CASE STUDY OF AUTISM SPECTRUM DISORDER

SHAMIMI BINTI STANIRUN

SEMESTER 8

BACHELOR OF PSYCHOLOGY

SULTAN IDRIS EDUCATION UNIVERSITY

SUPERVISOR’S NAME: MISS RUWINAH BINTI ABDUL KARIM

 CASE STUDY OF NUR AISYAH

NAME : NURAISYAH BINTI FAUZIH

DATE OF BIRTH : 3th SEPTEMBER 2015
AGE : 6 YEARS OLD
DIAGNOSIS : PROVISIONAL DIAGNOSIS OF AUTISM SPECTRUM
DISORDER (MODERATE)
PARENT’S OCCUPATION : FATHER – (GENERAL WORKER)
MOTHER – (HOUSEWIFE)

BACKGROUND INFORMATION
Patient is a 6 years old, Malay girl. She has been enrolled in Penawar Special Learning
Centre (PSLC) Hospital Penawar on 1st February 2021.

BIRTH HSTORY

Patient was a full-term baby born via spontaneous vaginal delivery (SVD). No other serious
complication reported by mother.

MEDICAL HISTORY

Patient has no medical history that lead to autism spectrum disorder. Patient also did not
undergo any therapy at any centre or hospital before. Currently, patient has been consuming a
vitamin C supplement for herself.

FAMILY HISTORY

Patient is the eldest child in the family and lives with her father, mother and her younger
brother in a house located in Taman Bukit Dahlia. Currently, her father has suffer from
hypertension and was on a medication while her mother is in a good condition. Mother also
reported that there is no inheritance of autism spectrum disorder in the family.
SCHOOL HISTORY
Before this, patient had enrolled in a pre-school at Taman Bukit Dahlia. However, her mother
received complaints from a teacher at school regarding her hyperactiveness including
difficulty to remain seated and focus in class, unable to understand and followed instructions,
throwing tantrum and difficulty to go to the toilet by herself. Thus, she had been eliminated
from the school.
INTRODUCTION

Autism is a developmental disorder diagnosed on the basis of early-emerging social and

communication impairments and restricted/repetitive behaviors. The manifestation of these
varies greatly with age and ability, and the notion of an autism spectrum has been introduced
to recognise this diversity. Symptoms can range from mild to severe and often change over
time. ASD is usually first diagnosed in childhood with many of the most-obvious signs
presenting around 2-3 years old, but some children with autism develop normally until
toddlerhood when they stop acquiring or lose previously gained skills. The characteristics of
autism are divided into two categories which is social interaction and communication
problems including difficulties in normal back-and-forth conversation, challenges in
understanding or responding to social cues such as eye contact and facial expressions and
deficits in maintaining relationships. The second categories is the restricted and
repetitive patterns of behaviors including hand-flapping and toe-walking, playing with toys in
an uncommon way (such as lining up toys) and experiencing the sensory aspects of the world
in an unusual or extreme way.

. ASSESSMENT

STANDARDIZE NON-STANDARDIZE

Gilliam Autism Rating Scale, 3th Edition Autism Observation Checklist

(Gars-3)

GARS-3 is a widely used instruments for This checklist was developed as non-
the assessment of autism spectrum disorder. standardized assessment for Autism child
It is suitable for an individuals with the age and adult that were adapted from Autism
of 2-22 years old. GARS-3 consist of 58 Communication Tool. It consist of 52 items
items that were divided into six subscales that were divided into four subscales
including Restricted/Repetitive Behaviour, including Communication, Restricted,
Social Interaction, Social communication, Repetitive, Stereotypes
Emotional Responses, Cognitive style, Behaviour/Movements and social skills.
Maladaptive Speech.
FINDINGS

1. Gilliam Autism Rating Scale, 3th edition

Based on Gilliam Autism Rating Scale, 3th edition, patient has an autism index of 94 which
shows that her probability of ASD is very likely. According to DSM-S severity level for
ASD, patient is being categorised as level 2 that requiring substantial support.

2. Autism Observation Checklist

Based on the communication subscale in the autism behaviour checklist, patient has a delay
in the development of her spoken language in which she has a very limited words. She also
has a difficulty in maintaining a conservation (eg; unable to respond when teacher ask her a
question) and display an unusual/ repetitive language (eg; echolalia and whispering). For the
restricted, repetitive, stereotyped behaviours/movements subscale, patient showed non-
functional play with toys in which she lining up the toys that were given by the teacher. She
also display a rigid behaviour with her hair. Whenever teacher tie her hair in the ponytails
pattern, she will get upset and prefer to wear a pigtails only. Next is the social skills subscale.
Patient shows a high impairments in her social skills including inconsistent eye contact,
blunted expression in certain situations, poor attention in responding when her name is being
called, unable to share things that she likes, showed no interest in praise or compliments and
prefers to be alone. Patient also display strong sensory preferences (eg; picky eater) and
showed a sensory seeking behaviour, (loves to climb on the monkey bar).
PROBLEM ANALYSIS

BIL COMPONENT DESCRIPTION

1. COGNITIVE SKILL  Fair attention (more to daydreaming) but still easily
get distracted with the surrounding
 Need to be called more than 3 times to get her
attention
 Fair in understanding complex instruction given by
the teacher
2. SENSORY a) Gustatory Input
- Picky eater especially regarding food taste and
texture (Eg; she refused to eat rice)
b) Proprioceptive Input
- Patient has restless behaviour (difficulty to sit
still)
c) Vestibular Input
- Climb on the monkey bar without any instruction
given by the teacher
d) Visual Input
- Patient often smile and stares at her own shadow
for more than 5 seconds

3. BEHAVIOUR  Fair sitting tolerance (able to sit for only 20 mins)

- having difficulty to sit still during an activity with
minimum supervision from the teacher
 Showed repetitive behaviour
- lining up chairs in the class without supervision
from the teacher)
 Showed rigid behaviour
- Prefer to wear her hair in pigtails rather than
ponytails
  Throwing tantrum when things doesn’t go on her
way (desperate to get things quickly).
4. SOCIAL  Poor eye contact with the people who talk to her
 Having difficulty in sharing things that she likes
 Blunted expression in certain situation
 Doesn’t mingle around with her peers (prefer to sit
alone
5. EDUCATION /  Pre-handwriting skill
HANDWRITTING - fair ability to trace line especially the curve line
(minimal physical prompt)
6. COMMUNICATION  Poor in answering a question asked by the teacher
SKILLS  Often repeat other’s word (echolalia)

OBJECTIVES

SHORT-TERM GOAL LONG-TERM GOAL

1) To improve her concentration and 1) To improve her school readiness

attention in doing an activity (able to sit and cooperate in a class
setting)
2) To improve her ability to follow an
instruction 2) To improve her activity daily living
skills (dressing, grooming,
3) To improve her sitting tolerance for buttoning, eating)
more than 20 minutes

4) To improve her social skills by

initiating her interaction with the
other kids

5) To sustain her eye contact for more

than 10 seconds
TREATMENT ACTIVITY/ IMPLEMENTATION

SENSORY ACTIVITIES

 Functional handstand (to improve her divided attention)

 Jumping on the trampoline (to increase her vestibular input)

COGNITIVE ACTIVITIES

 Playing puzzle (to improve her attention and sitting tolerance)

FINE MOTOR ACTIVITIES

 Inserting sticks into the container (to improve her attention, fine motor and sitting
tolerance)

 Inserting button into the shoe lace (to improve her attention, fine motor and sitting
tolerance)

 Playing clay (to improve her attention, fine motor and sitting tolerance)

MOTOR PLANNING ACTIVITIES

 Jumping from one hoop to another, crawling into the tunnel, walking from chair
to chair and inserting sticks into the container (to improve her attention and ability
to understand instructions)

 Running from on checkpoint to another checkpoint and sorts object according to

its color

SOCIAL ACTIVITIES

 Involved her in the group therapy (to improve her social play skills)

 Asking her to help her friends to get down from the table or to help her friend to
go downstairs (to initiate her interaction with peers)

 Show her an interesting objects and then bring the object towards my eyes (to
improve her eye contact)
  Asking her to give objects to her friends and her friends will insert the object into
a basket (to improve her sharing ability)

 Playing blocks and cooking set with her peers (to improve her social play skills)

TREATMENT PLANNING

• Expose her more on cognitive activity such as playing puzzle

• Involve her more on social activity

• Involve her more on sitting tolerance activity

• Expose her more on ADL activities such as dressing, buttoning, grooming, eating

REASSESMENT

After several weeks of implementation activities done with the patient

BEFORE AFTER
Cognitive Cognitive
1) Fair attention but still easily get 1) Improved: Able to pay attention to solve
distracted with the surrounding the puzzle but with the visual prompt
2) Fair in understanding complex 2) No progression
instruction given by the teacher
Behaviour Behaviour
3) Fair sitting tolerance (able to sit for 3) Improved: Able to sit for 30 mins to
only 20 mins)- having difficulty to complete an activity (eg:, solving puzzle,
sit still during an activity with inserting buttons into the shoe lace)
minimum supervision from the
teacher

Social Social
4) Doesn’t mingle around with her 4) Improved: Able to play with her friend
peers (prefer to sit alone) (run)
5) Poor eye contact 5) No progression
CONCLUSION

Currently, patient had been enrolled in the School Based Therapy programme at Penawar
Special Learning Centre in Pasir Gudang. The implementation of interventions on the patient,
showed positive improvement in certain area. However, continuous intervention is needed in
order to achieve short-term and long-term goal of the patient.
REFERENCES

Frith, U., & Happe, F. (n.d.). Autism spectrum disorder. Current Biology, 15(19).

Gilliam autism rating scale: Third edition. (n.d.). Retrieved April 13, 2021, from
https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-
Assessments/Behavior/Gilliam-Autism-Rating-Scale-%7C-Third-Edition/p/
100000802.html

Minaei, A., & Nazeri, S. (2018, September 10). Psychometric properties of the Gilliam
Autism Rating SCALE–THIRD edition (GARS-3) in individuals with Autism: A pilot
study. Retrieved April 13, 2021, from http://joec.ir/article-1-847-en.html