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Running Head: FAMILY/CHILD ASSESSMENT

Family/Child Assessment
Male Child With High Functioning Autism and Severe ADHD
Savannah Perez, JoAnne Saba
California State University, Stanislaus

FAMILY/CHILD ASSESSMENT

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Family/Child Assessment

Male Child With High Functioning Autism and Severe ADHD


It is estimated that "1 out of 88 children age 8 will have an ASD [autism spectrum
disorder] (www.ninds.nih.gov)." Autism spectrum disorder is a neurodevelopment disorder
which is typically characterized by varying degrees of social and communication difficulties.
These children have a specified pattern of behavior which causes them to develop slower than
their peers. Currently, it is uncertain as to the cause of autism, but there is research that suggests
it is caused by a genetic disruption during early fetal brain development. It is possible for some
children with autism to also develop other behavioral disorders such as attention deficit
hyperactivity disorder (ADHD). ADHD is a chronic condition that can include problems such as
short attention span, impulsive behavior, and hyperactivity (mayoclinic.org) This paper examines
an 8 year old boy who is affected by high functioning autism and severe ADHD and includes an
assessment of the family as a whole, his personal assessment, the resources that the family uses,
and anticipatory guidance and health promotion for the family.
Family Assessment
Family Data
Mother and Father are married and have two children; Son, their 8 year old son who has
autism and ADHD, and Daughter, who is 6 years old and has no developmental disabilities.
Mother works part time, night shift on weekends as a charge nurse at Doctors Medical Center
(DMC) in Modesto, California in the newborn nursery and postpartum departments. She
obtained her associates degree at Modesto Junior College and has no desire to further her
education. Mother has high job satisfaction working as nurse at DMC, although, at times she
stated she would prefer to work a different shift. She did state, however, that working nights

FAMILY/CHILD ASSESSMENT

earns six dollars more an hour and her husband can watch their children while she is at work.
Father works at Sunnyside Farms during weekdays on varying shifts. He states that he is content
with his job for now because he receives good benefits, particularly insurance that covers most of
his son's needs, and is able support his family. He plans to return to school when their children
are older in order to pursue a job in the medical field. Both children attend Medeiros Elementary
School in Turlock, California. Daughter is in the first grade, while Son is only in second grade.
His parents felt he was not ready to begin school at the age of six so they enrolled him in school
a year late.
Family Interaction/Roles
Mother cares for the children during the week while Father is working, and Father cares
for the children on the weekend while Mother is working. Since Father works during the day,
Mother is the one who takes Son and Daughter to all of their doctors' appointments and other
activities. There are many different doctors that he visits regularly including the following: a
pediatrician, an ears/nose/throat specialist, occupational therapy, a speech therapist, and
nutritionist. Mother stated it has been a bit easier since Son began school because she is offered
some relief due to Son the school district providing him with aides, speech therapists, and
counseling during school hours. In conjunction, they all assist him in his daily school activities
and assignments. She also has two young adult babysitters that she uses regularly in order to
attend meetings and when she absolutely needs space. One of the babysitters she has hired
through the school district, while the other is a caregiver of a cousin with autism so both are
trained specifically to help Son with his needs.
Neither Father nor Mother prefer this schedule since they rarely get to spend time
together as a couple or a family. It is added stress to their already hectic lifestyle but it is what

FAMILY/CHILD ASSESSMENT

works to provide for the needs of the family. She states that many of Son's doctors have not even
met Father because of their schedules. When they do have some time for each other Father has
been with the children all weekend and is exhausted. However, they feel there is not much that
can change because Father receives better insurance through his job that will cover more of Son's
medical expenses than what she receives from DMC.
Though Father and Mother parent at different times, they agree as to how to parent. They
treat their children as equal as possible. They feel as if it is unfair to have different rules for each
child so they use the same vocabulary, require both to finish homework and chores, and
discipline them as needed. What is different between the Daughter and Son are their expectations
at times. While it is simple for them to tell Daughter to go take a bath, they have to sit with Son
and divide the task in to each individual step so that he understands what to do. Mother and
Father will engage Son's attention, give him each step of a task, and have to reward him along
the way using a token system. They have found this works the best to preserve his autonomy and
to avoid breakdowns. The two have noted that Daughter does not thrive as well using a token
system but works better when there is a fear of punishment. Discipline is the same for both
children. In severe cases, such as safety or when being defiant, Mother will place the children in
time out so that they have a chance to recognize that fault in their behavior. She has learn that in
the stress of caring for a child with autism and ADHD, to not discipline her children because
punishment would be unfair. In those times, she will put herself on "timeout" to cool off and
recognize that it is necessary for her to take some time away from the children.
Health Care Function
As mentioned, the family does not try to treat the children differently and the same stays
true for their health. The family all eats the same diet. Mother tries to limit soda intake in the

FAMILY/CHILD ASSESSMENT

house and to serve mostly nutritious foods. She states that she understands that sometimes she
could make better choices, but she is "not going to fight over a piece of white bread (Mother,
personal communication, September 2, 2014)." Both children have a scheduled bedtime and have
regular sleeping patterns. This is an advancement for Son due to his medication; if not for it he
would not sleep well due to night terrors. Neither are enrolled in sports yet because the parents
would like for them to have more sportsmanship before doing so, but they are still active and full
of energy. They enjoy playing with other kids as well as each other. Daughter has normally
developed motor skills, while Son is still develop his fine motor skills. In addition, the family is
raising the children in the Church of Christ and attends church together regularly. This is place
where they find acceptance, understanding, and support.
The family's definition of health revolves around the happiness and functionality of the
family. They understand that living with autism is tough but if they can live healthy, happy,
functionally, and improve each day, they have exceeded their expectations.
They do not believe in the Jenny McCarthy theories of medicine. She knows that
vaccinations did not cause her son to get autism and that there were signs of developmental
delays before he was immunized. Mother and Father do not like to turn to medication at the first
problem. They choose to attempt all behavioral interventions possible, such as parenting courses
and counseling, before attempting drug therapies. Once they see that their child is miserable
causing the entire household to feel the same, then they begin drug therapies. She stated that,
"since I'm a nurse, I can ask for recommendations from the pediatric doctors on what I should try
(Mother, personal communication, September 2, 2014)." They also acknowledge that drug
therapy is also reversible. Mother sees that if they begin their child on a particular prescription
and do not like the effects, they can cease use at any time. The family does not make much use of

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complementary and alternative medicine besides occupational therapy. They see that this works
and is beneficial to Son's needs so they continue to use this service. Mother stated that at one
point they attempted to use a "diet Coke" method which is supposed to help calm the child but
saw little to no improvement.
Mother and Father believe that their family has a good health status and see
improvements in Son daily. He is learning empathy and gaining a better understanding of his
emotions and why he feels particular ways. He is more likely to give hugs and snuggle. Son is
also crying less and trying to socialize more with other children. These are all advances he has
made while being on Risperdal. According to their perception of health, their ways are working,
but see that each family has to find their own path.
There are many health care services that are necessary to use to ensure the continuing
development of Son. He makes use of an occupational therapist, speech therapist, behavioral
health specialist, sierra vista counselor, resource teachers, and aids. All have different roles in
assisting Son to stay on track and to learn to break down the pieces so that he can understand
them. In school, Mother feels as though he uses his aids as an excuse to not do his work because
he will wait for them, but this is the system that works best for him. Mother and Father can call
meetings with the school district to add or subtract services to create the best plan for Son to
become more successful.
Child Health Assessment
Physical Assessment
Son is an eight year old male who has blonde hair and blue eyes that appears to have good
hygiene. He weights approximately sixty pounds and is about four feet tall, both of which are
normal compared to expected growth charts for children his age. He does wear corrective lenses

FAMILY/CHILD ASSESSMENT

all the time to help with vision disturbances. Dental hygiene is a really important issue for Son.
His teeth started to grow in without enamel so they had to be capped as preventative measures.
Because of the issue with his enamel he brushes his teeth very regularly and has dentist
appointments approximately every six weeks. Son does have a past history of chiari
malformation, which is a structural defect of the cerebellum that results from a smaller than
normal indented bony space in the rear of the skull that can cause the cerebellum and the
brainstem to be pushed downwards (ninds.nih.gov).
Developmental Milestones
Mother informed me that Son had met all of his developmental milestones until he was
two years old. Son has a speech therapist because he is behind developmentally with his
language and communication skills. Mother stated that at one point in time Son would only grunt
and point because he got too frustrated when he tried to communicate using words. Son is now
speaking but he tends to have temper tantrums when he cant find the right words to express
himself. He also has trouble following three component instructions, which is a developmental
milestone that is usually reached at seven years of age. Mother told me he can be temperamental
at times and is very quick to anger and get frustrated. When he gets frustrated he verbally and
physically lashes out, especially when there are unexpected changes in his environment such as a
sudden loud noise.
During play and socialization, Son- according to developmental milestones- should be able
take turns and play cooperatively with others and should be able to understand rules of activities
such as board games (A. Knippa et al., 2012). Although Son desires to play and socialize with
other children, they often tend to make fun of him and he does not understand that they are
mocking him. He also still has a very egocentric point of view and has a hard time taking turns

FAMILY/CHILD ASSESSMENT

while playing with others. As far as the sexual milestones appropriate for his age, Mother stated
that Son was right on track.
Cognitive, Psychosocial, Moral/Spiritual Development
Cognitively, Son struggles every day to communicate effectively and to understand his
environment as well as his emotions. Mother stated that she has to explain instructions to him
one step at a time because if she gives him two or three step instructions he cannot comprehend
everything she is asking. She also explained that he is starting to be able to verbalize how he
feels. For example, Mother stated that Son will say things like my brain is angry, Im crying
right now and I want to stop but I cant, I will stop in a little bit.
Psychosocially, Son has trouble understanding rules that are set forth by others. In a lot of
ways it appears like he still has a very egocentric view of the world and cannot see things from a
different persons perspective. Mother stated that in order for him to follow rules around the
house or to get him to do something he does not want to do, such as homework, she has to use
the rewards system. She has a token board in her house and every time Son follows the rules or
does something she asks of him, he receives tokens for it. These tokens eventually add to up time
playing video games or watching television.
To help with Sons moral development, Mother is a very big advocate on going to
church. She and her family are very spiritual and believe that going to church gives Son
something to think about and helps teach him the right morals and values. Mother tries to have
Son examine things from a different persons perspective so he can see the consequences of his
actions and how they make other people feel. For example, Mother would ask things like how
do you think they feel? and tell him things like Jesus wouldnt want you to do that. For Son

FAMILY/CHILD ASSESSMENT

and his family, spirituality is an important aspect of their life that plays a big part in Sons
development.
Family/Child Resources
Internal Resources
This familys affluence plays a big part in their relationship with one another. Because
Son needs a lot of medical care, both Mother and Father are forced to work to provide for their
family. Mother also did a lot of extensive research into the law and about parents rights in order
to get Son the adequate care he needed both medically and in school. The fact that Mother is a
nurse at DMC provides her with a lot of resources that she would not have otherwise. She is able
to ask coworkers about different research or techniques that may help with Sons care. Mother
did state, however that she wishes that navigating through the healthcare system for a child with
autism was easier. She said that they had to go to many different doctors and get many referrals
before Son could get the care that he needed.
External Resources
The education system, after Mother had to fight to get the care Son needed, has been a
very big resource for this family. All of Sons specialists that he sees on a daily basis come while
he is at school to help him in his activities of daily living. The school district also provided
parenting classes that helped teach Mother how to care for a child with autism and helped them
create a game plan to help him throughout school. The church that they attend has also been a
very big resource for this family. They attend The Church of Christ where they have enormous
support from the whole community. Everybody at the church knows about Sons condition and is
understanding and helpful to the family. There are no other organizations or institutions that Son
and his family are a part of or receive support from.

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Anticipatory Guidance

Nutrition
The first point of guidance was for the family to attempt to have a common dinner time
more often. During the interview, Mother stated that she and Father do not spend much time
together, making it seem as if the family as a whole does not get time together either. If the
family could eat together, it would enable the family as a whole to spend time together. This
would increase familial bonding and ensure that nutritious meals are being consumed. It would
also assist the father in learning how to better handle and care for his children so that he is not as
drained at the end of the weekend. In addition, a brief review of the food pyramid would also be
beneficial for this family to remind them of what should be consumed. Though meals consist of
mostly nutritious foods, there are times when unhealthy foods are provided to avoid conflict. The
family was referred to myplate.org to compare their habits to the nation's standard for daily
intake.
Physical
Because of Son's developmental delays, it is difficult for him to practice many personal
self care acts. Often he is inhibited by his lack of fine motor skills so he has others carry out his
hygiene tasks for him. It would be particularly important to provide Son with modified tools so
that he can care for himself and increase his autonomy. One particular area in which Mother
outline as an issue is teeth brushing. She stated that it is difficult for him so he does not do as
good of a job as possible. We could provide Son with a thicker tooth brush so that he can use is
gross motor control and how to use this tool. Son understands specific sets of instructions best so
it would be pivotal to outline a specific path for him to follow and demonstrate it for him. For
example, tell him to brush the top of the back teeth on the bottom right first, then the bottom left,

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followed by the front of the teeth, and so forth. After this, we would have him try to do the same
while we assist in guiding his hands where to go. The final step would be for him to practice the
skill independently and assess skill gain.
Developmental
Developmental and social health promotion is particularly crucial to provide to Son and
his family since Son does have autism. How the parents interact with him and how they handle
Sons different behavioral episodes can strongly influence the social development of this child.
Since the family does not spend a lot of time all together as a whole, Son is at risk for separation
issues with his parents that could manifest into other social difficulties later in his life. Son is
also at risk for social isolation due to his lack of interaction with other children. Although Son
tries to play with other children at school, they often make fun of him because he cannot realize
what they are doing to him. To help with Sons social development, it is important to teach this
family that interaction with other children his age- ones that will not ridicule him- is vital for him
to acquire necessary social skills.
Safety
Safety teaching should also be included when talking with this family. Since Son has
developmental delays, it appears that at times Son cannot determine when a situation may be
dangerous. For example, Mother stated that several times when he gets upset or frustrated he will
run out into the street. It is crucial for Sons safety to provide teaching to the parents about
supervision of the child when he is outside or in areas that may contain safety hazards. This
teaching can also include the importance of putting medications and other poisonous substances
in locked cabinets where Son cannot get to them, since he can easily mistake them for something
that is not harmful.

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Conclusion

Autism is developmental disorder characterized by varying degrees of social and communication


difficulties (www.ninds.nih.gov). Some children, such as the child assessed in this paper, have
more than one behavioral disorder. In Sons case, he suffered from severe ADHD as well as high
functioning autism. ADHD is a chronic condition that affects with a childs ability to focus and
control their behaviors (mayoclinic.org). Since Son is affected by these conditions, he is not able
to accomplish developmental milestones in the same way as children without any disorders. This
paper examined the personal assessment of Son and compared it to developmental milestones
appropriate for his age and also examined the family as a whole and the resources that are
available to them. Anticipatory guidance was offered at the end of the interview with Son and his
family to help provide health promotion for the family.

References
Attention-deficit/hyperactivity disorder (ADHD) in children. (2013, March 5). Retrieved
September 9, 2014, from http://www.mayoclinic.org/diseasesconditions/adhd/basics/definition/con-20023647
Autism Fact Sheet. (2014, April 16). Retrieved September 9, 2014, from
http://www.ninds.nih.gov/disorders/autism/detail_autism.htm
Knippa, A., Sommer, S., Ball, B., Churchill, L., Elkins, C., Janowski, M., ... Stacy, B. (2012).
Health Promotion of the School-Age Child (6 to 12 Years). In RN nursing care of
children review module (8.0th ed., pp. 47-51). Stilwell, KS: Assessment Technologies
Institute.