
Overall, this paper has been devoted to the discussion of the case study, describing a boy with autism spectrum disorder named Tommy. He has been presented with evident signs of ASD in terms of behavior, cognition, and mental deficits. Therefore, the boy was suggested to undergo appropriate screening and detailed assessment. In addition, the study has outlined the most fundamental recommendations regarding accommodation and rehabilitation of Tommy, and stated certain prognosis for the future development of the boy and potential need for special education and counseling. It is important to note that the presented case is quite typical incidence of ASD, but its initial cause is based not only on a potential genetic predisposition but also on environmental factor, since the boy is Caucasian. In fact, exposure to a different climate and breathing conditions of his mother during prenatal and perinatal periods might have been a cause of Tommy’s ASD.
It is appropriate to make a general comment on the fact that Tommy’s condition is treatable, and the boy can potentially integrate into normal social life, if an early intervention is performed. Placing the boy in autism-friendly environments will facilitate his learning processes, helping him achieve certain academic excellence. The Metropolitan area is often reported to lack special education schools and sufficient staffing, but it is not a considerable problem for Tommy’s family, thus he can receive an adequate special education and counseling assistance. However, environmental factors as well as ethnical diversification of the U.S. communities have a global implication on causes of autism spectrum disorder. This evidence can be a push for researchers to initiate investigation on this topic, since this perspective seems not to receive a respective attention in daily practice of ASD research.
