Autism is a spectrum disorder, characterized as such for the broad array of symptoms and developmental possibilities reflected in those who suffer there from. At its core definition, autism is qualified as such by a “qualitative impairment in social interaction” which may result in an individual with severe impairment in any combination of conditions including notable impairments in nonverbal communicational ability and posturing, an incapacity to development meaningful personal relationships, an apparent disinterest in formulating relationships or engaging others collaboratively and a distinct absence in the expression of emotional attachment. (ANI, 1) To a more specific definition, we may refer to the notation that “autism is diagnosed on the basis of abnormalities in the areas of social development, communicative development, and imagination, together with marked repetitive or obsessional behaviour or unusual, narrow interests.” (Baron-Cohen, 1) A consideration of a possible treatment program for a special case study reveals an array of these symptoms without a necessary totality of presence for the condition of autism. Using the protagonist of the 2001 film, “I Am Sam,” this account offers a treatment program for a man who exhibits several conditions directly associated with the spectrum disorder.
Upon reviewing the details of Sam Dawson’s condition, the following decisions
have been made with regard to the pursuit of his treatment intervention through the assistance of public outreach groups. Aged 30 and highly afflicted by the cognitive and behavioral symptoms of mild autism, severe learning and developmental delays and persistent obsessive compulsive disorder, Sam is an individual who would significantly benefit from the assistance of a one-on-one advocate. Additionally, Sam’s emotional intelligence qualifies him as a candidate for continuing integrated education.
Sam’s history suggests that he is capable or relative consistency and emotional dependability. The strong emotional support system constituted of his advocacy group of similarly function, mentally disabled men and a close friend and neighbor help Sam lead a functional life. He holds down a job and is well-liked by those with whom he engages in social interaction. The conflict in his condition arises from the developmental delay which has detained him at an emotional age equivalent to that of a 7 year old. As the father of a 7 year old daughter named Lucy, he is loving and suited as a guardian, but her graduating intelligence has created a conflict in terms of his fitness as a father. These are all conditions which coalesce to stimulate the recommendation for assistance and continuing education.
Sam suffers from a mild mental retardation that is directly related to his developmental capabilities and the indications of a mild form of autism. Indeed, within that spectrum, his symptoms suggest something more in line with Asperger Syndrome.
Asperge Syndrome describes possession of a host of symptoms relating to the Autism Spectrum Disorder but often distinguished there from by higher levels of awareness, functionality and linguistic development.. According to Klin et al (2000), “Asperger Syndrome (AS) is a serious and chronic neurodevelopmental disorder which is presently defined by social deficits of the type seen in autism, restricted interests as in autism, but, in contrast to autism, relative preservation of language and cognitive abilities.” (Klin et al, 25)
A consideration of some of Sam’s symptoms help to underscore a discussion both on his suitability as a father and on the basic need for some outside assistance. One key issue for Sam is the need for a highly structured day. Most individuals with symptoms such as those which denote Sam as both autistic and obsessive compulsive will likely experience “difficulty with changes in routine.” (Mims Consumer Health Group, 1) As we can see when Sam’s routine is altered such as the incident in the Big Boy, he has difficulty coping. The heightened challenges associated with rearing an increasingly intelligent and curious child do place a man in Sam’s condition in a difficult position.
Though autism is a condition which can severely inhibit a sufferers ability to function in mainstream settings, there is a great deal of practical evidence that Sam is capable of social and emotional interaction. He does possess the type of emotional connectivity with under individuals that prevents us from addressing him as autistic. Instead, he must be seen as one possessing symptoms from within the autism spectrum disorder. Indeed, it had been previously accepted that a majority of autistic individuals would never be capable of functioning independently, professionally or socially. In the context of modern inclusive education though, a product such as Sam would be considered a relative success. In consideration of his suitability as a father, his abilities and that which he has overcome do justify consideration on his behalf.
Abnormal-psychology experts now recognize that a modest success rate in those exhibiting evidence of autism is often bound further by low-expectations. Investigations into educable autistics over the last two decades offer much more to be optimistic about. Most specifically, behaviorally modifying intervention is now recognized as potentially more beneficial to the advancement of autism sufferers. By enforcing only behavior recognition patterns, a treatment program runs the risk of locking the subject into a new routine, from which any needed deviations or recontextualizations could elicit serious negative consequences. Therefore, in Sam’s case, it is wise to begin to deregulate his need for routine by providing him with the type of parental support which could help him to navigate the daily tumult of parenting.
Ultimately, Sam’s needs are to be addressed in a six session program of cognitive behavioral treatment which revolves on acclimating he and his daughter to the presence of a foster support system. A first session would be focused on consultation alone with Sam. Here, a behavioral therapist will isolate Sam’s greatest vulnerabilities, his areas of greatest need and his relative strengths as a parent and a functioning adult. This is typically an initial step for those with developmental delays such as Sam’s. His emotional and mental age being what it is, it is appropriate to evaluate his consultation needs as we might those of a child. Indeed, “the purpose of an evaluation is to find out why your child is not meeting their developmental milestones or not doing well in school. A team of professionals will work with you to evaluate your child.” (Boyse, 1) This evaluation will be central to planning out the intervention thereafter.
A second consultation session will bring Lucy and Sam in together to help assess the needs reflected by the relationship between father and daughter. Here, we can assess the deficits to his parenting ability and the demand thereby created for more effective support.
A third session would return to Sam alone, and would begin to address the specific issue of his obsessive compulsive disorder. Sam’s dependency on routine and consistency must be considered here, with an interest in finding ways to integrate this need with the otherwise tumultuous experience of rearing a child. As our research indicates, “a person who has OCD may not have enough serotonin. Many people who have OCD can function better when they take medicines that increase the amount of serotonin in their brain.” (AAFP, 1) This is a justification for a consultation that will determine whether or not Sam is a candidate for this treatment approach.
A fourth session would bring Sam together with the foster family which will soon take an active part in Lucy’s upbringing. By taking this active interest, the foster family must also become closely involved in Sam’s treatment. This session will help to develop the mutual sensitivity required, with the therapist helping to moderate this relationship by helping parties to verbalize needs and expectations. Ultimately, this will begin the process by which the foster family can come to understand and accommodate the patterns upon which Sam depends for stability.
A fifth session will bring Lucy into the equation with the foster family, beginning the process by which she accepts the presence of her new guardians. Working together in a context with Sam and the foster family can help to create the sense of a single, functional family unit. The sixth session would repeat this group’s interaction, but with the concerted interested of creating a plan, schedule and set of goals for developing comfort and consistency with one another.
By resolution, the compliment to Sam’s parentage of a foster family could significantly aid both in Lucy’s upbringing and in the improvement of Sam’s capacity for parenting. Contrary to many spectrum disorder sufferers, Sam has shown the ability to retain and integrate knowledge and education into actionable behavior. Therefore, with regard to parenting, and especially with the addition of a willing and able matriarchal figure of full intellectual capability, Sam is both fit and entitled to actively and directly raise his daughter. With the further reinforcement of his support system as here recommended, Sam will be an able and effective father to Lucy, who will be raised in a loving and full family context. Her emotional development will be nurtured in this context.
Works Cited:
American Academy of Family Physicians (AAFP). (2006). Obsessive-Compulsive Disorder: What It Is and How to Treat It. Family Doctor.org.
ASA. (2004). Information Sheet 17: Classroom Issues. Autism SA. Online at <http://www.autismsa.org.au/pdf/strategies/IS17_Classroom_Issue pdf>.
Baron-Cohen, S. (2000). Is Asperger’s sundrome/High-functioning Autism necessarily a disability? Developmental and Psychopathology. Online at http://www.geocities
Boyse, K. (2008). Developmental Delay. University of Michigan Health Systems.
Klin, A.; Volkmar, F.R. ; Sparrow, S.S. (2000). Asperger Syndrome. Guilford Press.
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MHCS. (March 2004). Autism – how to help and understand your child.
NSW Health Department. Online at http://mhcs.health.nsw.gov.au/mhcs/publication_pdfs/6965/BHC-6965-ENG.pdf.
Mims Consumer Health Group. (2006). Autistic Spectrum Disorder. My
Doctor. Ret. 11/1/06 http://www.mydr.com.au/default.asp?Article=2353.
