Symptoms and Developmental Consequences of Autism - Case Study Example

Running Head: Case Study on an Individual with Autism Student’s Name: Instructor: Course Code and Name: Institution: Date Assignment is due: Case Study on an Individual with Autism Introduction The medical condition known as Austin is also referred to as Autistic spectrum disorder or pervasive developmental disorder (Howlin and Moorf, 1997). This is an emotional disorder mainly characterized by a patient’s profound withdrawal and insulation from social contact with other people, love of repetitive actions and behavior as well as a pronounced fear of environment change (Howlin and Moorf, 1997). The disorder results from brain impairment on its ability to perceive, receive, interpret and act on sensory information (Howlin and Moorf, 1997). Patients of autism are unable to act in a normal way, or at least as other people consider normal (NIH, 1996). They will have difficulties in talking to others, difficulty in maintaining eye contact with others and will prefer not to be touched by anyone. A description used to capture the condition is that while man is an outwardly social animal, autism patients are turned inwards where their social ability is only with the self (NIH, 1996). This explains why they talk to themselves freely and regularly when they cannot talk to others, laugh about their personal thoughts, and spend hours rocking to and floor on a seated or standing position (Kanner, 2009). A great area of handicap among autism patients is that they revolt against change and learning new behaviors is usually very hard if not impossible in some cases. Learning how to use a toilet, fitting in to a school, travelling etc are all things that present challenges to autism patients (Damodharan, 2006). The disorder is mostly diagnosed during early childhood consequent to symptoms as will be elaborated later on in the easy such as poor communication ability, repetitive behaviors and lack or hate of social interactions (Kanner, 2009). Leo Kanner identified and named the condition back in 1943, after studying 11 ‘unusual children’ or what he later name early infantile autism/childhood autism (Kanner, 2009). This was almost immediately collaborated by Hans Asperger on a similar study identifying a subset of the condition today called Asperger syndrome (Kanner, 2009). This essay is a case study of Grisham Bell, an autism patient positively diagnosed from the age of three. Grisham has lived with the condition for twenty one years now. Using Grisham’s case, the essay will establish the complex array of symptoms that indicate autism in children, which may lead to positive diagnosis of the condition (Kielinen, 2004). Further, the essay will identify the consequences of having the condition, or more precisely, the development impact of the condition from a child’s age until the patient grows up. Using Grisham’s case, the essay will also elaborate on variant occurrences in the development of children with the condition. Before concluding, the paper will also detail some preventive options as expounded by modern research and as can be deduced from Grisham’s case. Symptoms of Autism Grisham bell is today twenty four years old and lives in New York with his parents. He is the first born in a family of four children, born a few minutes before his twin brother Lincoln. The two boys were born in perfect health with a normal weight and all development signs going as normal of any healthy boys. Lincoln actually fell sick more often than Grisham in the first two years of life and was physically compact as compared to a robust Grisham. At the onset of the third year however, Grisham begun depicting what his parents later described as a funny behavior and an absolute zero rate of physical and mental growth. Lincoln who had all the time seemed a slow starter when compared to his brother, picked up fast and left Grisham fixated at the same level (Zwaigenbaum, 2005). By the age of five, the two boys looked and acted as if they had been born years apart. A close inspection of the circumstances that led to the diagnosis of Austin in Grisham will help elaborate on the common symptoms of the condition. The first thing to note is that this condition depicts itself in individuals valiantly and in different degrees of severity (Damodharan, 2006). Autism patients have variant symptoms such that, researchers and health care professionals regard autism not as a singular condition but as a spectrum disorder with as many versions as the number of patients. The Asperger syndrome is for instance one of the mild versions of the autism disorder. Beginning at the age of three, Grisham began showing great difficulties in communication, both verbal and nonverbal types of communication. This is a typical symptom in autism children below the age of two years or thereabout (Fiona, 2002). One indicator of these poor communication ability was when Grisham started gesturing and pointing at things he wanted instead of speaking out in words as he had always done. No matter how much the parents pestered him, Grisham never spoke more than a few words in a day. Grisham had all over a sudden, grown hostile to any form of change and always insisted on sameness. He resisted changing clothes or anything that altered what he was used to. At other times, Grisham started repeating the same words or even phrases instead of communicating in complete normal sentences. He would not say that ‘I want ice-cream’, rather he would keep on repeating the word ‘ice-cream’ over and over irrespective of what anyone said until the ice was given to him. That repetitive, non-responsive language is a telling symptom of the condition (Fiona, 2002). Another key thing that the parents noted with Grisham is that he was totally unresponsive to the normal teaching methods that worked easily with Lincoln. It reached to a point when Grisham could not be shown anything in which he showed any interest or sign of understanding. Again, he reviled any form of touch by others, and could not let his mother to cuddle him let alone anyone else. Fifthly, Grisham who had always been playful and very social especially with his twin brother on the play pen, started avoiding any social interactions and preferring instead to lie on his back and watch the ceiling all the time, hour on a row. When he participated in any form of play with Lincoln or other children who came visiting, Grisham was excessively aggressive in play or impervious to any invitation to join the other children. At first, his parents thought that he was having mood swings and hoped it would go away soon (Knott, 2006). Nevertheless, when he began being aggression towards himself, biting his fingers and scratching until blood started running, the parents knew it was time to seek for help. On the morning to the day he was taken to a local clinic, Grisham had spent the entire night scratching his chin over and over again, not stopping even when bleeding started. When his father discovered him lying on bloodied sheets and still scratching the chin in the morning, Grisham was smiling and scratching mechanically in perfect rhythm. This was explained to the family doctor who recognized the possibility of self directed aggression as a possible indicator of autism (Kielinen, 2004). By the time the parents took Grisham to a specialist with the recommendations of their family doctor, he was showing great signs of distress at times when the parents could not identify the cause of such distress. What sealed the confirmation for the autism diagnosis was avoiding eye contact by all means, such that Grisham never responded to the mention or call of his name. When talking to someone, Grisham never established or maintained eye contact. After the diagnosis, the symptoms continued and even became more pronounced. Grisham became oblivious to emotions of others and could never take a cue from the tone of voice or facial expression of others. He became oblivious to the impact of his negative behavior to others, something that increased with age. His self-directed aggression became repetitive, expressed in scratching, head banging or biting himself persistently. When he wanted to say what he wanted, he always used his name and not the pronouns ‘I’ or ‘me’. For instance, he would say, “Grisham is going to bed” when he wanted to go to bed. He started using a sing-song voice while speaking when he did, always speaking out of cue and about a topic totally in discordance with what others were talking or asking about or interested in (Knott, 2006). He would later develop an abnormal sensitivity to sounds, touches and other sensory stimulations, especially showing a reduced sensitivity to pain. Developmental Consequences of Autism By six years old of age, Grisham had been classified to have a mild disorder. His brain’s development disorder was not severe and he began attending a regular school about a year later than Lincoln (Loveland and Tunali-Kotoski, 2005) . Luckily for him, he could grow up and lead a near-normal life. For severe cases of autism (called high functioning autism), individuals are unable to do anything on their own and cannot support themselves without being given care. Grisham has grown up with the disorder with an almost near-normal life although he lives with his parents (Zwaigenbaum, 2005). He has a job at the local post office where he spends the day sorting mail. He is also engaged to Sophia, who is in her final years of college. To get to the point he is now, Grisham has had to go through a very abnormal growth process, one that his parents always compared with that of their other son, Lincoln, or the second set of twin girls who also have a degree of mild autism (Skellern, 2005). To begin with, children learn mostly by stimulation. The environment and the people around a child stimulate thought and actions in babies to help them learn. Autistic children do not easily respond to stimulation thereby resulting to slow process of learning. Grisham took a lot of time to learn most of the things that Lincoln learnt by default. Riding a bicycle for instance was only possible when Grisham was seventeen, something Lincoln could do at age six. For most autistic children their development process I marred by a self imposed deprivation of a primary array of learning processes during childhood simply because they disallow or are unable to bear sensory experiences (Damodharan, 2006). A child learns most of the things he or she does in the early years of life from his or her mother/caregiver/loved ones. However, for the autistic child, the emotional and social cues from these people are not welcome and they solicit no learning reaction. They rarely watch as others are doing things meaning they cannot learn from observation. This inability to learn via imitation of those around the child always significantly retards the child’s social, cognitive and emotional development. Grisham’s development since he was a child and after the diagnosis has been one riddled with handicaps. His communication skills never developed much even after going to school. As the other children were playing outside, Grisham would be in his room arranging his toys in line repeatedly, something he did almost every day until he was eight. Most autistic children can spend hours making patterns and arranging things like Grisham, doing the same thing every day without ever changing or doing it differently. While most autistic children and adolescents are prone to depression and chronic stress, Grisham has never exhibited signs of depression. Nonetheless, Grisham grew up without regard for social interactions either at home or at school, having answered a teacher in class only six times in his education life. Most of his free time since he was a kid, was always spent in his room, watching TV or reading a book. From the age of five, his parents gave him his own room to avoid the daily confrontations with Lincoln when any of his things were touched. In his entire life, the only friend he ever made has been Sophia mostly because he has never given anyone else a chance to be friends. Research has indicated that autistic children have problems in developing those skills that require them to calculate or respond fast. Whenever speedy reaction to sensations is called for, Grisham always seems baffled or perplexed and even overwhelmed (Midence, 1999). A remarkable thing about Grisham’s school days is that he woke up at exactly the same time daily by himself, dressed and brushed in a perfect rhythm. He only got mad and still does, when things are changed. With behavioral therapy, Grisham started developing an appreciation of other people where he became sensitive to offending al hurting others. The changes became evident during his early adolescence years (in which he was not as problematic and as many autistic adolescents are (Howlin, 2000)), although he still prefers not to socialize. He has however learnt how to stay out of people’s way as long as other people keep out of his at home and at work. Grisham started out being hypersensitive to being touched by other people and could even react violently especially during his adolescence (Lovaas, 1979). Nevertheless, continued behavioral therapy has helped him to condone such normal action as greeting, occasional hugs by his family and Sophia, although there is still a sign of discomfort. Grisham walks in a stilted manner even today and is slow in most tasks requiring motor skills. Research has established that autistic children usually have difficulties with such tasks as involve fine motor development such as drawing, coloring, taking notes etc. They also have a deficit in gross motor coordination such as those involved in walking and running such that they walk in a largely stilted fashion, adopt a tilted gait. These deficits have been attributed to improper growth of leg muscles. His language skills are still not good but not remarkably poor either as they were in childhood. Autistic children have also been known to develop some extremely impressive abilities that seem extraordinary especially when compared to their rather suppressed personalities (Howlin, 2000). Grisham has an extremely impressive ability to conduct a mechanical task with speed, perfect pattern and without making an error as long as the actions required are repetitive. This unique ability has been with him all his life, and his friends and family call it the robot-like movements. At the post office, he sorts thrice as many mails in a day as any other person and he does it with the outmost ease. This concurs with the findings of extraordinary talents noted in most Austin patients, especially those with the savant syndrome (Midence, 1999). Variance in Autism Development The life of an autistic child such as Grisham is one into stunted growth and isolation. They differ from normal children in their communication abilities, their social skills, their motor abilities and a preference for withdrawal. But these are the most common symptoms and characteristics of autism patients. As noted earlier, autism depicts itself in different individuals in a variant manner, with some symptoms being unique to individual patients and others common across the board (Ozonoff, South and Miller, 2000). Variations come in types. Some autistic children and adults revile personal contact while others are overly insisting on touching, hugging and patting other people on the back (Attwood, 2000). Some autism patients are indifferent to emotions expressed by others while some are very responsive to emotional expressions and gestures (Kim, 2000). Some are strangely silent all the time while others will even initiate conversation. Some are handicapped in speech while others can speak normally. Grisham was very slow to learn most things in childhood and yet his sibling sisters who have both also been diagnosed with the condition have been fairly fast in learning and are not as socially handicapped as Grisham was (Ozonoff, South and Miller, 2000). While Grisham could not live in the same room with Lincoln, his sisters insist on sharing not just a room but also a bed (Ross and Cuskelly, 2006). Another vital variance in autism is the age in which the disorder becomes overt. For Grisham, it was at age three after being normal in growth and development for over two years. For his sisters, the signs (especially communication and repetitive behaviors) were detectible even under the age of one year. Again, Grisham is an unusual case because the symptoms of his condition were very severe before he reached the age of nine and yet they seem to have resided ever since to become but a mild condition, which is not solely attributable to interventions such as behavioral therapy (Gillott, 2001). Some conditions are severe for a time, as in Grisham, while others run through the lifespan of the patient(Howlin, 2000). Contextual Influences on Autism Development The development process of an autistic child is not entirely dependent on the condition (Perez, 2007b) . To some extent, the environment in which that child is in and other contextual factors also have a role in charting the development process. Health of the child for instance influences the development process (Perez, 2007b) . If the child is diagnosed with another disease, the retardation and handicap caused by autism becomes compounded and the development process skewed not exclusively by the condition (Kim, 2000). Relevant factors that may also impact on the development process besides the symptoms of the autism condition include presence or lack of a supportive home environment, education, exposure to social settings such as school, body health of the child, supportive measures such as medication and therapy, age at which the condition becomes overt etc (Tantam, 2000). A supportive home helps the child gain some stimulation to grow out of the condition by and by (Attwood, 2000). Education gives an autism child the exposure needed in learning how to decode and express emotions just as social settings help the child to appreciate the need of socialization and the proper manner to socialize (Folstein and Rutter, 1977). Medication for tension and depression as well as behavioral therapy can help a child or adult with autism overcome some of the delimiting symptoms of the condition (Tantam, 2000). If the condition developed later in life than the first two years since birth, the child has a higher chance of developing a mild form of autism than when the condition is diagnosed at a very young age. Protective and Risk factors for Autism The causes of autism are unknown yet and there is no cure. The condition lasts for a person's lifetime although treatment can help manage a patient’s behavior, such as communication therapies, drug therapy to control symptoms etc (Skellern, 2005). Contemporary research has however pointed out that genetics have an important role in predisposing Austin in individuals. On average, about one child in every 500 develops autism all over the world or at least related disorder (Medhurst. and Beresford, 2007). In families with an autistic child, chances there being another sibling with the disorder dramatically increase to about 20%. This perhaps explains why Grisham’s sisters were diagnosed with the condition too. Biological siblings always have approximately half common genes including non-identical twins (like Grisham and Lincoln, which explains why Lincoln does not have the condition) (Perez, 2007a). In identical twins, all their genes are shared making their chances of sharing the condition rise up to over 70% (which explains why the identical twin sisters of Grisham are both autistic) all their genes (Folstein and Rutter, 1977). Nonetheless, genes are not all that causes autism all else, identical twins would be autistic with a 100% of incidences (Perez, 2007a). Another probable cause of autism is brain damage consequent to injuries or malformation (Escalant-Mead, 2003). There are some prenatal viral infections like cytomegalogvirus (CMV), rubella and a few others, which have also been attributed to the condition. In current research circles researchers are trying to establish whether parents age at conception, ethnicity, social-economic conditions of the family, working mothers and parenting style have a role to play in causing Austin. Family planning drugs, immunization drug preservatives, breastfeeding, smoking and drinking by pregnant mothers and such childcare factors are being considered by contemporary research to identify any potential risk factors (Boulware, 2006). While the area remains an active research field, what is known today is that autism occurs irrespective of age, social status and age of parents (Perez, 2007a). It is not exclusive to certain regions, races and ethnic groups. When something is not known in terms of what causes it, prevention of its risk factors become highly contentions and based on guesswork. It is however important that, as Boulware (2006) says, mothers avoid harmful substances during pregnancy to avoid affecting the fetus development as well as avoiding baby accidents that may cause brain damage. Conclusion Austin is a disorder that impairs a person’s emotional, cognitive and social abilities, usually diagnosed in childhood. It interferes with eth normal growth process of a child socially, intellectually and emotionally. Once the condition is diagnosed, some factors may perpetuate its effect on the development of a child. Such contextual factors include diseases, care and support, education etc. While autism has no cure and no empirically confirmed cause, protective measures will include proper care of a pregnancy and prevention of head injuries in babies. References Attwood, T. (2000). Strategies for Improving the Social Integration of Children with Asperger Syndrome. Autism. Vol. 4. pp. 85-100. Boulware, G. et al. (2006). Project DATA for Toddlers: An inclusive approach to very young children with autism spectrum disorder. Topics of Early Childhood Special Education. Vol. 26 (2). pp. 94-105. Damodharan, S. et al. (2006). Letters to the Editors: Delays in the diagnosis of autistic spectrum disorder in a community child and adolescent mental health service (CAMHS). Autism. Vol. 10 (6). pp. 649-650. Escalant-Mead, P. et al (2003). Abnormal brain lateralization in high-functioning autism. Journal of Autism Development Disorder. Vol. 33, pp. 539-543. Fiona, J. et al. (2002). Brief Report Prevalence of Autism Spectrum Conditions in Children Aged 5-11 Years in Cambridgeshire. UK. Autism. Vol. 6. pp. 231-237. Folstein, S. & Rutter, M. (1977). Infantile Autism: A Genetic Study of 21 Twin Pairs. Journal of Child Psychology and Psychiatry. Vol.18 (4). pp. 297 – 321 Gillott, A. et al. (2001). Anxiety in High-Functioning Children with Autism. Autism. Vol. 5. pp. 277-286. Howlin, P. (2000). Outcome in Adult Life for more Able Individuals with Autism or Asperger Syndrome. Autism. Vol. 4. pp. 63-83. Howlin, P. & Moorf. A. (1997). Diagnosis in Autism: A Survey of Over 1200 Patients in the UK. Autism. Vol. 1. pp. 135-162. Kanner. L (2009). Autistic disturbances of affective contact. Nervous Child. Vol. 2. pp. 217-250. Kielinen, M. (2004). Associated Medical Disorders and Disabilities in Children with Autistic Disorder: A Population-based Study. Autism. Vol. 8. pp. 49-60. Kim, J. et al (2000). The Prevalence of Anxiety and Mood Problems among Children with Autism and Asperger Syndrome. Autism. Vol. 4. pp. 117-132. Knott, F. et al. (2006). Living with ASD. Autism. Vol 10 (6). pp. 609-617. Lovaas, O. et al (1979). Stimulus overselectivity in autism: A review of research. Psychological Bulletin. Vol. 86 (6). pp. 1236-1254. Loveland, K. and Tunali-Kotoski, B. (2005). The school-age child with an autistic spectrum disorder. In, F. R. Volkmar, R. Paul, A, Klin, D, Cohen (Eds). Handbook of autism and pervasive developmental disorders, Vol. 1: Diagnosis, development, neurobiology, and behaviour (3rd ed) (pp 247-287). Hoboken, NJ, US: John Wiley & Sons Inc. Medhurst, B. and Beresford, J. (2007). Thomas training: An early years intervention for children with an autistic spectrum disorder. Educational Psychology in Practice. Vol. 23 (1). Pp. Midence, K. (1999). The Experience of Parents in the Diagnosis of Autism: A Pilot Study. Autism. Vol. 3. pp. 273-285. National Institutes of Health (1996). Office of Scientific and Health Reports. NIH Bethesda: Maryland Publication No. 96-1877. Ozonoff, S., South, M. and Miller, J. (2000). DSM-IV-Defined Asperger Syndrome: Cognitive, Behavioral and Early History Differentiation from High-Functioning Autism. Autism. Vol. 4. pp. 29-46. Perez, J. et al (Eds). (2007a). New developments in autism: The future is today. London: Jessica Kingsley Publishers. Perez, J. et al (2007b). Early manifestations of autistic spectrum disorder during the first two years of life. In, New developments in autism: The future is today. London: Jessica Kingsley Publishers. Ross, P. & Cuskelly, M. (2006). Adjustment sibling problems and coping strategies of brothers and sisters of children with autistic spectrum disorder. Journal of Intellectual & Developmental Disability. Vol. 31 (2). pp. 77-86. Skellern, C., et al. (2005). From complexity to category: Responding to diagnostic uncertainties of autistic spectrum disorders. Journal of Pediatrics and Child Health. Vol. 41(8). pp. 407-412. Tantam, D. (2000). Psychological Disorder in Adolescents and Adults with Asperger Syndrome. Autism. Vol. 4. pp. 47-62. Zwaigenbaum, L., et al (2005). Behavioral manifestations of autism in the first year of life. International Journal of Developmental Neuroscience, Vol. 23(2-3). pp. 143-152. Read More