Diagnoses of Autism Spectrum Disorder (ASD) have been on a constant rise (Centres for Disease Control and Prevention, 2015) it is imperative that therapists and doctors are aware of approaches to improve and develop their patient’s lives and enhance their work life. The subject of this case study is a 9 year old boy, Mikey and has gone back and forth to clinicians and therapists for two years. He has trouble with sustaining communal communications and connecting with his sibling and school friends.
His parents articulated that he has been having problems with his daily morning schedule, and that it is creating behavioural problems. If Mikey’s morning starts off bad, it affects his whole day. If it is a normal school day, he would not be able to concentrate on his work and have trouble corresponding with his class and school friends. His parents shared that Mikey shouts when he is awaken by the sound of his alarm clock, the cries of his baby sister and the blender; also, that he has trouble waking up in the morning, preparing for school, connecting with his peers and finishing his class work (Lober, 2015). Mikey also has difficulty staying asleep at night and always seems tired but cannot have a lie-down during the day. He also has difficulty with playing and sharing with his younger sister; if asked to share a toy with her, he ignores the request and continues playing as if he did not hear what was asked of him. When the caregiver sat down and watched him play, she noticed that he was in a world of his own repeatedly watching a single spinning toy. He seemed to show that he can be kept interested in a single toy or action for several minutes.
According to Benson (2016), there are three categories of characteristic of individuals who have ASD. First, they have issues communicating with others. It was observed that Mikey had trouble communicating with his sister and peers from school. N the case study, it was found that Mikey was at the developmental stage of a twelve month old. The Revised Knox Play Scale was used to test his capability to mingle with others optimistically and confidently while playing (Knox, 1974). Mikey was then scored as being at the level of a twenty four month old in imitation. His level of being able to imagine and pretend to be in another person or somewhere else was at the level of a thirty month old. Mikey’s result for his motor skills development was at the age of a thirty six month old on the other hand, he had the developmental skills of a forty eight month old in terms of using his whole body during play and social connections with others while playing. The final score was of his attention towards toys which was at the level of a sixty month old.
After weigh up all of Mikey’s ability levels, it is obvious that he has trouble with communication, relations with things and people, and bodily movements and behaviour. All these characteristics and what Benson (2016) highlighted that individuals with ASD have trouble with. He also acknowledged that children with ASD have trouble adapting to new customs and sounds, which seemed like Mikey had shown some difficulty with as well. It concluded that Mikey has Autism Spectrum Disorder. It was suggested to Mikey’s parents tha Mikey should undergo treatment from a professional therapist outside of his school to promote more productivity in his school work along with improving his involvement in daily routines and reducing his negative behaviour especially in the mornings as that seemed to affect his whole day.
The therapist will be working to modify or change Mikey’s developmental behaviour. Because ASD is a mental health issue, there is no medicine to make everything better again, however, there are behavioural and educational strategies that are helpful and support skills to children with ASD. When dealing with children with ASD, it is important that parents and therapists use positive reinforcements to complement or change the behaviour of the child. Changing the behaviour in the form of punishments is not recommend as it might help in the short term, but not in the long term. According to Autism Speaks (2012), children who are punished by lectures or removing something they like, has a more negative influence and children may amplify a child’s destructive behaviour and damage the relationship between the child and the punisher.
The Person-Environment-Occupation-Performance (PEOP) theory, Cognitive Behaviour theory (CBT) and Sensory Integration theory (SIT) will be used to create a specific behavioural treatment plan for Mikey. The PEOP consists of four factors which include the person, that includes his neurobehavioral and psychological factors, the environment, which includes his cultural background and physical surroundings, the occupation, which covers all his observable actions, and finally, the occupational performance which brings together all the other three factors and the required adjustments that need to be made (Brown, 2014).
The cognitive behavioural therapy leans more towards an individual’s thoughts, feelings and behaviour. In other words, our thoughts regulate our feelings along with our behaviours (McLeod, 2015). Children with ASD have trouble communicating themselves, expressing feelings of emotions and controlling their behaviour, in this case, Mikey could really benefit from learning how to communicate and express himself in a proper manner. White et. al. (2010) acknowledged that CBT conducted on ASD individuals need to focus more towards their social skills for the reason that “the core social deficits in young people with ASD contribute to the experience of anxiety, which then serves to intensify the teen’s social problems”. CBT can be carried out in many ways such as individual, family or group sessions. This is a great help for parents who go group therapy with their child to discover the different challenges their child goes through and ways to cope and deal with real life circumstances. Most individuals know that with all sorts of difficulties, early intervention is the best solution before it becomes a habit or routine. The biggest issue is that if the child actually learns that behaviour, it can be very difficult to modify or completely change the behaviour. According to Anderson (2012), in the near future, “CBT is likely to be a major treatment improving quality of life for older children, teens, and adults on the autism spectrum”.
It is common for children with ASD to have a Sensory Processing Disorder (SID). Children who have ASD have also been reported to have trouble regulating their reactions and certain stimulus and will normally use their “self-stimulation” to balance or steer clear of over stimulating themselves (Roberts, King-Thomas & Boccia, 2007). The SIT’s main goal is directed towards “the neurological processing of sensory information” (Pfeiffer, Koenig, Kinnealey, Sheppard & Henderson, 2011). Treatment that is supported by the SIT utilize a more mapped and guarded sensory contribution in agreement with the needs of that specific child.
For Mikey, based on the SIT a clinician or counsellor might hand a ball on a raised area swing with a small basketball net and hoop close by. The counsellor could persuade Mikey to play on the swing while trying to get the ball into the hoop. This movement could help with his “equilibrium response” by allowing him to decrease the amount of force he needs to throw the ball with during the changes of positions the swing swings him at. This will help Mikey improve his reactions towards the amount of force required at different places.
Furthermore, the type of CBT I would like to use on Mikey would be the Rational Emotive Behaviour Therapy (REBT) which was first developed by Ellis in 1962. This form of therapy mainly focuses on emotional and behavioural problems expressed by and individual and ways to change their irrational emotions and behaviours into rational ones. Ellis (1957, 1962) suggested that every individual has a “unique set of assumptions” regarding ourselves and that it serves as a guide of the way we react in different situations. Ellis then invented an ABC model theory to help in analyzing the process of how an individual develops their unreasonable values. In Mikey’s case, he could be upset because was not able to buy his favourite movie on DVD because the shop had run out. So, the stimulating event A, is that he was not able to buy his favourite movie on DVD. The belief, B is that he must have his DVD or else he would have nothing else to do and be bored. The consequence, C, is that Mikey will be upset. Once the counsellor has identified the unreasonable value causing Mikey to act that way, she can work with him to view his negative thoughts in a more realistic way and help him expand a more rational way of thinking and good ways of coping with the let down.
The counsellor can help Mikey realize that not getting what you want is not necessarily a bad thing and it does not make life less better, there is always another shop or come back another day. Once he realizes that it is disappointing and not horrible to not get what you want, he will feel less depressed and upset about it. There are several other theories that can be used to aid in modifying and changing different behaviours based on separate motor skill functions and thinking ability however, not all can be mentioned here. It is very important that counsellors or therapists do an adequate amount of research and note down the different theories they use and how they approached the theories with different ASD children so they are able to treat all their clients with the best possible care.
In conclusion, ASD is a very wide neurobehavioral condition that will impact a child’s existence. It is vital that counsellors conduct a proper and thorough analysis of their client and previous researchers done on children with ASD and certain behaviour modification techniques before they proceed to conduct the treatment. There are many researches and theories out there to help with considering which type of treatment is best for a specific child. The SIT is important in helping the ASD children cope with their sensory issues, it is also important that counsellors and therapists look into other theories and researches with other theories that are not based on sensory motor functions.
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