Final Paper PSYC 320

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University of Mary Washington *

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320

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Psychology

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Dec 6, 2023

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Autism, also known as Autism Spectrum Disorder, is a neurodevelopmental condition that affects an individual's communication, social interaction, and behavior. This disorder is typically diagnosed during early childhood because symptoms can begin to show as early as before the age of 3. Andrew Soloman says in his book Far From the Tree, “Autism is deemed a pervasive disorder because it affects almost every aspect of behavior, as well as sensory experiences, motor function, balance, the physical sense of where your own body is, and inner consciousness”(2013). Since autism is classified as a kind of disorder, symptoms and severity range vastly from person to person. Some individuals with autism may struggle with social interaction and communication with others, while others may have repetitive behaviors, and others may have all 3. Although autism is a lifelong condition, though there is no cure for it, there are many different interventions that can be implemented to ease symptoms. The causes of autism are not fully known, but research suggests it is caused by a combination of factors that include genetics, environmental factors such as infections during pregnancy, complications during birth, and exposure to teratogens during pregnancy. These factors do not always cause autism, but they do increase the risk and have been present in those who have autism. Autism spectrum disorder is also commonly paired with the individual having an intellectual disability (ID). ID is typically diagnosed in childhood and can vary in severity from mild to severe. Individuals with ID may have difficulty with forms of communication, learning skills, and problem-solving. They may also experience challenges with socializing, taking care of themselves, and not putting themselves in dangerous situations. ID can be caused by a variety of factors, including genetic abnormalities, brain damage, and environmental factors. In the 1900s, autism was not yet recognized as a distinct condition, and children with what would now be considered autism were often misdiagnosed with other conditions such as schizophrenia and/or

mental retardation. Autism was not recognized as its own disorder until the 1940s. Therefore, prior to the 1940’s, children who have now been diagnosed with autism would have been labeled by doctors and the public as mentally retarded and child minded. Unfortunately, children with these labels often faced harsh treatment and neglect in the institutions they were so frequently placed in. They often experienced physical restraints, electroconvulsive therapy, and lobotomies. These treatments were not based on any scientific understanding of autism and most of the time caused a great deal of harm to those who suffered from it. Many people with autism embrace their identity as part of a neurodiversity movement, which seeks to spread acceptance and understanding of neurodiversity as a natural part of human diversity. The neurodiversity movement recognizes that different brains in different people are all wired differently, thus leading to different ways of thinking, learning, and problem-solving that can be used for the benefit of society. For some individuals with autism, seeing their autism as an identity can be empowering and can boost their confidence, helping them to connect with others who share similar experiences and share a sense of belonging and community from those shared experiences. It can also be a way of reclaiming their identity from the medical model, which views autism primarily as a disorder to be treated or cured, which risks the idea of eugenics coming into play. Many individuals with autism decide that their neurodiverse identity can be expressed in different ways. Some express through advocacy, they become advocates for the autism community and are working to raise awareness, promote acceptance, and advocate for policies that support people with autism. Others express through art and creativity, many people with autism have a cast interest in expressing their emotions through a form of art. This may help them voice what they feel without having to use their voice. They use self-expression of their neurodiversity through art, music, and writing. Others tend to find a fascination from exploring

their autism identity. This can help individuals with autism understand themselves better, identify their strengths and challenges, and develop strategies to cope with their difficulties. This is a very common aspect of forms of therapy for those with autism. There can be many overlapping identities with autism that people may have. Research from the University of Cambridge suggests that individuals with autism may be more likely to identify as LGBTQ+ than people who are neurotypical. Another common overlapping identity is a person's neurodivergent identity. Many individuals who have autism identify as neurodivergent, rather than explicitly autistic. This refers to a broader identity that includes people with various neurological differences, and can create a sense of comfort by being able to identify as neurodivergent without having to explicitly state what their diagnosis is. In my case study, Bella has been diagnosed with autism spectrum disorder as well as having an intellectual disability. I believe that Bella also has a sensory processing disorder because of her smearing feces after defecating. Smearing is a large sign that a child has a sensory processing disorder. When a child with a sensory processing disorder participates in smearing, it is commonly something they do to feel different sensations from the texture, smells, arm movement, not enjoying how it feels in her diaper, and not enjoying how it feels being wiped. Along with that, children with sensory processing disorders are also accompanied by anxiety. Due to Bella having a sensory processing deficit, I think it would be worth her parents time considering sensory integration therapy. Sensory integration therapy may also help with Bella only eating the outside skins of her food, which is associated with a sensory processing deficit because of all of the different textures. Sensory integration therapy has a clear goal, the brain will adapt and allow Bella to process stimuli more efficiently. Within Bella’s behavior, she has clear signs of repetitive behavior. This is a very common symptom in children who have autism

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spectrum disorder. In Bella’s case, she has a distinct repetitive sequence of events that she takes part in. She is partaking in self stimulating behavior in the example her father gave. The National Autistic Society recommends that when this occurs, it is helpful to change the environment, figure out what the repetitive behavior is satisfying, don’t escalate any anxiety, and to intervene the repetitive behavior early in the sequence. I also recommend that future assessments utilize the motivation assessment scale. “The MAS is a 16-item questionnaire with items grouped to reflect four sources of motivation to: (i) gain attention, either positive or negative; (ii) gain access to tangible objects or as a response to removal of tangible reinforcers; (iii) escape from or avoid people or activities; and (iv) experience sensory feedback or stimulation” (Joosten and Bundy, 2010). I recommend Bella’s parents try these techniques to attempt solving a piece of Bella’s problematic behavior. Along with that, Bella should continue treatment with applied behavioral analysis because her behavior is still not appropriate for a child her age. As for Bella’s significant language regression, I believe that was her symptoms of autism spectrum disorder making itself known. “Regression is a phenomenon that has been documented repeatedly over the past several decades and has been described as occurring in somewhere between 20% and 33% of all cases of autism” (Luyster et al., 2005). A regression in word loss is one of the more common aspects of autism spectrum disorder paired with intellectual disability. Enrolling Bella in speech therapy was a great idea by her parents, however I think that Bella is overwhelmed by the vast amount of therapies she is already in. I recommend her parents try at home tasks to attempt to communicate with Bella, and also to consider American Sign Language as an alternate form of communication. By opening a line of communication that Bella is able to tolerate, I believe she would have far less tantrums and it would lead to better behavior because she would be able to communicate her needs.

Bella’s family appears to be in denial about Bella’s behavior as well as diagnosis. This is most likely an extremely stressful time in their lives due to Bella not being the only child they have together who needs their attention 24 hours a day 7 days a week. Her parents continue to have children in order to have enough caregivers for her oldest sister Cynthia, which implies to me that Bella’s needs are not being seen as a priority, but yet another thing they have to worry about other than Cynthia. I also believe that they are also not giving therapy enough of a try. Parents state that she would not settle down enough for therapy, but perhaps being in a form of therapy that would tackle her hyperactivity first in order to get down to the root of what is going on would be helpful. They are also in denial about Bella’s significant regression of language because they continuously state that she is smart and knows everything about the iPad, but to someone on the outside of their bubble, it is clear that she is just tapping the screen randomly, most likely to get a specific kind of sensory experience. Bella’s parents had previously enrolled Bella in different kinds of therapy including speech therapy, applied behavior analysis, and occupational therapy. Instead of trying three different kinds of therapy at once, I recommend to the family that they choose one and stick with it for as long as it takes to see progress. After seeing progress with the first chosen therapy, the therapist should suggest strategies for Bella’s parents to help her at home. If there is progress at home then they may discontinue therapy and move to another one of the two left, and so on. Bella is currently homeschooled. I believe that if she is given the opportunity to go to a public/private school outside of her home then she would be more successful with a lot of her skills. Her mom may not be able to actually give all of the children the time they need in order to be homeschooled. If Bella were to go to a school outside of her home, I think an IEP would be appropriate. I would have Bella be enrolled in an academic, social, and behavioral IEP. Bella’s

IEP would consist of the following accommodations: academic accommodation, Bella will learn new skills appropriate for her age such as basic math. Social accommodation, Bella will be taught social skills to interact with children her age properly. Behavioral accommodation, Bella will be taught new skills to cope with her emotions, such as asking for help and replacing inappropriate behaviors with socially acceptable behaviors. As for Bella being educated in her least restrictive environment, to figure out what this means for her we would first have to put her into an education system outside of the home. I believe that an aid would be helpful in this process because they would be able to closely monitor her behavior. If being in the classroom with the general population does not work, then we could try putting Bella into a class with the specially educated classified children. However if that does not work either, then being taught one on one with a special education specialist may be Bella’s least restrictive environment for education. In a study done about the correlation between physical activity and school engagement with children who have autism spectrum disorder, researchers found that physical activity caused engagement with group circle time as well as independent work increased for every child done in the study. “Low rates of PA are even more concerning for children with developmental disabilities such as autism spectrum disorders” (Harbin, Davis, Fettig, 2021). This study shows the importance of remaining active is for the education of children with special needs. This would be ideal for Bella because she appears to have an overload of energy, so physical activity throughout the day may help her tolerate sitting down in a classroom to learn because she would not be bouncing off of the walls with energy. The transition to adulthood is typically very tough on the individual and the family of a person with an exceptionality. I can imagine that when the time comes for Bella to transition to adulthood the family should prepare for a tough path. They may begin to feel depressed, anxious,

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and in a case study from Andrew Solomon's Far From the Tree, Cece, daughter to Betsy Burns and Jeff Hansen. Cece had been diagnosed with autism when she was three years old, and had to eventually be put in a group home when she was eight years old because her parents were unable to care for her needs. This transition was extremely hrd on both Betsy and Jeff. Betsy had been hospitalized twice in the first few months of Cece being put into a group home for severe depression and Jeff had also been hospitalized due to him developing bipolar disorder. Bella’s parents need to prepare themselves as well as their other children in terms of their mental health. Seeing a family counselor may be a good idea in order for the parents and the children to be able to talk to a professional about how Bella being put into a group home is affecting them. Along with that, the family should keep the lines of communication open with Bella when she moves out, but before that happens I believe that Bella should get another evaluation to see the extent of her diagnoses at that point in her life. They should begin to plan for her future by discussing if she will be capable of furthering her education into college as well as possible career options. This family will have to jump through multiple hurdles that they may face such as Bella suffering another severe regression of the progress she had made over time, if she does not have to skills to be on her own, if the family is unable to pay for Bella to live in a group home, declining mental health of any family members including Bella, and maintaining proper care throughout Bella’s life. If Bella’s behavior is similar to what it is now, I would recommend Bella goes into a group home so that someone is always there to care for her because she does not have the skills she needs to take care of herself. In conclusion, if we were able to give Bella a large amount of time to try one therapy at a time in order to not overwhelm her, I believe that it would help with her behavior and word regression. Along with that, we need to meet the family where they are at and work with the

parents so they can learn how to help their daughter more effectively. References Autism after high school: Nine tips to help teens transition to adulthood: Back and spine: Brain: UT southwestern medical center . Back and Spine | Brain | UT Southwestern Medical Center. (n.d.). Retrieved April 20, 2023, from https://utswmed.org/medblog/autism-transition-teens/ Autistic individuals are more likely to be LGBTQ+ . University of Cambridge. (2021, September 20). Retrieved April 20, 2023, from https://www.cam.ac.uk/research/news/autistic-individuals- are-more-likely-to-be-lgbtq The benefits of an autism IEP . Applied Behavior Analysis Programs Guide. (2022, October 14). Retrieved April 20, 2023, from https://www.appliedbehavioranalysisprograms.com/faq/how- can-an-iep-help-someone-with-autism/ Nicole Baumer, M. D., & Julia Frueh, M. D. (2021, November 23). What is neurodiversity? Harvard Health. Retrieved April 20, 2023, from https://www.health.harvard.edu/blog/what-is- neurodiversity-202111232645 Luyster, R., Richler, J., Risi, S., Hsu, W.-L., Dawson, G., Bernier, R., Dunn, M., Hepburn, S., Hyman, S., McMahon, W., Goudie-Nice, J., Minshew, N., Rogers, S., Sigman, M., Spence, M. A., Goldberg, W., Tager-Flusberg, H., Volkmar, F., & Lord, C. (2005). Early regression in social communication in autism spectrum disorders: A CPEA study. Developmental Neuropsychology , 27 (3), 311–336. https://doi.org/10.1207/s15326942dn2703_2 Joosten, A. V., & Bundy, A. C. (2010). Sensory processing and stereotypical and repetitive

behaviour in children with autism and intellectual disability. Australian Occupational Therapy Journal , 57 (6), 366–372. https://doi.org/10.1111/j.1440-1630.2009.00835.x Martin, A. F., Jassi, A., Cullen, A. E., Broadbent, M., Downs, J., & Krebs, G. (2020). Co- occurring obsessive–compulsive disorder and autism spectrum disorder in young people: Prevalence, clinical characteristics and outcomes. European Child & Adolescent Psychiatry , 29 (11), 1603–1611. https://doi.org/10.1007/s00787-020-01478-8 Harbin, S. G., Davis, C. A., Sandall, S., & Fettig, A. (2021). The effects of physical activity on engagement in young children with autism spectrum disorder. Early Childhood Education Journal , 50 (8), 1461–1473. https://doi.org/10.1007/s10643-021-01272-4 Obsessions and repetitive behaviour - A guide for all audiences . undefined. (n.d.). Retrieved April 20, 2023, from https://www.autism.org.uk/advice-and- guidance/topics/behaviour/obsessions/all-audiences Solomon, A. (2013). Far from the tree: Parents, children, and the search for identity . Scribner.

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