Sara has just turned 15 and is graduating from Gordon Junior High this year. Because of a history of early neglect and abuse in her biological family, she was placed in a foster home and subsequently in a residential program for 2 years because of her unmanageable behaviors. Sara was finally diagnosed with Asperger’s syndrome, and she has lived with her current foster mother for the past 2 years. Her placement in this therapeutic foster home provides the support services she needs to make the transition back to a normalized community setting. Sara loves to swing, spending long periods of time in the family’s backyard. She was very disappointed when she found out that her junior high school did not have swings.
Sara’s foster mother has noticed some unusual behavioral characteristics. Sara becomes almost hypnotic when she eats; she will continue to eat as long as there is any food available. Her foster mother wonders if this is due to the early physical neglect. When she is asked to slow down, Sara will blurt out, “Well, I’m hungry!” It is becoming problematic as Sara is beginning to gain weight as a result of the nonstop eating.
Sara also seems to have a very high tolerance for pain. One day she was riding down the driveway in the back of a truck and fell off. She was on the ground, her tooth chipped and her face bruised. Her foster mother said that she had a “bizarre look in her eyes,” but she didn’t shed a tear. Sara seems unresponsive to most physical stimuli. Her foster mother thinks she doesn’t express the pain she feels. Once again, her foster mother wonders if this is part of her condition or if it is the result of her early abuse.
Sara is very intelligent, and she can’t understand why the other students aren’t getting what the teacher is teaching. She doesn’t understand that what is obvious to her might not be obvious to someone else. She sees the world only from her own perspective, assuming that everyone sees things the way she does. Sara’s foster mother is particularly concerned about her egocentrism and sees it getting in the way of her making friends at school.
Sara participates fully in her general education classes, and with the help of Carol, her one-on-one aide, she makes good grades. Her measured intelligence is in the average range, and she demonstrates grade-level achievement on tests and her report cards. Carol has noticed, however, that Sara needs explicit directions for each task. For example, when the teacher says, “Take out your notebooks.” the other children take them out and open them, whereas Sara just takes hers out.
Sara also has a Big Sister named Nancy, a professor at a nearby community college. Sara and her Big Sister share a love of libraries and books. It often seems that Sara would prefer to be alone and to read and write her books. To her credit, she has actually written three stories which she calls her “books.”
Sara seems to be a very concrete thinker. One day Sara and her Big Sister were talking about sex. Sara told Nancy that she’s never getting pregnant and that ‘Tm going to wait until I’m 21, and then I’ll get married to someone I’m really in love with, and then maybe I’ll have sex.” But then she added that she guessed she would get pregnant. When asked why she thought that, Sara said, “Well, I saw this sign at school that said that girls who play sports don’t get pregnant … and I don’t play sports.” Sara also doesn’t understand figurative phrases like “You’re on thin ice!”
Sara doesn’t seem to realize that sometimes people need to do things they’d rather not but that doing them is part of the social contract. One day, her aide asked her if she would throw something in the trash can, and Sara said, “No!” Another day, Sara hurt her foster sister’s feelings by criticizing her singing. Sara was puzzled because she thought she was “helping” her sister. Carol takes note of these situations and reports them to Sara’s speech therapist. The speech therapist works on social conversational skills like these that most young people pick up by observing others. Then Carol follows up by spending IO hours a week working with Sara in a community setting, reinforcing the social interaction skills that her speech therapist has been working on. Her foster mother tries to reinforce them, too, but she sometimes tires of being a “24-7” teacher when she would rather just be Sara’s mother.
Her foster mother is concerned that at the age of 15, Sara doesn’t seem to have a sense of personal boundaries. One day they had a visitor with a beard, something new for Sara. She reached up and pulled his beard and started laughing, even when he reacted with pain. At camp last summer, she met a boy. She was “all over him, hugging and kissing, like a much younger child.” She was happy to have a friend, but she doesn’t realize which behaviors would be considered appropriate or inappropriate in such social situations.
Recently, her foster mother has seen her become very “boy crazy.” Sara is very interested in a boy at school named Bob, but he hardly seems to notice that Sara is there. Sara hates to be ignored, and she can’t understand why Bob ignores her. She responds by inappropriately putting her hands on him, often with an altercation ensuing. She doesn’t appreciate the subtleties of adolescent interactions, responding much like a third grader who chases another child around the playground to make him be her friend. The problem is that as a young adolescent such behaviors are apt to be seen as sexually inappropriate and definitely odd.
Sara has some long-standing problems with appropriate personal hygiene. She doesn’t seem to notice the need to change her clothes or take a shower, even when her clothes are dirty and her body odor has become offensive. She does not appreciate that the changes in her adolescent body require more attention to hygiene if she is to be welcome in social environments. This really bothers her foster mother, who can’t understand why Sara would be so oblivious to the appearance she presents. She has noted, however, that recently Sara seems to be developing an interest in her grooming.
Another issue that has surfaced is the constant presence of Carol, Sara’s aide, in school and in the community. Recently, Carol has been consciously attempting to step back a bit and let Sara try to handle her own social interactions. However, Carol remains vigilant and intervenes as needed. For example, at graduation practice, Sara was sitting with some other girls, trying to interact with them. Carol became aware that the girls were trying to embarrass Sara by calling Bob over, although Sara was oblivious to their motives. Carol stepped in to stop the teasing. She continues to be concerned that Sara doesn’t seem to recognize when others are laughing at her rather than with her. Sara’s foster mother knows that Sara will continue to need her aide’s help when she moves to the high school next year, but she hopes that the social coaching Sara receives from Carol and the speech therapist will begin to make her capable of handling the social side of adolescence with fewer interventions from Carol. There seems to be a real deficit in her level of socializing, a deficit that her foster mother fears will continue to cause Sara problems.
Sara’s lack of social awareness and skill continues to concern everyone. At the graduation ceremony this week, it was painfully obvious that Sara was not at the social level of the other girls. She wants people to like her, but she stands out in her immaturity. When someone does something she doesn’t like, she is apt to respond by pushing or biting, because the other person “wouldn’t leave me alone.” These behaviors cause others to avoid her. Recently she was at a parade downtown and tried to greet some girls from school. The girls whispered to each other and walked away. Her foster mother wonders how to explain what happened to Sara. She realizes that these might be girls Sara had yelled at inappropriately just the day before.
The questions remain: How might her foster mother and teachers help Sara develop the social competence to match her academic abilities?
Questions
After reading the case study in Module 4, from the information provided in this case study and the power points for the week:
1. Identify descriptive elements that suggest that Sara’s diagnosis of Asperger’s disorder is appropriate and in line with DSM-V and IDEA definitions. Be thorough
2. From the case study information, make a list of Sara’s strengths and needs. Relate (Compare/Contrast) these to your knowledge of typical developmental patterns.
Please submit a one-page analysis in response to the questions above. This analysis must be grounded in the case study. Assume that your audience is already familiar with the case, eliminating the need for background information. No need for any header information…begin your answer on line one of your page. There should be strict adherence to the 1 PAGE MAXIMUM.
The analysis will be graded on the basis of (10 points per item) :
• does the answer reflect familiarity with the case study-
• does the answer reflect knowledge and/or application of the concepts outlined in the reading
• Grammar/Technical components (including APA 7th edition guidelines)
• Adherence to assignment guidelines (length and formatting as directed)
ONLY ANSWER THE QUESTION(S) ASKED.
Reference:
Learners with Mild Disabilities: A Characteristics Approach, Enhanced Pearson 5th Edition By Eileen B. Raymond Published by Pearson, p. 186 – 187. Copyright © 2017 ISBN-10: 0-13-382711-9; ISBN-