Overview of the case
Echo Richard is a three-and-a-half-year-old first-born male who presents to the clinician with his parents with concerns of developmental delay. He required oxygen during the birthing process, and his parents report a difficult delivery. During the first few months of his life, his parents were concerned due to his lack of social contact and response to baby games. His babbling had no conversation intonation, and his speech consisted of echoing words and phrases from others with the original speaker’s accent. he could use one or two such phrases to indicate his simple needs .His parents report that he does not communicate with facial expressions or gestures. he was intensely fascinated with lights and sound and showed significant difficulties in communicating. He displays intense resistance to any attempts to change or extension of interests. Any change he faces can precipitate temper tantrums that could last one hour or more, which can include screaming, kicking, and biting himself or others. Psychological testing resulted in a mental age of three years in non-language dependent skills, but only 18 months in language comprehension.
Mental status exam with target symptoms
Appearance: Appropriate, appears stated age, eye contact: avoidant. disconnected from activities, fixated on miniature toy car, expressing ritualistic behaviors, engaging in maladaptive behaviors with frustrated (explosive and self-injury
Behavior/ Motoric: agitation in the presence of bright lights and music, repetitive hand fapping, tiptoeing, ritualistic behaviors by rearranging kitchen utensils
Speech: echolalia, monotone
Orientation: Alert/ orintedx4
Mood and Affect: Uninterested, Flat
Thought Process: unable to assess due to lack of engagement
Thought Content: unable to engage in meaningful conversations
Perception: unable to fully assess
Insight and Judgment: Limited due to lack of engagement in activities and social interaction, poor
Autism Spectrum Disorder is a developmental disorder characterized by a deficit in social behavior and specific interactions such as reduced eye contact and body gestures. Some characteristics of the ASD condition are lacks in social behavior and in non-verbal interactions. More specifically, ASD children avoid eye contact, have problems with social interactions, and perform repeated body movements and actions (Mazumdar et al., 2021).
Rett’s disorder includes disruptions and social interactions during the regressive phase of this neurological condition(between ages one and four) which is also characterized by declaration in head grow lots of hand movements and poor coordination.
There are other differential diagnosis can be language server that is characterized by a lack of qualitative impairment in social interaction and the individual range of interests and behaviors are not restricted (First, 2014).
Appropriate laboratory or diagnostic test/screening tool
Signal processing techniques can be used for identifying autism spectrum disorder symptoms.
Features extracted from image content and viewing behavior support an early diagnosis of autism spectrum disorder. Eye following and machine learning algorithms are come together to implement a fast and accurate diagnosis system (Mazumdar et al., 2021).
Treatment plan and the rationales for each section of the treatment plan
The treatment goals for ASD are: Minimize essential problems, maximize independence and quality of life, and help the child and family deal more effectively with the disorder. Many children with ASD receive psychotropic medications: Antidepressants, stimulants, and tranquilizers/ antipsychotics. Depending on the child’s needs, speech therapy to improve communication skills, occupational therapy to teach activities of daily living, and physical therapy to improve movement and balance may be beneficial. A psychologist can recommend ways to address problem behavior.
Some other treatment can be:
- Behavioral management therapy.
- Cognitive behavior therapy.
- Educational and school-based therapies.
- Joint attention therapy.
- Medication treatment.
- Nutritional therapy (“Social Skills Treatments for Children with Autism,” 2007)
Describe one risk factor
Advanced parental age at time of conception can be one risk factor.
One clinical feature of autism in infants or children and one effective parenting or coping strategy that may be used for parents/caregivers or siblings of persons with autism spectrum disorder.
People with autism may have difficulty with communication and social interaction.
One of effective parenting or coping strategy for parents with autism kid can be: Positive thinking and self-talk. Relaxation and breathing strategies.
Echo Richard is a 3-year-old boy was referred by his parent for evaluation due to his uneven development and abnormal behavior. Richard appeared to be self-sufficient and aloof from others. Echo seemed to suffer from separation anxiety. When left with a baby-sitter, he tended to scream much of the time. The major management problem was Richard’s intense resistance to any attempt to change or extend his interests. Removing his toy car, disturbing his puzzles or patterns, even retrieving, for example, an egg whisk or a spoon for its legitimate use in cooking, or trying to make him look at a picture book precipitated temper tantrums that could last an hour or more, with screaming, kicking, and the biting of himself or others. These tantrums could be cut short by restoring the status quo. Otherwise, playing his favorite music or a long car ride was sometimes effective. His parents had wondered if Richard might be deaf, but his love of music, his accurate echoing, and his sensitivity to some very soft sounds, such as those made by unwrapping a chocolate in the next room convinced them that this was not the cause of his abnormal behavior. Psychological testing gave him a mental age of 3 years in non-language-dependent skills (fitting and assembly tasks), but only 18 months in language comprehension.
mental status exam with target symptoms
Physical appearance, motor development and self-help skills all age appropriate. lack of response to social contact. Fascinated by bright lights and spinning objects, stare at them while laughing, flapping his hands, and dancing on tiptoe. He also displayed the same movements while listening to music, which he had liked from infancy.
Laboratory and Diagnostic Tools
ADHD diagnosis requires the symptoms of ADHD to be present both in school and at home. Furthermore, all patients must have a full psychiatric evaluation and physical examination. The diagnosis of attention deficit hyperactivity disorder (ADHD) is based on clinical evaluation (Gephart, 2019). No laboratory-based medical tests are available to confirm the diagnosis. Basic laboratory studies that may help confirm diagnosis and aid in treatment are as follows: Serum CBC count with differential Electrolyte levels Liver function tests (before beginning stimulant therapy) Thyroid function tests. The Conners Parent-Teacher Rating Scale is a questionnaire that can be given to both the parents and the child’s teachers (Gephart, 2019).
Autism Spectrum Disorder – Developmental Screening, CSBS DP Infant-Toddler Checklist, Modified Checklist for Autism in Toddlers (MCHAT)
Describe one risk factor and one clinical feature of autism in infants or children and one effective parenting or coping strategy that may be used for parents/caregivers or siblings of persons with autism spectrum disorder
Risk Factor- Advanced maternal age. Prenatal exposure to air pollution or certain pesticides. Maternal obesity, diabetes, or immune system disorders. Extreme prematurity or very low birth weight (Cooper et al., 2018).
Clinical Feature- Delayed language skills
Coping Strategy- Coping mechanisms that are often demonstrated by parents when caring for their child with ASD include support from family, friends, social support groups, other parents of children with ASD, service providers, advocacy, and religion.
The antipsychotic drugs risperidone and aripiprazole demonstrate improvement in challenging behavior that includes emotional distress, aggression, hyperactivity, and self-injury, but both have high incidence of harms (Cooper et al., 2018). No current medical interventions demonstrate clear benefit for social or communication symptoms in ASDs. Evidence supports early intensive behavioral and developmental intervention, including the University of California, Los Angeles (UCLA)/Lovaas model and Early Start Denver Model (ESDM) for improving cognitive performance, language skills, and adaptive behavior in some groups of children (Cooper et al., 2018).
Echo Richard aged 3 ½, a first-born child, was referred at the request of his parents because of his uneven development and abnormal behavior. Richard appeared to be self-sufficient and aloof from others. His babbling had no conversational intonation. At age 3 he could understand simple practical instructions. He was intensely attached to a miniature care, which he held in his hand, day, and night, but the never played imaginatively with this or any other toy. His speech consisted of echoing some words and phrases he had heard in the past, with the original speaker’s accent and intonation; he could use one or two such phrases to indicate his simple needs. He did not communicate by facial expression or use gesture or mime, except for pulling someone along and placing his or her hand on an object he wanted. He was fascinated by bright lights and spinning objects, and would stare at them while laughing, flapping his hands, and dancing on tiptoe. The major management problem was Richard’s intense resistance to any attempt to change or extend his interests. Removing his toy car, disturbing his puzzles or patterns, even retrieving, for example, an egg whisk or a spoon for its legitimate use in cooking, or trying to make him look at a picture book precipitated temper tantrums that could last an hour or more, with screaming, kicking, and the biting of himself or others. These tantrums could be cut short by restoring the status quo.
Mental Status Exam with Target Symptoms
Eye contact -poor -less than 3 seconds
Interest in others-only passively responds – aloof from others
Pointing skills -only follows point
Language -single words
Pragmatics of Language n/a
Repetitive behaviors /stereotypy- insists on routine
Unusual or encompassing preoccupations – He was intensely attached to a miniature care, which he held in his hand, day, and night, but the never played imaginatively with this or any other toy.
Autism Spectrum Disorder
DSM-5 criteria require that a child has persistent impairment in social communications and interactions across multiple contexts as well as restricted or repetitive patterns of behavior, interests, or activities; that symptoms should present in early childhood and cause significant functional impairments; and that the impairments are not better explained by intellectual disability.
Laboratory and Diagnostic Tests
Blood Tests -Thyroid Panel,T4,T3 CBC, CMP
As methods to identify ASD at a very young age have developed, possibilities for effective early intervention with infants and toddlers increased dramatically. Treatments for ASD are directed at maximizing the child’s potential and helping the child and family cope more effectively with the disorder. Treatments for ASD focus on the specific social, communication, cognitive and behavioral deficits displayed by the children with this disorder. Current treatments for autism spectrum disorder (ASD) seek to reduce symptoms that interfere with daily functioning and quality of life. ASD affects each person differently, meaning that people with ASD have unique strengths and challenges and different treatment needs. Therefore, treatment plans usually involve multiple professionals and are catered toward the individual.
Treatments can be given in education, health, community, or home settings, or a combination of settings. It is important that providers communicate with each other and the person with ASD and their family to ensure that treatment goals and progress are meeting expectations.
As individuals with ASD exit from high school and grow into adulthood, additional services can help improve health and daily functioning, and facilitate social and community engagement. For some, supports to continue education, complete job training, find employment, and secure housing and transportation may be needed.
There are no medications that treat the core symptoms of ASD. Some medications treat co-occurring symptoms that can help people with ASD function better. For example, medication might help manage high energy levels, inability to focus, or self-harming behavior, such as head banging or hand biting. Medication can also help manage co-occurring psychological conditions, such as anxiety or depression, in addition to medical conditions such as seizures, sleep problems, or stomach or other gastrointestinal problems.
It is important to work with a doctor who has experience in treating people with ASD when considering the use of medication. This applies to both prescription medication and over-the-counter medication. Individuals, families, and doctors must work together to monitor progress and reactions to be sure that negative side effects of the medication do not outweigh the benefits.
Families who have one child with autism spectrum disorder have an increased risk of having another child with the disorder. It’s also not uncommon for parents or relatives of a child with autism spectrum disorder to have minor problems with social or communication skills themselves or to engage in certain behaviors typical of the disorder.
Some children show signs of autism spectrum disorder in early infancy, such as reduced eye contact, lack of response to their name or indifference to caregivers. Other children may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose language skills they’ve already acquired. Signs usually are seen by age 2 years.
Each child with autism spectrum disorder is likely to have a unique pattern of behavior and level of severity — from low functioning to high functioning.
Some children with autism spectrum disorder have difficulty learning, and some have signs of lower-than-normal intelligence. Other children with the disorder have normal to high intelligence — they learn quickly yet have trouble communicating and applying what they know in everyday life and adjusting to social situations.
Because of the unique mixture of symptoms in each child, severity can sometimes be difficult to determine. It’s generally based on the level of impairments and how they impact the ability to function.
Parent Strategy or coping skills
Parents that have an autistic child, might forget to make time for themselves. One way to reduce stress levels in the family is by making sure that all family members – including the parents – have time to do things that make them feel good. One way to do this is by getting everyone in your family to make a list of things that they enjoy. Then try to make sure that everyone gets to do something from their list every day or every couple of days. The lists should have a mix of activities that vary in cost and time.