Case Study of Autism Individual with ADHD; From Assessment to Discharge

Introduction: Autism spectrum disorder, or ASD, includes what used to be called Autistic Disorder, Asperger syndrome, or Pervasive Developmental Disorder – NotOtherwise Specified, all of which affect a person’s social and emotional skills and nonverbal communication. ASD has many similarities to ADHD, but there are alsodifferences between the two. Can a person be diagnosed with both ADHD and ASD? More than half of all individuals who have been diagnosed with ASD also have signs ofADHD. In fact, ADHD is the most common coexisting condition in children with ASD. On the flip side, up to a quarter of children with ADHD have low-level signs of ASD,which might include having difficulty with social skills or being very sensitive to clothing textures, for example. Why do ADHD and ASD coexist so often and what are thesimilarities between them? Both ADHD and ASD are neurodevelopmental disorders (brain development has been affected in some way). That means both conditions/disorders affect the central nervous system, which is responsible for movement, language, memory, and social and focusing skills. A number of scientific studies have shown that the two conditions often coexist, but researchers have not yet figured out why they do. With ADHD or ASD, brain development has been affected in some way. Mostimportantly, that includes the brain’s executive functioning, which is responsible for decision making, impulse control, time management, focus, and organization skills. Formany children, social skills are also affected. Both ADHD and ASD are more common in boys. ASHA’s Guidelines for Speech-Language Pathologists in Diagnosis, Assessment,and Treatment of Autism Spectrum Disorders Across the Life Span provides information related to assessment and intervention including a focus on AAC. The guidelinesrecognize that AAC choices must be based upon an individual’s needs, including learning strengths and weaknesses, level of social communication skills, and motor abilities. These guidelines and other ASHA policy documents are now a part of a continuing education program (see sidebar below). These policy documents can help clinicians navigate the case studies presented below and assist with their own decisions about assessment and intervention tools and strategies. The following case study present child with ASD and describe the SLP’s strategies to enhance communication and quality of life. Methods: Case study; Hosein: A ۳ years old boy that diagnosed with both ASD andADHD was evaluated by me (a speech language pathologist). I assessed his language, speech, pragmatic, memory, attention, and making communication with others. He wasfar from the same ages in every aspect. For example his verbal communication skills are in preverbal stage, the speech was in making sounds randomly, he didn't know anything as pragmatic, he forgot everything that his mother taught him and the attention wasn't switch at different tasks at the end he didn't use to be like human very hyperactive very lonely with repetitive movements in his hands. Assessment: The Communication Symbolic and Behavior Scales Developmental Profile (CSBS DP) was used to determine communicative competence. This norm-referenced instrument for children ۶–۲۴ months old is characterized by outstanding psychometric data (i.e., sensitivity=۸۹.۴%–۹۴.۴%; specificity=۸۹.۴%). Although Hosein was ۳۶ months old, this tool was chosen because it provides salient information about social communication development for children from ۶ months to ۶ years old. Intervention: First of all i referred him to the doctor and received medicine for paying attention and after that we started speech and behavior therapy. Hosein’s team and family members developed communication goals that included spontaneously using a consistent communication system for a variety of communicative functions and initiating and responding to bids for joint attention. Research suggests that joint attention is essential to the development of social, cognitive, and verbal abilities. Because Hosein could not meet his needs through verbal communication, AAC was considered. He had been taught some signs but did not use them communicatively. More importantly, his motor imitation skills were so poor that it was difficult to differentiate his signs. His communication partners would need to learn not only standard signs, but Hosein’s idiosyncratic signs. Therefore, the Picture Exchange Communication System was chosen to provide him with a consistent communication system. Additionally, a visual schedule was used at home and school to aid in transitions and to increase his symbolization. Incidental teaching methods including choices and incomplete activities were embedded in home and preschool routines. In addition, a variety of joint activity routines (e.g., singing and moving to “Ring Around the Rosie” or “Row Your Boat” while holding hands) that were socially pleasing to Hosein were identified. These were infused throughout his day in various settings and with various people. Picture representations of these play routines also were represented in his PECS book. Research: Several evidence-based strategies were chosen to support intervention, including PECS, visual supports, and incidental teaching. Results: By the end of the year, a video taken at preschool showed that Hosein was spontaneously using PECS for requests and protests. He was using speech along with his PECS requests in the “I want” format. He also used speech alone for one-word requests and for automatic routines such as counting or “ready, set, go.” He shared excitement and joy in several joint activity routines with various people and referred to their facial expressions for approval and reassurance.

کلیدواژه ها:

Autism ، ADHD ، Assessment ، Discharge.