The DSM-IV-TR diagnoses autism as having the symptoms of. qualitative impairment in social interaction, qualitative impairments in
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1 Lena Treadway Final Treatment Plan April 27, 2011 Diagnostic Related Group: The DSM-IV-TR diagnoses autism as having the symptoms of qualitative impairment in social interaction, qualitative impairments in communication, and restricted repetitive and stereotyped patterns of behavior (American Psychiatric Association [DSM-IV-TR], 2000). Social interaction in people with autism can be seen in many ways. Lack of nonverbal behaviors, peer relationships, and emotional reciprocity are all social interaction symptoms for autism (Mash & Wolfe, 2005, p229). Communication is also a difficulty for someone with autism. Deficits in language, total lack of language, and inability to hold a conversation are communication symptoms of autism (Comer, 2010.p.576). Restricted repetitive and stereotyped patterns of behavior symptoms can be seen as inflexibility in routine, repetitive motor mannerisms, and restricted areas of interest (Comer, 2010, p.573). Autism is a spectrum condition and affects every one in a different way (National Autism Society 2010). Autism characteristics can be seen as early as infancy (prior to the age of 3). In some cases parents have reported seeing autistic characteristics from birth or shortly thereafter. However, the signs of Autism in babies are more subtle and difficult to diagnose than those of children over the age of 2. Autism is a life-time disease, children are either born with classical ADS or they are not. Autism is
2 also a continuous disease that follows a person throughout their lifetime. More developed characteristics are common and can been seen throughout a person s lifespan, however, degenerative characteristics are also common (American Psychiatric Association [DSM-IV-TR], 2000). Siblings of those who have autism spectrum disorder are more at risk for autism spectrum disorder as well. Personal barriers include difficulty communicating with others, understanding verbal cues, being social and making friends, as well as using repetitive behaviors and routines (National Institute of Mental Health, 2009). Environmental barriers consist of the stability and familiarity with their surrounding environment (The National Autistic Society, 2010). Patient: John is a 12 yo BM Dx autism spectrum disorder. His main characteristics are lack of verbal communication, preoccupation with unusual interests, inability to develop friendships, as well as emotional reactions to different stimuli in his environment (National Institute of Mental Health, 2009). He has a hard time socially interacting with other people due to his inability to accurately predict someone else s thoughts and feelings. John has a specific routine which he goes through everyday. He is being raised as the youngest of three children, and is presently living with his single mother and grandmother (Barbarin 2011). He is currently attending a public middle school in his area. His mother is a teacher at his school who stays busy in their church and community (Barbarin 2011). His strengths are that his mental capacity is high, and he is able to communicate using pictures. His deficits include loud outbursts whenever his senses are over
3 stimulated, and his attention span is very short. His interests are stacking toys in his room over and over, drawing, and painting. He plans to continue living with his mother and become more active in their community (Barbarin 2011). Intervention: Helping young males, ages 10-14, with high-functioning autistic spectrum disorder (HFASD) maintain higher quality friendships with other males was the main purpose of the study that I chose to replicate. They selected two groups of six young males, one group of six had high functioning autistic spectrum disorder, and the other six did not. Both groups were taught for 3-6 weeks how to play a popular videogame. Before and after they were given questionnaires on friendship, intervention interviews which ask about social situations and intervention outcomes. The researchers believed that physical competence played a big role in social rank, and that if the children with high-functioning autistic spectrum disorder learned how to play this popular videogame it might improve their social rank, therefore improve their friendship quality. They hypothesized that in doing this it would improve the quality of friendships in the selected population (Chiang, I., Lee, Y., Frey, G., & McCormick, B., 2004). I chose this treatment because I think it will be very effective with my patient seeing as he is 12 yo and M. He is also the same age as the boys used in the study; this also makes me think that it will be more successful with him.
4 Goal and Objective: Goal- To improve social affiliation Objective- While engaging is in a 60 min. social video game session with a typical peer 3 x/ week for 1 mo., John will maintain 15 min total conversation time (initiated by peer or self) as monitored by CTRS. (Skill acquisition and practice). Progress Note: S stands for Subjective- Pt. told me that he really enjoys playing the video games. John stated that he has fun talking to the other boys, but still finds it hard communicating with them. He said he loves having something to do after school, and would like to talk more to the other boys. O stands for Objective- Pt. only attended 10 sessions in one month out of the targeted 12 sessions. At each session John has declined in communicating with the other children, and has spoken less and less in each session as the month progressed. A stands for Assessment- John is not improving in conversational skills and has become quieter throughout the treatment. He has started to slowly detach himself from the other child. He is also not meeting his requirement to attend 12 sessions.
5 P stands for Plan- To encourage John to be more social with the other children and increase his time with the children so that he feels more comfortable communicating, and engaging in conversation with them. Giving the children a snack break halfway through the session could allow them time to speak to one another. Discharge Plan- Pt. has problems verbally communicating and impairment in forming friendships. His goals when he came in were to improve his social interaction with others, increase his verbal communication, and enhance social affiliation. Services he received in therapeutic recreation were 10 sessions out of the 12 in a month. During these sessions we were teaching, as well as getting the pt. to teach and communicate with other children without HFASD. The patient s response to the tx was not as positive as I was expecting. He did not improve his social affiliation skills in a way that met his goals from the beginning of the tx. His communication decreased with the other child during treatment. I am concerned that he has not improved enough in socially communicating to be done with treatment, so I feel the need to refer him to a social skills group. Referral- I have asked permission from the pt., as well as his family since he is a minor, to release his personal information. They signed the permission form and granted me authorization, so I am referring him to a social skills group within his
6 community. They work with children with HFASD, helping them communicate with other children with and without HFASD. L Treadway, RT Student 4/19/11 References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Barbarin (2011). Characteristics of African American families. (2/23/11) American-Families-in-New-Millennium.html Chiang, I., Lee, Y., Frey, G., & McCormick, B. (2004). Testing the situationally modified social rank theory on friendship quality in male youth with highfunctioning autism spectrum disorder. Therapeutic Recreation Journal, 38(3), Comer, Ronald. Abnormal Psychology. seventh edition ed. New York: Worth Publishers, National Institute of Mental Health. (2009). What Are the Autism Spectrum Disorders?. (2/7/2011). The National Autistic Society. (2010) TEACCH. (2/12/11)
7 Wolfe, A. David, Mash, J. Eric. (2005). Abnormal Child Psychology. Third edition, ed. Wadsworth.
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