Case Study

Here is the story of Liam, who was diagnosed with autism as a child. Liam was born after a normal pregnancy and birth. He was a placid baby initially. His eye contact was poor in the first year of life, he did not like cuddling and showed no response to his mother leaving or returning. His milestones were delayed, he did not crawl until 13 months and first walked at 16 months. His speech was also delayed and at the age of 2 he pointed and grunted when he wanted something. He did not babble much and was described as ‘an empty shell’ as a toddler. At 3 years of age his mother was concerned about his lack of response to her voice and to the world around him and this led to his hearing being tested which was found to be normal. At kindergarten he was noted to be emotionally immature and to speak only in monotonous three word sentences. When he started school it was reported that he seemed to have no anxiety about separation. He had set routines (e.g. would panic if his mother did not drive the same way to school every day), and brief and intense special interests/unusual behaviours lasting for about 4 weeks (e.g. blinking, looking up the ceiling, counting things) which would then be replaced by another ‘obsession’. Academically his work was reported to be adequate except for language skills; however he remained isolated from the other children. He did not engage in pretend play with toys but would line them up in order of size or colour. As his speech improved he developed a tendency to monologue about his own interests. He was the target of bullying moved and between several primary schools as a result. He was assessed by a paediatrician in 1995 at the age of 7 and diagnosed as having Asperger’s Syndrome, and it was noted that his communication skills were generally poor. Assessment at the age of 13 by a speech therapist at a local Child and Adolescent Mental Health service reported that he had severe language disorder with significant impact on academic and social functioning. He received a teacher’s aide at this stage. Liam left school at the age of 18 and started TAFE. However he was disruptive in class, interrupting the teacher and not paying attention. He had a fight with one of his co-students and pushed her down the stairs after which he was not allowed back. He now works in a sheltered setting packing boxes, which he enjoys and does well as long as he is left alone. He has not made any friends and spends most of the day by himself but appears happy with this. He is unable to identify any plans for the future and his parents worry about where he will live in the longer term.