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In this case study we will look at Mia (not the real name). Mia is a 9yr old girl. She lives with both parents  - who are professionals - and her 12yr old sister. There are some neurodevelopmental traits and diagnosis (e.g. dyslexia) in the wider family. Her mum and older sister have OCD and her sister also has anxiety receiving CBT therapy. 

Her parents listed a number of concerns regarding 

  • Interactions with others – Mia takes things literally, not understanding humour – often thinking that people are cruel – and she can also become rude to others telling them off. She is very honest which can cause issues as people think she’s rude, she just says it straight e.g. ‘You are fat’. She did not like anyone visiting the family at home and can get tearful and upset in birthdays: she withdraws and plays in her room. She then does not interact with other family members. 

  • Friendships – She struggles making friends. 

  • Emotion Regulation – Mia gets stressed about school. She often complained of getting tummy ache when she was younger. Even to date there are days she gets anxious and doesn’t want to go to school. 

  • Repetitive behaviour – Mia likes order e.g. she packs her bag in school in a very particular order. She also likes to play the same thing all the time. Similarly she likes to eat the same things (has a very restricted diet).

  • Sensory needs – Mia is sensitive to noise, smells and textures. Noise causes her the most upset for example she avoids the dining hall at school as it gets very busy and noisy. 

Mia was offered an assessment in the clinic. The assessment consisted of a face to face observation appointment (ADOS-2) where Mia spent approximately one hour with a clinician (a Specialist Speech and Language Therapist). The aim of the appointment was to check Mia’s social communication and interaction skills with an unfamiliar adult who was friendly and attempted to engage Mia in various activities and talk. 

The second part of the assessment involved Mia’s parents. They spoke to a Clinical Psychologist (who had the overall responsibility for the assessment) about Mia from birth. The focus of the interview (ADI-R including a developmental history) was to check different aspects of Mia’s life such as social, emotional, behavioural and learning with a particular focus on Mia’s social communication skills. 

The third part consisted of information from school. 

When all the information was provided the two clinicians reviewed the evidence and decided that Mia met the criteria for a diagnosis. Mia scored above the clinical threshold in both the ADOS-2 and the ADI-R. The school information partially agreed with the information provided from Mia’s parents. However, this is not uncommon especially with regards to young girls as the school might to observe fewer difficulties than those reported by parents at home. This happens for various reasons including the child’s ability to mask certain behaviours in school from fear of rejection. 

Mia presented as a friendly and anxious girl in the clinic. She showed difficulties in many areas associated with ASD including non-verbal, verbal and reciprocal communication as well as sensory seeking and unusual/repetitive behaviours. The observation matched the parental detailed reports. The differential diagnosis performed by the Clinical Psychologist showed that the reported and observed behaviours could not be explained by reference to any other possible issues (e.g. anxiety, OCD, ADHD etc). There were also no significant events in the child’s history. There was also obvious impact of the presence of these behaviours to Mia’s life including her ability to self-regulate her emotions, her behaviour and her ability to interact with other and form relationships. It was therefore concluded that the observed difficulties (or differences) could only be attributed and explained by reference to an underlying condition, namely Autism. 

Mia was given a diagnosis of Autism. Given the fact that there were no learning related needs Mia would belong to the informal category of High Functioning Autism. Although Mia has no difficulties understanding academic related concepts (she is in fact above average in school) however she has difficulties making sense of social cues and contexts resulting in increased levels of anxiety in social situations (this can partially explain her anxiety about going to school). Sensory related needs further increase her difficulties in unfamiliar and unpredictable environments. 

The Clinical Psychologist provided feedback to the family explaining the assessment process and the conclusion in detail with reference to the information that was available from all parties. 

The clinic also offered Mia’s parents psychoeducation which was purchased separately from the assessment. Psychoeducation enabled parents to understand Autism better in reference to Mia. They were able to reflect on Mia’s ‘unusual’ behaviours and get a glimpse of how she sees the worlds through her Autistic ‘filter’. They were also provided with some strategies to help Mia with emotion regulation and behaviour and given advise about accessing professional help for mental health difficulties. The report also contained advice about different aspects of Autism including Sensory, Behaviour, Emotional and Social. 


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