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Case Study
Allison Qualls
University of Utah
November 29, 2018
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Client Interview and Assessment

I am completing my clinic hours at Matt’s Place. Matt’s Place is alternative school

system that has different team members; Psychologists, Recreational Therapist, Occupational

Therapist, and Teachers. Matt’s Place population ranges from 8 to 18 years old and the diagnoses

range from, depression, and anxiety to Autism and ADHD. Many of the students there, struggle

with the traditional school system and being able to thrive in that setting. This allows the

students to have a less stressful environment with a smaller population and to learn skills that

they can use in their everyday life. Each week there is a different theme that focuses on skills

that the students can work on there at Matt’s Place and at home as well. The students start of the

day with school, then there is 15 minutes of freedom and reading. They are in school until 11 am,

this is when they get lunch and have free time again. They have group around 12:30 pm to

discuss the weeks theme and their goals. At 1 pm they have recreational therapy until almost 2

pm. At 3 pm parents come to pick up the students. My duties were to follow my Recreational

Therapist, and I would ask her questions about how recreational therapy works. I would

occasionally help with group that involved recreational therapy.

The student who was interviewed will be called Student C. Student C is diagnosed with

Autism as his Intellectual disability, but he is also diagnosed with depression. Student C is a

seventeen-year-old white male who is a senior in high school and will be graduating on time. He

has several siblings and lives with his parents. He recently moved to a new area, due to some

expenses that may be because of his treatment. He is aware of this and works to help earn money

for his parents. Until recently, his mother was the one driving him to places, he has since then

utilized the bus system. He mentioned that he enjoys card games and playing them with others.
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He is a hard worker in school and when he is finished with his work book, he helps other

students if they need it.

Behaviorally Student C during the interview had minimal eye contact and his body

language indicated that he did not want to answer my questions. During the interview, my body

was directed towards him, however for him his body was directed towards the wall. His answers

were minimal and mainly one-word answers. He did have some difficulty coming up with some

answers or thinking of situations that he has difficulties with. However, I have noticed that when

he is with his peers that he is comfortable with, he makes jokes and is very sarcastic. He did

mention that he does not have any friends. He does not always engage with others and tends to

keep a distance. The first day I met him, we went to a park and he was dribbling the basketball

around the court by himself. I suggested a game to do with him, but he was uninterested.

Goals and Objectives

Student C does very well by himself and when he is given instructions, he can follow

directions. He seems productive if it does not include working closely with others. Goals that

would be beneficial for him would include working on social skills and having to work in group

settings to accomplish an activity with others. The activities that I have seen have had many

individual activities that allowed Student C to isolate himself and not work on his social skills.

My objectives for him would to do a card game that would require communication to win the

game. For example, there are many games that mimic escape rooms, where the person needs to

communicate with others to complete the game in the time given. We did play one game where

the students had to toss a ball to someone in the circle and remember that person’s name and the

order of where the ball went to who. To make this more challenging more balls were added and

trying to maintain a fast pace.

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Diagnostic Protocol

Autism is classified as a developmental disability which is defined by the Center of

Disease Control (CDC) as “a group of conditions due to an impairment in physical, learning,

language, or behavior areas. These conditions begin during the developmental period, may

impact day-to-day functioning, and usually last throughout a person’s lifetime ( CDC, 2019).The

National Autism Association (NAA) defines autism spectrum disorder (ASD) as a bio-

neurological development disability that can be present by the age of 3. Approximately 1 out of

54 children are diagnosed with autism with boys being diagnosed 4 times more than girls.

Autism is linked to co-morbid medical conditions such as allergies, asthma, epilepsy, digestive

disorders, persistent viral infections, feeding disorders, sensory integration dysfunction, sleeping

disorders, and more (NAA, n.d.). The CDC defines ASD as deficits in social communication,

nonverbal communication and developing, maintaining, and understanding relationships (CDC,

2016).

The CDC lists signs and symptoms of autism being; not pointing at objects of interest,

avoiding eye contact and wanting to be left alone, difficult understanding other people’s feelings

and/or talking about their own feelings, repeating words or phrases that others said to them,

difficulty expressing needs with typical words or motions, trouble adapting to changes in routine,

different reactions to senses compared to neurotypical reactions, and losing skills that they once

had (CDC, 2020).

Currently there is no cure for autism, but some interventions have proven to be successful

in treating symptoms. There are four different categories of treatments as listed by the CDC;

Behavior and Communication Approaches, Dietary Approaches, Medication, and

Complementary and Alternative Medicine. Treatments that are common in Behavior and
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Communication Approaches are; Applied Behavior Analysis (ABA), Assistive Technology,

Developmental, Individual Differences, Relationship-Based Approach, Occupational Therapy,

Social Skills Training, and Speech Therapy. Dietary Approaches have little evidence that these

treatments help alleviate symptoms, as always talking to a doctor first important to determine if

this is the best action for your child. Medication is used to help manage high energy levels,

inability to focus, anxiety and depression, behavioral reactivity, self-injury, or seizures.

Complementary and Alternative Medicine Treatments have not had enough research ton to

determine the effectiveness of the treatments (CDC, 2016).

Based on the diagnosis definition and the behaviors observed by the recreational

therapist, Student C meets the symptoms of struggling to engage appropriately in social

situations, not giving eye contact, and not having interest in other people. Student C is

independent in the clinic and perform activities that he is familiar with. He is currently learning

how to ride the bus system and does need help in these beginning stages of learning how the

system works. Student C has a job and can perform the tasks that he is assigned. The only

support that Student C needs currently is working on managing emotions and finding coping

skills that help him, when he is overwhelmed.

Intervention

An activity that was performed by the current CTRS was a social engagement activity.

Clients were set up in a circle and because of new clients or students from the university that

were observing, everyone was instructed to say their name. The instructions of the activity were

to throw a ball to an individual and say their name, if you did not remember their name, you

needed to ask them and initiate the question. Each person threw the ball to another person who

had not received the ball until the last person threw the ball back to the person who began the
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activity. The group threw one ball for a few rounds as they got use to the pattern and then

another ball was added to the activity. After each round another ball was added and the group

continued to throw the balls until there was more than 10 balls being thrown at once. Eventually

the group ended when there was multiple droppings of the balls and it was difficult to keep up

the movement of the pattern. This activity required the clients to work on social skills that

involved eye contact and addressing other people. If they did not interact with the person and

ensured that there was eye contact, it was more likely that the ball was dropped and the flow of

throwing of the balls was interrupted. Student C threw the ball to me and did struggle with

interacting with me by giving eye contact and calling my name to inform me that he was tossing

the ball to me.

In the article “I Wanna Play Too: Factors Related to Changes n Social Behavior for

Children With and Without Autism Spectrum Disorder After Implementation of a Structured

Outdoor Play Curriculum” By Michael J. Morrier and Sonja M.T. Ziegler focus on how

structured play can increase social interaction. While this article does take place outside, the

intervention used above can be implemented in any setting. The main intervention used in this

study is called the “Buddy Game” in this intervention which is a game where the children mimic

movements and actions of another child. When this activity was done the children had fifteen

minutes to do free play. Morrier concludes the article with that structured play promotes positive

peer interactions for the rest of day. It also helps to increase social interaction for children with

autism (p.2539). While the game intervention that was used at Matt’s place was a different, it

would be classified as structured play. This is because it is game but is led by facilitator with

rules and expectations of the participants. Based on the article presented structured play can

improve social interaction, which also improves communication.

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Goals of the activity is to work on appropriate communication between participants.

Appropriate communication is evident by using eye contact and verbal communication of calling

the person’s name. Objectives of the intervention are that the student will successfully call the

person’s name eight out of ten rounds. Student will ensure eye contact was made before throwing

the ball eight out of ten rounds. If student makes a mistake when passing the ball, they will

communicate with the other person and work on improving by the next round.

Outcome Evaluation

In conclusion of the intervention, students expressed what went well and what was

difficult about the activity. Student C did not have much to share about the activity but was

listening to his peers as they explained what they thought. Student was engaged during the

activity due to the nature of the activity. In other activities that are less hands on or require less

speaking, student seemed more withdrawn and would choose not to communicate with peers.

Student C did struggle with engaging eye contact or calling my name before throwing the ball,

however, client did manage to remember the social cues for over fifty percent of the rounds that

were completed.

Student C is interested in card games when we discussed activities that he enjoyed in the

interview that was done with the University Student. Card games require communication of the

action that the person plans to do next. For example, in the card game UNO” it is important to

vocalize when there is a switch in colors, or actions. This can also be done with a minimal

number of participants of two or have up to four players or more. Based on the interview, it

would be in the student’s best interest to start with one peer that they are comfortable with and as

the student gets better with that peer, introduce other peers that the student is less comfortable

with, but give them the option to take a break if they feel overwhelmed.
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An overview of the case study presented above, individual who was interviewed for the

case study is a 17-year old white male who has been diagnosed with Autism and depression. The

individual was identified as Student C to comply to HIPPA guidelines. Student C presented

difficulties in communication and giving eye contact with University Student. Student C was

more interested in doing activities by himself instead with peers. If the activity encouraged

communication with peers, Student C was able to engage with some impairments in social

interactions. Student C meets the definition of Autism as described by the CDC and NAA.

Student C has the potential to do well in society, but does need help to initially learn some skills,

but does well after learning the skills.

Signature & Date

A.Qualls, RT Student, November 29, 2018
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Resources

Autism Fact Sheet. (n.d.). Retrieved November 22, 2018, from

https://nationalautismassociation.org/resources/autism-fact-sheet/?

gclid=CjwKCAjwj975BRBUEiwA4whRBzsKAEOOoMZ86Hv3f9QDZ3B-

_KrGyVXpzL0w7w7L1__xwq2aosTeKRoCP7gQAvD_BwE

Autism Spectrum Disorder (ASD). (2016, April 18). Retrieved from

https://www.cdc.gov/ncbddd/autism/hcp-dsm.html

Facts About Developmental Disabilities. (2019, September 26). Retrieved November 22, 2018,

from https://www.cdc.gov/ncbddd/developmentaldisabilities/facts.html

Morrier, M.J., & Ziegler, S.M.T. (2018). I wanna play too: factors related to changes n social

behavior for children with and without autism spectrum disorder after implementation of

a structured outdoor play curriculum. Journal of Autism and Developmental Disorders,

48, 2530-2541.

What is Autism Spectrum Disorder? (2020, March 25). Retrieved November 22, 2018, from

https://www.cdc.gov/ncbddd/autism/facts.html