The Case of Henry Smith

Below is an assessment I recently wrote for a client to continue funding (whose name I have changed to"Henry Smith"). This assessment accurately reveals the type of biopsychosocial challenges teens with ASD face on a daily basis.

The assessment is lengthy --  6 pages (at a 12 font/single space). As such I will post the assessment in three sections.

Six Month Assessment:

This report is written reference to Henry Smith. Over the past six months Henry's conversation skills have remained limited by his orientation towards areas of special interest as conversation topics. Henry is capable of sustaining a conversation with peers and adults on topics related to film, music, and events within pop culture. Henry is able to focus on the communication of a partner and is capable of asking relevant questions that serve to sustain conversation. Unfortunately, Henry has great difficulty when the conversation moves in a direction outside of his range of interests or when his conversation partner expresses a preference, idea, or perception that violates Henry's worldview or moral standards.

Henry is easily offended and quickly rejects and criticizes peers when they express or defend a position different from his. This is particularly problematic because Henry often takes exception to topics that are within the mainstream of teen discourse. Most notably, Henry has great difficulty accepting conversations related to dating or to sexual behavior. Henry is hostile and often rejecting of his peers when they express an interest in opposite sex relationships, dating, or sexuality. Although Henry is certainly a kind and generous young man, his adherence to narrow moralistic standards and general unwillingness to investigate different points of view lead to a very limited capacity to communicate.

Henry's has many strengths with respect to relationship skills. He can be kind and supportive of his friends, particularly when a friend is struggling with an emotional issue at school, at home, or within the community. Henry is capable of demonstrating empathy and warmth and is capable of prioritizing a friend’s needs over his own. With this said, Henry has great difficulty with age-level emotional intimacy. Henry is guarded, avoidant, and fearful of age-appropriate emotional connections with peers. Henry avoids peers outside of school or group settings, opting instead to stay close to home and engage with his parents. As such, Henry is unable to maintain relationships based on shared positive experiences, common attributes, interests, and mutual concern. Correspondingly, Henry has yet to develop a shared memory bank of bonding experiences that include overcoming challenges with a partner, mutual enjoyment, empathy, and mutual trust. Henry also continues to struggle to successfully repair inevitable conflicts and misunderstandings.

Henry has strong a group interaction skills. He is capable of contributing to a common goal, is capable of allowing others to lead and direct activities, and can make compromises during group activities in order to maintain group cohesion. Henry also consistently demonstrates good sportsmanship during competitive games, joins activities with enthusiasm in order to support group cohesion, and is able to maintain involvement in group activities when he may be tired or disinterested. The problem with group interaction for Henry is related to his degree of cognitive in flexibility. As was noted above, if Henry does not share common point of view or has a perspective that is in conflict with a peer or a group, he can be quick  to reject the activity or topic of conversation and withdraw. This withdrawal may also include criticism and negative comments directed towards an individual or the group as a whole.

Henry has significant difficulties in the area of self management. As has been noted in previous reports, he suffers from severe obsessive compulsive disorder. Henry is highly anxious about harm coming to himself and to his family and has elaborate rituals that intrude upon his daily life. Henry engages in a variety of counting, checking, and praying rituals that affect his ability to maintain conversations, transition from one activity to another, and focus on a particular person or activity. Henry is fully capable of regulating physical and verbal impulsivity, but is lacking in his capacity to cope with his anxiety disorder. Henry’s parents have been referred to mental health specialists who could work with Henry using cognitive behavioral therapy techniques. Unfortunately, due to the fact that his parents are monolingual and have very limited financial resources, they have been unable to access appropriate mental health care for Henry.

With respect to conflict resolution skills, Henry is often able to negotiate differences when angry, can be flexible during negotiations, and often will focus on positive solutions. The problem for Henry is there is a point at which he becomes incapable of adopting and empathic perspective on a problem. Henry is easily triggered when a friend or conversation partner adopts a perspective that he finds to be morally offensive. Henry has very strict rules and regulations as it relates to what types of films people should watch, what types of activities peers should engage in, and most of all whether or not it is appropriate to talk about topics related to opposite sex relationships. When a peer wanders into one of these areas innocently, Henry can be harsh, rejecting, and contemptuous. When an adult attempts to mediate the conflict, Henry often rejects the assistance, opting instead to lecture and engage in monologues about why he is right and why his conversation partner is wrong.

 

With respect to the area of cognitive flexibility, Henry struggles to monitor, evaluate, and adjust his actions, attention, and thinking in a dynamic or fluid manner based on contextual information and feedback. Henry has significant deficits in managing real-world or grey area social problems, is generally incapable of improvising in social settings, and rejects “good enough” solutions. Henry adopts the perspective that it is his way or no way. As such, he frequently rejects peers who are very interested in maintaining relationships with him.

Part two: next post

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