Final Week

Devontae's mother died when he was 59 years old, and he didn't know what to do with himself. In fact, he was only beginning to have an idea about what death actually was and only recently really understood that his dad was gone. He was beside himself with grief and pain. He cried for days as others gathered together to provide a service and a burial for his mother.

It was decided that Devontae would live with some family friends who were in their 70s and who had know he and his family for many years. In this way, Devontae could continue to live his life and have support of caring others.

Devontae lived this way for 11 more years. His was a simple life, and he kept his "foster" parents company until he himself was considered 'elderly.' He died in his sleep at the age of 70.

1) What are developmental milestones of late adulthood? To what extent is Devontae able to participate in those events/milestones?

2) What kinds of rituals surround death in Devontae's religious tradition?

Week Ten

Devontae has lived a long life and has come to understand himself well. Now at age 56, he is able to reflect on what it has meant to live a life with and autism spectrum disorder. It seems that the aging process has led to a "mellowing" of Devontae's moods and symptoms associated with OCD, and now he is taking stock of where he has come.

Devontae was never quite able to commit to an intimate relationship with a woman, and he has lived his life in the company of his parents. He was saddened profoundly by the passing of his father when he was 47. His dad had had cancer, and all of the efforts of the family to help him fight the disease ultimately came to naught. Devontae missed his father terribly, and the death provided him an opportunity to reconnect somewhat with his Islamic faith. Devontae took to wearing clothing that one might find on a daily sojourn in Marrakech or Riyadh. His co-workers did not think much of it since they knew that he was "a little weird" anyway. For Devontae, it was a way to keep a connection with his father.

As the years went by, Devontae took to spending more and more time with his mother. She was not in good health either and, after retiring, kept to herself and looked forward to visits from her son on a daily basis. She helps him with certain tasks of daily living, and he helps her to look after the yard and shop for groceries.

1) Is there any evidence for the symptoms of an Autism Spectrum Disorder decreasing over time?

2) Provide statistics for people with Autism finding life partners.

3) Describe the manner in which those with Autism experience the death of a loved one. While we know that there is extreme variability in the degree of disability associated with Autism (particularly in Devontae's case), provide information based on current research.

Week Nine

A few more months went by, and their DD waiver was denied. They said that since he had received medical assistance care for so long, such as Devontae’s speech therapy or occupational therapy, that the care would no longer be required in the sense that they requested and they had to deny the claim.

Devontae continued to struggle with communication skills and reading, but his excellence in math pushed him through high school to his graduation. He graduated at age 19 with a regular high school diploma, just like the rest of his classmates.

Since both of Devontae’s parents have doctorate degrees, they encouraged him to attend college. Due to his ASD, it was determined that it would be better for him to attend a local community college and live at home until he graduated. He took classes part time so he could take his time complete his work and work on his communication skills. He graduated in 4 years with an Associate’s Degree in Computer Science from the community college.

After graduating, he found a job at a local business as their computer technician. This job was good for him because it required little interaction with strangers and he understood computers very well from his training.

Once he held his job for a year, he decided to move out at the age of 23. He found a small apartment near his parent’s house, at their request.

Through his job, he gets health insurance that covers his regular doctor’s appointments and medications as needed. Devontae is still attempting to control his ASD without medication. He doesn’t have tantrums anymore, but he still has OCD tendencies, which does not cause many problems.

Ten years later, he is still working at the same company, because Devontae does not like change if it is unnecessary. Because of this, he has made some acquaintances at work. 

There is a female book keeper named Anne that he gets along well with. She understands his love of numbers, so they can communicate well about math. He decides to try to see her outside of work and takes her to lunch one day. It goes well, and they decide to continue seeing each other on the weekends. He is unsure of where this relationship will go because he has not had many relationships with females, but he is nervous and excited about where it will go with Anne. 

1) Provide statistics for children with ASD earning their high school diploma.

2) Has Devontae met his transition goals thus far? Is he setting anymore for his future (family, future employment, more schooling), and if so, what are they?

3) How is Devontae doing living on his own? Do most people with ASD move away from their caregivers and into the real world, and if so, at what age?

4) Although it doesn't cause him any prominent problems, Devontae has severe OCD. What are some things that he is OCD about? Do ASD and OCD go hand-in-hand?

5) If things start to escalate with Anne, Devontae will eventually have to tell her about his disorder. Write a short dialogue between the two discussing Devonate’s ASD.

Week Eight

Now 17 years old, Devontae is similar to his peers in many ways and just as dissimilar in just as many ways. Devontae has continued to struggle to communicate his basic needs, but he has developed a fairly large vocabulary with the assistance of some sign. He occasionally uses visual means of communication, and he is able to use these strategies to do relatively well academically. He is weak in all areas of verbal language, but his math is exceptional. In the 10th grade, Devontae was ready for Calculus. His reading and verbal reasoning, however, are on a 5th grade level.

Plans for transition are complicated by Devontae's limitations in the verbal realm, and Devontae's parents and teachers know that he will not be able to attend a traditional college or even a community college. The IEP team has decided that it would be best for Devontae to continue at his high school for the next few years and to enroll in advanced math courses through an agreement with a local university which sends professors into the surrounding high schools.

Sasha and Julius have continued to provide for Devontae. They had to cut back on many of his additional services; Devontae was also more able to manage without those. They also applied for an EDCD waiver and a DD waiver. Devontae received the EDCD waiver within 6 months, but the family is still waiting for approval of the DD waiver. This opened up some additional possibilities for the family with regard to care for Devontae.

It is only a few months until Devontae turns 18, and his parents look toward his birthday with a mix of anticipation and concern.

1) What is an EDCD waiver? What is a DD waiver? What services become possible with these waivers?

2) Research specific services available through the Medicaid system for children with autism. Which agencies in Virginia provide these services?

3) Provide statistics for people with autism spectrum disorder with regard to employment.

Week Seven

Devontae has continued to grow and change throughout early and middle childhood. Now at age 12, his tantrums are mostly controlled; he began taking some medication (Risperdal) when he was 9. His parents, though in the medical field, were skeptical and have exercised great caution when putting him on medication. They feel like he is ready to move forward in his life without the meds.

The last few years have not been without challenge, however. Devontae had a particularly bad tantrum at the grocery store when he was 9 (just before going on the medication) and pulled down a display on top of himself. Some glass containers broke, and Devontae had some fairly significant lacerations. Getting him to the ER and helping him through the process of getting stitches involved sedatives. After this experience, Sasha and Julius developed a specific safety plan and put Devontae on medication to help manage the tantrums.

When he was 10, Devontae got into some difficulty at school with another boy in his class. He bit the boy after a misunderstanding involving a piece of notebook paper. Devontae was screaming and crying, and there was a little bit of blood from the boy's arm. Of course, both sets of parents were called, and Devontae was sent home for a few days. This incident was the last of its kind, and the school was able to put a plan in place to prevent such issues from happening in the future.

At age 12, Devontae is just beginning to experience the first signs of puberty. Sasha and Julius are uncertain about how to talk with him about the changes he is experiencing given his relatively low level of cognitive and emotional capacity.

1) When are transition goals developed for students with an IEP? What would some transition goals be for Devontae?

2) Describe typical developmental milestones for a 12 year old boy. How is Devontae atypical?

3) Write a dialogue that might take place between Devontae and one of his parents regarding the changes of puberty. How do they explain what is happening to his body to him?

4) How do schools consider disciplinary issues that arise from students who are on the Autism spectrum?

Week Five/Six

Even with a Nanny in the home, Julius and Sasha are exhausted! Because the Jones love their son so very much, they want the best for him and fight everyday to get just that. Three years have since passed and Devontae has just had his 8th birthday. Devontae’s IEP had been developed. Julius and Sasha had been to several meetings with special education teachers, representatives of the public schools who are knowledgeable about the program and other individuals invited by the school. Both Julius and Sasha played an important part in creating Devontae’s program and had set specific goals for him. Both Julius and Sasha attend meetings once a year to review Devontae’s progress and to make any alterations to reflect his changing needs. Devontae’s IEP included continuing his education at public school. Devontae is now enrolled in 2nd grade at the local public school, and the start of the year has already been filled with a challenge. It seems like going to school everyday is a struggle for Devontae. He just isn’t like other kids, and his peers are still getting use to handing him in the classroom with them. He throws tantrums for no reason at all and has difficultly following instructions. Devontae has trouble learning to interpret what others are thinking and feeling, and gets frustrated when he can’t do this. Devontae likes to throw a fit when he finds that nobody understands what he wants. The skill of social interaction, especially the skill of using his imagination seems to be a problem for Devontae. When given free time, Devontae will wander off by himself and spend the entire time, not playing with cars but lining them up over and over again. 

Julius and Sasha have put together a top of the line multidisciplinary team for their son.  Devontae is still receiving structured, therapeutic activities for 25 hours every week by a therapist. This therapy continues to focus on core areas such as language and communication, social skills, imitation, motor skills, and play skills. Devontae sees a Speech Pathologist every week and is working hard to become more and more audible every day. Devontae also works with an occupational therapist. Devontae still continues to make regular visits to his pediatrician.  When time, he receives his immunizations. Julius and Sasha have also been receiving training in behavior therapy. This training helps to provide them with the key tools to encourage desired and un desired behaviors of their son. This training also gives Devontae’s parents the chance to meet and discuss with other parents of children with ASD. 

When Devontae went to his 8 year old checkup, both his pediatrician and therapist brought up the thought of being prescribing him Prozac. Although this medicine was originally designed to treat depression, it helps to reduce repetitive or compulsive behaviors in children with ASD. His dosage would start very small, at 1-2 mg and go up 1 mg every 1-2 weeks.

Even though Julius and Sasha are both doctors and have a good salary, they are starting to encounter financial problems.  All this therapy is extremely expensive and even though Devontae is now in school all day, they still have a live in Nanny. They now love this Nanny and highly admire her for being a tremendous help in helping to raise their son. The Jones’ feel as if she is part of their family now. Letting her go would be so sad and the Jones’ don’t know if they can come to parts to do this.

1) Do most insurance plans cover behavioral therapy and speech therapy?

2) What kind of skills would the Jones’ learn in behavioral therapy for their son’s autism management?

3) Is there evidence that behavioral therapy is useful in managing ASD? Is there evidence that occupational therapy is useful in addressing the problem of ASD in children?

4) Has Prozac been tested for use in children? Does it have any side effects?

DECISION POINTS:

Should the Jones’ let the nanny service go to save money?

Should the Jones’ agree to put Devontae on Prozac?

Week Four

Devontae’s family is African-American, and they live in a medium-sized city (think of Roanoke, VA or Charlottesville, VA). Both parents are medical doctors, Julius works as an ER doctor in the local hospital, and Sasha is an OB/GYN in a local private practice. They practice Islam and regularly attend the local mosque; they are part of a large group of friends who are all roughly the same age and are all professionals in one field or another. Both sets of grandparents are still living and live close by. Additionally, Julius’ two brothers live in the same town, and Sasha’s sister lives 30 minutes away.

Now at age 4, the Jones’ have found a way to begin to understand their son and his condition. It is still tough. Sasha and Julius are ever confident that they can love Devontae so much that he won’t even know of his difference. In spite of how difficult having a child with a disability can be, Devontae has helped Julius and Sasha to become closer. They have been able to hire a full-time, live-in nanny for Devontae so that he has someone to provide him care when his parents are at work. The nanny is highly qualified and has had training in ABA; he works closely with a local university to have students come out to help as well. The Jones family could not be happier with his work and his care for Devontae.

Devontae also has the chance to be with those in his extended family – he goes to each grandparent’s home once a week and gets to see his uncles regularly too. Though he is still non-verbal, he is remarkably communicative with those eyes. Everyone that meets him can see that he has so much going on in his little head – he just can’t express it.

Devontae has done well with sign language and knows several different words. He continues to improve in this area. His parents are learning too, and this helps with meeting his needs on a regular basis. Of course, he has his moments of severe dysregulation which usually mean a tantrum on the floor and some physical containment by his parents.  

1) Contrast what the Jones’ are able to do for Devontae with the typical service plan for a child who has Medicaid. What Medicaid-funded services would be available for Devontae from birth through age 4? What service would be available under IDEA Part B and IDEA Part C from birth through 4?

2) What are the typical developmental milestones for a 4 year old? How far off is Devontae likely to be from these?

3) What is known about the causes of Autism?  

4) If Devontae were to attend preschool, develop some goals and objectives that might be found on his IEP.

DECISION POINT ::: Does Devontae attend preschool? If so, where? Public or private?