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Case Study

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Homare Atkinson

on 20 June 2014

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Transcript of Case Study

By Homare Atkinson
Question 1
6 year old Jimmy was diagnosed with Autism Spectrum Disorder (ASD) also known as Asperger Syndrome at the age of 3. Before and after his diagnosis, Jimmy showed many symptoms and signs of ASD. Before we go into further detail about Jimmy's diagnosis, here is a video which explains the symptoms of ASD in children.
Children with ASD like Jimmy, experience difficulty in social communication. Between the age of 15 and 18 months, Jimmy gradually stopped playing with his siblings and by the age of 2 stopped talking. He would not imitate actions of others around him, nor play with other children. He also had little eye contact and limited facial expressions (Ghaziuddin, 2005).
From the young age of 1, Jimmy showed early development in his speaking and language skills and other early developmental motor milestones. Children like Jimmy are also known as 'Little Professors' (Ghaziuddin, 2005).
Although there were no interests of Jimmy's reported, Jimmy performed repetitive movements which is one of the motor features associate with ASD (Rausch, Johnson, & Casanova, 2008). Jimmy repetitively plucked the fur of his stuff animals and the fibres from carpets and afghan. He also frequently collected shoes and lined them up, mouthed objects and licked windows.
Other symptoms Jimmy showed that were not mentioned in the video were:

Sleeping difficulties
Extreme tantrum behaviours
Walking on his toes while flapping his hands and spinning in circles
Sleeping difficulties are common in patients with ASD where they may show decreased sleep time, rapid eye movement, REM sleep disruption and other symptoms (Rausch, Johnson, & Casanova, 2008).
Extreme tantrum behaviors are one of the symptoms of ASD. They can be caused by various factors such as social situations (Kuttler, Myles, & Carlson, 1998).
One of the symptoms of ASD are movement abnormalities. Jimmy experiences simple motor repetitive behaviors (Rausch, Johnson, & Casanova, 2008).
However, Jimmy's case study did not mention the presence of interests which is one of the main characteristics of ASD. These interests are often of a more sophisticated nature such as batteries or astronomy (Ghaziuddin, 2005). Therefore, Jimmy does not meet the criteria of ASD. An alternative diagnosis for Jimmy could be Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS).
What is PDD-NOS?
Jimmy shows one major symptom that only shows in children with ASD.

'Little Professor'
(Ghaziuddin, 2005)

Early development in language and speaking skills and in other areas such as mathematics, is a unique area of ASD (Rausch, Johnson, & Casanova, 2008). Jimmy's case study clearly reports that he experienced early development from the young age of 1.
Therefore, it is concluded that Jimmy has ASD and not PDD-NOS.
So does Jimmy have
Question 2
Children with ASD are supported by a group of Health Professionals who each specialize in a different area of ASD. Health Professionals who may be involved in treating Jimmy's condition are (Society, 2014):
Occupational Therapist
Speech Therapist
General Practitioner
General Practitioners are responsible for general health. However, they do not specialize in specific areas of health. Therefore, they are unable to treat children with ASD (Society, 2014).
However, they are able to refer Jimmy and his family to health professionals who specialize in health areas that are relevant to the treatment necessary for the Jimmy (Society, 2014).
How can a General Practitioner help Jimmy?
Booking an appointment with a General Practitioner is a good starting point for Jimmy and his family to finding the most effective treatment for ASD.
Clinical Psychologist
Clinical Psychologists focuses on the intellectual, emotional, biological, psychological, social and behavioral aspects of an individual (American Psychological Association. Division of Clinical Psychology).
How can a Clinical Psychologist help Jimmy?
By seeing a Clinical Psychologist, Jimmy would be able to receive treatment that can improve and control his cognitive thinking and behavior. This will lead to improvement in his communication skills, abnormal movements and behavior.
Counselor's are responsible in developing an interpersonal relationship with the patient and their family and enable them to understand the patients health condition. They also assist patients and families to meet the criteria of living with the health condition and help make changes to their life style and environment (Australia, 2014).
Counselors tend not to offer treatment to patients other than introducing coping skills. Rather, they are there to support and assist the patient and their family in the changes they are experiencing (Australia, 2014).
How can a counselor
help Jimmy?
By attending a counseling session, Jimmy and his family would be able to expand their knowledge and understanding of ASD, and also receive advice in what changes in their life style and environment are most suitable for a child with ASD.
How can an
Occupational Therapist help Jimmy?
By interacting with an Occupational Therapist, Jimmy's actions and behaviors when performing tasks would be analyzed. From this, his occupational issues would be identified. The Occupational Therapist can then give advice to Jimmy and his family about changes in tasks
can help jimmy function in
everyday activities.
Speech Therapist
Speech Therapists assess speech and language and treat patients who have communication disabilities (S. P. Australia, 2014).
How can a Speech Therapist help Jimmy?
Although Jimmy is a bright and unique child, Speech Therapy can improve his communication skills with people around him. From this, people would better understand Jimmy's needs and wants. Speech Therapy may also help Jimmy to speak again.
Pediatricians are health professionals who treat the health and development of children.
How can a
Pediatrician help Jimmy?
Question 3
There are several challenges that Health Professionals face when working in an interdisciplinary team. Interdisciplinary teams are the collaboration of Health Professionals who specialize in different areas of Health (Last, 2007). By working in an interdisciplinary team, Health Professionals are able to discuss the type of diagnosis, solve health problems and decide which treatment is most suitable for the patient. Patients and their families are also able to attend these meetings (Tracy & Chlan, 2014 ).
Dominant personality types are one of the main risks of interdisciplinary teams. This may interfere with the process of treating Jimmy's condition. When discussing among patients and their families, doctors tend to take the lead during the meeting and spend most of the time talking. This can intimidate Jimmy an his family to be involved in the meeting and share their ideas and thoughts (Jessup, 2007).
Health Professionals who are less experienced or quiet may feel intimidated working in an interdisciplinary team. This can result in an imbalanced share of ideas and strategies across the different health specializations. Therefore, they are unable to achieve patient-centered practice (Jessup, 2007).
Health Professionals may not conclude on the same agreement. This can lead to conflict between the group members. Areas they may not agree with each other may be the type of treatment they want to use for the patient or choosing who will take the lead in publications which shows the outcomes (Jessup, 2007) and effects of the treatment.
Weak trust relationships can occur between the Health Professionals when they first work together. However, this depends on the experiences of each Health Professional. Some may have never experienced interactions with other colleagues or experienced being in an interdisciplinary team (Tracy & Chlan, 2014).
Time constrains can impact on the process of treating a patient. For Health Professionals, it takes time to commit to other members, communicate and problem solve as a team. Therefore meeting times are not flexible, and sometimes, members of the team may not be able to attend (Tracy & Chlan, 2014).
Question 4 & 5
Two solutions, one which does not require
technology and one which does require technology, have been designed to resolve the challenges of role overload.
1. Effective communication in a face-to-face environment
2. Use of email and videoconferencing
Solution 1
Solution 1
Limitations and Benefits
Not all Health Professionals will be comfortable sharing their work and ideas especially when responsibilities overlap
Attending meetings in a face-to-face environment may be limited due to time constraints (Tracy & Chlan, 2014 )
Less chances of preventing dominant personality (Becker-Beck, Wintermental & Borg, 2005)
Allows Health Professionals to better understand the various roles of the Health Professionals (Reader, Flin, Meanrs & Cuthbertson, 2007).
Clarifying roles and expectations in a face-to-face environment will build a stronger trusting relationship between the Health Professionals, Jimmy and his family
Solution 2
Solution 2
Solution 2
Limitations and Benefits
Technical difficulties in using email or videoconferencing
Many video conferencing programs may be expensive, however there are alternatives such as Skype which is free and easy to use (Becker-Beck, Wintermental & Borg, 2005)
Weaker trusting relationships between the Health Professionals, Jimmy and his family
Some videoconferencing may include heavy and large equipment which are difficult to move around
Non-verbal actions and cues cannot be transferred resulting in misunderstanding of conversation (Becker-Beck, Wintermental & Borg, 2005)
Health Professionals can communicate in an environment that is comfortable for them to work in
Health Professionals are able to communicate to each other at any time through email
Health Professionals will have more flexibility in meeting times through the use of videoconferencing
Dominant personality can be prevented (Becker-Beck, Wintermental & Borg, 2005)
(Williams, 2012 )
(Hodgdon, 2010)
Treatments for Jimmy can vary from highly structured academic approaches to more naturalistic approaches in which teaching is guided by his interests. Clinical Psychologists use a wide range of treatments that target specific skills such as communication or broad educational approaches. Several treatments they may use for Jimmy are Discrete Trial training, Applied Behavior Analysis and the Picture Exchange Communication
System (Ridge, 2011).
Research shows that patients
who engaged in behavior interventions such as the Applied Behavior Analysis show significant improvement in their cognitive, linguistic and adaptive skills (Ridge, 2011).
Ridge (2011, pp. 240) states that research by Dempsey and Foreman has shown that a more "integrated approach in which complementary elements of different methods of treatment are combined" have been effective with children with ASD.
Occupational Therapists do not often use treatment. Rather they conduct experiments to identify the problem and give advice to the patient and family in what changes can be made. Experiments include:
The Sensory Integration
Developmental and Behavioral Models
Sensory Processing
Play and Behavioral Management

Research shows that children with ASD showed decrease in the number of negative behaviors due to repeated exposure to sensory over-responsivity scales and the listening program SBI (Gee, Thompson & St John, 2013).
Research shows that children with ASD can improve their communication and social interaction skills when adults respond positively, establish eye contact, wait for the child to respond to a request and adjust the environment to increase communication attempts (Arbesman & Case-Smith, 2008).
(Masne Kadar, 2012 )
Speech Therapists develop communicative
strategies such as the Verbal Behavior Intervention for children with ASD. They organize programs that both target specific skills and broad educational approaches. Parents are also often involved in the treatment process (Devin M. Casenhiser, 2013 ). The Picture Exchange Communication System is one of the most common communication systems used by children with Autism. Furthermore, with modern technology, new communication strategies such as the use of iPad's and computers are being
developed to treat patients
(Speaks, 2014).
Research shows that children with ASD who were involved in a program that targeted a specific skill made significantly greater gains in social interactions skills compared to children who were involved in a program that included various treatments (Devin M. Casenhiser, 2013 ).
Research shows that by involving parents throughout the program and using caregiver skills showed significant changes in the children's interaction skills (Casenhiser, 2013).
By comparing the advantages and disadvantages of texting and email, email is more beneficial for various reasons. Texting does not have the capability to send high quality research and compare results as the phone does not have the technology create graphs or other programs. Email is effective as it allows Health Professionals to save and record any results and findings they have received from other Health Professionals. It also allows them to compare their results on the computer and identify any consistent or inconsistent results. Although texting on the phone is easily accessible, it can be expensive. Email is also accessible at anytime and anywhere through the phone, iPad and computer making it easily accessible for the Health Professionals and Jimmy's family. Email is also free. Communicating by email also allows Health Professionals to communicate at their own pace without any pressure of time constraints and other Health Professionals if they were in the same room.
By comparing the advantages and disadvantages of talking on the phone and using video conferencing, video conferencing is more beneficial for various reasons. Video conferencing allows both the Health Professionals and Jimmy's family to communicate in an environment they are comfortable and familiar in. Like email, videoconferencing is gradually becoming more accessible through phones, iPads and computers. Some videoconferencing programs, such a Skype, are also cheap or free therefore easy to obtain and setup. It also allows Health Professionals and patients to conduct meetings regularly as they do not have to travel or alter their time table. Although talking on the phone shares some of the advantages of using video conferencing such as communicating in an environment that is comfortable and being easily accessible there are also many disadvantages. Talking on the phone can be expensive and only allows you to talk to one person at a time. It also does not allow you to see non-verbal communication and can sometimes be frustrating as you cannot see the other Health Professionals, Jimmy and his family as a whole. Talking over a phone for a long period of time, as meetings can last for several hours, is also unconventional.
Effective communication in a face-to-face environment solves:

Unequal share of workload
Possible poor treatment for Jimmy
Poor achievement of patient-centered practice
Weaker trusting relationships between the Health Professionals, Jimmy and his family
Poor understanding of the roles of other Health Professionals
Dominant Personality types
Research shows that miscommunication is caused by dominant personality, differences in training and gender (Cornell, Townsend-Gervis, Vardaman & Yates, 2014).
Research shows that
communication blocks, role conflict and poor process skills occur in early stages of working together which decrease the quality of patient-centered practice (Farrell, Schmitt & Heinemann, 2001).
The use of email and videoconferencing allows:

Health Professionals to analyze and compare their work, results and findings to others
Health Professionals to identify any consistent or inconsistent results and findings
Health Professionals to equally contribute their strategies, ideas and results without the pressure of others if they were in the same room
More meetings to be held if using video conferencing
Health Professionals to work in a comfortable environment they are familiar in

Research shows that online communication allows Health Professionals to communicate more frequently in comparison to communicating in a face-to-face environment (Goodman & Chinowsky, 1996).
Research shows that communication through technology such as email and videoconferencing increases the amount of access Health Professionals have to information such as results of the treatment. This is because resources can be accessed from numerous locations at any time (Robinson, Patrick, Eng & Gutafson, 1998).
Effective communication in a face-to-face environment allows:

Health Professionals to equally divide the work load in relation to their respected areas of health amongst each other
Set goals and expectations for the treatment for Jimmy
Discuss overlapping responsibilities
Equally share ideas and strategies that may improve treatment for the Jimmy

Research shows that poor communication among Health Professionals can increase the likelihood of medical errors occurring and also decrease Health Professionals understanding of the patient care plan (Reader, Flin, Meanrs & Cuthbertson, 2007).
Research has shown that the exchange of ideas takes place with more fine-tuning in a face-to-face environment as the sequence of questions, answers and reinforcement occur regularly (Becker-Beck, 2005).
The use of email and videoconferencing will solve:

Limited meeting times
Low attendance
Long travel hours
Unequal share of workload
Limited communication between the Health Professionals

Research has shown that computer based communication such as email has decreased certain traditional gender differences between the group members (Strombeck & Levy, 2002).
Research has shown that participants are more willing to engage in sharing information through online communication such as email or videoconferencing (Robinson, 1998 ).
As mentioned in questions 3 and 4, there were two solutions developed to help Health Professionals improve the function of interdisciplinary teams. Although both solutions contribute to the improvement of working in an interdisciplinary team, solution 2 is recommended. The next few slides show the limitations and the strengths of the two solutions.
Question 6
Conducting meetings over videoconferencing creates more opportunities to conduct meetings as the Health Professionals do not have to consider travel hours or alter their daily time schedule. This will result in an increase of communication and meetings among the Health Professionals, leading to better treatment for Jimmy’s health condition and achieving patient-centered practice (Goodman, 1996). Videoconferencing is also cheap or free and easy to set up, making it easily accessible and convenient.
By using email and videoconferencing, Health Professionals will be able to exchange their findings and results to others and compare results (Robinson, 1998 ). This will allow them to see any consistency or inconsistency in the results they have obtained and therefore leading to better treatment for Jimmy.
Health Professionals will be able to work in an environment they are comfortable and familiar in while they are talking to other team members through videoconferencing or email. This will enable Health Professionals, especially individuals who are less experienced with working in an interdisciplinary, to be involved and feel less pressured without the company of other Health Professionals if they were in a face-to-face environment.
Work will be equally divided as the Health Professionals will have more frequent meetings through videoconferencing which leads to better communication between the Health Professionals. This will be less popular if meetings were conducted in a face-to-face environment as time is limited. They are also able to send results and ideas they have developed which fulfills their roles and expectations.
Reflection and movie Time !!!

Question 1
Question 2
Question 3
Question 4
Thank you !!!
Role overload which is related to the pressures of being a Health Professional can be a risk. Studies have shown that role overload, which includes the lack of institutional support and heavy workload, can reduce the efficacy of team functioning and an imbalance between workloads can lead to poor treatment for Jimmy posing a risk to his health and development (Peiró, González-Romá, Tordera & Mañas, 2001).
Dietary approaches
Applied Behavior Analysis (ABA)
Pivotal Response Training
Developmental, Individual Differences, Relationship-Based Approach (DIR, also called "Floortime")
Treatment and Education of Autistic and related Communication handicapped Children
ABA allows children with ASD to
shape and reinforce new behaviors, such as learning to speak and play (CDC, 2014 ). Research has shown that children who participated in the ABA showed higher IQ and improvement in adaptive behavior measures than children who received other treatment (Peters-Scheffer, Diddena, Korzilius &
Sturmeye, 2011).
Risperidone is one of the most common
medications used for children with ASD. Research shows that Risperidone was effective for the treatment of tantrums, aggression and self-injurious behaviors. Increase in weight could also be seen in children who were treated by Risperidone. Although there are some side effects to the medication such as dizziness and drooling, they are resolved in a few weeks. Therefore Risperidone is thought to be a favorable treatment for children with ASD (McCracken, Mc-Gough, Shah, Cronin & Hong, 2002 ).
By going to a Pediatrician, Jimmy will be able to receive effective treatment from a Health Professional who specializes in children's health. He will also be able to receive medication if needed.
(Last, 2007)
(Jessup, 2007)
(Peiró, González-Romá, Tordera & Mañas, 2001)
(Tracy & Chlan, 2014 )
(Robinson, Patrick, Eng & Gutafson, 1998)
(Jessup, 2007)
(Tracy & Chlan, 2014)
(Goodman & Chinowsky, 1996)
(Tracy & Chaln, 2014)
(Goodman & Chinowsky, 1996)
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Peer Review
Research has shown that inter-professional education is critical for future Health Professionals as it improves the delivery of treatments and care to patients and the communication and teamwork skills among the students. Computer-supported inter-professional education also encourages the students to maintain positive attitude towards their profession. By participating in the computer-supported education, research has shown that students improved significantly in their scores throughout one year of education. In addition, using online inter-professional education rather than face-to-face education allows students to complete learning actives, engage in group reflections based on their individual time schedule, promote learning information exchange, encourage students to engage and support further discussion within the group (Smith, 2014). Therefore, future Health Delivery to patients will improve if future Health Professionals continue to enagage in Computer-supported education.

(Columbia, 2012 )
'Jimmy and the Doctor'
How do we know whether a research paper is high quality or not?
High Quality research paper
Published in the last 3-5 years
Peer reviewed
Demonstrates both quantitative and qualitative research
Method includes a large population of participants to produce a more accurate result
Demonstrate theories
Include other research and compare findings
Low Quality Research Paper
Published over 5 years ago
Not peer reviewed
Does not show author
Lacks quantitative and qualitative research
Does not show theories
Method includes a small population of participants
Lacks other research to compare findings
Full transcript