Autism Spectrum Disorder: Symptoms, Diagnosis and Treatment

This clinical research report provides an overview of Autism Spectrum Disorder (ASD), including its symptoms, diagnosis and treatment. It highlights the importance of early treatment and the role of medication, behavioral, psychological and educational therapies in improving the quality of life of children with ASD. The report also includes a case study of a 5-year-old boy with ASD and recommendations for his treatment, including cognitive behavioral therapy, visual support and transitional object, and parent training.

PSY3032 – Clinical Research Report Template
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Background
Autism spectrum disorder (ASD) is a developmental disability that leads to significant social,
communication and behavioral challenges. ASD is also classified under neurodevelopment disorders
that is characterized by repetitive patterns of behavior and difficulties in making social communication
and interaction. The term spectrum is used to denote a wide range of symptoms and skills along with
different level of disabilities.. Some children or adults with ASD are able to perform all the activities of
daily living while others might require significant support in order to accomplish those activities.
According to Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Asperger syndrome,
childhood disintegrative disorder and pervasive developmental disorder are part of ASD. ASD is
common among every racial and ethnic group, irrespective of the socio-economic levels. However,
boys are more vulnerable to become victims of ASD in comparison to the girls (National Institute of
Mental Health (NIH), 2019). According to the survey conducted by Center of Disease Prevention and
Control (CDC) (2018) every one out of 68 children as ASD.
The main symptoms of the patients with ASD include repetitive behaviors (Echolalia) and not
comfortable in welcoming any change in life or daily living activities. This mental health complication
mainly surface during early childhood and according to the DSM-5, people with ASD experiences
difficulty in communicating with others, restricted interests and other symptoms that hamper the ability
of the child to perform properly at school (National Institute of Neurological Disorders and Stroke,
2019). The children suffering from ASD also try to avoid eye contact during communication and
experiences difficulties in communicating their needs. They also expressed trouble in relating to others
or understanding other people’s feelings. Children with autism are found to avoid playing pretend game
and show unusual expression towards any particular taste, smell, sound or look. Children with autism
also experiences sleep problems along with irritability. However, they have certain unusual strength
that sets them apart from others like excellent mathematical skills, strong auditory learners and ability
to remember information for a long period of time. The symptoms of ASD in the later stages of disease
include impaired ability to sustain conversation, lack of focused interest (National Institute of
Neurological Disorders and Stroke, 2019).
The exact cause behind the development of ASD is still not clear. However, scientists are of the
opinion that presence of genetic pre-disposition increase the chance of developing ASD among
children. Having older parents, very low birth weight and co-occurrence of other genetic diseases like
Down syndrome, fragile X syndrome increase the susceptibility of developing ASD. Environmental
factors also play an important role in the disease development however, no specific causes has yet been
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identified. The vaccination given to prevent childhood infections does not increase the risk of
developing autism (National Institute of Neurological Disorders and Stroke, 2019).
Diagnosis of ASD is usually done by observing the behavior of the person and following their
developmental patterns. ASD can be diagnosed reliably by the age of 2. Diagnosis of ASD among the
children is a two step process. The first stage includes general developmental screening conducted
during well-child checkups (9 months, 18 months, 24 months and 30 months) (National Institute of
Neurological Disorders and Stroke, 2019). Children showing developmental problems during the time
of screening will be referred for second stage of evaluation. Stage 2 is the second stage of evaluation
and is termed as additional evaluation. This is conducted by an experienced team of experts including a
pediatrician, child psychologist, neuropsychologist and speech-language pathologist. The process of
evaluation is based on assessment of the cognitive skills, communication skills, and age-appropriate
ability of accomplish the activities of daily living. For comprehensive evaluation, blood tests and
hearing tests are also conducted. Diagnosis among older children or among the adolescents is done
based on the observational skills of parents or teachers based on facial expression, body language and
tone of voice (Centers for Disease Control and Prevention (CDC), 2018).
Treatment for ASD must be initiated as soon as the disease is being diagnosed. Early treatment of
ASD is important as giving early care can help to reduce the difficulties of the individual while
assisting ASD individuals to learn new skills and make majority of their strengths. There is no single or
best treatment for ASD. Working collaboratively with the doctors and allied healthcare professionals, is
important for designing right treatment on right time. Medication management for ASD is done in
order to manage symptoms like irritability, repetitive behavior, aggressiveness, hyperactivity, anxiety
and depression problems and attention problems. Apart from medication therapy, behavioral,
psychological and educational therapies are also used in order to improve the quality of life of the
children suffering from autism or ASD. These therapies include improvement in the communication
skills, language skills, reducing challenging behavior and aiding to learn to lead life skills in order to
lead an independent life (Centers for Disease Control and Prevention (CDC), 2018).
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PRIVATE AND CONFIDENTIAL
Name: Jim (name changed)
Age: 5 years
Report compiled by:
Your Name and “title”
Date of report:
Client Profile
Referral Reason
The parents of Jim have conceived him when both of them were in their 40s. Jim’s uncle
(paternal) was a patient of ASD. Thus Jim’s parents are anxious about his mental health
condition. Jim is 5 years old and hardly speaks or mainly communicate in monosyllables. He
refuses to make eye contact expect to her parents. Hates to take bath or to have food by himself
independently. He is good in studies but have no friends and suffer from frequent mood swings.
Mental State Examination
Summaries the results of the MSE here.
(See attached form)
Clinical observations and relevant psychological data
Stated in both the forms
Client Case Study
Presenting Problems
Repetitive behavior or speech
Communicating in monosyllables
Refusal to make eye contact
Irritability or hyperactivity
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Inciting Incident
Medical History
No significant medical history apart from occurrence of seasonal flu
Current Medication
Nil
Forensic History
Nil
Substance Use
Nil
Family History
Paternal uncle was a patient of ASD
Social History
His mother reports that he refuse participate in group bases activities at school like playing of
games. He hates of socialize.
Personal History
Developmental
Lack of proper intellectual development as Jim is unable to conduct the activities of daily living
like independently taking bath or having food with his own hands. Lacks proper logical reasoning
Unlike the children of his age.
Education and Occupation
Student of class 1
Sexual/Marital/Social Relationships
Not applicable
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Hobbies/Interests
Loves to eat chicken and to draw pictures and solve math
Accommodation/Finance
NA
Personality
Disoriented and lack of confidence
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Case study Notes
Analysis of Symptoms
Potential Diagnosis and justification
According to the DSM V criteria of ASD the main symptom include persistent deficits in the
social communication under multiple contexts. This is reciprocates in the form of lack of proper social-
emotional functioning and reduced sharing of emotions or thoughts (CDC, 2019). Analysis of the Jim
highlighted that he refuses to communicate with others apart from his parents. Though he was showing
partial interest in communicating with the children of his age group, he was refusing to express any
significant emotions like excitement. Another principal symptom of ASD as per DSM V includes lack
of non-verbal communication skills and poorly integrated verbal communication skills (CDC, 2019).
Jim avoids eye contact during communication and mainly speaks in monosyllables. He also makes
hand wringing while speaking. Madipakkam et al. (2017) reported that in ASD the lack of proper
maintenance of the eye-contact is unconscious and thus atypical response of eye is not done
intentionally. The children suffering from ASD, deficits in developing, maintaining and understanding
the proper relationships like difficulty in adjusting the behavior under different social contexts and
difficultly in taking part in imaginative play or making friends. Other symptoms include absence of
interests in interacting with the peers (CDC, 2019). Jim also refused to take part in the group-based
activities and mainly keep himself isolated, close to her mother. He also refused to take part in the
imaginative play. Chan et al. (2016) stated that lack of pretend play among the ASD children is used
poor cognitive skills and logical reasoning skills and this can be explained with the help of the theory
of mind deficit. However, the theory of mindfulness is not associated with the development of the
playfulness among the ASD. However, Jim showed limited proactive initiatives to take part in playful
activities with his peers under the pediatric psychology ward.
Since majority of the symptoms of the ASD highlighted in the DSMV criteria coincides with
the condition of Jim, a detailed ASD diagnosis of Jim s recommended.
Therapies/treatments/management and outcomes
Primary psychotherapy that would be suitable for Jim includes cognitive behavioral therapy.
Application of the cognitive behavioral therapy my trained mental health nurse will help to improve the
level of cognition along with mood elevation like improvement in the level of depression and anxiety
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(Weston, Hodgekins & Langdon, 2016). Visual support and transitional object is an evidence-based
initiative in order to improve the attention and concentration among the ASD children while helping to
reduce different types of social phobia. Visual support and transitional object will be helpful for the Jim
as this will help Jim in purpose and focus during the transition from one place to another. In doing so
he will not feel shy or conscious or seek his mother helps while entering in a new place. In order to
improve the effective communication for Jim, auditory-motor mapping training will be helpful in
comparison to the effect of the novel speech treatment. Chenausky et al. (2016) stated that auditory
motor mapping training is an intonation-based treatment that helps in facilitating verbal communication
skills among the minimally verbal autistic child in comparison to the normal speech therapy.
Recommendations
The main recommendation that will be suitable for the effective treatment of Jim is parent
training. Cammuso (2018) are of the opinion that training parents in behavior management strategies is
regarded as an effective means of treating numerous aspects of functioning like decreasing the
frequency of problem behaviors. Learning the behavior management by the application of positive
reinforcement approaches is vital for majority of the families who present for ASD care. Cammuso
(2018) argued that while parents’ behavior management skills are not directly associated with the
outcome of the child’s behavior however, parental responses inadvertently strengthens and maintains
the typical behavioral responses among child with ASD. Pickles et al. (2016) reported that proper
training of the parents in the behavior management strategy will help to facilitate the parent-mediated
social communication theory (PACT). Proper application of the PACT helps to improve the effective
communication skills among the ASD patients and at the same time helps to reduce the repetitive
behavior and thus proving to be helpful for Jim.
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Mental Status Examination Record Form Date: 14.09. 2019
Client Name: Jim Circumstance of presentation: Presented in the
paediatric ward by his parents in order to understand the
reasons behind this mood swings, irritability and
repetitive behaviour. He is presented with other children
between the age group of three to 7 years who have
various other mental health complication
Date of Birth: 26th
Jan 2014
Gender: Male
Appearance and Behaviour
General
Appearance
Clothing:
Normal
and
clean
Grooming:
Normal
Other Features: Unable
to adjust the clothes
while out of washroom
unlike children of same
age group
Attention
and
Attitude
Posture:
Walking
slowing
with
head
held low
and
staring at
the fllow
Communicatio
n style: Mono
syllable
communication
with repetitive
words
Other Features:
Refusing to
communicate with elder
however,
communicating with the
children of same age
group but
communication in
limited
Behaviour Rapport:
Having
limited
rapport
with the
children
of same
Eye contact:
Refusal to
maintain eye
contact
Psychomotor activity:
Frequent nodding to
head and blinking of
eyes when asked to
answer any question
along with Hand
wringing
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age
groups
Other Features:
Speech
Rate: Pressured Rhythm: monotone Volume: loud
Content: The child repeats the same words three to four times in order to answer any
particular question but speaks in monosyllables. When asked to reply do you love to
eat food:, Jim said, Chicken..... Chicken.., chicken.... with nodding to head and eyes
staring at floor. Response came after 2 mins with limited facial expression. Moreover,
when asked to speak in sentence his content is tangential that is never returning back to
the original topic
Mood: Irritable
1 2 3 4 5 6 7 8 9 10
Affect: anxious
Range:
Restricted to flat
Congruence:
Mood and affect are not
congruence
Stability: Facial
expression and body
movement is linked with
mood
Perceptions and Cognitions
Memory: Immediate
memory is
strong
Long-term
memory is
poor
Short-term
memory is also
strong
Intellectual
functioning:
Moderate
Orientation: Person:
Normal
Place: Normal Time: Normal
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Thought processes:
Thought process is not uniform, shifts
from one through to another
(tangential or flight of ideas)
Thought content: The thought content
is relevant with so significant indication
for hallucination but at times shows
signs of dissociation
Insight and Judgement: Jim’s memory is strong he as he can remember the name of
10 states at a stretch when asked to play memory game with his peers. His intellectual
capability is also strong as he sum addition, multiplication, division and subtraction
verbally without any pen or paper or use of calculator (with more than two digit
number)
Jim is too young to state that whether he is ill or not. However, it seems that he will
agree to take part in the therapy as he is obedient. The application of the psychotherapy
will help to bring promising outcome for Jim.
Other relevant observations
Prior diagnosis
Current psychotherapy Nil
Current psychoactive
medication
Nil
Current illicit drug use Nil
Other
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References
Cammuso, K. (2018). Psychotherapy for autism spectrum disorders: Using evidence‐based strategies to
support practice. The Brown University Child and Adolescent Behavior Letter, 34(2), 1-6.
Centers for Disease Control and Prevention. (CDC). (2018). What is Autism Spectrum Disorder?.
Access date: 14th September 2019. Retrieved from:
https://www.cdc.gov/ncbddd/autism/facts.html
Centers for Disease Control and Prevention. (CDC). (2019). Diagnostic Criteria for 299.00 Autism
Spectrum Disorder. Access date: 14th September 2019. Retrieved from:
https://www.cdc.gov/ncbddd/autism/hcp-dsm.html
Chan, P. C., Chen, C. T., Feng, H., Lee, Y. C., & Chen, K. L. (2016). Theory of Mind Deficit Is
Associated with Pretend Play Performance, but Not Playfulness, in Children with Autism
Spectrum Disorder. Hong Kong Journal of Occupational Therapy, 28(1), 43-52.
Chenausky, K., Norton, A., Tager-Flusberg, H., & Schlaug, G. (2016). Auditory-motor mapping
training: comparing the effects of a novel speech treatment to a control treatment for minimally
verbal children with autism. PloS one, 11(11), e0164930.
Madipakkam, A. R., Rothkirch, M., Dziobek, I., & Sterzer, P. (2017). Unconscious avoidance of eye
contact in autism spectrum disorder. Scientific reports, 7(1), 13378.
National Institute of Mental Health. (NIH). (2019). Autism Spectrum Disorder. Access date: 14th
September 2019. Retrieved from: https://www.nimh.nih.gov/health/topics/autism-spectrum-
disorders-asd/index.shtml
National Institute of Neurological Disorders and Stroke. (2019). Autism Spectrum Disorder Fact Sheet.
Access date: 14th September 2019. Retrieved from:
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Autism-
Spectrum-Disorder-Fact-Sheet
Pickles, A., Le Couteur, A., Leadbitter, K., Salomone, E., Cole-Fletcher, R., Tobin, H., ... & Aldred, C.
(2016). Parent-mediated social communication therapy for young children with autism (PACT):
long-term follow-up of a randomised controlled trial. The Lancet, 388(10059), 2501-2509.
Weston, L., Hodgekins, J., & Langdon, P. E. (2016). Effectiveness of cognitive behavioural therapy
with people who have autistic spectrum disorders: A systematic review and meta-
analysis. Clinical psychology review, 49, 41-54.
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