AISHWARYA ROY

21BSHH0061

CASE CONSTRUCTION AND INTERVENTION PLAN IN

REHABILITATION PSYCHOLOGY

DISORDER

AUTISM SPECTRUM DISORDER (ASD)

Autism Spectrum Disorder (ASD) is a developmental disorder that impairs the

ability to communicate and interact. Autism impacts the nervous system of an

individual and affects the overall cognitive, emotional, social and physical health

of the person. Although it can be diagnosed at any age, it is said to be a

developmental disorder as the symptoms usually appear in the first two years of a

person’s life.

CASE CONCEPTUALISATION
Name Sky Mill

Chronological age at assessment 3 years

Developmental age at assessment 1 years 4 months

Diagnosis Autism Spectrum Disorder

Background

Sky is a 7-year-old girl diagnosed with Autism Spectrum Disorder (ASD). She

lives with her parents and younger brother in a suburban neighbourhood. The

family generally speaks in Hindi. Her parents’ marriage is a non-consanguineous

one. Sky's parents noticed developmental differences in her from an early age,

including delayed speech and difficulty with social interactions.

1. Medical History: Sky’s pre-natal history reveals that her mother had a

history of typhoid, fever and cough during the third month of gestation
 due to which she was hospitalised for one week. She also experienced

stress during the initial phase of her pregnancy. Sky was born full-term

with a c-section delivery due to Meconium Aspiration Syndrome. When

she was 1 year old, Sky had cough and fever, leading to hospitalisation for

fifteen days. All his immunisations are on track and his nutritional

consumption is good. Parents reported that he eats solid food like roti,

vegetables, dal, rice and fruits. Her parents noted that Sky experienced

delays in achieving developmental milestones such as babbling,

pointing, and making eye contact. Sky's paediatrician diagnosed her

with ASD at the age of 3 based on clinical observations and

standardized assessments.

2. Social Environment: Sky's family consists of her parents, who are both

working professionals, and her 3-year-old brother. Her parents provide a

supportive and nurturing environment for her, but they struggle to

understand and manage her unique needs. Sky attends a mainstream

elementary school where she receives support from special education

teachers and therapists to address her communication and socialization

difficulties.

3. Psychosocial Factors: Sky's parents experience emotional distress and

uncertainty about her future due to her diagnosis. They often feel
 overwhelmed by the challenges of raising a child with special needs

while balancing work and family responsibilities. Despite their efforts to

support Sky, they encounter difficulties in accessing appropriate

interventions and services due to limited resources and financial

constraints.

Using the Biopsychosocial Model, the biological, psychological, and social

factors that contribute to the development and maintenance of ASD are:

1. Biological Factors:

o Genetic predisposition: Research suggests that genetic factors play

a significant role in the development of ASD. Sky may have

inherited genetic variations that increase her susceptibility to the

disorder.

o Neurological differences: Individuals with ASD often exhibit

atypical brain development, including differences in neural

connectivity and processing of sensory information. Sky may

experience difficulties in processing social cues and regulating her

emotions due to neurological differences.

 o Prenatal and perinatal factors: Although Sky's prenatal and

perinatal history appears unremarkable, factors such as maternal

stress, exposure to toxins, or complications during childbirth could

potentially influence her neurodevelopment.

2. Psychological Factors

o Cognitive processing: Individuals with ASD often exhibit

differences in cognitive processing, such as difficulty in

understanding abstract concepts and interpreting social cues. Sky

may struggle with theory of mind and perspective-taking abilities,

impacting her social interactions and communication skills.

o Behavioural patterns: Sky may engage in repetitive behaviours and

exhibit restricted interest’s characteristic of ASD. These behaviours

serve as coping mechanisms to regulate sensory experiences and

mitigate anxiety in unfamiliar situations.

3. Social Factors:
 o Family dynamics: Sky's family plays a crucial role in shaping her

social and emotional development. Despite their best efforts, her

parents may experience stress and strain in navigating the challenges

associated with raising a child with ASD.

o Peer relationships: Sky's ability to form meaningful relationships

with peers may be compromised due to her social communication

deficits and difficulties understanding social norms. Limited social

interaction opportunities may contribute to feelings of isolation and

loneliness.

EARLY INTERVENTION PROCESS

1. Identification: The first step starts with identifying infants or children

with higher risk of developing a disability. It also involves identifying

young children showing early signs of social, emotional or behavioural

problems such as withdrawal and fearful behaviour, anxiety, distress,

aggression or disruptive behaviour.

2. Referral: This step involves referring the child and family to specialist

services for assessment of development, behaviour and overall wellbeing

 of the child. A comprehensive assessment is done, and such an assessment

helps understand the current level of a child’s abilities, identify what

should be taught next, and address any guidance and counselling needs of

the parents. Furthermore, such an assessment is helpful in framing a

therapy routine for the child. In case of concerns associated with a child’s

development or behaviour, families could consult a general practitioner for

initial assessment.

3. Diagnosis: The third step is diagnosis. The early intervention service

provider diagnoses the child after gaining an in-depth understanding of the

factors affecting the child and the family. Such a diagnosis involves the

use of various assessment tools.

4. Individualised Early Intervention Plan: This stage involves drafting an

intervention structure with a timeline to support positive development

outcomes of the child. Here, long-term (quarterly) goals and short-term

(monthly) goals are identified for every individual child. These are then

reviewed on a monthly basis. This review informs the next cycle of goal-

setting for the child.

 5. Early Intervention Support: Finally, treatment and support services are

provided in accordance to the individualised intervention plan of the child.

These interventions involve working with occupational therapists, speech

therapists, special educators and psychologists.

INTERVENTON DESIGN FOR SKY

On doing a comprehensive assessment, the assessment revealed that Sky had mild

developmental delay. His major areas of concern included the following:

o Difficulty in maintaining eye contact

o Poor sitting span

o Inability to play with other children in a group

o Difficulty with gross and fine motor skills

o Delayed speech

o Hyperactivity

o Poor attention span

Following the assessments and identification of challenges, an individualised

therapy plan was formulated for Sky. She began receiving occupational therapy,

speech therapy and special education sessions three days a week. The
interventions were aimed at certain therapeutic goals for Sky including better

linguistic skills and the ability to play and socialise while decreasing

hyperactivity. Other goals for him included improving eye contact, sitting span

and speech.

THERAPY GOALS ACTIVITY

 Improving eye contact:

OCCUPATIONAL o Laser light
Enhancing Sky's ability to
THERAPY tracking
make eye contact is

crucial for improving his

o Nose to nose
social communication
pointing
skills and interpersonal

connections. To achieve
o Clip activity
this goal, occupational

therapy sessions will

o Beads and
incorporate activities such
thread
 as laser light tracking, activity

where Sky follows a laser

pointer with his eyes, and

nose-to-nose pointing

exercises, where he

practices directing his

gaze towards a partner's

face.

 Improving sitting span:

Increasing Sky's sitting

span will support his

participation in structured

activities and learning

opportunities.

Occupational therapists

will engage Sky in clip

activities, where he

practices manipulating

small clips to improve

hand-eye coordination
 and fine motor skills,

while also increasing his

tolerance for seated

activities.

 Improving attention

span: Enhancing Sky's

attention span is essential

for facilitating learning

and engagement in

various environments.

Occupational therapy

sessions will include bead

and thread activities,

where Sky threads beads

onto a string, promoting

sustained attention and

concentration while also

refining his fine motor

control and hand

 dexterity

o Blowing
SPEECH  Improving attention
bubbles
THERAPY span: Enhancing Sky's

attention span and eye

o Chew tubes
contact skills are

fundamental for his

receptive and expressive o Thread and

language development. bead activity

Speech therapy sessions

will incorporate activities Vocalisation

such as blowing bubbles, Placement of
which encourage articulators
sustained attention and

eye contact as Sky

anticipates and interacts

with the bubbles.

 Improving eye contact:

 Strengthening Sky's Oro-

facial muscles is

important for improving

speech articulation and

clarity. Speech therapists

will introduce chew

tubes, which encourage

Sky to practice chewing

motions to strengthen his

jaw muscles, improving

his oral motor skills and

speech production

abilities.

 Improving oro-facial

strengthening:

Promoting vocalization

and proper placement of

articulators are essential

for improving Sky's

speech intelligibility and

 language development.

Speech therapy sessions

will involve activities

such as thread and bead

exercises, where Sky

practices vocalizing

sounds while

manipulating beads with

his fingers, promoting

coordination between oral

motor movements and

speech production.

 Improving gripping the o Pencil

SPECIAL
pencil: Developing Sky's holding
EDUCATION
pencil grip is crucial for

facilitating his o Scribbling

 participation in writing

and drawing activities. o Colouring

Special education

sessions will focus on

pencil holding

techniques, providing Sky

with opportunities to

practice holding and

controlling a pencil using

an appropriate grip.

 Improving scribbling:

Enhancing Sky's

scribbling skills lays the

foundation for pre-writing

and drawing abilities.

Special education

activities will include

guided scribbling

exercises, where Sky

practices making
 controlled marks and

lines on paper, promoting

hand-eye coordination

and fine motor control.

 Improving eye contact

Improving attention

span: Enhancing Sky's

ability to maintain eye

contact and attention is

essential for his academic

and social development.

Special education

sessions will incorporate

engaging activities such

as colouring, where Sky

practices attending to

visual stimuli and

sustaining attention while

engaging in creative
 tasks.

The intervention plan for Sky's Autism Spectrum Disorder integrates evidence-

based strategies and activities across occupational therapy, speech therapy, and

special education domains. By addressing specific therapy goals related to eye

contact, attention span, fine motor skills, oral motor abilities, and academic

readiness, Sky's therapy program aims to support his overall development and

enhance his functional abilities across various contexts. Additionally, the

collaborative efforts of interdisciplinary professionals ensure a comprehensive

and individualized approach to addressing Sky's unique needs and promoting his

overall well-being.

JUSTIFICATION

The proposed interventions for John's Autism Spectrum Disorder (ASD) are

justified by drawing upon relevant theories, empirical evidence, and case studies

within the fields of occupational therapy, speech therapy, and special education:
1. Occupational Therapy (OT)

o Sensory Integration Theory: The activities such as laser light

tracking and bead threading are grounded in sensory integration

theory, which posits that individuals with ASD may have difficulties

processing sensory information. By engaging in sensory-based

activities, John can improve his sensory processing abilities and

regulate his responses to sensory stimuli (Case-Smith & Arbesman,

2008).

o Applied Behavior Analysis (ABA): ABA principles are incorporated

into clip activities to reinforce desired behaviours and increase John's

tolerance for seated tasks. ABA techniques have been widely used to

address behavioural challenges and promote skill acquisition in

individuals with ASD (Dawson & Osterling, 1997).

2. Speech Therapy

o Oral Motor Therapy: The use of chew tubes and bead threading

activities targets John's oral motor skills, which are essential for

speech production. Oral motor therapy interventions have been shown

to improve articulation and speech intelligibility in individuals with

 speech disorders (American Speech-Language-Hearing Association,

2010).

o Social Communication Theory: Activities like blowing bubbles

promote social interaction and communication by encouraging eye

contact and turn-taking. Social communication theory emphasizes the

importance of nonverbal communication skills, such as eye contact, in

facilitating social interaction and language development (Siller &

Sigman, 2008).

3. Special Education

o Developmental Milestones Theory: The focus on improving pencil

grip and scribbling aligns with developmental milestones theory,

which highlights the importance of fine motor skills in preparing

children for academic tasks like writing and drawing (Case-Smith &

O'Brien, 2010).

o Universal Design for Learning (UDL): The use of visual supports

and structured activities in special education interventions reflects the

principles of UDL, which advocate for multiple means of

representation, engagement, and expression to address diverse learning

needs (Rose & Meyer, 2002).

4. Empirical Evidence
 o Meta-analytic reviews and systematic reviews have consistently

demonstrated the effectiveness of occupational therapy, speech

therapy, and special education interventions in improving outcomes for

individuals with ASD, including communication skills, social

interaction, adaptive behavior, and academic achievement (Reichow &

Volkmar, 2010; Rogers & Vismara, 2008).

o Longitudinal studies have provided evidence for the enduring

benefits of early intervention programs that incorporate a combination

of therapy modalities, emphasizing the importance of early

identification and intervention for optimal outcomes in children with

ASD (Dawson et al., 2010; Warren et al., 2011).

REFERENCES

o Signs & Symptoms | Autism Spectrum Disorder (ASD) | NCBDDD | CDC.

(2023, January 11). Centers for Disease Control and Prevention.

o Force, A. O. T. A. E. C. I. T., & Dunn, W. (1989, January 1). Guidelines

for Occupational Therapy Services in Early Intervention and Preschool
Services. Amer Occupational Therapy Assn.

o Medicine, N. A. O. S. E. A., Division, H. A. M., Education, D. O. B. A. S.

S. A., Families, B. O. C. Y. A., & Health, F. O. P. C. C. A. A. B. (2016,
October 24). Ensuring Quality and Accessible Care for Children with
 Disabilities and Complex Health and Educational Needs. National
Academies Press.

o Need, Significance & Efforts by Sarthak

o Class notes