Colleague 2: Jennifer

Upon reviewing the case of Chase, a 12 year adopted boy, it is reasonable to presume that his original diagnosis of Pervasive Developmental Disorder NOS and Transient Tic Disorder would currently be classified as an Autism Spectrum Disorder (ASD) (Plummer, Makris, and Brocksen, 2014; APA, 2013).

Chase meets the following diagnostic criteria for ASD: persistent deficits in social communication and social interaction – including deficits in developing and maintaining relationships, and failure to respond to social interaction; restricted, repetitive patterns of behavior, interests or activities – including inflexible adherence to routine and ritualized behaviors, fixated interests of abnormal intensity, repetitive use of objects; symptoms were exhibited during early developmental periods; symptoms cause significant impairment in social and educational areas of functioning and are not better explained by an intellectual disability (APA, 2013). Chase’s ASD diagnosis would be accompanied by intellectual impairment due to decreased functioning typical of children his chronological age (Plummer et al., 2014; APA, 2013). Based on information from Chase’s case, current symptomology would be rated at a Level 1, indicating that additional supports are necessary to increase functioning across the social and behavioral domains (APA, 2013). ASD diagnosis is established based on exhibiting factors including: difficulties transitioning from one task to another, inability to focus, frequent meltdowns, speech and language issues, facial tics, inability to sit still, overly focused on details of WWII, inability to make friends and/or successfully interact with family members, disrupted sleep patterns, and noted intellectual impairments or delays. Z-Codes which would be applicable to his diagnosis would include Z55.9 – academic or educational issues, Z60.4 – social isolation, Z62.890 – parental-child relational problem, Z62.891 – sibling relational problem, Z65.9 unspecified problem related to unspecified psychosocial circumstances, Z72.810 child antisocial behavior, and Z91.5 personal history of self-harm.

Risk and prognostic factors include gender-related diagnostic issues – males are four times more likely to be diagnosed with ASD; and functional consequences associated with ASD – lack of social and communication abilities may have hindered growth and development in educational settings or in settings with peers (APA, 2013). Additional considerations regarding his behaviors would include gathering a history of the experiences Chase had prior to and during his stay at the orphanage.

Functional consequences of ASD include: hindered learning and development of relationships, insistence on routines interferes with sleeping and routine care, decreased coping and adaptive skills, and difficulties establishing adulthood independence, social isolation and communication issues, and reduced help-seeking behaviors (APA, 2013).

Further evaluations would be necessary to determine the extent of Chase’s diagnosis; involvement with Chase’s school as well as his parents would be necessary to determine the range of his abilities and to pinpoint the areas in which his disorder was causing the greatest impact. Consistency between the home and school is necessary for success, while an IEP or placement into special education programming would be necessary to meet his educational needs, applied behavioral analysis therapy may also prove effective in modifying some of Chase’s behaviors and promoting effective coping mechanisms.