CASE OF TOMMY

The Case of Tommy – High Level Autistic Disorder
Tommy R. is a 6-year-old Caucasian male kindergarten student in a K-8 combined elementary
and junior high school in the San Jose greater metropolitan area. He has a sister ahead of him
in the third grade who is enjoying school with numerous friends. The school principal has
requested a meeting with you (an elementary school counselor), the district psychologist, and
the parents to discuss Tommy’s classroom behavior as well as his level of academic school
performance. The principal has received numerous complaints from Tommy’s kindergarten
teacher over the past 2 months about Tommy’s inability to comply with basic classroom rules
and expectations as well as his difficulty in performing expected academic tasks. An IEP
(Individualized Education Plan) process has been initiated.
During the IEP interview with the parents, his father presents as a very shy, soft-spoken man
who often works from home as a computer software engineer; his mother works in an office as
an administrative support specialist, and in contrast, appears bright and vivacious. At the
meeting the principal asks the parents what they have experienced while raising Tommy. The
parents state that “Tommy has always been a little different, but he is a good boy.” They also
say that he did not start talking until he was about 2 years old, but Tommy’s father interrupts
and says, “I didn’t start talking until I was almost 2 years old and I turned out ok!” The mother
states that Tommy has trouble on “play-dates” with other children. She says that when at a
neighborhood park with Tommy, when he is playing in the sandbox with other children, he
doesn’t share toys, sometimes hits other children when he is angry, and also cries in a shrill,
loud voice when he doesn’t get his way.
Tommy’s mother also says that he doesn’t have any “real” friends and that she has stopped
taking him on play dates because he is too difficult to manage. She also reports that he
doesn’t always respond to her voice when she calls. She has to touch his shoulder and directly
look him in the eyes before he responds. She also says that he needs a lot of coaching and
supervision to get dressed in the morning. His hand also has to be held tightly when crossing
the street because he sometimes darts out into the street.
Tommy’s kindergarten teacher reports that there are major problems with Tommy’s behavior in
her classroom. She states that during circle time she has to have Tommy sit right next to her.
She says it is necessary for her to put her hand on his shoulder and speak to him firmly and
loudly in order to keep him in the circle. She says that his attention often wanders, he doesn’t
follow directions like other children, and he sometimes appears either not to understand her
directions or does not seem to care about what she says. She reports that he has hit other
children who casually bumped into him on the playground or tried to get him “to share” toys.
She also states that when he has to change activities he cries and rocks back and forth for 10
to 20 minutes before he can go on to the next activity.

1. In a Background section, summarize the current DSM criteria (use the following website if
you do not have a copy of the current DSM: http://behavenet.com/apa-diagnosticclassification-dsm-iv-tr)
and description for the selected case study, making sure toinclude
the following:
a. What genetic and environmental contributions may influence this disorder?
b. What brain abnormalities may be indicated for this disorder and what information
might be revealed by use of brains scans such as PET, fMRI, SPECT,etc.
c. What legal, ethical, and forensic issues arise following a diagnosis of dementia,
stroke, or autistic disorder? (Hint: Discuss applicable mental health laws versus
noncompliance due to challenges in meeting required standards of care due to
funding limitations in the current managed care environment.)

2. What interviews, tests, and assessment would you use to diagnose this disorder and
what results do you expect from these tests and assessment? Describe the use of the
following tests and assessments (as applicable) to describe the psychologicaldisorder:

c. Assessment of Cognitive Speed – There is a child’s version of the Trails A & B. If a child can do the WISCIV,
there is a Digit-Symbol Test within it; but consider using the DAS which has alower
―floor‖ and may be more doable for children with autistic disorder.

d. Assessment of two and three dimensional constructional ability

e. Assessment of Verbal and Spatial memory (CVLT, Rey Osterreith Complex Figure). For
autism disorder case h. Assessment of Intellectual Ability and Achievementstudy, use Differential Ability Scales subtests only; other tests are
too complex for children

f. Assessment of Verbal Fluency (Boston Naming Test, FAS; for autism disordercase
study, use Differential Ability Scales)

g. Assessment of Social Cognition (For the autistic disorder case study, use Autism
Diagnostic Observation Scale — ADOS level 1 or 2. Do not use WAIS Picture
Arrangement as it is too complex for children.)

h. Assessment of Intellectual Ability and Achievement Use Differential Ability
Scales for autistic disorder with children (unless the child is very high functioning, in
which case you can use WISC-IV).

i. Assessment of Executive Function (WCST, Category Test, Stroop). Use NEPSY battery
for high functioning autistic disorder children.

k. Assessment of daily functioning (―Vineland‖ for autism only

3. What recommendations for accommodations or rehabilitation do you suggest?
4. What prognosis do you make for your client?

Use 5-7 pieces of empirical literature in support of your observations and discussion.
Each citation must be presented in appropriate APA format.

Be approximately 7-10 pages, double-spaced, and created in 12 pointfont