THE CASE OF ARTHUR
ARTHUR
10
nd
2 of 3
What do we know
about the client?
SYMPTOMS
1.
Distracted, fidgety, always out of his seat, unable to wait for his turn
2.
Does not do well with routines, mother should drive the same route, there should be no
changes in afternoon schedule, rules must be followed
3.
Preoccupation with cars
4.
No effort to interact with children, does not know how to respond
5.
Struggles to share, and take turns at school
SYMPTOMS
6. No social smile, poor eye contact
7. Does not point to things of interest
8. Limited facial expressions, less emotionally expressive,” harder to read”
9. Did not seek parents’ praise, no empathy, no efforts to comfort them
10. Behaved aggressively, does not know how to engage with other children in conversation and
in play
SYMPTOMS
11. Did not participate in group games, alone during recess
12. Frequently suspended in because of agitation and aggression
13. Periodically spaced out
14. Walked at 12 months, single words between 24-28 months
15. Correct grammar but stilted and pedantic speech
16. Average IQ, superior to gifted abilities in information and block design
17. Inattention, impulsivity
DIFFERENTIAL
DIAGNOSIS?
DIFFERENTIAL DIAGNOSIS
1.
ADHD
2.
ASD
3.
ODD
4.
RAD
5.
SOCIAL (PRAGMATIC) CD
FINAL DIAGNOSIS?
299.00 (F84.0) Autism Spectrum
Disorder
Diagnostic Criteria:
A. Persistent deficits in social communication and social interaction across multiple contexts:
1.
Deficits in social-emotional reciprocity (No social smile, poor eye contact, did not seek
parents’ praise)
2.
Deficits in nonverbal communicative behaviors used for social interaction (Does not point to
things of interest)
3.
Deficits in developing, maintaining, and understanding relationships (Did not participate in
group games, alone during recess, No effort to interact with children, does not know how to
respond, Struggles to share, and take turns at school, lack of interest in pretend play with
toys )
299.00 (F84.0) Autism Spectrum
Disorder
Diagnostic Criteria:
Restricted, repetitive patterns of behavior, interests, or activities, (as manifested by at least two
of the following)
1.
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or
nonverbal behavior (Does not do well with routines, mother should drive the same route,
there should be no changes in afternoon schedule, rules must be followed)
2.
Highly restricted, fixated interests that are abnormal in intensity or focus (Preoccupation
with cars)
299.00 (F84.0) Autism Spectrum
Disorder
C. Symptoms must be present in the early developmental period (but may not become fully
manifest until social demands exceed limited capacities, or may be masked by learned strategies
in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important
areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual
developmental disorder) or global developmental delay.
314.01 (F90.2) Attention-deficit/ Hyperactivity
Disorder, Combined Presentation
A.
A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development, as characterized by (1) and/or (2):
1.
Inattention
314.01 (F90.2) Attention-deficit/ Hyperactivity
Disorder, Combined Presentation
2. Hyperactivity/ Impulsivity
a.
Often fidgets with or taps hands or feet or squirms in seat. (fidgets)
b.
Often leaves seat in situations when remaining seated is expected (always put of his seat)
c.
Is often “on the go,” acting as if “driven by a motor” (restless)
d.
Often has difficulty waiting his or her turn (unable to wait his turn)
e.
Often interrupts or intrudes on others (struggles to take turns at school)
314.01 (F90.2) Attention-deficit/ Hyperactivity
Disorder, Combined Presentation
B. Several inattentive or hyperactive-impulsive symptoms were present prior to age
12 years. (early childhood)
C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (school
and home)
D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social,
academic, or occupational functioning. (suspended)
E. The symptoms do not occur exclusively during the course of schizophrenia or another
psychotic disorder and are not better explained by another mental disorder (e.g., mood
disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication
or withdrawal).
ETIOLOGY
1.
Genetic Influences
2.
Neurobiological Influences: Fewer neurons in and larger amygdala, lower levels of oxytocin
in the blood
TREATMENT
Social deficits
Inappropriate social initiations
Lack of behavioral control (outbursts, aggression, and oppositional behavior)
Compulsive and ritualistic behaviors
Issues with self-control
TREATMENT
1.
Parent behavioral training
2.
Individualized education program (IEP) goals, including social goals
3.
Training in basic social discourse skills
4.
Self-management techniques