San Pedro College

Graduate School Studies

Department of Psychology

Case no. 01
A CASE REPORT ON
AUTISM SPECTRUM DISORDER
(Level A)

A Course Requirement on
Advance Abnormal Psychology
Master of Science in Clinical Psychology

Submitted by:
MICHAEL JOHN P. CANOY, RPm

Submitted to:
DR. ORENCITA V. LOZADA, RP, RGC, CSCLP
Professor

A.Y. 2019-2020
Michael John P. Canoy, RPm MS in Psychology

CLINICAL PROFILE

I. IDENTIFYING INFORMATION
a. Demographic Profile
Name: Sam Williams
Age: 3 Years Old
Gender: Male
Religion: Not Specified
Ethnicity: Not Specified
Mother’s Name: Carrol Williams
Mother’s Occupation: Homemaker
Father’s Name: John Williams
Father’s Occupation: Lawyer

b. Medical History
Medical
In the early stages of the client’s life, there were no reported difficulties. Aside
from being delivered by caesarean section, early development was reported to seem normal.
During the client’s first 2 years, there were no notable illnesses except some common colds.
At the age of 2, the client is slowly showing some signs for underdeveloped motor skills
which led to concerns from his parents. The next year onward, difficulties are more visible
and notable to observe.

Psychiatric
At the age of 3, client’s parents sought help from a psychiatrist months after the
client’s pediatrician recommended for a complete physical and neurological examination.
The psychiatrist was able to observe and have firsthand manifestation of Autism Spectrum
Disorder based on the maladjusted behaviors that the client has shown.
Michael John P. Canoy, RPm MS in Psychology

c. Family Background
Family Dynamics
Relationship Age/Status Occupation Medical History Psychiatric
History
Father Age was not Lawyer Not Specified Not Specified
mentioned in
the case
Mother Age was not Homemaker Had a caesarian Not Specified
mentioned in labor when
the case delivering Sam
Sister Age was not Not Specified Not Specified Not Specified
mentioned in
the case
however it is
known that she
is older than the
client

d. Psycho-emotional-social History
Early Development Stage
Client’s parents describe his early development to seemed quite normal. There
were yet no notable illnesses other than mild colds. The client was able to eat and sleep
well and was not colicky.

2nd Year of Life

By the time the client turned 2 years old, her parents were able to begin to have
concerns. His parents reported that they began to observe that the client is somewhat
slower than his older sister in achieving some developmental milestones (such as sitting
up alone and crawling). There were also observed uneven motor development. He would
crawl normally for a few days and then not crawl at all for a while. Although he made
babbling sounds, he had not developed any speech and did not even seem to understand
Michael John P. Canoy, RPm MS in Psychology

anything his parents said to him. Simple requests, such as “Come” or “Do you want a
cookie?” elicited no response. His parents thought the he was deaf and escalated to
thinking that the client is just being stubborn. They reported many frustrating experiences
in which they tried to force him to obey a command or say “Mama” or “Dada.”
Sometimes Sam would go into a tantrum during one of these situations, yelling,
screaming, and throwing himself to the floor. That same year, their pediatrician told them
that Sam might be mentally retarded.
Sam’s parents noticed him engaging in more and more strange and puzzling
behavior. Most obvious were his repetitive hand movements. Many times each day, he
would suddenly flap his hands rapidly for several minutes (activities like this are called
self-stimulatory behaviors). Other times he rolled his eyes around in their sockets. He still
did not speak, but he made smacking sounds, and sometimes he would burst out laughing
for no apparent reason. He was walking now and often walked on his toes. Sam had not
been toilet trained, although his parents had tried.
Sam’s social development was also worrying his parents. Although he would let
them hug and touch him, he would not look at them and generally seemed indifferent to
their attention. He also did not play at all with his older sister, seeming to prefer being
left alone. Even his solitary play was strange. He did not engage in make-believe play
with his toys—for example, pretending to drive a toy car into a gas station. Instead, he
was more likely just to manipulate a toy, such as a car, holding it and repetitively
spinning its wheels. The only thing that really seemed to interest him was a ceiling fan in
the den. He was content to sit there for as long as permitted, watching intently as the fan
spun around and around. He would often have temper tantrums when the fan was turned
off.

3rd Year of Life

The client was found to be in good physical health, and neurological examination
revealed nothing remarkable. This was found out after the family’s pediatrician
recommended a complete physical and neurological examination. A psychiatric
evaluation was also done several months after. During that time, the psychiatrist was able
to see firsthand most of the behaviors that Sam’s parents had described—hand flapping,
Michael John P. Canoy, RPm MS in Psychology

toe walking, smacking sounds, and preference for being left alone. When the psychiatrist
evaluated Sam, she observed that a loud slapping noise did not elicit a startle response as
it does in most children. The only vocalization she could elicit that approximated speech
was a repetitive “nah, nah.” Sam did, however, obey some simple commands such as
“Come” and “Go get a potato chip.” The psychiatrist then diagnosed Sam as having
Autism Spectrum Disorder and recommended placement in a day treatment setting.

II. REASON FOR REFERRAL

Prior to the referral, his parents were already seeing pediatricians and psychiatrist
assessments and diagnosis. Neurological and physical examinations were also done by
these professionals. Physical, social, and behavioral, difficulties were seen in his daily
activities that led to his psychiatrist’s diagnosis as autistic disorder. Nonetheless, we will
still be evaluating the client for the presence of specific symptoms that may classify to
Autism Spectrum Disorder and the possibility of other comorbid disorders. We may also
identify specific treatment for should there be a specific diagnosis presented.

III. PROBLEMS AND SYMPTOMS

Identifying Data and Presenting Conflict
 He elicited underdevelopment in motor functioning as compared to her
older sister
 Simple requests or instructions were ignored
 Tantrums were also bothering and frustrating the parents
 Repetitive behaviors are eminent many times each day
 He walks tipped-toed
 Social Development was also worrying her parents because the child
doesn’t play with her older sister. Lack of eye contact and physical
connections were also a difficulty for the client.

IV. CONTRIBUTORY AND CAUSAL FACTORS

Michael John P. Canoy, RPm MS in Psychology

Although contributory factors and/or causal factors were not fully stipulated in the
case, the diagnostician in training is looking into possibility that these difficulties may
involve hereditary factors such as DNA or genes from the parents or in their family
genealogy. Other factors may include vaccine and other environmental factors. With that
being said, the diagnostician in training needs to have a further evaluation and
observation to have a clear picture of the case. This may include, making a genogram,
biological checking of the parents’ DNA and other in-depth interview that can provide
relevant data pertaining Sam’s concerns.

V. MENTAL EXAMINATION
The diagnostician in training conducted a Mental Status Examination to Sam and
found out the following based on the data collected:

Appearance
 The client doesn’t look physically unkept nor untidy
 Clothing is also not messy nor dirty
 There is no unusual physical characteristics

Behavior
 Posture is not seen as slumped
 Rigidity, and tense posture is sometimes seen especially when walking tipped toe
 When he was younger, he showed atypical posture such as inability to sitting up
alone and crawling
 In his facial expressions, he doesn’t show any anxiety, fear, nor apprehension
 Occasionally, his facial expression suggests anger and hostility especially during
his tantrums
 There is also marked decreased variability of expression as shown everytime his
parents call his attention and make plays with him
 His facial expressions also sometimes, show inappropriateness and bizarreness
such as bursting into laughing for no apparent reasons
Michael John P. Canoy, RPm MS in Psychology

 There is also marked dominance especially in insisting doing the things that he
wants and showing tantrums whenever it is apprehended.
 Submissiveness and overly compliant is not present to the client
 Provocative behaviors are also not present
 There is also no suspicious behavior being shown
 Client is uncooperative especially doing things that he doesn’t want to do

Feeling (affect/mood)
 There is no inappropriateness to the client’s thought content
 There is instability to client’s mood and affect
 Euphoria and elation is not present in the client
 Anger, hostility is markedly shown by the client especially during his tantrums
 There is no fear, anxiety and apprehension shown by the client
 There were no signs of depression and sadness however his tantrums may indicate
sadness.

Perception
 There were no illusions experienced by the client
 Auditory hallucinations were also not present
 There were also no visual hallucinations presented nor other type of
hallucinations

Thinking
 Although same is aware of his interests, there is marked impairment with his level
of consciousness as he has trouble recognizing his environment such as inability
to respond and follow his parent’s instructions
Michael John P. Canoy, RPm MS in Psychology

 Marked impairment with his attention as he has trouble recognizing his

environment such as inability to respond and follow his parent’s instructions.
Sometimes, he is also too preoccupied on a single activity.
 Impairment in calculation ability is not present with the client
 There is also marked impairment in his intelligence as has not achieved
developmental milestones that his age requires.
 Sam doesn’t show disorientation to person
 He also doesn’t show any disorientation to place
 The client did not show any disorientation to time
 There is no data showing whether the client is showing difficulty in
acknowledging the presence of psychological disorder
 Blaming others for his difficulties was not present
 There is marked impairment in managing the client’s daily living activities such
as not accomplishing toilet trainings
 There is also marked impairment in his ability to make reasonable decisions
 Impaired immediate recall was not present
 Impaired recent memory was also not present
 Impaired remote memory was also not present
 Obsessions were markedly present with the client as shown in his keen interest in
watching the fan and often turns into tantrums whenever he is not allowed
 Compulsions were also present in his self-stimulatory behaviors
 There were no signs of phobias
 Depersonalization is not present with the client
 There were also no suicidal and homicidal idealization with the client
 Delusions are not present with the client
 There were also no ideas of reference nor ideas of influence
 The client also doesn’t show disturbance in association of thoughts
 Decreased and increased flow of thoughts were not seen
Michael John P. Canoy, RPm MS in Psychology

Although there were tendencies and other difficulties seen with the client, further evaluation
and assessments are needed for a more holistic and definitive diagnosis.

VI. CASE OVERVIEW

During the lifespan of Sam, his parents saw physical, social, and behavioral,
difficulties in his daily activities. Sam’s parents also consulted to pediatrician and
psychiatrist to have medical opinion and diagnosis to their son’s difficulties. Some of
these professional opinions were mental retardation and autistic disorder. The Sam is
growing up, these difficulties are even more eminent and are not congruent to the
acquired skills or behavior his age should require. Thus, further evaluation and
observation is needed in order to objectively know Sam’s condition as well as provide
him the suitable intervention.

VII. PRELIMINARY DIAGNOSIS

Based on the information provided and thorough evaluation of the data, the symptoms
and history of the client have fully met the criteria of Autism Spectrum Disorder ICD
Code: 299.00 (F84.0)
Note: The color red indicates that the presented fact(s) is present in the case. The color
green means that it is evident in the case, however, it is not directly stated. The color
blue, on the other hand, means that it is not present in the case but is probable which will
be given a remark “for further observation”
AUTISM SPECTRUM DISORDER 299.00 (F84.0)
Note: the following criteria app
DIAGNOSTIC CRITERIA PRESENTED FACTS
A. Persistent deficits in social Parents reported many frustrating experiences
communication and social interaction in which they tried to force him to obey a
across multiple contexts, as command or say “Mama” or “Dada.”
manifested by the following, currently Other symptoms are presented below
or by history (examples are
illustrative, not exhaustive; see text):
Michael John P. Canoy, RPm MS in Psychology

1. Deficits in social-emotional Although he made babbling sounds, he had

reciprocity, ranging, for example, not developed any speech and did not even
from abnormal social approach and seem to understand anything his parents said
failure of normal back-and-forth to him. Simple requests, such as “Come” or
conversation; to reduced sharing of “Do you want a cookie?” elicited no response.
interests, emotions, or affect; to failure
to initiate or respond to social Nearing his third birthday he still did not
interactions. speak, but he made smacking sounds, and
sometimes he would burst out laughing for no
apparent reason

2. Deficits in nonverbal communicative Although he would let them hug and touch
behaviors used for social interaction, him, he would not look at them and generally
ranging, for example, from poorly seemed indifferent to their attention
integrated verbal and nonverbal
communication; to abnormalities in
eye contact and body language or
deficits in understanding and use of
gestures: to a total lack of facial
expressions and nonverbal
communication.

3. Deficits in developing, maintaining, He also did not play at all with his older
and understanding relationships, sister, seeming to prefer being left alone.
ranging, for example, from difficulties Even his solitary play was strange. He did not
adjusting behavior to suit various engage in make-believe play with his toys
social contexts; to difficulties in
sharing imaginative play or in making
Michael John P. Canoy, RPm MS in Psychology

friends; to absence of interest in peers.

B. Restricted repetitive patterns of Restricted repetitive patterns of behavior,
behavior, interests, or activities, as interests, or activities, were manifested in all
manifested by at least two of the of the following either currently or by history:
following, currently or by history
(examples are illustrative, not
exhaustive; see text):

1. Stereotyped or repetitive motor Many times each day, he would suddenly flap
movements, use of objects, or his hands rapidly for several minutes
speech (e.g., simple motor (activities like this are called self-stimulatory
stereotypies, lining up toys or behaviors). Other times he rolled his eyes
flipping objects, echolalia, around in their sockets.
idiosyncratic phrases). He was more likely just to manipulate a toy,
such as a car, holding it and repetitively
spinning its wheels.

2. Insistence on sameness, inflexible He would often have temper tantrums when

adherence to routines, or ritualized the fan was turned off.
patterns of verbal or nonverbal
behavior (e.g., extreme distress at
small changes, difficulties with
transitions, rigid thinking patterns,
greeting rituals, need to take same
route or eat same food every day).

3. Highly restricted, fixated interests The only thing that really seemed to interest
that are abnormal in intensity or him was a ceiling fan in the den. He was
focus (e.g., strong attachment to or content to sit there for as long as permitted,
preoccupation with unusual watching intently as the fan spun around and
objects, excessively circumscribed around
Michael John P. Canoy, RPm MS in Psychology

or perseverative interests).

4. Hyper- or hyporeactivity to When the psychiatrist evaluated Sam, she

sensory input or unusual interest in observed that a loud slapping noise did not
sensory aspects of the environment elicit a startle response as it does in most
(e.g., apparent indifference to children
pain/temperature, adverse response
to specific sounds or textures,
excessive smelling or touching of
objects, visual fascination with
lights or movement).

Specify current severity: Severity is based For further observation

on social communication impairments and
restricted, repetitive patterns of behavior
C. Symptoms must be present in the early Difficulties were observed staring the age of 2
developmental period (but may not until the present
become fully manifest until social
demands exceed limited capacities, or
may be masked by learned strategies
in later life).
D. Symptoms cause clinically significant Although it was not clearly stated in the case,
impairment in social, occupational, or it is eminent that the client is not able to
other important areas of current perform behaviors that are expected to his age
functioning. compared with other mentioned individuals
such as his older sister.
E. These disturbances are not better Disturbance and impairments exceed
explained by intellectual disability difficulties expected on the basis of
(intellectual developmental disorder) developmental level.
or global developmental delay.
Intellectual disability and autism
Michael John P. Canoy, RPm MS in Psychology

spectrum disorder frequently co-occur;

to make comorbid diagnoses of autism
spectrum disorder and intellectual
disability, social communication
should be below that expected for
general developmental level

Note: Individuals with a well-established

DSM-IV diagnosis of autistic disorder,
Asperger’s disorder, or pervasive
developmental disorder not otherwise
specified should be given the diagnosis of
autism spectrum disorder. Individuals who
have marked deficits in social
communication, but whose symptoms do not
otherwise meet criteria for autism spectrum
disorder, should be evaluated for social
(pragmatic) communication disorder.
Specify if;
With or without accompanying intellectual For further evaluation
impairment

With or without accompanying language For further evaluation

impairment

Associated with a known medical or Not specified in the case however, further
genetic condition or environmental factor evaluation is needed to whether confirm or
(Coding note: Use additional code to identify refute the presence of such.
the associated medical or genetic condition.)

Associated with another Not specified in the case however, further

 Michael John P. Canoy, RPm MS in Psychology

neurodevelopmental, mental, or behavioral evaluation is needed to whether confirm or

disorder refute the presence of such.
(Coding note: Use additional code[s] to
identify the associated neurodevelopmental,
mental, or behavioral disorder[s].)

With catatonia (refer to the criteria for Not specified in the case however, further
catatonia associated with another mental evaluation is needed to whether confirm or
disorder, pp. 119-120, for definition) refute the presence of such.
(Coding note: Use additional code 293.89
[F06.1] catatonia associated with autism
spectrum disorder to indicate the presence of
the comorbid catatonia.)
Justification Fully satisfied. The diagnostic criteria for
Autism Spectrum Disorder (ASD) is fully
met.

VIII. DIAGNOSTIC FEATURES

The essential features of autism spectrum disorder are persistent impairment in reciprocal
social communication and social interaction (Criterion A), and restricted, repetitive
patterns of behavior, interests, or activities (Criterion B). These symptoms are present
from early childhood and limit or impair everyday functioning (Criteria C and D).

As stated in the case, several criteria of the disorder were fully met by the client
involving difficulties in social communication and social interaction. Repetitive and
restrict behaviors were also noted by the client’s parents as seen in his interests and done
activities. Although symptoms were not visible in the first years of the client’s life, at the
age of 2 years old, symptoms and tendencies were leaping out and still continue to show
different behavior complementing the diagnosis. These difficulties limits him to perform
behaviors that are expected to his age. Other behaviors that are supposed to let him do
daily functioning were also limited due to these difficulties.
Michael John P. Canoy, RPm MS in Psychology

IX. ASSOCIATED FEATURES

Many individuals with autism spectrum disorder also have intellectual impairment and/or
language impairment (e.g., slow to talk, language comprehension behind production).
Even those with average or high intelligence have an uneven profile of abilities. The gap
between intellectual and adaptive functional skills is often large. Motor deficits are often
present, including odd gait, clumsiness, and other abnormal motor signs (e.g., walking on
tiptoes). Self-injury (e.g., head banging, biting the wrist) may occur, and
disruptive/challenging behaviors are more common in children and adolescents with
autism spectrum disorder than other disorders, including intellectual disability.
Adolescents and adults with autism spectrum disorder are prone to anxiety and
depression. Some individuals develop catatonic-like motor behavior (slowing and
"freezing" mid-action), but these are typically not of the magnitude of a catatonic
episode. However, it is possible for individuals with autism spectrum disorder to
experience a marked deterioration in motor symptoms and display a full catatonic episode
with symptoms such as mutism, posturing, grimacing and waxy flexibility. The risk
period for comorbid catatonia appears to be greatest in the adolescent years.

Most of which mentioned above were reported to be experienced by the client such as
motor dysfunction and other social underdevelopment. Except for catatonic features,
other difficulties were mostly experiencing by the client.

X. ETIOLOGY AND PREVALENCE

Prevalence
In recent years, reported frequencies for autism spectrum disorder across U.S. and non-
U.S. countries have approached 1% of the population, with similar estimates in child and
adult samples. It remains unclear whether higher rates reflect an expansion of the
diagnostic criteria of DSM-IV to include subthreshold cases, increased awareness,
differences in study methodology, or a true increase in the frequency of autism spectrum
disorder.
Michael John P. Canoy, RPm MS in Psychology

Development and Course

The age and pattern of onset also should be noted for autism spectrum disorder.
Symptoms are typically recognized during the second year of life (12-24 months of age)
but may be seen earlier than 12 months if developmental delays are severe, or noted later
than 24 months if symptoms are more subtle. The pattern of onset description might
include information about early developmental delays or any losses of social or language
skills. In cases where skills have been lost, parents or caregivers may give a history of a
gradual or relatively rapid deterioration in social behaviors or language skills. Typically,
this would occur between 12 and 24 months of age and is distinguished from the rare
instances of developmental regression occurring after at least 2 years of normal
development (previously described as childhood disintegrative disorder).

XI. RISK AND PROGNOSTIC FACTORS

The best established prognostic factors for individual outcome within autism spectrum
disorder are presence or absence of associated intellectual disability and language
impairment (e.g., functional language by age 5 years is a good prognostic sign) and
additional mental health problems. Epilepsy, as a comorbid diagnosis, is associated with
greater intellectual disability and lower verbal ability.

Environmental
A variety of nonspecific risk factors, such as advanced parental age, low birth weight, or
fetal exposure to valproate, may contribute to risk of autism spectrum disorder.

Genetic and physiological

Heritability estimates for autism spectrum disorder have ranged from 37°/^ to higher than
90%, based on twin concordance rates. Currently, as many as 15% of cases of autism
spectrum disorder appear to be associated with a known genetic mutation, with different
de novo copy number variants or de novo mutations in specific genes associated with the
disorder in different families. However, even when an autism spectrum disorder is
associated with a known genetic mutation, it does not appear to be fully penetrant. Risk
for the remainder of cases appears to be polygenic, with perhaps hundreds of genetic loci
making relatively small contributions.
 Michael John P. Canoy, RPm MS in Psychology

XII. DIFFERENTIAL DAGNOSIS

Rett Syndrome. The client fully met the criteria of Autism Spectrum Disorder so this
should be ruled out.

Selective Mutism. The client shows impairment in social reciprocity making this
differential diagnosis to be ruled out. Further, the client shows restricted and repetitive
behaviors that is basis for ruling out this differential diagnosis.

Language disorders and social (pragmatic) communication disorder. Since the client
has restricted, repetitive patterns of behavior, interests, or activities, this should also be
ruled out.

Intellectual disability (intellectual developmental disorder) without autism spectrum

disorder. Social communication and interaction are significantly impaired relative to the
developmental level of the individual's nonverbal skills thus this also be ruled out.
Stereotypic movement disorder. The repetitive behaviors are better explained by
Autism Spectrum Disorder so this should also be ruled out

Attention-deficit/hyperactivity disorder. The client’s attentional difficulties or

hyperactivity exceeds that typically seen in individuals of comparable mental age. This
should also be ruled out

Schizophrenia. There were no hallucinations and delusions present in the client’s case
thus, should also be ruled out

XIII. TREATMENT PLAN

LONG-TERM GOALS THERAPEUTIC INTERVENTION
1. Develop basic language skills and the ability to Therapy sessions with professionals that
communicate simply with others. specializes in speech, language, psychomotor.
Continual practices at home is also suggested.
2. Establish and maintain a basic emotional bond Encourage detached parents to increase their
with primary attachment figures involvement in the client’s daily life, leisure
 Michael John P. Canoy, RPm MS in Psychology

activities, or schoolwork

Actively build the level of trust with the client

through consistent eye contact, frequent
attention and interest, unconditional positive
regard, and warm acceptance to facilitate
increased communication
3. Family members develop acceptance of the Conduct family therapy sessions to provide the
client’s overall capabilities and place realistic parents and siblings with the opportunity to
expectations on his / her behavior. share and work through their feelings pertaining
to the client’s autism spectrum disorder
Assign the client and his parents a task (e.g.,
swimming, riding a bike) that will help build
trust and mutual dependence
4. Engage in reciprocal and cooperative interactions Consult with the client’s parents and teachers
with others on a regular basis. about increasing the frequency of his social
contacts with peers by working with student
aide in class, attending Sunday school,
participating in Special Olympics, refer to
summer camp. Allowing Sam to actively
participate in activities that builds his social
skills.
5. Stabilize mood and tolerate changes in routine or Teach the parents to apply behavior
environment. management techniques (e.g., prompting
behavior, reinforcement and reinforcement
schedules, use of ignoring for off-task behavior)
to decrease the client’s temper outbursts.
6. Eliminate all self-abusive behaviors. Applying behavior management techniques
such as shaping, prompting behavior,
reinforcement and reinforcement schedules, use
of ignoring for off-task behavior to decrease the
client’s self-abusive behaviors.
 Michael John P. Canoy, RPm MS in Psychology

7. Attain and maintain the highest realistic level of Teaching the client essential self-care skills
independent functioning. (e.g., combing hair, bathing, brushing teeth) in
school and in home.

Use modeling and operant conditioning

principles and response- shaping techniques to
help the client develop self-help skills (e.g.,
dressing self, making bed, fixing sandwich) and
improve personal hygiene

SHORT-TERM GOALS THERAPEUTIC INTERVENTION

1. Complete an intellectual and cognitive evaluation. 1. Complete an intellectual and cognitive
evaluation.
2. Complete vision, hearing, or medical examination. 2. Complete vision, hearing, or medical
examination.
3. Refer the client for medical examination
to rule out health problems that may be
interfering with speech/language
development.
3. Complete a speech/language evaluation. 4. Refer the client for speech/language
evaluation; consult with speech/language
pathologist about evaluation findings.
4. Attend speech and language therapy sessions. 5. Refer the client to a speech/language
pathologist for ongoing services to improve
his/her speech and language abilities.
5. Complete a neurological evaluation and/or 6. Arrange for neurological evaluation or
neuropsychological testing. neuropsychological testing of the client to rule
out organic factors.
6. Comply fully with the recommendations offered 7. Consult with the parents, teachers, and
by the assessment(s) and individualized other appropriate school officials about
educational planning committee designing effective learning programs,
classroom assignments, or interventions that
build on the client’s strengths and compensate
 Michael John P. Canoy, RPm MS in Psychology

for weaknesses.
7. Comply with the move to an appropriate 8. Consult with parents, school officials,
alternative residential placement setting. and mental health professionals about the
need to place the client in an alternative
residential setting (e.g., foster care, group
home, residential program)
8. Participate in a psychiatric evaluation regarding 9. Arrange for psychiatric evaluation of the
the need for psychotropic medication. client to assess the need for psychotropic
medication
9. Increase the frequency of appropriate, self-initiated 10. Actively build the level of trust with the
verbalizations toward the therapist, family client through consistent eye contact, frequent
members, and others. attention and interest, unconditional positive
regard, and warm acceptance to facilitate
increased communication.
11. Teach the parents behavior management
techniques (e.g., prompting behavior,
reinforcement and reinforcement schedules,
use of ignoring for off- task behavior).
10. Decrease the frequency and severity of temper 12. Teach the parents to apply behavior
outbursts and aggressive behaviors management techniques (e.g., prompting
behavior, reinforcement and reinforcement
schedules, use of ignoring for off-task
behavior) to decrease the client’s temper
outbursts and self-abusive behaviors
13. Design a token economy for use in the
home, classroom, or residential program to
improve the client’s social skills, anger
management, impulse control, and
speech/language abilities
11. Parents verbalize increased knowledge and 14. Educate the client’s parents and family
understanding of autism spectrum disorders. members about the maturation process in
individuals with autism spectrum disorder and
 Michael John P. Canoy, RPm MS in Psychology

the challenges that this process presents.

15. Assign the parents to view videotapes
that add knowledge to their child’s condition
12. Demonstrate essential self-care and independent 16. Counsel the parents about teaching the
living skills client essential self-care skills (e.g., combing
hair, bathing, brushing teeth).
17. Monitor and provide frequent feedback
to the client regarding his/her progress toward
developing self-care skills.
18. Use modeling and operant conditioning
principles and response- shaping techniques
to help the client develop self-help skills (e.g.,
dressing self, making bed, fixing sandwich)
and improve personal hygiene
13. Parents increase social support network. 19. Refer the client’s parents to a support
group for parents of children with autism.
14. Parents and siblings report feeling a closer bond 20. Conduct family therapy sessions to
with the client. provide the parents and siblings with the
opportunity to share and work through their
feelings pertaining to the client’s autism
spectrum disorder
21. Assign the client and his parents a task
(e.g., swimming, riding a bike) that will help
build trust and mutual dependence.
15. Increase the frequency of positive interactions with 22. Encourage family members to regularly
parents and siblings include the client in structured work or play
activities for 20 minutes each day.
23. Instruct the parents to sing songs (e.g.,
nursery rhymes, lullabies, popular hits, songs
related to client’s interests) with the client to
help establish a closer parent-child bond and
increase verbalizations in home environment.
 Michael John P. Canoy, RPm MS in Psychology

24. Encourage detached parents to increase

their involvement in the client’s daily life,
leisure activities, or schoolwork
16. Increase the frequency of social contacts with 25. Consult with the client’s parents and
peers teachers about increasing the frequency of his
social contacts with peers (working with
student aide in class, attending Sunday school,
participating in Special Olympics, refer to
summer camp).

XIV. REFERENCES

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: Author

Brill, M. (1994). Keys to Parenting the Child with Autism. Hauppauge, NY: Barron’s.

Etlinger, R., and Tomassi, M. (2005). To Be Me. Los Angeles: Creative Therapy Store.

Koegel, R. L., and Koegel, L. K. (2006). Pivotal Response Treatments for Autism
Communication, Social, and Academic Development. Baltimore: Brookes.

Marcus, L. M., and Schopler, E. (1989). Parents as Co-therapists with Autistic Children. In C. E.
Schaeffer and J. M. Briesmeister (Eds.), Handbook of Parent Training: Parents as Co-
therapists for Children’s Behavior Problems (pp. 337–60). New York: Wiley.

Rimland, B. (1964). Infantile Autism. New York: Appleton Century Crofts.

Siegel, B. (1996). The World of the Autistic Child. New York: Oxford.

Simons, J., and Olsihi, S. (1987). The Hidden Child. Bethesda, MD: Woodbine House.

Tillon-J ameson, A. (2004). The Everything Parents’ Guide to Children with Autism. Holbrook,
MA: Adams Media Corp.

XV. ATTACHMENTS
CASE STUDY
Reporter: RAMA KATRINA REBUSA Topic: Autism Spectrum Disorder
Michael John P. Canoy, RPm MS in Psychology

CASE:
Sam Williams was the second child of John and Carol Williams. The couple had been
married for 5 years when Sam was born; John was a lawyer and Carol a homemaker. Sam
weighed 7 pounds, 11 ounces at birth, which had followed an uncomplicated, full-term
pregnancy. Delivered by caesarean section, he came home after 6 days in the hospital.
His parents reported that Sam’s early development seemed quite normal. He was not
colicky, and he slept and ate well. During his first 2 years, there were no childhood illnesses
except some mild colds. By Sam’s second birthday, however, his parents began to have
concerns. He had been somewhat slower than his older sister in achieving some developmental
milestones (such as sitting up alone and crawling).
Furthermore, his motor development seemed uneven. He would crawl normally for a few
days and then not crawl at all for a while. Although he made babbling sounds, he had not
developed any speech and did not even seem to understand anything his parents said to him.
Simple requests, such as “Come” or “Do you want a cookie?” elicited no response. Initially, his
parents thought that Sam might be deaf. Later they vacillated between this belief and the idea
that Sam was being stubborn. They reported many frustrating experiences in which they tried to
force him to obey a command or say “Mama” or “Dada.” Sometimes Sam would go into a
tantrum during one of these situations, yelling, screaming, and throwing himself to the floor.
That same year, their pediatrician told them that Sam might be mentally retarded.
As he neared his third birthday, Sam’s parents noticed him engaging in more and more
strange and puzzling behavior. Most obvious were his repetitive hand movements. Many times
each day, he would suddenly flap his hands rapidly for several minutes (activities like this are
called self-stimulatory behaviors). Other times he rolled his eyes around in their sockets. He still
did not speak, but he made smacking sounds, and sometimes he would burst out laughing for no
apparent reason. He was walking now and often walked on his toes. Sam had not been toilet
trained, although his parents had tried.
Sam’s social development was also worrying his parents. Although he would let them
hug and touch him, he would not look at them and generally seemed indifferent to their attention.
He also did not play at all with his older sister, seeming to prefer being left alone. Even his
Michael John P. Canoy, RPm MS in Psychology

solitary play was strange. He did not engage in make-believe play with his toys—for example,
pretending to drive a toy car into a gas station. Instead, he was more likely just to manipulate a
toy, such as a car, holding it and repetitively spinning its wheels. The only thing that really
seemed to interest him was a ceiling fan in the den. He was content to sit there for as long as
permitted, watching intently as the fan spun around and around. He would often have temper
tantrums when the fan was turned off.
At the age of 3, the family’s pediatrician recommended a complete physical and
neurological examination. Sam was found to be in good physical health, and the neurological
examination revealed nothing remarkable. A psychiatric evaluation was performed several
months later. Sam was brought to a treatment facility specializing in behavior disturbances of
childhood and was observed for a day. During that time, the psychiatrist was able to see firsthand
most of the behaviors that Sam’s parents had described—hand flapping, toe walking, smacking
sounds, and preference for being left alone. When the psychiatrist evaluated Sam, she observed
that a loud slapping noise did not elicit a startle response as it does in most children. The only
vocalization she could elicit that approximated speech was a repetitive “nah, nah.” Sam did,
however, obey some simple commands such as “Come” and “Go get a potato chip.” She
diagnosed Sam as having autistic disorder and recommended placement in a day treatment
setting.