.

What is Autism?

Autism is a brain disorder that affects a child’s ability to:

• Communicate• Develop social relationships • And often accompanied by acute behavioral

challenges• According to the CDC About 1 in 88 children has

been identified with an Autism Spectrum Disorder

What causes Autism?

There is no known cause for Autism. There are only theories regarding the cause of Autism such as:

• Genetics • Abnormal Brain Development• Environmental “Triggers” • VaccinesNone have been proven. The true cause of Autism

remains a mystery

CURE?

• There is no cure for autism. However studies have shown that early intervention services helps children with autism go on to live productive lives.

Situation

• Ms. Conteh and her 3yr old son Musa came to Montifiore Pediatrics Clinic for Musa’s annual physical. Musa has a diagnosis of Autism. Ms. Conteh complains of Musa’s increasing behavioral problems at home and in daycare. She is having difficulty managing Musa’s behaviors and is very overwhelmed

Assessment

• Ms. Conteh is from Gambia, West Africa. She is a single mother of two boys. Omar who is 7yrs old and Musa is 3yrs old.

• Musa was diagnosed with Autism at age 14months old. He is the only one in the family with Autism

• Ms. Conteh expresses some knowledge about Autism stating “I know is not my fault he has this disease. I read on the internet that they don’t know where this disease comes from.”

Assessment

• Ms. Conteh has no support from family. She admits she does not like to take Musa around other family members stating “I do not like the way they look at my son, its very uncomfortable”

Assessment

• The behaviors reported were Physical aggression (hitting, Throwing objects), verbal Aggression (screaming) and refusing to cooperate with activities (i.e. dressing, bathing, ect.)

Assessment

• When Ms. Conteh was asked if she knew what triggers Musa’s behaviors she stated “I don’t know he will starts flapping his hands and before you know it things get out of control”

• Ms. Conteh stated some of her friends suggested to put Musa on Medication but she wants to know if she has other options

Assessment

• Ms conteh expresses concerns about being in fear losing her job because of the constant interruptions she receives from Musa’s daycare when they cannot manage his behavior. “I am really frustrated and need help.”

• Ms. Conteh prefers to learn with auditory and visual aids

Risk Factors:

• Single parent, lack of resources, lark of knowledge, lack of support

Identified Strengths

• Motivated to learn, optimal age range to implement a behavior plan

Identified need

• Developing a consistent behavioral plan that will help reduce or eliminate child’s maladaptive behaviors

Plan

• Discuss with client possible factors that can triggers child’s behaviors such as communication barriers, transitions from activities or environmental (i.e.; noise, lights, smells)

• Teach client how to observe and document what is causing child’s behavior using the A-B-C approach.

• Antecedent: Triggers/warning signs which typically occur that causes the child to misbehave

• Behavior: what is the actual behavior that results• Consequence: Events that happens immediately following

the behavior to help resolve the behavior

.

Plan• Assist client to identify possible

reinforcers (toys or food) that can be used to help reward good behavior and the likelihood to repeat positive behavior

• Impairment of communication skills in a child with autism makes them easily frustrated because they cannot express their wants and needs and cannot understand what is expected of them.

• Teach client communications skills that will help communicating with child more effective. To avoid long verbal instructions instead use simple words and gestures

• Teach client the use of Picture Exchange Communications Systems (PECS) to help child express their wants and needs

Plan• Children with Autism have

needs for routine and rituals. This results in difficulties with transitioning from one task to another

• Discuss with client ways to make transitioning from one task to another easier. Start by showing child picture of activities that needs to be done; letting them complete a desired activity first and give frequent warnings before transitions take place and to provide reinforcement with positive outcome

Plan• Provide client with different strategies on managing or

preventing heavy tantrums that usually leads to physical aggression– Outline activities in sequence(i.e. easy activity, difficult activity, easy

activity, ect.)– Make token boards to show them what they will get to do when they

are finish with the difficult activity (i.e. first washing then ride bike)– Do not allow them to leave the activity area (i.e. getting up from table

when eating) until they are finish. If you do they will always use tantrums to get their way. You must ignore their tantrums.

– If they are following through with activity provide heavy praising (i.e. Good Listening, Good sitting) and continue to prompt them through the activity with a primary reinforcer (i.e. toy or food)

Plan

• Children with Autism can get overly stimulated with their surroundings. They are easily hypersensitive to noise or lights. They are also unaware of dangerous situations and have heightened tolerance for pain which can put them at risk for injury.

• Provide client with list of ways to make living environment less of a “trigger” to childs behaviors– Environment must be clean an clutter free– Eliminate sources that causes over stimulation (I.e. bright lights,

loud noises, ect)– Place flags in areas that are off limits to child like the kitchen or

bathroom.

Plan

• Refer client to have child evaluated for early intervention(E.I) services where child can benefit from a structured teaching environment. Where child can also receive services like speech, physical and occupational therapy in one setting freeing client from having to make time for appointments. Also child will be in an environment with people that are trained to handle his condition.

Evaluation

• Follow up visit with Ms. Conteh 4 weeks later:• Client states the use of positive

reinforcements child is now motivated to completed undesired activities without tantrums

• Client express that using simple language and gestures enables child to follow instructions easily without any frustrations

Evatuations

• Ms Conteh reports that teaching Musa to use the picture exchange system helps Musa communicate his wants and needs. She is now happy that she can understand her son and able to better provide for him

• Ms conteh happily expressed the joy she feel now that instead of daycare Musa has been placed in an Early intervention program. Where he is receiving speech, occupational and physical therapy. She never receives phone calls at work anymore and is no longer in fear of losing her job

. • Ms. Conteh feel in control now that she has a handle on managing Musa’s behavior. She no longer lives in chaos and frustration and express joy when with her son.

http://www.youtube.com/watch?v=RO6dc7QSQb4

Recommendations

• Explain to Ms. Conteh that plan may need to be restructured as Musa meets expected Milestones

• Ms. Conteh is a dedicated mom who achieved her goal of helping her son cope with behavioral challenges of Autism. Ms. Conteh will continue to use utilize resources provided for her to help guide her in the future.