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Group Work Intervention for Children with Autism

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. Name: Lucy Murphy Date of birth(D.O.B.): 15/03/08Family members:(Think about extended family &– who are they)Lucy’s has a family composing of 3 members excluding herself. Her parents are Pat and Joan Murphy and, she has a brother Jack who is 7 years and, a brother Sean who is 3 months. Joan’s parents Elizabeth and John Mc Carthy live close by along with Joan’s sister Geraldine and her 3 children aged between 3-11. Her brother Patrick lives ½ an hour away and, he has a new born with his partner Olivia. Pat’s side of the family live in Clare. His father passed away 7 years ago however, his mother is still alive and, lives with his sister Jessica her husband and, their 5 children in Clare.What has happened to this person? What is their present story?Lucy showed signs of delayed development since the age of 12 months, i.e no words at 18 months. She was noticeably disinterested in interacting with her siblings, cousins, family and peers and, was unmotivated to explore her environment.She was obsessed with eating organic non-food items (8 months) such as clay and sticks, Lucy would have severe tantrums and, proved to have difficulties with transitions. She lacked a comprehension about rules and consequences from an early age and, her behaviour was unpredictable. Is there anything in child’s past history that has relevance to this?Other parents assured Joan that Lucy would start talking when she was ready to do so. However, from 30 months both Joan and Pat along with friends who were parents suspected that developmentally Lucy wasn’t typical for her age in terms of speech, communication and play. Initially Joan and Pat thought it was a speech and language or communication difficulty.Lucy was brought to their GP at 24 months whereby concerns were expressed about her unusual eating habits and also her lack of verbal communication and social interaction. She was diagnosed with Pica and was referred to a hearing specialist to rule out any developmental delays associated with hearing, i.e deafness. Joan and Pat applied for an assessment of need and she received this at 27 months. The outcome of this was that she was to be assessed by an inter-disciplinary autism team however, the waiting list for this was 24 months. At 51 months, Lucy was assessed by the autism team which comprised of a clinical psychologist, SLT, OT and social worker. At 55 months, she was finally diagnosed with autism. | ENVIRONMENT (E) | Context of the person’s environment:Personal (where does this person live, and with whom?)(Think about all the means of support this person will or won’t have)Lucy lives in rural west Kerry, a mile from Dingle town in County Kerry. They live in a single storey house with a pictures view of the sea. Outside they have a stable yard and arena where 8 horses are stabled. Joan works from home as a card and gift manufacturer. At the weekend Joan gives horse riding lessons to children from nearby. Lucy loves going out to the horses (brushing them, getting their tack ready and, feeding them). Lucy is very motivated in doing tasks associated with the horses and, has a horse of her own called claddagh. Lucy attends a pre-school in Dingle which starts at 9am and finishes at 2 pm. Joanne says that Lucy doesn’t particularly like going to the pre-school as she prefers to play on her own, which other children do not understand therefore, when they try to play with Lucy or share toys Lucy can throw a temper tantrum which, a lot of the times is physical. Lucy will be entering into primary school next September. Joan and Pat mindful of the fact that all subjects for the exception of English are taught through Irish in Dingle schools therefore, they have decided to send Lucy to a main stream school in Tralee. They have also decided on this as this school has supports in place (such as resource teachers, relaxation room, integrative timetables and, special needs assistance) which will be more beneficial for Lucy as the timetable is very structured and, Lucy loves structure. Jack attends the local primary school and, also has a keen interest in the sport of horse riding. Jack and Lucy have a strong relationship which has been enhanced with their love for horses and, they carry out a lot of their jobs in the stables together. Joan says that it is more noticeable when out in the yard that Lucy tends to pick up non-organic items and mouths them. Sean is Lucy’s 3 month old brother. Sean is a very contented baby who Lucy is very protective of and, loves to mother him on occasions but, Joan is very mindful of Lucy as she can get frustrated and have a temper tantrum expectantly. Pat is the local postman in the area who is very much a part of Lucy’s support system. He attends the majority of Lucy’s appointments with Joan and, has been very involved in Lucy’s journey. Joan explained that there will be a lot of pressure once September comes around both time wise and financially. Driving in and out of Tralee every day is not feasible for the Murphy family to do on their own. Joanne stated that there is a bus which leaves Dingle and, drops the children at their school but, feels this is not an option at the moment. Elizabeth and John who both drive along with Patrick Joan’s brother and, Joan and Pat themselves have structured a timetable to make this possible. Lucy is very close to all these members and therefore, would be comfortable in their presence. Temporal(what age and stage in life are they in?) * (This is important – give a great deal of thought to where they are in their life but also – what has gone before them in a “Big Picture” sense to be aware of past influences – different cultures etc.)Lucy showed signs of delayed development since the age of 12 months. By 18 months she still had no words which really concerned Pat and Joan. They knew through reflecting back on the development of Jack (their eldest child) that something was wrong. Lucy was also noticeably disinterested in interacting with her siblings, cousins, family and peers and, was unmotivated to explore her environment. At around 8 months Lucy was obsessed with eating organic non-food items such as clay and sticks. Lucy would have severe tantrums if her toys were moved or when she couldn’t find her special blanket. Lucy also proved to have difficulties with transitions which would also cause tantrums. She lacked a comprehension about rules and consequences from an early age and, her behaviour was unpredictable therefore, Pat and Joan felt very on edge when brining her into public places which might ignite a tantrum such as going to mass as Lucy likes to move around and gets frustrated when sitting all the time and, she gets frustrated with the various stages in mass such as sitting kneeling etc. Even though friends told Pat and Joan that Lucy would start speaking when she was ready they both felt they should pursue this further. At 30 months both Joan and Pat along with friends who were parents suspected that developmentally Lucy wasn’t typical for her age in terms of speech, communication and play. Initially Joan and Pat thought it was a speech and language or communication difficulty.Lucy was brought to their GP at 24 months whereby concerns were expressed about her unusual eating habits and also her lack of verbal communication and social interaction. She was diagnosed with Pica and was referred to a hearing specialist to rule out any developmental delays associated with hearing, i.e deafness. Joan and Pat applied for an assessment of need and she received this at 27 months. The outcome of this was that she was to be assessed by an inter-disciplinary autism team however, the waiting list for this was 24 months. At 51 months, Lucy was assessed by the autism team which comprised of a clinical psychologist, SLT, OT and social worker. At 55 months, she was finally diagnosed with autism.Lucy is now 5 years (60 months) and, attends a pre-school from Monday to Friday (9am to 2pm). Lucy’s teacher Ms. O’ Donnell although aware of Lucy’s diagnosis finds that Lucy can have her good days and he bad days, like everyone. Lucy doesn’t interact with the other children and, can have a tantrum if her particular toy is taken or if her box in the room is messy. Lucy is not interested in any group activities such as circle time or jigsaws however, she has noticed that Lucy does not mind standing next to others while carrying out her task (Parallel play) Reference: Roger, L., S. (2005). Foundations for occupational therapy practice with children, section 1. In J. Case-Smith (Ed.), Occupational therapy for children (6th ed.) (pp.98). St. Louis, MO: Elsevier Mosby. Where, before she would remove herself totally from the class and go into a corner and do her task.Ms. O’ Donnell at present is working with Lucy to gain a more efficient grasp of her pencil. Lucy uses a hooked position with movement coming from her wrist when she is attempting to write her name and when colouring and, gets tired very easily.Lucy will be transitioning to a mainstream school in Tralee come September. This will entail a 2 hour car journey every day for Lucy which may prove difficult but, Pat and Lucy have got a head rest TV for the car which Lucy can watch a cartoon of during her journey. The main stream school in Tralee has supports in place (such as resource teachers, relaxation room, integrative timetables and, special needs assistance) which will be more beneficial for Lucy as the timetable is very structured and, Lucy loves structure along with the fact that teaching is done through English. Ms. O’ Donnell has stated that Lucy does not have many close friends in pre-school as her social skills (language, interacting, sharing, and turn-taking) have had an impact on relationships being established. However, the other children recognise that there are certain toys that “make Lucy happy” and therefore, they leave this toy alone which reduces any conflicts within the class. At home Lucy loves to go out in the yard along with her brother and mom and, feed, brush, clean out and prepare the horses. Lucy has a pony of her own called Claddagh and, is very dedicated to looking after her. Lucy is able to tackle claddagh up (knows what piece of tack goes on first etc) and often (lead by Joan) goes into the arena where she rides for an hour or so where she really connects and interacts with horse and, seems more relaxed says Joan. Lucy’s loves to watch Dora the explorer on TV and, Pat usually sits with her and, engages with her. Lucy must have her Dora the Explorer teddy with her while watching Dora on TV and, this acknowledged by everyone who is a part of Lucy’s life. Lucy’s day is very routinely orientated. She gets up around 8 o’clock and has her breakfast which is always cheerios’’. Dressing can prove difficult in the mornings as Lucy maybe uncooperative and refuse to wear certain items or would prefer to wear her slippers rather than her shoes. She goes to pre-school from 9am until 2pm. Joan collects Lucy and, when she comes home she watches Dora the Explorer and has her lunch. Lucy goes with Joan to collect Jack from school and, when they come home both Jack and Lucy go up to the horses and, then come down when their dinner is ready. These are the main events which fill Lucy’s day. Lucy is very protective of her baby brother Sean and, gives him some attention but, can become very frustrated when Sean cries.Both Joan and Pat have noticed since an early age that Lucy likes to place non-organic objects like sticks and clay in her mouth. This is still and ongoing occurrence and, a watchful eye has to be over Lucy while with the horses as if she found substances like rat position this would prove to be fatal. Physical(what is the physical environment like where they live e.g. is it rural,urban, etc.?)(Think about where they live – what is it like for access inside / outside, what is the transportation like? The Murphy family live in rural West Kerry a mile from Dingle town. Both Joan and Pat drive and, Joan’s mother and father who live close by drive also. Due to their location trips into bigger towns such as Tralee and Killarney are done once every two weeks. There are bus schedules to opt for however, departures and return journeys take place at unsuitable times (too early or too late) and Joan feels with the unpredictability of Lucy’s behaviour having a time constraint puts her under pressure.Dingle is a very tourist oriented town. Its amenities are limited and, the Murphy’s would travel to either Tralee or Killarney to carry the children for a day out. Although amenities are limited the Murphy’s avail of the playground, boat trips to see Fungie and, making pottery.The Murphy family live in a bungalow near the sea. The house comprises of 9 rooms (a sitting room, kitchen/living space, bathroom, 4 bedrooms, a playroom and, Joan’s workshop room). Lucy’s room is very clean and organised and, has lots of Dora the Explorer toys. Most of Lucy’s toys are in her room as she prefers to play there rather than the play room where there is little order Joan says. Lucy has her own bathroom (en-suite) as this gives order and, reduces Lucy getting frustrated if things are unclean which aids in her carrying out her ADL’s such as self-care. Their house is located on a steep height which can be difficult to climb if walking. Outside the Murphy’s have stables and, a yard with an arena. There is plenty of space outside to be utilised and, Lucy’s grandmother and grandfather are over the road (bohereen) and, Jack and Lucy often walk over to their house. |

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