1. Case scenario Mental illness and Social Work Practice Instructor: Chris Leamy Presentation By: Sarah Taylor

2. Case scenario Austin is a five year old male. Austin resides with both his parents. He does not speak words, but grunts and makes other unusual noises. He points when he wants something. He is not toilet trained. He has a younger sister that is two years younger and is more socially appropriate and on task developmentally. He is not in any school programs, even though special services has been offered. His mother is afraid that he would not be able to attend school without melt-down, which does occur frequently during the day. When there is an unusual event, he has a melt down. His father is not actively involved and tends to play with the younger sibling. His mother is his primary caregiver and he tends to be with her all the time. There are not many family members he will go to. Parents noticed at an early age that he was not developing at a “normal” pace.

3. DSM five axis classification Axis I – Autism spectrum disorder Axis II- none Axis III- parents stated no known medical conditions Axis IV- socially and developmentally immature Axis V- GAF score: 40- 50

4. Presenting problem(s) The presenting problems of not speaking, pointing when he wants something, not being toilet trained, frequent melt- downs throughout the day and not many family members he will go to.

5. Diagnostic criteria of Autism Spectrum Disorder that my client meets. 1. Deficits in social and emotional interaction/communication. 2. Poor verbal communication, my clients mother states that Austin does not speak. 3. Stereotyped or repetitive movements, Austin's mother states that he point to communicate his needs. 4. Insistence on sameness, Austin's mother states that he has frequent melt-downs in a day, particularly when there is an unusual event, not in his daily routine.

6. Info regarding existing literature/data about diagnosis and presenting problems Condition seems to show problems in neurological development. DSM V listed under Neurodevelopmental Disorder A. Persistent deficits in social communication and social interactions across multiple contexts: 1. Social emotional reciprocity: failure of back and forth conversations, reduced sharing of interests, emotions, or affect, failure to initiate or respond to social interactions. 2. Deficits in nonverbal communicative behaviors used for social interaction: poor integrated verbal and non-verbal communication, abnormalities in eye contact and body language, deficits in understanding and using gestures, lacking in facial expressions.

7. Info regarding existing literature/data about diagnosis and presenting problems. Deficits in developing, maintaining, and understanding relationships: adjusting behaviors in specific contexts, difficulties in imaginative play or making friends, lack of interest in peers/others. B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive motor movements, speech, or use of objects: echolalia, flipping objects, lining things up 2. Insistence on sameness; inflexible adherence to routines, ritualized patterns of verbal or nonverbal behavior: extreme distress at small changes, difficult transitions, rigid thinking patterns, greeting rituals, eating same food daily 3. Highly restricted, fixated interests that are abnormal in intensity or focus : strong attachment or preoccupation with unusual objects, excessive interests 4. Hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment: indifference to pain/temperature, adverse response to noises, textures, excessive smelling, touching, visual fascination with lights or movement.

8. Diagnosis C. Symptoms must be present in the early developmental period, may not become manifested until social demands exceed limited capacities or could be masked by learned strategies later in life. D. Symptoms cause clinically significant impairment in social, occupational, or other important area of current functioning. E. The symptoms are not explained by an intellectual disability or global developmental delay.

9. Literature says about prognosis According to the DSM V the best prognosis for this type of presenting problem is individual factors, presence of absence of associated intellectual disability and language impairment. Environmental- a variety of nonspecific risk factors, such as advanced parental age, low birth weight. Genetic and physiological – heredity estimates 15% of all cases appear to be associated with known genetic mutations

10. Literature says about prognosis cont. According to our book, Mental Health in Social Work, Autism spectrum disorder states that Autism at its core is a genetic, neurobiology disorder, although specific causes have not yet been identified. Again as like the DSM V the book points to heredity One difference I noted was that our book also brings up the possibility of brain abnormality's

11. Tentative intervention plan After conferring with Austin's school psychologist, his doctor and speech and language pathologist we have devised a tentative intervention plan as follows: 1. have Austin's mother look into special education classes at school to see which one(s) could he benefit from. 2. Family involvement- two hours a day Austin, his parents and younger sibling need to have play time to help Austin socially grow. 3. Behavioral Management- Austin's melt-downs need to be less frequent, according to his mother unusual events cause the melt- downs, so the parents need to work on introducing new activities to his daily routine and when he completes a task without an issue he can receive a reward. 4. medication- to help Austin with his melt downs

12. Works cited American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Corcoran, J. and Walsh, J. (2013). Mental Health In Social Work A Casebook in Diagnosis and Strengths Based Assessment (2 nd ed).New Jersey. Person Education. Childrens gaf sale. (n.d.). Retrieved from http://people.ehe.osu.edu/dgranello/files/2009/05/childrens-gaf.pdf