Running Head: CHILD AND ADOLESCENT MENTAL HEALTH 1

Module Title: Child and Adolescent Mental Health and Neuro-developmental disorders

Module No: PS7309

Assessment Task: Clinical Report Based upon Oliver Brown’s Case Study

Module Leader: Dr Julie Ann Kirkham

Academic year: 2020/2021

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Introduction

Child health psychology is one of the emerging disciplines, helping practitioners

diagnose and treat some of the prevailing psychological and mental health disorders affecting

children and young adults. Concerning Oliver Bronw’s Case Study, this report focuses on

evaluating the aetiology of the mental disorder Oliver Brown is suffering from, the best

assessment method to be used in this case as well as the most suitable recommendation for the

treatment of the disorder. The case study is about a teenager known as Oliver Brown, aged 12

years, who is suspected to be suffering from a mental disorder from the previous diagnosis.

Given the observations made by Dr O'Malley, a consultant Neuropsychologist and other

observations as described in the case study, the suggested diagnosis for Oliver’s problem is

formal Autism Diagnosis. The primary aim of the report is therefore to critically evaluate and

determine the aetiology of the disorder Oliver is suffering from, utilize the right psychological

assessment to offer reliable recommendations on the most suitable intervention to treat and

improve the condition the patient is suffering from for better personal and academic growth in

the future.

Analysis of Aetiology

According to the description by Campisi et al. (2018), autism spectrum disorder is a

condition that is mainly related to brain development, which affects how an individual socializes

with or perceives other people, resulting in different levels of problems in communication and

socialization. The disorder may include repetitive and limited patterns of behaviour. The term

Autism Spectrum disorder (ASD) covers a wide variety of conditions, which were previously

considered separately as Asperger’s syndrome, autism, childhood disintegrative disorder and a

form of pervasive developmental disorder. The diversity in the conditions associated with ASD
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tends to make it a bit hard for a successful diagnosis of the condition. As Per the illustration by

Parikh, Iosif and Ozonoff (2020), some children may start showing signs of ASD in their

infancy, including lack of response to their name, reduced eye contacts and indifferences to

caregivers or parents. In some other cases, such signs may start showing after some months of

their birth. Conducting an aetiology analysis is always advisable to identify and differentiate

such symptoms, starting from their main causes to determine the most suitable interventions.

Oliver, as per the information provided in the case study, shows a wide variety of

symptoms that can be linked to ASD condition. The symptoms range from behavioural disorder

to difficulties socializing with other people, to learning problems and cognitive capability.

According to the information provided by his parents, Oliver is struggling with normal tasks,

including getting dressed, travelling alone using the school bus, and looking after his room

among other personal chores. The mother further notes that he is difficult to communicate and

deal with as he seems to have temper issues and poor ability to follow instructions. The diagnosis

is done by Dr O’Malley and Dr McIntosh also shows some significant communication problems

as he is not able to communicate well non-verbally. He also shows some social interactions

problems as he cannot relate with other children in a normal way. His lack of concentration at

school as well as poor academic performance is also a key symptom that shows that Oliver is

suffering from ASD.

Experts have identified several causes of autism thus making it hard for one to identify

the actual factors that contribute to the condition. Conducting an aetiology analysis is normally

important as it helps sufficient and effective diagnosis of ASD thus giving room for better

interventions (Lodge, 2019). ASD aetiology is heterogeneous and very complex, with numerous

causes of the condition identified and described which may vary from epigenetic, genetic, social
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or environmental factors in association and isolation. It normally evaluates the condition based

on the genetic factors, such as the family members with similar problems, which are then

connected to environmental factors, such as the economic, social and geographic factors.

The studies on genetic causes of ASD have identified possible genes that are likely to

pass the condition from one generation to another or from the parent to the children. As per the

explanation by BURLIBAȘA and DOMNARIU (2018), in the epigenetic area, varying

mechanisms have been identified, which explains the genetic causes of autism, including

epimutations, genomic imprinting and methylation. Also, the copy number variations (CNVs) are

known to provide reliable information on the actual causes of autism. The tests have therefore

proved that a child can inherit an autistic condition from his/her parents. In the case of Oliver,

both his children have long term mental health problems. The parents could have passed the

autistic genes to Oliver thus increasing the likelihood of him developing the condition.

In an explanation by Fett-Conte et al. (2015), and oligogenic inheritance in the case

where the parents of an autistic child had mental problems is possible following the holomorphic

alterations in some genes. An oligogenic inheritance is representative of an intermediate between

polygenic inheritance and monogenic inheritance. A monogenic inheritance occurs where a trait

of a person is determined by a single causative gene while a polygenic inheritance is a trait that is

influenced by environmental factors and more than one gene (Fett-Conte et al., 2015). In the case

of Oliver, given that both his parents have been suffering from mental problems and provided

that the environment in which he has been raised is not conducive for a mentally challenged

child, such an oligogenic inheritance can be a major cause of his autistic condition. In a situation

like this, where Oliver was born of two mentally challenged parents, there are numerous genes in
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molecular pathways that could have contributed to the neurodevelopment disorders that

contributed to his condition.

Even though most studies have only linked autism with genetic abnormalities, there are

several types of research that have indicated the possibility of contributions of environmental

factors. As per the argument by LaSalle (2013), one of the key findings in this set of studies has

linked toxic products emerging for the complex genetic-environmental interactions with the

likelihood of developing autism. Considering the case of Oliver, his mother mentions that he is

not able to look after his room, which might create an unhealthy environment for him to live in.

Toxic products that can contribute to brain problems might be dust in his room as he is unable to

clean. Some studies have linked autism to conditions, such as immune system dysregulation,

metabolic system and oxidative stress. Oliver was born three weeks prematurely, which could

have contributed to such abnormalities.

Studies have found significant links between weak social capital ties and other social

factors with autism. According to the illustration by Farran and Karmiloff-Smith (2012), in most

cases, children with autism could have experienced unstable childhood, especially where they

lacked proper love and attention from their parents or other family members. Oliver is born into

a family with social problems. His parents have been suffering from different mental health

problems, which mean that they have not been able to provide the right parenting care to their

child. Also, is taking to a normal school could have contributed to the worsening of Oliver's

condition. As per the illustration by Farran and Karmiloff-Smith (2012), children with ASD

require special care, which can only be provided under special learning programs. The reason he

does not relate well with other children could be because he finds himself unique to others thus

being demotivated to interact with them healthily. Given the information provided in the
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aetiology analysis, we can conclude that among the major contributing factors of Oliver autistic

condition are genetic, environmental and social, with genetic being the major ones.

Assessment Recommendations

Early diagnosis of any mental health problem is always important as it helps caregivers,

families, school administration and practitioners to determine and implement the most suitable

interventions for quick and better recovery. Experts, including adolescent and child psychiatrists

and psychologists, have created diagnostic assessment methods that help in diagnosing children

as young as one year through to over 18 years of age. Such assessments techniques can be used

in the case of Oliver to undertake sufficient diagnosis and come up with the right clinical

information to apply in identifying the suitable intervention for his treatment.

As per the argument by Farran and Karmiloff-Smith (2012), any comprehensive

assessment for ASD for the children should include a number of visits with the developmental

and clinical child psychologists. The psychologists are experts in assessing and diagnosing

young children and toddler with symptoms suspected to be ASD, including difficulties in

communication and other behavioural disorders. Oliver shows such symptoms as per the

information provided in the case study. He is also a teenager, which qualifies him for the

assessment by experts. Among the most suitable assessment methods that can be applied in the

case of Oliver are the Autism Diagnostic Observation Schedule (ADOS) and

Neuropsychological Testing.

Autism Diagnostic Observation Schedule™ (ADOS™-2)

ADOS™-2 is defined as a standardized assessment approach of social interactions,

communication, repetitive and restricted behaviours and play among the children. ADOS™-2

involves a process through which the specialist interacts with the affected child in play and social
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activities (McCrimmon & Rostad, 2014). In the case of Oliver, the practitioners will engage him

in some games and other social activities, such as communicating with him about some playful

activities. From the case study, Oliver seems to portray some problems when interacting with

other people as he has few friends at school. The specialist can further assess such social skills

using the (ADOS™-2) technique.

One of the primary objectives of this particular assessment method is to look for certain

characteristics that qualify to be hallmarks of ASD, including circumscribed interests, problems

with age-appropriate social interactions and repetitive behaviours or speech. It also assesses the

ability of the child to communicate non-verbally and verbally. With such features in this

assessment method, it can be effective in evaluating whether the non-verbal communication

problems identified in the observations made during Oliver’s referral appointment are autistic.

This may be possible by communicating with him more while identifying any abnormalities. The

assessment method can also help in determining whether the problems Oliver is experiencing

while interacting with his parents and other peers at school qualify him to have an autism

spectrum disorder or not. One of the primary strengths of this method is that it applies multiple

evaluations based on direct observations that provide firsthand data regarding the condition of a

child (McCrimmon & Rostad, 2014). The method is also less complex as it involves observation

through interactions. However, the assessment method can be time-consuming and might

provide misleading information in case the child has other behavioural problems.

Neuropsychological Testing

The other effective assessment method that can be used in evaluating Oliver’s condition

is neuropsychological testing. According to the illustration by Zucchella et al. (2018), this

assessment technique involves achievement and cognitive testing. It further focuses on more
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specialized testing of the individual's attention, memory and executive function, to identify the

deficits and abilities of a child in communicating and learning. During the assessment, the

parents of the child with the mental problem are encouraged to provide the specialist with a

comprehensive history of the symptoms and behaviours of the child since birth (Zucchella et al.,

2018). The specialist also gathers information from other reliable sources, such as the hospital

where the child had been assessed before. In the case of Oliver, the parents will be encouraged to

provide accurate and reliable information about his development progress since his birth. The

method is appropriate for this case as both Oliver’s parents seem willing to collaborate with the

experts to enhance the treatment of their son. From the case study, they have already provided

reliable information about the history of Oliver’s development that will play a significant role in

his future treatment. As a matter of fact, the information about Oliver’s premature birth and the

development process as well as that regarding how he behaves at home and while interacting

with the step-sisters will come in handy in ensuring effective assessment using the

neuropsychological testing method.

Instead of only relying on the secondary information provided by the parents or any other

third party, this particular assessment technique also applies primary data collected through

observations and interviews conducted by the experts. For instance, in the case of Oliver, the

specialists will visit his school to observe how he interacts with the teachers and other peers. The

visit will help in getting a second opinion from teachers and other students about Oliver’s

communication and social skills. To successfully understand the condition Oliver is suffering

from, experts must gather information from a variety of sources and this technique provides the

chances for such comprehensive and wide evaluations thus making it the most suitable to apply

in this case.
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The assessment technique is believed to have several benefits. For instance, the findings

from the process tend to yield crucial information about the intellectual strengths and ability of

the affected child (Zucchella et al., 2018). Such information may include the ability to

communicate and use different languages, executive and attention functions and organization and

social skills. However, one of the primary drawbacks of this technique is that it fails to determine

how an individual performs independently. The test involves collecting information from other

sources but the patient, which might be misleading in some cases.

Intervention Recommendation

Based on the information provided in the case study, several interventions can be applied

in treating Oliver, helping him recover from the current behavioural and psychological

conditions. According to the illustration by Spain et al. (2017), family therapy has proved to be

highly effective in helping children with ASD strengthen their social relationships, improve

communication skills and enhance mental, coping and well-being. In most cases, people with

ASD experience varying troubles in their day-to-day lives. They experience issues

communicating with others, and while maintaining or establishing normal relationships and

friendships as indicated in the case of Oliver. His mother admits that it is hard for one to deal

with Oliver as he has some antisocial tendencies, including a high temper. He has only two

friends at school and only gets along well with one of the step-sisters but not all his siblings.

With such low tendencies of making friends and socializing with other people, children with

ASD tend to rely on their family members, including siblings and parents, for their social

support. Not all family members are in the right position of offering the required support to help

their mentally challenged children recover. Most members lack sufficient information on how to

deal with such individuals with ASD, ending up either neglecting them or experiencing stress
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and depression. As per the argument by Spain et al. (2017), family members of such individuals

with ASD may suffer from anxiety, stress and depression as dealing with their mentally

challenged kin might prove stressful.

Studies have noted that there are benefits associated with family therapies for people with

ASD and their family members. Such therapies have been proved to improve coping,

communication, well-being and mental health of individuals with ASD and their family members

(Spain et al., 2017). When well-implemented, family therapy enables individuals within such a

family to make sense of the challenging situations they are experiencing when dealing with their

mentally challenged family members and enable them to work as a team and in harmony to

acquire new ways of seeing such difficulties and the best approaches to address them. Stress can

affect the productivity of a family negatively, making it hard for them to even care for the sick

family member. Looking at the case of Oliver, it is clear that his parents are under intense stress,

especially while trying to deal with his stubbornness. His mother reports that he can be a difficult

child to handle and that his stubbornness makes it hard for one to interact or even communicate

with. Dealing with such an individual is not only difficult but also psychologically draining and

lead to extreme stress.

Family therapy is simply defined as a psychotherapeutic intervention that follows a

formal process, to understand and promote relationships, functioning and communication

between family members of the individual with ASD. As noted in the case study, one of the

primary issues Oliver’s family is facing is communicating and interacting with him, which is

making it hard for them to offer the necessary support to enhance his recovery. Using family

therapy, therefore, it is easy for the members of Oliver's family to devise the most suitable ways
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of supporting him to improve his social and communication skills and at the same time minimize

chances of leading stressful and unproductive lifestyles.

While there are several types of family therapies, they all share a central tenet and are

underpinned by systematic theories. According to the illustration by Dallos and Draper (2010), it

is proposed that different problems, such as maintenance and development of interpersonal

relationships and mental health functioning are bound contextually, which is an indication that

they are most likely to be perpetuated and predisposed by the systems and contexts within which

they are found, rather than been associated with the persons themselves. Further, it is noted that

cultural and societal norms, expectations and values tend to shape and influence family beliefs

and collective behaviours and that problems within a family are better understood through such

cultural and social influences (Dallos & Draper, 2010). It is also assumed that families normally

manage to develop effective mechanisms of coping with transitions and changes as well as

diversities and illnesses as an effort of maintaining unit stability. When a family faces a problem,

such as an illness the patterns of coping are shared and are adaptive between different family

members. However, where family members lack sufficient support and guidance, each individual

may decide to adopt distinct coping styles, resulting in problems in leadership and

communication. Finally, there are some commonalities in the way different members of the same

family communicate using narratives and language.

The above-highlighted assumptions provide a clear picture of the manner in which family

therapy helps in treating an individual with ASD by influencing the way other family members

interact and communicate with him/her as well as creating a family environment that promotes

recovery. There are several interventions that family therapists can employ to treat an individual

with ASD. Some of such options include psychoeducation, narrative techniques and the
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application of questioning styles. In the case of Oliver, the most suitable family therapy to apply

is parent-mediated communication.

In the parent-mediated communication method, parents are given sufficient training by a

professional therapist to first improve their parental responsiveness and sensitivity to the child

communication and minimize any cases of responses of mistimed parenthood (Green et al. 2010).

When applied in the case of Oliver, the parents will first receive sufficient education from the

professional therapists on the best way of communicating with him and the most suitable

parenting practices that will encourage him to try to learn more communication and social skills.

As per the illustration by Green et al. (2010), in most cases, children with ASD wonder why they

are different and why they are unable to carry out different tasks like their peers. Such therefore

may lead to stress and anxiety. Oliver could have developed such anxiety and stress as witnessed

in his outburst, withdrawal and stubbornness. By enlightening his parents on the possibility of

such added mental problems, it will be easy to enable the creation of a less stressful environment

thus enabling Oliver to improve on such behaviours. Oliver's mother sounds like someone who is

almost giving up on him, especially where she says that 'he was/is “hard work”.’ It is not in most

cases where you will find someone’s mother referring to them as hard work. This means that she

needs guidance on how she can handle the son with love and prevent getting into depression as

well as facilitate the recovery of Oliver.

Parent-mediated communication therapy for ASD has been associated with numerous

benefits, which make it more effective compared to other types of ASD therapies. One of the

primary benefits, as noted by Oono, Honey and McConachie (2013), is that the intervention leads

to the improvement of the life quality of not only the child with ASD but also other family

members. The treatment intervention goes beyond treating the affected child to also helping the
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family members recover from the stress and anxiety they might have developed dealing with

their affected child. The intervention focuses primarily on improving parent-child

communication and the overall quality of the family life as well as reducing significantly the

autistic symptoms among the affected individuals.

The ability to collectively improve the lives of all family members is the one that makes

parent-mediated communication therapy better than the individual therapies, such as cognitive-

behavioural therapy (CBT), which only looks at the needs of the person with ASD without

considering any needs of the family members (Oono, Honey & McConachie, 2013). The

intervention also helps experts understand the expectations of the parents, and their hopes thus

devising the most suitable process to achieve both short-term and long-term goals. In most cases,

ASD therapies fail because specialists only focus on the patients, forgetting that for the full

recovery of such patients they have to stay in an environment that supports their gradual

recovery. Such an environment is created by the parents and other family members. In that case,

through discussions and parent communication therapies, experts are able to enlighten parents on

how they should continually support their sick children through interaction to help them recover

gradually and improve their behaviours and skills. Parent-mediated communication therapy is

not free of some weaknesses, which can affect its application and its result. The intervention

could be time ineffective, as the process of training parents how to communicate with their

children with ASD can take longer than expected (Oono, Honey & McConachie, 2013). This

makes it less effective compared to other individual therapies that involve working with

individuals with ASD only when it comes to time.

Several studies have indicated the effectiveness of parent-mediated communication as an

ASD treatment therapy. In a randomized trial published in 2010 in Lancet, where a preschool
CHILD AND ADOLESCENT MENTAL HEALTH 14

autism communication trial (PACT) was used, the parent-mediated communication was tested

(Green et al., 2010). In the trial, about 77 children were assigned to the PACT group while 75

were assigned the normal and usual treatment procedures. In the results, it was noted that while

in both groups the autism symptoms seemed to improve, in the PACT group there was a slight

increment in the results (Green et al., 2010). A similar study was repeated in 2016 whereby the

researchers realized that there was a significant reduction in symptom severity and in long-term

outcomes. Both studies, therefore, proved the effectiveness of involving parents in autism

therapies. The intervention also proved to be less expensive and less complex as it can be easily

and efficiently implemented.

A previous qualitative study by Carr and Lord (2016), examined a range of parent

perceptions in different autism interventions, including applied behavioural analysis, naturalistic

development behavioural interventions, adapted responsive reaching, music theory among

others. All the parent-based interventions, therefore proved insights into acceptability, feasibility

and perceived effectiveness over individual-based interventions. When it comes to the parent-

mediated communication theory, the study by Green et al. (2010), proved that the intervention

has significant impacts on the parents themselves, including confidence, parental empowerment,

skills and understanding. When applied in the treatment of a child with ASD, the intervention is

capable of enlightening the parents of that child together with other members of the family on the

most appropriate communication approaches to apply to improve the way the affected individual

interact with them and other peers, event at school.

In this particular therapy, both the therapist and the parents have unique roles to play. For

instance, it is the responsibility of the therapist to educate the parents on the best way to

communicate and interact with children with ASD. Throughout the therapy, a therapist takes the
CHILD AND ADOLESCENT MENTAL HEALTH 15

parents through a session on how they should treat the affected individuals and how they should

communicate with them. On the other hand, the work of the parent is to follow the guidelines

provided by their therapist and put everything into practise to ensure better results. The

collaboration of the two parties is what defines the overall success of the intervention. For the

treatment of Oliver, parent-mediated communication therapy is highly recommended.

Conclusion

From the case study, Oliver is a child suffering from several behavioural and

psychological problems, which show the possibility of autism spectrum disorder. From the

aetiology analysis, the possible causes of Oliver’s condition might be genetic, social or

environmental. Genetically, he could have inherited the genes from the parents who have long-

term mental health problems. Also, the condition might have been a result of a lack of proper

social and moral support from his parents and other family members. His inability to take care of

the place he sleeps could have resulted in toxic substances that increase the chances of

developing problems of the brain. Among the most effective and suitable interventions that

should be administered in treating Oliver is family-mediated communication therapy, which will

help his parents learn how to communicate with their son in a way that will help improve his

social and communication skills and on the autism symptoms.

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References

BURLIBAȘA, L., & DOMNARIU, C. D. (2018). Epigenetic landscape of human diseases.

Campisi, L., Imran, N., Nazeer, A., Skokauskas, N., & Azeem, M. W. (2018). Autism spectrum

disorder. British Medical Bulletin, 127(1).

Carr, T., & Lord, C. (2016). A pilot study promoting participation of families with limited

resources in early autism intervention. Research in autism spectrum disorders, 25, 87-96.

Dallos, R., & Draper, R. (2010). An introduction to family therapy: Systemic theory and practice.

McGraw-Hill Education (UK).

Farran, E. K., & Karmiloff-Smith, A. (Eds.). (2012). Neurodevelopmental disorders across the

lifespan: A neuroconstructivist approach. Oxford University Press.

Fett-Conte, A. C., Bossolani-Martins, A. L., Rosan, D. B. A., & Fitzgerald, M. (2015). Etiology

of autism: The complexity of risk factors in autism spectrum disorder. Autism Spectrum

Disorder: Recent Advances, 315.

Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., ... & PACT

Consortium. (2010). Parent-mediated communication-focused treatment in children with

autism (PACT): a randomised controlled trial. The Lancet, 375(9732), 2152-2160.

LaSalle, J. M. (2013). Epigenomic strategies at the interface of genetic and environmental risk

factors for autism. Journal of human genetics, 58(7), 396-401.

Lodge, K. M. (2019). The Aetiology of Autism. ABC of Autism, 9.

McCrimmon, A., & Rostad, K. (2014). Test review: Autism diagnostic observation schedule,

(ADOS-2) Manual (Part II): Toddler module.

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Oono, I. P., Honey, E. J., & McConachie, H. (2013). Parent‐mediated early intervention for

young children with autism spectrum disorders (ASD). Evidence‐Based Child Health: A

Cochrane Review Journal, 8(6), 2380-2479.

Parikh, C., Iosif, A. M., & Ozonoff, S. (2020). Brief report: Use of the infant–toddler checklist in

infant siblings of children with autism spectrum disorder. Journal of autism and

developmental disorders, 1-6.

Spain, D., Sin, J., Paliokosta, E., Furuta, M., Prunty, J. E., Chalder, T., ... & Happe, F. G. (2017).

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Zucchella, C., Federico, A., Martini, A., Tinazzi, M., Bartolo, M., & Tamburin, S. (2018).

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