CHILDHOOD DISORDERS PRACTICAL REPORT

Name: Anushka Sharma

Roll No.: 23211725088

Semester: IV

Course: M.A. Psychology

Paper: Childhood Disorders

Submitted to: Dr. Subhash Meena

DEPARTMENT OF PSYCHOLOGY

UNIVERSITY OF DELHI

NORTH CAMPUS
 CASE STUDY ON AUTISM SPECTRUM DISORDER

Aim: To conduct a screening assessment of a child with Autism Spectrum Disorder (ASD),

identify potential etiological factors contributing to the condition, and suggest appropriate

interventions.

Introduction

Autism Spectrum Disorder (ASD) is a neurological and developmental condition impacting

individuals' social interaction, communication, learning, and behavior. While it can be

diagnosed at any age, it is considered a "developmental disorder" because symptoms

typically emerge within the first two years of life. As outlined in the Diagnostic and

Statistical Manual of Mental Disorders (DSM-5), individuals with ASD commonly struggle

with communication, exhibit restricted interests, and repetitive behaviors, and experience

symptoms affecting their functioning in various life areas. The term "spectrum"

acknowledges the wide range of symptoms and their varying severity. It is estimated that

worldwide about 1 in 100 children have autism (Zeidan, 2022). This estimate represents an

average figure and reported prevalence varies substantially across studies.

Some well-controlled studies have, however, reported substantially higher figures. The

prevalence of autism in many low- and middle-income countries is unknown. Nevertheless,

ASD affects people irrespective of gender, race, ethnicity, or economic background. Though

it is a lifelong condition, interventions, and support services can enhance an individual's daily

functioning. The American Academy of Pediatrics recommends autism screening for all

children, encouraging caregivers to discuss this with healthcare providers (NIMH, 2023).

Signs and symptoms of ASD

Symptoms of ASD vary among individuals diagnosed with the condition. Not everyone will

exhibit all these behaviors, but many may display several of the following:
In social communication and interaction, individuals with ASD might demonstrate:

● Limited or inconsistent eye contact

● Appearing disengaged or not responsive to people speaking

● Rarely sharing interests, emotions, or joy in activities, including infrequent gestures

like pointing or showing things to others

● Slow or no response to their name or attempts to gain attention verbally

● Challenges in engaging in reciprocal conversation

● Engaging in lengthy monologues about personal interests, unaware of others'

disinterest

● Displaying facial expressions or movements that don't match their speech

● Unusual or peculiar tone of voice

● Difficulty understanding others' perspectives or predicting their actions

● Struggles adapting behavior to different social situations

● Challenges in imaginative play or forming friendships

Regarding restrictive and repetitive behaviors, individuals with ASD may:

● Repeat certain actions or words (echolalia) or exhibit unusual behaviors

● Show intense, enduring interest in specific subjects, details, or facts

● Display overly focused attention on moving objects or parts of objects

● Experience distress due to minor changes in routine or struggle with transitions

● Exhibit sensitivity (heightened or reduced) to sensory stimuli like light, sound,

clothing, or temperature

Individuals with ASD might also face sleep issues and irritability. However, they often

possess strengths such as Ability to learn and retain detailed information for extended periods
and Strong visual and auditory learning capabilities. Proficiency in subjects like mathematics,

science, music, or art (NIMH, 2023)

Epidemiology

According to the World Health Organization (WHO), average prevalence of ASD among

children globally is approximately 1% (Salari et al., 2020). However, this figure varies

significantly between regions and countries. For example, the Centers for Disease Control

and Prevention (CDC) reports that the prevalence of ASD among 8-year-olds in the U.S. is 1

to 54. ASD is significantly more prevalent in males than females, at a ratio of approximately

4:1 (McCarty, 2021). This gender difference may reflect differences in genetic susceptibility

and/or gender bias in the diagnostic process. Early diagnosis is key to improving

developmental outcomes for children with ASD. Despite this, many children are not

diagnosed by age 3. The CDC reports that most children are first evaluated for ASD by age 4,

but diagnosis may occur later. Research suggests that ASD is highly heritable, but multiple

genetic variants are associated with disease risk and environmental factors also play a role

ASD is a global public health problem, and its incidence, time to diagnosis, and treatment

access are influenced by multiple factors (Maenner et al., 2020).

Causes

The exact cause of autism spectrum disorder remains unknown due to its intricate nature and

the variability in symptoms and intensity. It is believed that multiple factors contribute to its

development, encompassing both genetic and environmental influences.

Genetics plays a significant role, with various genes being implicated in ASD. Some children

might have ASD linked to specific genetic conditions like Rett syndrome or Fragile X

syndrome. Mutations in genes could heighten the risk of ASD, impacting brain development
or communication between brain cells. Certain genetic mutations may be hereditary, while

others occur spontaneously.

Researchers are investigating environmental factors to understand their potential contribution

to triggering ASD. Factors such as viral infections, medication use or complications during

pregnancy, and exposure to air pollutants are being explored for their possible role in the

onset of autism spectrum disorder.

Rationale

While a formal diagnosis is critical for the treatment of ASD, early screening and assessment

are equally important in understanding the child’s current developmental profile. Screening

tools such as the Childhood Autism Rating Scale – Second Edition (CARS-2) or Indian Scale

for assessment of Autism (ISAA) provide a structured way to observe behaviors and evaluate

the presence and severity of traits associated with autism. These assessments not only aid in

tailoring interventions but also help caregivers and educators understand the unique needs of

the child.

Equally essential is an exploration of the potential causes of ASD. Current research evidences

point toward a multifactorial origin, involving genetic, neurological, and environmental

influences. However, it is also important to consider psychosocial contexts such as parenting

stress, access to healthcare, and socio-cultural factors, which may shape how the disorder is

experienced and managed within families.

This case study aims to present a detailed case study of a child with an existing diagnosis of

Autism Spectrum Disorder. The focus is not on re-diagnosing but on conducting a screening

assessment to better understand the child’s functional challenges and strengths. Using a

biopsychosocial lens, the report also explores possible etiological factors and recommends
individualized, culturally sensitive interventions that support the child’s growth and

development across home and school environments.

Method

Design of the Study: The present study employs a case study approach of a single case of a

child with Autism Spectrum Disorder (ASD). A case study approach is particularly suitable

for in-depth investigation of complex phenomena within real-life contexts, especially when

multiple variables need to be observed simultaneously and holistically. This design facilitates

a detailed exploration of the child's unique presentation, early developmental history,

potential etiological factors, and response to current interventions. The study incorporates

both observational data and informant-based reports to form a comprehensive understanding

of the case. Tool such as the Childhood Autism Rating Scale – Second Edition (CARS-2) is

used for structured screening, while additional insights are gathered through clinical

interviews, developmental history analysis, and behavioral observations. These multiple data

sources help in triangulating findings to enhance the credibility and depth of the case profile.

Assessment Tool Used: Childhood Autism Rating Scale – Second Edition (CARS-2). One of

the most widely used rating scale for the detection and diagnosis of autism is the childhood

autism rating scale. It was developed by Schopler, Reichler & and Renner in 1988. The

CARS consist of 14 domains assessing behaviors associated with autism, with a 15th domain

rating general impression of autism. Each domain is scored on a scale ranging from one to

four; higher scores are associated with a higher level of impairment. Total scores can range

from a low of 15 to a high of 60; scores below 30 indicate that the individual is in the non-

autistic range, scores between 30 and 36.5 indicate mild to moderate autism, and scores from

37 to 60 indicate severe autism. The psychometrics of the CARS have been well documented.

The CARS-2 is an update of the Childhood Autism Rating Scale (CARS), an older and
widely-used rating scale for autism. The original CARS was developed primarily with

individuals with comorbid intellectual functioning and was criticized for not accurately

identifying higher-functioning individuals on the autism spectrum. The CARS-2 retained the

original CARS form for use with younger or lower functioning individuals with an estimated

IQ of 79 or lower (now renamed the CARS2-ST for "Standard Form"), and it developed a

separate rating scale for use with higher functioning individuals with intelligence quotient

scores above 80 (named the CARS2-HF for "High Functioning"). The CARS-2 consists of 15

questions and is evaluated by clinical experts based on individual interviews with the primary

caregiver and direct observation of children. Each question is rated on a scale of 1 (normal at

the corresponding age) to 4 (severely abnormal at the corresponding age), and the scores of

each question are added to obtain a total score for each patient, which ranges from 15– 60. In

the case of the CARS2-ST, a total score of <30 indicates non-autism, 30–36.5 indicates mild

to moderate autism, and a total score of ≥37 indicates severe autism. For the CARS2-HF, a

total score of ≤27.5 indicates non-autism, a score between 28–33.5 indicates moderate autism

and a score of ≥34 indicates severe autism.

Reliability and Validity of CARS-2

The Childhood Autism Rating Scale – Second Edition (CARS-2) is a widely recognized

screening tool for identifying Autism Spectrum Disorder (ASD) and determining its severity

across multiple domains. It has been praised for its strong psychometric properties and

clinical applicability in both research and practice settings. CARS-2 exhibits strong reliability

across various measures. The inter-rater reliability—the degree to which different raters agree

on scoring—is high, with coefficients ranging from 0.71 to 0.85, suggesting consistency in

scoring across evaluators (Schopler, Van Bourgondien, Wellman, & Love, 2010). The test-

retest reliability, which assesses the stability of scores over time, has also been reported to be
high, with coefficients typically exceeding 0.80, supporting the tool's consistency (Perry et

al., 2005).

CARS-2 demonstrates strong content validity, as it covers core symptoms of ASD including

deficits in social communication and the presence of restricted, repetitive patterns of behavior

(Schopler et al., 2010). The tool is aligned with the diagnostic criteria outlined in the DSM-5,

ensuring it assesses clinically relevant behaviors. In terms of construct validity, studies have

found strong correlations between CARS scores and other established diagnostic tools such

as the “Autism Diagnostic Observation Schedule (ADOS)” and the “Autism Diagnostic

Interview-Revised (ADI-R)” (Perry et al., 2005; Ventola et al., 2006). Furthermore, the

discriminant validity of CARS-2 is well-established, effectively differentiating children with

ASD from those with other developmental conditions such as intellectual disability or

language impairments.

CARS-2 includes two forms: The Standard Version (CARS2-ST) for children with more

apparent symptoms and the High-Functioning Version (CARS2-HF) for children with

average or above-average cognitive ability, improving the tool’s sensitivity across the autism

spectrum.

Scoring and Interpretation

Total score is determined by summing the ratings on all 15 items. The total scores can also be

translated into T-Scores, which show how the person’s actions compare to the authors large

clinical norms sample of people. CARS total scores range from a low of 15 (within normal

limits on all items) to a high of 60 (severely abnormal on all items). Scores range from 15 to

60 with 30 being the cutoff rate for a diagnosis of mild autism. Scores 30-37 indicate mild to

moderate autism, while scores between 38 and 60 are characterized as severe autism. On a

scale from one to four, the categories of the Childhood Autism Rating Scale are assessed,
with half points given for those that fall in between those steps. For behavior that does not

meet the requirements for a score of one or two, a score of 1.5 may be assigned. The criteria

for scoring are as follows:

● 1: Within normal limits for that age

● 1.5: Very mildly abnormal for that age

● 2: Mildly abnormal for that age

● 2.5: Mildly-to-moderately abnormal for that age

● 3: Moderately abnormal for that age

● 3.5: Moderately-to-severely abnormal for that age

● 4: Severely abnormal for that age

CASE HISTORY

Name: DS

Age: 5 year

Sex: Male

Grade: Withdrawn from preschool

Referral Source: Pediatrician

Reasons for Referral (based on observations): Concerns regarding limited speech, lack of

social interaction, no eye contact, repetitive behaviors and developmental delays.

Chief Complaints (as stated by Mother)

“Baat nahi sunta hain, naam leke bulane pe bhi”

“Eye contact nhi karta bilkul”

“Kisi se baat nahi karta, bas light ki taraf dekhta rehta hai”
“Agar yeh kuch sunta h toh bas vahi repeat krta rehta hai pura din”

“Beech beech m kabhi kabhi ghumne lag jata hai”

History of Present Illness

The child was born after 3 years of marriage through c-section delivery. His parents first

started to notice developmental concerns around 2 year of age. The initial symptoms included

no eye contact, delayed speech and lack of social interaction. By the end of 1 year, parents

reported that he did not respond to his name when called, preferred to play alone and showed

limited interest. These issues become more pronounced between 18-24 months when he still

had no meaningful speech and was not engaging with other children. He spent most of his

time spinning or looking at the lights around the house. His parents initially assumed these

were temporary delays, but his difficulties in communication and social interaction became

more pronounced as he grew older. By the age of 3, he began showing signs of distress in

unfamiliar environments, intense sensitivity to certain sounds and lights, and rigidity in

routines. He displayed echolalia and would often repeat dialogues of his parents or other

people without understanding their context. His playschool teachers expressed concerns

about his limited peer interaction and challenges in following group activities. At age 4, he

was taken to a pediatrician, who referred to a clinical psychologist for a comprehensive

assessment and confirmed a diagnosis of Autism Spectrum Disorder. In the last 12 months,

he has been taking sessions behavioral therapy, speech therapy and occupational therapy and

has shown little improvement in basic speech and social communication.

Family History

The child lives in a nuclear family with his mother and an older sister, aged 7 years. There is

no known family history of psychiatric or neurological illnesses on either the maternal or

paternal side. His maternal grandmother visits occasionally and provides some support to the
family. His parents have been married for eight years and had him 3 years into their marriage.

There is no history of infertility, miscarriages, or complications during pregnancy. The

parents are not consanguineously related. His mother, a science graduate and homemaker, is

actively involved in his day-to-day care, including managing his routines, therapy sessions,

and school-related needs. She is described as nurturing, patient, and emotionally responsive

to his needs. In contrast, his father, who works in the finance sector and holds an MBA, is

largely unavailable due to work commitments and is minimally involved in the child’s

upbringing and therapeutic processes. Although he is aware of his condition, his emotional

and physical presence in the child's life is limited. His sister is in good health and attends a

regular school. She shares a close bond with him and often accompanies him to the therapy

center with their mother. Overall, the primary caregiving responsibilities lie with the mother,

and the family environment is structured around his needs with moderate external support.

Medical History

The child has had no major medical concerns. He experienced occasional mild respiratory

infections in early childhood, which resolved without complications. There is no history of

seizures, surgeries, or chronic illnesses. His immunizations are up to date. Mild self-injurious

behaviors like head-banging or throwing objects occur occasionally during temper tantrums

but have not required medical intervention. Overall, his physical health is stable.

Birth and Developmental History

Prenatal History

The child’s mother had a healthy and well-monitored pregnancy. There was no history of

nutritional deficiencies, infections (such as measles, mumps, or chickenpox), or chronic

illnesses like diabetes or hypertension during the antenatal period. She did not experience any

significant complications such as bleeding, threatened abortion, or impaired fetal movement.

There was no exposure to harmful medications, substances, or radiation. The pregnancy was

planned and full-term, with regular antenatal check-ups and appropriate supplementation.

Perinatal History

He was born at 39 weeks of gestation through a c-section delivery. Labor was prolonged,

with evidence of fetal distress. His birth weight was 3.2 kg, and he cried immediately after

birth. There were no signs of congenital anomalies, and he did not require resuscitation. The

delivery was not assisted or induced. Apgar scores were within normal range (not

documented specifically), and the post-delivery period was stable.

Postnatal History and Developmental Milestones

During the neonatal period, he had mild feeding difficulties, which resolved over time. He

did not have neonatal jaundice or significant infections. Developmentally, his motor

milestones were within normal limits: head control by 3 months, sitting without support at 9

months, and independent walking by 16 months. He could run and climb stairs by 3.5 years.

Speech and language development showed marked delays. Babbling began around 8 months,

but he did not speak meaningful words until after 3 years, and even then, his speech was

mostly echolalic. He had difficulty forming two-word phrases and did not engage in

meaningful verbal communication. Social and personal milestones were also delayed.

Although he recognized his mother and smiled socially, he showed limited imitation and joint

attention, and rarely interacted with peers. Skills such as feeding without help, indicating

toilet needs, and dressing independently were inconsistently achieved. He was not fully toilet

trained by age five. Adaptive milestones such as pretend play, writing alphabets, and

understanding body parts were significantly delayed or absent. His play was mostly solitary

and repetitive and would mostly play alone or spend most of his time spinning in circles or

gazing at the lights. Overall, his developmental history indicates significant delays in speech,
social communication, and adaptive functioning, consistent with features of Autism Spectrum

Disorder.

Educational History

He was enrolled in a regular playschool at the age of 3.5 years. However, he faced significant

difficulties adjusting to the school environment due to poor social interaction, limited

communication, and challenges in following group instructions. Teachers reported that he

was often disengaged, did not respond to his name, and struggled to participate in classroom

activities. As a result, he was withdrawn from schooling and enrolled in a child early

intervention center at the age of 4. Since then, he has been attending a structured program

focused on communication, sensory integration, and behavioral skills as well as special

education. His academic skills, including reading, writing, and arithmetic, remain below age

level. He has minimal participation in co-curricular tasks. Peer interaction continues to be

limited, and faces challenges with attention, comprehension, and task-following.

Assessment Tool used: Childhood Autism Rating Scale (CARS)-2

The Childhood Autism Rating Scale (CARS)-2 is a standardized behavioral rating scale

developed to identify children with Autism Spectrum Disorder (ASD) and to determine the

severity of their symptoms. It is widely used by clinicians to differentiate children with

autism from those with other developmental delays. CARS consist of 15 items, each rated on

a 4-point scale based on direct observation and information from parents or caregivers. The

items assess a broad range of behaviors and developmental functions commonly affected in

autism. These include:

1. Relating to people

2. Imitation
3. Emotional response

4. Body use

5. Object use

6. Adaptation to change

7. Visual response

8. Listening response

9. Taste, smell, and touch response

10. Fear or nervousness

11. Verbal communication

12. Non-verbal communication

13. Activity level

14. Level and consistency of intellectual response

15. General impressions

Each item is scored from 1 (within normal limits) to 4 (severely abnormal), with a total

possible score ranging from 15 to 60. A score of 30–36.5 indicates mild to moderate autism,

while a score of 37 or above suggests severe autism. Scores below 30 suggest that the child is

unlikely to meet the criteria for autism.

Procedure: Information about the child was gathered through a detailed case history

interview conducted with the child’s mother. This allowed for comprehensive insights into

the child’s developmental, medical, familial, and psychosocial background. In addition to the

parental report, direct behavioral observation of the child was carried out in a naturalistic
setting to assess social interaction, communication patterns, play behavior, and motor

activity. Based on the collected information and clinical observation, the Childhood Autism

Rating Scale – Second Edition (CARS-2 ST) was administered. The child was rated across 15

domains of functioning to evaluate the presence and severity of autism-related behaviors,

facilitating a structured understanding of his symptom profile.

Behavioral Observations: DS was observed during both unstructured and structured tasks

in the clinical setting. When he entered the room, he did not respond to greetings or make any

effort to interact. He avoided eye contact entirely and seemed unaware of the examiner’s

presence. There was a noticeable lack of social interaction, and he did not attempt to engage

with the examiner or his caregiver throughout the session. He spent a lot of time gazing at

lights and reflective surfaces, appearing fascinated by them. When his name was called

several times, he did not respond, showing poor responsiveness to verbal cues. He used very

little language, and when he did speak, it was only to express basic needs like asking for

water or objects. Much of his speech consisted of echolalia, where he repeated words or

phrases without clear meaning or context. During free play, he preferred to be on his own and

engaged in repetitive behaviors, such as spinning in circles and flapping his hands. These

behaviors became more frequent when he was unoccupied or overstimulated. He did not

show interest in toys in a typical way, and there was no pretend or imaginative play observed.

His attention span was short, and he frequently moved from one activity to another without

finishing any. He did not imitate actions or gestures, even with prompting, and needed

constant support to remain engaged. Overall, he appeared more comfortable in solitary, self-

directed activities and showed clear difficulties with communication, social interaction, and

flexibility in behavior—patterns consistent with autism spectrum traits.

 Results

Table 1

Total Score and Severity

TOTAL RAW SCORE SEVERITY GROUP

35.5 Mild to Moderate Symptoms of Autism
Spectrum Disorder.

Table 2
Category wise Ratings

CATEGORY RATING

Relating to People 3

Imitation 3

Emotional Response 2.5

Body Use 3

Object Use 3

Adaptation to Change 1.5

Visual Response 3

Listening Response 2

Touch, Smell and Taste Response and Use 1.5

Fear or Nervousness 2

Verbal Communication 2

Non-Verbal Communication 2.5

Activity Level 2.5

Level and Consistency of Intellectual 1.5

Response

General Impression 3
 Interpretation of CARS-2 ST Results

DS obtained a total score of 35.5 on the Childhood Autism Rating Scale, Second Edition –

Standard Version (CARS-2 ST), placing him within the mild to moderate range of Autism

Spectrum Disorder (ASD). The CARS-2 is a standardized tool used to assess the presence

and severity of autistic traits across multiple domains of functioning, based on direct

observation and parental report. His profile reflects core features of ASD, with significant

impairments noted in social interaction, communication, and the presence of restricted and

repetitive behaviors, alongside relative strengths in a few areas.

In the domain of relating to people, he received a score of 3, indicating considerable

difficulty in establishing social connections. He appears socially distant, avoids eye contact,

and shows minimal interest in initiating or maintaining interactions with others. Similarly, his

imitation abilities, also rated at 3, suggest a marked deficit in copying actions or gestures,

which limits his capacity to learn through social observation and restricts opportunities for

reciprocal play and communication.

His emotional responsiveness was rated at 2.5, reflecting a tendency toward blunted or

atypical emotional expressions. While he may exhibit emotional reactivity at times, his

responses are often not well-matched to the context and may appear muted or delayed. His

body use, with a score of 3, indicates frequent engagement in stereotyped motor behaviors

such as hand flapping or toe walking. These repetitive movements may serve a self-

regulatory function but also interfere with purposeful motor activity.

A score of 3 in object use further highlights his preference for repetitive, non-functional

interactions with objects, such as spinning or lining up toys, rather than engaging in symbolic

or constructive play. In contrast, his adaptation to change, rated at 1.5, reflects relatively

preserved flexibility. While he does display some resistance to transitions or changes in

routine, the intensity of these reactions is comparatively mild, suggesting some capacity for

environmental adaptation with support.

In terms of visual response, he received a score of 3, indicating highly atypical visual

engagement. He often fixates on specific visual stimuli or avoids social visual cues, such as

eye contact or following another’s gaze. His listening response, rated at 2, points to

inconsistent auditory responsiveness. He may not always attend to verbal instructions or

social sounds, although he is not entirely unresponsive, indicating some receptive abilities

that could be developed further.

His response to taste, smell, and touch, scored at 1.5, suggests minimal sensory defensiveness

in these domains. He appears to tolerate various textures, tastes, and tactile experiences

without significant distress, which stands as a relative strength compared to other children

with ASD who exhibit pronounced sensory sensitivities. His fear or nervousness, rated at 2,

indicates the presence of mild anxiety or fear responses that may not be clearly linked to real

threats or typical developmental fears.

In terms of verbal communication, a score of 2 reflects delayed yet emerging language

abilities. His speech may consist of echolalic phrases or single words, with limited

spontaneous communication or pragmatic language use. His non-verbal communication

(rating 2.5) was noticeably limited. He did not use gestures such as pointing, waving, or

nodding to communicate. Facial expressions were minimal, and he rarely used them to show

emotion or respond to others. Even when he wanted something, he typically led an adult by

the hand or showed signs of frustration rather than using gestures or expressions to indicate

his needs. Although there were occasional moments where he looked toward objects he was

interested in, these instances were rare and not clearly used to share attention or engage

others. Overall, his ability to use non-verbal behaviors to communicate or connect socially
was significantly below what is expected for his ag His activity level, rated at 2.5, shows that

he may alternate between periods of hypoactivity and hyperactivity, potentially reflecting

difficulties with self-regulation and arousal modulation.

A key area of relative strength lies in his level and consistency of intellectual response, rated

at 1.5. When presented with structured tasks and appropriate supports, he is able to engage

and demonstrate cognitive understanding, suggesting that his intellectual functioning is not

globally impaired. Lastly, the general impression score of 3 reinforces the overall

presentation of behaviors consistent with autism, based on clinical observation and caregiver

input.

Possible etiological factors

The etiology of DS’s developmental presentation appears to be multifactorial, involving a

likely interaction between neurodevelopmental vulnerabilities and early environmental

factors. Although there were no notable prenatal or perinatal complications and no family

history of neurodevelopmental or psychiatric disorders, developmental delays were more

evident by the age of two, particularly in the domains of language, social reciprocity, and

imitation.

Importantly, the onset and early progression of symptoms occurred during the COVID-19

pandemic, a time when access to social interaction, early childhood education, and structured

interventions was severely restricted. Emerging literature has highlighted how pandemic-

related isolation may contribute to delays in social and communication development in

children, particularly those already at risk. For instance, Irwin et al. (2022) found that

children exposed to social restrictions during the pandemic displayed increased social-

emotional difficulties and reduced language development compared to pre-pandemic cohorts.

Similarly, Deoni et al. (2021) reported significantly reduced verbal, motor, and cognitive
performance in children born during the pandemic, emphasizing the importance of early

environmental stimulation.

In Mr. D’s case, the lack of early peer interaction, minimal exposure to varied communicative

environments, and delays in accessing professional support may have exacerbated pre-

existing developmental vulnerabilities. While environmental deprivation is not considered a

primary cause of Autism Spectrum Disorder, it can influence the severity and visibility of

symptoms during critical developmental windows (Bradshaw et al., 2020). Additionally,

neurodevelopmental theories of autism suggest early disruptions in brain systems responsible

for social cognition, language, and sensory integration (Courchesne et al., 2007). His’s

pattern of delayed speech, absent joint attention, and sensory-seeking behaviors (e.g.,

spinning in circles and gazing at lights) aligns with these neurological profiles. Though no

genetic testing has been conducted, research supports the idea that many cases of ASD have

idiopathic origins—with no clearly identifiable cause—yet are likely influenced by subtle

neurobiological and genetic factors (Lord et al., 2020).

Overall, his developmental profile is best understood through a bio-psycho-social lens, where

early neurodevelopmental differences may have been amplified by reduced environmental

input and delayed intervention due to the COVID-19 context. This highlights the need for

early screening and continued support, especially for children who passed critical

developmental stages during times of social restriction.

Individualized Intervention Plan

Mr. D has been diagnosed with Autism Spectrum Disorder (ASD), and his intervention plan

should focus on helping him communicate better, improve his social skills, manage

behaviors, and become more independent. Early intervention is very important for making

progress in these areas.

One of the main concerns for the child is his communication. He struggles with speaking and

often repeats phrases (echolalia). To help with this, speech therapy should focus on teaching

him how to communicate more effectively. ‘Speech therapy’ involves working with a speech

therapist to improve skills like talking, understanding language, and using language in a

functional way. This might include using alternative communication methods like the

‘Picture Exchange Communication System (PECS)’, which is a method where he would use

pictures to communicate his needs or wants. This method helps children with limited speech

express themselves and reduce frustration. Speech therapy should also include practicing

simple phrases and using visual aids to support his learning. Visual aids could be pictures,

gestures, or written words that help him understand and use language. Since he has difficulty

with non-verbal communication (like eye contact, pointing, and paying attention to others),

social interaction therapy is essential. ‘Social interaction therapy’ focuses on teaching

children how to engage with others in meaningful ways. Techniques like ‘Floor Time’ and

‘Reciprocal Imitation Training’ (RIT) can help him learn to share attention and engage in

turn-taking activities. Floor Time is an approach where the therapist follows the child’s lead

in play, creating a supportive and motivating environment. RIT focuses on encouraging

imitation and interactive play to build social and communication skills.

He also engages in repetitive behaviors (e.g., spinning in circles) that can be addressed with

occupational therapy (OT). Occupational therapy focuses on helping children develop the

skills they need for daily life. OT can help him regulate his sensory responses (e.g., to lights,

sounds, or textures) and reduce repetitive actions. Additionally, OT can help improve his

motor skills (like using his hands for tasks), teach him daily tasks (like dressing, feeding, and

toileting), and encourage him to stick with tasks for longer periods of time. A sensory

integration approach in OT helps children with sensory processing challenges by providing

activities that help them organize and respond appropriately to sensory input. To help him

with his slight rigid behaviors and repetitive routines, behavioral therapy like ‘Applied

Behavior Analysis (ABA)’ can be helpful. ‘ABA’ is a therapy that uses positive reinforcement

to teach new skills and reduce unwanted behaviors. It involves breaking down tasks into

small steps and rewarding the child for making progress. ‘Discrete Trial Training (DTT)’ is a

structured teaching method used in ABA that involves presenting a task and providing

rewards when the child completes it correctly. ‘Natural Environment Teaching (NET)’ is

another ABA technique where skills are taught in natural settings (like at home or school) to

encourage learning in real-life situations.

His limited ability to play with others and interact socially means that he will also benefit

from social skills training. ‘Social skills training’ involves teaching children the basic skills

they need to interact appropriately with peers. Small group sessions with other children can

help teach skills like greeting others, taking turns, and recognizing emotions. Techniques like

role-playing (acting out social situations), social stories (stories that describe social situations

and appropriate responses), and video modeling (watching videos of people demonstrating

social skills) can help him practice these skills in a supportive environment. Academically, he

will do best in a special education classroom with a small number of students and a structured

routine. A special education classroom is a setting where teachers are trained to support

children with learning differences. Visual tools like schedules (which show what activities

will happen throughout the day) and task strips (step-by-step guides for completing tasks) can

help him understand what to expect during the day. Lessons should be short and predictable,

with plenty of breaks and rewards for staying on task.

Parent involvement is crucial. Parents should be given regular training to understand his

needs and learn how to support him at home. Parent psychoeducation and training helps

parents understand their child’s behavior and learn effective strategies to support their

development. They can be taught to use strategies like positive reinforcement (rewarding

desirable behaviors) and visual aids to create a consistent and supportive environment.

Finally, it is important to keep track of his progress over time. Regular assessments should be

done to see how he is doing, make changes to the plan if necessary, and check for any other

concerns, such as anxiety or behavior problems. The intervention plan should be flexible and

adapt to his changing needs and interests, helping him become more engaged with the world

around him and work towards greater independence.

Conclusion

Based on screening assessment, the CARS-2 scores strongly correlate with the case history

and behavioral observations. DS displays classic features of Autism Spectrum Disorder

across communication, social interaction, and behavioral domains. His placement in the mild

to moderate autism category underscores the need for early and structured intervention,

including speech therapy, behavior management strategies, social skills training, and parent

counseling. A multidisciplinary approach will be essential to support his developmental needs

and enhance adaptive functioning.

 References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental

disorders (5th edition). American Psychiatric Publishing.

Bradshaw, J., McCracken, C., Pileggi, M., Brane, N., Delehanty, A., Day, T., Federico, A.,

Klaiman, C., Saulnier, C., Klin, A., & Wetherby, A. (2021). Early social

communication development in infants with autism spectrum disorder. Child

development, 92(6), 2224–2234. https://doi.org/10.1111/cdev.13683

Courchesne, E., Redcay, E., & Kennedy, D. P. (2007). The autistic brain: birth through

adulthood. Current Opinion in Neurology, 20(2), 118–12

Deoni, S. C. L., Beauchemin, J., Volpe, A., D’Sa, V., & RESONANCE Consortium. (2021).

Impact of the COVID-19 pandemic on early child cognitive development: Initial

findings in a longitudinal observational study of child health. medRxiv.

https://doi.org/10.1101/2021.08.10.21261846

Irwin, M., Lazarevic, B., Soled, D., & Adesman, A. (2022). The COVID-19 pandemic and its

potential enduring impact on children. Current opinion in pediatrics, 34(1), 107–115.

https://doi.org/10.1097/MOP.0000000000001097

Lord, C., Elsabbagh, M., Baird, G., & Veenstra-VanderWeele, J. (2020). Autism spectrum

disorder. The Lancet, 392(10146), 508–520.

Maenner, M. J., Shaw, K. A., Baio, J., EdS1, Washington, A., Patrick, M., DiRienzo, M.,

Christensen, D. L., Wiggins, L. D., Pettygrove, S., Andrews, J. G., Lopez, M.,

Hudson, A., Baroud, T., Schwenk, Y., White, T., Rosenberg, C. R., Lee, L. C.,

Harrington, R. A., Huston, M., … Dietz, P. M. (2020). Prevalence of Autism

Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental

 Disabilities Monitoring Network, 11 Sites, United States, 2016. Morbidity and

mortality weekly report. Surveillance summaries (Washington, D.C.: 2002), 69(4), 1–

12. https://doi.org/10.15585/mmwr.ss6904a1

McCarty DCA. Tools of the traits: the impact of sex and IQ on autism spectrum disorder

assessment and diagnostic measures. The University of Utah. 2021.

Salari, N., Rasoulpoor, S., Rasoulpoor, S., Shohaimi, S., Jafarpour, S., Abdoli, N., Khaledi-

Paveh, B., & Mohammadi, M. (2022). The global prevalence of autism spectrum

disorder: a comprehensive systematic review and meta-analysis. Italian journal of

pediatrics, 48(1), 112. https://doi.org/10.1186/s13052-022-01310-w

Schopler, E., Reichler, R. J., DeVellis, R. F., & Daly, K. (1980). Toward objective

classification of childhood autism: Childhood autism rating scale (CARS). Journal of

Autism and Developmental Disorders, 10, 91–103.

Schopler, E., Reichler, R. J., & Renner, B. R. (1988). The childhood autism rating scale. Los

Angeles, CA: Western Psychological Services.

Zeidan, J., Fombonne, E., Scorah, J., Ibrahim, A., Durkin, M. S., Saxena, S., Yusuf, A., Shih,

A., & Elsabbagh, M. (2022). Global prevalence of autism: A systematic review

update. Autism research: official journal of the International Society for Autism

Research, 15(5), 778–790. https://doi.org/10.1002/aur.2696