WEEK 3 CASE OF ARTHUR EXPLANATION

F84.0 Autism Spectrum Disorder, Level I “requiring support” F95.1 Persistent Motor or Vocal Tic Disorder, with motor tics only Z55.9 Academic or Educational Problem Z65.8 Other Problem Related to Psychosocial Circumstances Z72.810 Child or Adolescent Antisocial Behavior IDENTIFYING/DEMOGRAPHIC DATA: Arthur is a 12-year-old male in 5th grade who was brought in for services by his adoptive mother. He is very small in stature, appearing to be only 8 years old. He also acts younger than his 12 years, carrying around toy cars in his pockets, which he proudly displays and talks about in detail. Arthur was adopted at age 2 by distant cousins. His mother was a single mom that had become involved with drugs. She knew she was unable to care for Arthur and decided to give him a better home. The adoptive parents are upper middle class and have three biological children (ages 9, 7, and 5). CHIEF COMPLAINT/PRESENTING PROBLEM: Arthur hates any type of transition and will get upset and have temper tantrums if she does not prepare him for any changes in plans. He is reported to kick and hit both parents, and they have had to restrain him at times to stop him from hurting himself and others. He sometimes reacted when his lunch was packed differently within his lunch box for school. He also seemed to pay less attention to teachers and often interrupted class with his own comments. HISTORY OF PRESENT ILLNESS: Initially Arthur’s parents were unsure what to do about their son’s behaviors. His mother is the primary caretaker and his father thought she should handle any therapy or problems related to school. His mother reported that she was now “at the end of her rope” and was ready to give her son up to foster care. Both parents are exhausted. Arthur’s mother shared her frustration with Arthur’s father, who “just does not understand how hard it is to care for him.” Arthur’s language and developmental skills were far less developed than his age at the time of his adoption. When the adoption was completed and they brought him home, Arthur cried often and refused to sleep for the first 2 days they had him. They tried holding him, but he would not quiet down. Arthur is reported to often get upset with his siblings and hit or kick them. His mother stated that Arthur has always had issues with jealousy, and when her other children were younger, she had to closely monitor him when he was around them. She reported several occasions when she found Arthur attempting to suffocate each of his younger siblings when they were babies. Arthur’s mother explained this as part of his “always being immature” and not good at explaining himself. Besides this, his mother reported that he is not a “mean” child but tends to function according to his own rules. He often needed reminders to use his “indoor voice” and to “wait his turn to speak.” The mother reported that Arthur often hides food in his room and gorges himself when he eats. She said she does not understand this behavior because he always has enough food, and she never restricts his eating. In fact, because of his small size and weight, she often encourages him to eat more. The parents have never sought help before, as Arthur managed to largely keep up with his schoolwork. He does have an aide in the classroom to help with his work and behavior. His mother said that he has always taken things literally, but up until 5th grade, he had attended school without major problems. They had not been concerned about his grades or lack of friends. His mother said that he has always been “very shy” and never had a “best friend.” He has always shown interest in cars, trains, and trucks. Recently, behaviors at school changed and worsened. His school has complained of his inability to focus and the increase in his disruptive behaviors. Collateral contact with his teachers confirmed that he struggles with school, has no friends, and often has “meltdowns” when he does not get his way. One teacher noted that in small group classroom activities, Arthur has trouble with restlessness and will stumble over his words, pause excessively, and restart talking fairly rapidly and loudly. His teachers noted a concern about occasional facial “tics” that occurred at times. His teachers commented that he talks a lot about details of World War II at times in school. PAST PSYCHIATRIC HISTORY: Arthur had never had any official testing for special education, nor had he ever received any counseling services. Since up to know he was able to keep up with his school work with the help of the aide.