Multidisciplinary approach in managing adult with autism: A single case study

Abstract

Autism is a Neurodevelopmental disorder believed to have neurological and genetic components. It was first identified in 1943. Since that time, research has shown that children with Autism spectrum disorders (ASD) have difficulties in three general areas :Social Interaction: qualitative difficulties responding to and interacting with other people in social situations, ranging from avoiding social interactions altogether at one extreme to being interactive but inappropriate at the other.Communication: qualitative difficulties in verbal and non-verbal communication, ranging from a lack of language and gestures in some cases to the use of complex language in odd or inappropriate ways in other cases.Behaviour: behaviours are often described as being repetitive and stereotypical, ranging from needing to perform daily activities in a very specific way to having a very restricted range of interests.Autism is a polygenetic developmental neurobiologie disorder with multiorgan system involvement, though it predominantly involves central nervous system dysfunction. The evidence supports autism as a disorder of the association cortex, both its neurons and their projections. In particular, it is a disorder of connectivity, which appears, from current evidence, to primarily involve intrahemispheric connectivity (Nancy & Diane, 2007).Investigators have suggested that, to achieve the best possible outcomes, children with autism should begin intensive behavioural treatment as early as possible, preferably before the age of 4 years (Green, 1996). Younger children with autism may have more behavioral and neural plasticity than older children do (Borman & Fletcher, 1999)andthey may not have fallen as far behind their peers. Many children with autism do not have an opportunity to start intensive behavioral treatment prior to age 4. Some do not even receive a diagnosis of autism until they are past this age (Howlin & Moore, 1997)Homer, Carr, Strain et al. (2002) discuss the importance of comprehensive intervention planning and state that comprehensive interventions involve multiple strategies applied across all or most of the individual's day.The process of comprehensive intervention planning begins with a thorough understanding of the individual's needs, especially those related to the underlying characteristics of ASD. Next, a comprehensive daily schedule for the child is critical. A schedule should embed the supports needed for success as well as develop individual skills and measure those skills with a vision of how this will affect the child now and in the future (National Research Council, 2001).The caseA 19 year old boy was brought with the complaints of age inappropriate communication skills, poor socialization and severe behavioural disorders including soiling self, frequent urination and loud screaming if his demands are not met immediately. He was diagnosed with Autistic disorder at the age of 4 years, since then he was taken to different treatment approaches including special education and even Ayurveda, but no significant improvement noticed as reported.During the first visit his parents were almost hopeless in taking into the new place for the treatment since they were rejected from many places due to the age factor of the boy and severity of the condition.AssessmentsInitial assessments were done using detailed clinical interview with the parents, behavioural observation and with the use of Sensory Integration (SI) Inventory and Childhood Autism Rating Scale (CARS). In behavioural observation, he was not co-operative, eye contact was not maintained, no name calling response noticed. Productive verbal communication was absent and he showed the sign of distress throughout the session through self stimulatory loud voices and behaviours. He was motivated by objects especially balls not by humans.Sensory Integration (SI) Inventory suggests that, he had tactile defensiveness, hyposensitivity in vestibular, proprioceptive, visual, auditory & olfactory senses. …