Aaron is an 18-month-old who was diagnosed with autism at 17 months of age. His parents were devastated to learn that Aaron had autism. He had been diagnosed with epilepsy by a neurologist when he was 15 months old. Aaron has been on medication for his seizure disorder since his diagnosis. His seizures have been under control. His birth was much anticipated and uncomplicated. Aaron was the first born to his young parents. His parents describe him as a fussy baby who did not like to cuddle. His mother and father first became concerned when Aaron did not smile. His grandparents attributed this to his parent’s inexperience. Aaron also experienced some early feeding issues. These included some vomiting and slow weight gain.
At his six-month medical checkup Aaron’s parents brought up their concerns to his pediatrician. Aaron’s pediatrician was also concerned about Aaron’s slow weight gain. Some tests were ordered. He was found to be anemic but otherwise healthy. He was placed on an iron supplement.
Aaron’s parents became increasingly concerned, as he did not seem to be meeting his developmental milestones. For example, Aaron was 8 months old when he sat; 11 months old when he crawled; and 15 months old when he first starred to walk. Additionally, he was not responding to his name. His parents brought up concerns about deafness to their pediatrician. Although he was uncooperative with his hearing test, he did not appear to have a significant hearing loss.
Aaron experienced his first seizure at 15 months of age while he was on vacation with his parents. He was rushed to an emergency facility. After running some tests, a pediatrician made the diagnosis of epilepsy and recommended to the family that Aaron see a neurologist and receive an interdisciplinary evaluation when he returned home.
Although he was seen immediately by a neurologist, it took the family a couple of additional months to receive the interdisciplinary
evaluation. An occupational therapist, psychologist, and speech language pathologist evaluated him in consultation with the neurologist. The evaluations were conducted in a clinical setting. The evaluation consisted of administration of standardized tests, a series of questionnaires, and informal observations.
During the evaluation Aaron demonstrated fleeting eye contact. He did not respond to his name when called by either his parents or the examiners, nor did he follow simple commands such as “come here”, “give me” or “sit down”. He did not use gestures or words to communicate during the evaluation. Aaron was quiet, although some vocalizations, mostly vowel-consonant combinations, were heard. Aaron did not attempt to gain the attention of other people. He often maintained an open mouth posture with a protruding tongue.
Some drooling was also noted.
The mental and motor scales from the Bayley Scales of Infant Development-II were given to Aaron as well as the Receptive and Expressive Emergent Language Scale (REEL). His adaptive and social emotional abilities were informally assessed. Results revealed that Aaron demonstrated global developmental delays with atypical behaviors. His cognitive abilities were measured at the 7-month level. His motor skills were at the 12-month level. Aaron’s language skills were at the 6-7 month level. His feeding skills were considered significantly delayed. He had not started feeding himself; ate mostly stage two baby foods; and continued to drink from a bottle. The atypical behaviors that were observed included hand flapping and staring at the lights. Additionally, he did not play with the examiners. He did seek out his parents occasionally for some comfort.
The evaluation concluded that Aaron had epilepsy, autism, and global developmental delays. Early intervention services were recommended and Aaron was referred to the District of Columbia Early Intervention Program.
Discussion Questions—Aaron
1. Is Aaron eligible for services through the District of Columbia’s Early Intervention Program? Why or why not?
2. What are some of the characteristics of autism?
3. Since the diagnosis of autism is based on clinical rather than laboratory findings, what do you think the clinical assessment should include? What other assessments and or methods would you recommend for an evaluation of a child suspected of having autism?
4. What are some of the common and uncommon treatment strategies used with children who are diagnosed with autism?
5. What intervention strategies are used with children with autism? Select one intervention approach used with children with autism and discuss the evidence that supports its use.
6. What arc some questions you can think of that would be appropriate to ask Aaron’s parents in order to obtain more information about him?