Case Study

Mitchell: A Boy with Autism Spectrum Disorder

Mitch was six years old when his family contacted me. He had been diagnosed as having autism spectrum disorder two years earlier by a multi-discipline clinic at a university medical school. Autism spectrum disorder (ASD) is a developmental neurological disorder characterized by atypical development in social interactions and in communication. Mitch had trouble making eye contact with listeners. His expressive language was vague: his sentences were long enough and had the right grammar and syntax (word order) but the words he chose did not quite communicate his meaning and the listener had to work extra hard at decoding the message. It was hard to have a conversation with Mitch: he tended to monopolize the taking, worked hard to steer it toward one of his favorite subjects and did not appear to be listening when it was the other person’s turn to talk. He had trouble with focus and attention: he was quite distractible. He had two favorite subject (farm tractors and the carved images at Mt. Rushmore)) and didn’t really talk much about anything else. He did not play very much with other children at school or in the neighborhood and interacted mainly with adults. Mitch periodically had bouts of anxiety and if was much harder for him to focus when that was happening. In speech therapy, among other objectives, we practiced looking at the listener and using just exactly the right word(s) to answer questions.

Children on the autism spectrum vary widely. However, we usually see some difficulty with language pragmatics, the social rules of conversation, including making eye contact, taking turns talking and listening, responding appropriately to questions, knowing how to insert oneself into a group, knowing what to talk about, and when older, knowing how to lead a conversation. There may be an intense desire to talk about one specific subject over and over. Often with children on the spectrum, we also see difficulty being specific with word use and difficulty organizing one’s thoughts into clear, concise sentences. The goals for Mitch fell into these two areas. Mitch was also receiving speech therapy at his school. His school speech language pathologist and I tried to talk by phone at least once every two or three months.

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