1. Introduction

Learning is a beautiful word that can open many doors. Unfortunately we are not all equal in the path of learning. On our diverse planet, not everyone is learning the same way and has the same capabilities in the quest for knowledge. It happens that some children struggle more to learn and cannot follow the usual school courses. Those struggles have been often diagnosed in disabilities. Because of the large range of learning disabilities, specialists have to list them into different categories. Amongst them there is ADHD, who is a brain disorder with a pattern of inattention problem and high hyperactivity and impulsivity or Executive Functioning Disorder that is a deficiency of cognitive skills like multitasking, managing time and space. However this paper will mainly cover Autistic Spectrum Disorder that is a large term that designates people with difficulties in social-interaction, communication and fine motor processing. The autistic spectrum disorder symptoms will be demonstrated trough observations of child X of 10 years.

2. What is autism?

According to the Colin English dictionary it is ‘’a developmental condition characterized by difficulties with social communication and interaction, and restricted and repetitive behaviors and interests’’. Autism was name after the Greek word ‘’αυτός’’ which mean self, by Eugen Bleuler, a Swiss psychiatrist while he was defining symptoms of schizophrenia in 1910. Autism can be found in all races, ethnics or social groups. The first symptoms start to appear between 18 and 24 months old. It is noticeable by a lack of babbling, gesturing and the use of single or two phrases words. During those past few years the number of children’s diagnosed with autism has raised: 1- 2 person on 1,000 has autism and close to 6 persons on 1,000 has ASD.

3. Different types of Autism

Today we do not speak anymore of only autism but of autism spectrum disorder (ASD). The reason behind the change of appellation is that there is a too large scale of symptoms and different form of autism to only label it in one word. Within the term ASD we can class 3 different form of autism:
• Autistic disorder: It is the most common of the tree and it is notice by a deficit in thinking and language development as well as social interactions problems. However every child is not affected the same way, there is different stage in autism.
• Asperger's syndrome: Very similar to autistic disorder, the big difference stands in the relation to language that they have. These children instead of having a problem with it usually score more than the average in intelligence test and have natural abilities in learning languages. However they have the same struggle in social and communications skills.
• Pervasive developmental disorder or PDS-NOS -- also known as atypical autism: This category is for all children who show sign of autistics behavior but don’t fit in any category.
• Asperger's syndrome: Very similar to autistic disorder, the big difference stands in the relation to language that they have. These children instead of having a problem with it usually score more than the average in intelligence test and have natural abilities in learning languages. However they have the same struggle in social and communications skills.
• Pervasive developmental disorder or PDS-NOS -- also known as atypical autism: This category is for all children who show sign of autistics behavior but don’t fit in any category.

4. Diagnostic

The current diagnosis of autism is based on 3 different categories of symptoms. The first one is language and communication, the second one is social and relatedness and the last one is behavior (sensory/motor development). (From the ‘’Diagnostic and Statistical Manual of Mental Disorders: DSM IV]’’)

5. Methods of therapy

It exist a lot of different sort of therapies as the field of research on autism keeps to extend. Therapists and psychologists are constantly finding new data and new idea to improve the therapeutic approach on kids with ASD.

1) ABA: Applied Behavior Analysis
ABA is one of the most effective therapies. It usually starts before the age of 5. ABA teaches on one side, behavior skills like social interactions, motoric development, language and communication and on the other side academics skills like reasoning, focus, memory. The method is based on observations and positive reinforcement. It uses the idea that when a behavior is value by a reward it has greater chance to be repeated. Another important part of the ABA method is the ABC (Antecedent behavior Consequences). First, there is the antecedent, what comes before the behavior; it could be an object, a person… In second place, the resulting behavior, it can be an action, a verbal respond… In last, the consequence, it is what follows directly the behavior. In ABA, the instructor measures the progress by monitoring each session in order to adjust and improve his therapy trough the data he is collecting.

2) RID: Relationship Development Intervention
RID is a new form of therapy for children on the spectrum. The principal goal is to teach flexibility and stimulate social skills through engaging relationship with others. One of the key of this therapy is the implication of the parents in the intervention. Parent’s involvement will help to seek every opportunity in developing the child social and behavioral skills.

3) OT: Occupational therapy
Occupational therapy is aiming to connect the child to his environment through daily activities. It can be used for therapy and evaluation. For the therapist, it is a good way to observe what the child is able to do or not. This therapy includes physical activities, interactions exercises, and developmental as well as adaptive activities. The final goal of the OT is to allow the child to live as independently as possible.

4) Speech Therapy
Speech therapy focus on the language and communication skills. It helps autistics children’s to improve their verbal and nonverbal-communication in a functional way. The therapy is based on an anterior evaluation with a speech language pathologist (SLP) to then adapt the goals in function of the kid abilities. The therapy also use Alternative Augmentative Communication (AAC) who is a way of training the spoken language trough image or technology for example sign language, Picture exchange communication system (PECS).

5) Animal Assisted therapy
Animal Assisted therapy is a therapeutic intervention on autistics children’s with animals such as horse, sheep, dolphins… It is use to reinforce and complement the basic therapy. Animal can be source of calmness, stillness, safety and comfort this is why they help the children’s to escape stressful situations. The benefits from the therapy are the enhance of self-trust, self-regulation (behavior and emotions), socialization.

6) Play therapy
Play therapy is a good way to improve social and communication skills by doing an activity that they know and recognize which is playing. The outcome is to make the kid with ASD interact with others and express himself not with words but trough playing. In the play therapy there is different approach. First the floor time, creating a back and forth game to stimulate the interaction, his thinking and attention. In second there is Integrate play group (PIG). The goal is to mix one or two kid with ASD with a small group of normal kids. The PIG helps the kids with interactions and quality of playing. In last there is Joint Attention Symbolic Play Engagement and Regulation (JASPER). This technic is a way of improving the skill to focus on a toy and a person at the same time which can help in social and interaction skills development.

6. Observations :

Base on my observation of student X age 10, I found multiple symptoms as follow:
The client X, aged 10 years old has fine motor problem as well as language issue. First, he is not aware of all his movement and his strength. For example he slams the door and windows violently because he is unable to understand the degree of strength he has to put in his actions. Secondly, he barely speaks. He doesn’t understand the meaning of words and mostly do echolalia but without understanding it. He only knows few simple instructions taught to him like no, sit still... Conversely, he cannot speak in structured sentence and express his feelings with words. That is why, he screams when he is happy or anxious, do Tantrum (‘’an uncontrolled expression of childish anger: an angry outburst by a child ’’Merriam-Webster dictionary) when he is angry and bangs his head and hands on the table when he is being asked a too difficult task. Client X has probably also ADHD because he is always moving and running all around, his attention focus is very small and he always forget what he is doing because he is distracted by something else. He avoids as much as possible eye contact and don’t like to be touch too much. He has also a tendency to eat and put in his mouth things non-eatable. He gets angry and dislike when people change his routine.

Symptoms:
(From the ‘’Diagnostic and Statistical Manual of Mental Disorders: DSM IV]’’)

Communication and language

  • Communication and social-interaction problems
  • Lack of understanding what others may think or feel
  • Does not understand jokes or sarcasm Behavior
  • Difficulty regulating emotions (Tantrum, scream ...)
  • Pica (eating non-food items)
  • Constant moving / hyperactivity (ADHD)
  • Short attention spam
  • Lack of coordination (Clumsiness)
  • Get upset by routine change
  • Obsessive interest
  • Sensitive (touch)
  • No of very little eye-contact
  • Impulsivity
  • Does not seems to ear the person talking Social
  • Flat face expression and robotic or high pitched voice
  • Delayed speech, difficulty with language (non-verbal)
  • Echolalia

Based on the observations and the list of symptoms from the ‘’Diagnostic and Statistical Manual of Mental Disorders: DSM IV] I came to the conclusion that the student X age 10 has severe autistic disorder (level 3) combine with ADHD .