Observations: ASDTerm Paper

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Clinical Journal Observation Entries: Autism and Related Disorders

Today, I spent time with a boy named A.L.A.L has been diagnosed with autism spectrum disorder (ASD). Although A.L. is verbal, he has many difficulties with social interactions. He never initiates play-related activities with other students. Most of his play is focused on repetitive actions, such as lining up a series of Hot Wheels cars according to color and shape. He will speak if questioned, but only monosyllabically. Also, his responses frequently do not make sense or reflect any real listening skills. For example, when I saw him playing with the cars, I asked him what was his favorite car and he merely replied "yes." A.L. was not aggressive or hostile; when other children walked over to him and took away some of the cars to engage in their own interactive play, he did not object or try to stop them, he merely focused on his particular activities once again and ignored the fact that he had been interrupted. He continued to neaten his lines of cars.

At first, I tried to draw A.L. forth in conversation about his playtime activities. He also enjoyed playing with various trucks and other mechanical toys. Some of these toys made noise, but A.L. did not seem to be particularly bothered by this, although I know children with ASD are often highly sensitive to noise and bright colors. However, his mother said that there were specific sounds and types of sensory experiences that were bothersome to A.L. For example, he was extremely disturbed by the sounds of balloons popping and would have to be taken home from a birthday party if one burst. Going to a restaurant was extremely difficult as he had trouble filtering out the ambient noises coming from other tables and could become overwhelmed. The classroom seemed to be a familiar enough setting that he could cope with any various distractions.

When I observed him, A.L. was extremely focused on what he was doing, to the point of shutting me out. This caused me to feel frustrated at times. I found a book about cars and tried to read it to him. I encouraged him to mimic the sounds in the story, asked him questions about the illustrations, and tried to engage him but he seemed uninterested in the book or in me. According to the teacher, A.L. would sometimes show interest in shutting on and off the lights and take things off and on the shelves. He seldom expressed interest in other students. However, he never challenged other students, even when teased. A.L. often acted in a very passive manner and seemed to be lost in his own world.

Entry 2

Today I spent time with a little girl E.M.E.M. was very talkative although sometimes her long monologues would meander and not make a great deal of sense. I tried to keep her focused and on-topic as we played with clay. E.M. made various shapes but did not seem interested in making a particular project from the clay. When I made suggestions for various things for her to create (a flower, a puppy, and so forth) she seemed to ignore me. Although E.M. was verbal, I noted that she did manifest some characteristics typical of children with ASD, such as the fact that she did not ask for things (like a different color clay) when she wanted them, even though I was closer to them than herself. She merely grabbed them. Also, when I asked her questions she frequently did not respond.

When I suggested activities, E.M. was fairly compliant in going along. When I asked if we play should with dolls, she agreed and we spent some time taking off the doll's clothes and putting on the doll's clothes. E.M. seemed to have some motor difficulties but I am not sure if they would really be severe enough to be labeled as abnormal. The teacher said that E.M. was not yet capable of tying her shoes and had some trouble in putting on a coat by herself. She was able to put on and take off the doll clothes with some assistance. When asked questions about the dolls, she responded that they had blonde hair and were wearing pink but did not respond to questions about their relationships, such as if they were mother and daughter. She described the dolls instead.

I watched E.M. On the playground and noted how she would walk alone by herself, often in a very halting way, not swinging her arms. She did not use any of the playground equipment but would tend to run a bit in one direction, then in another. She spent a long time playing with rocks in a corner by herself. Once again, there was no spontaneous social action with other children. However, when I came over to her she did not seem disturbed or unhappy. She talked to me about some of the equipment on the playground she observed without making moves to actually play on any of the swings and slides herself.

I wondered if E.M. might benefit from some remedial gym classes, showing her how to play on the playground since she did not seem to intuitively understand how to do so in a natural, unforced and spontaneous manner. Enabling her to establish some sort of physical link with other children through play would likely prove useful on a social basis. Also, given that children with ASD often have motor difficulties, early intervention would seem warranted to reinforce the principle of positive social activities.

Entry 3

It has often been noted that some children with autism, while not nonverbal, show significant deficits in exhibiting spontaneous communication. Children diagnosed with ASD often have to be prompted to say "thank you" and "hello" in ways that children without ASD do not. This can often cause significant social impairment despite the fact it seems like a relatively minor matter in the abstract. Failure to acknowledge other children by the correct name, to make eye contact, and to reach out to other children to engage in dialogue and play activities make children with ASD seem profoundly 'abnormal' in the eyes of other children, as appearing normal is prized in the social economy of the playground.

I noticed this on several occasions during my observations. Children with ASD at times seemed to wish to initiate contact and followed other children around. They appeared to want to play but rather than joining in merely stared. Sometimes they would take a toy away from another child without asking. I thought it was not that they were being aggressive or greedy but wanted to participate but seemed to have no idea how to do so.

Explicitly teaching children how to interact socially can be useful. Individuals without ASD may wonder why it is necessary to teach children to be polite, to ask for things, and to show interest in other people's activities through verbalization. Many children learn these skills naturally but children with ASD are not cognitively equipped to do so. It seemed to me very unfair to expect them to understand this without being told, given the nature of their disability, as no one would ever expect a child with dyslexia to read naturally without being given additional support and assistance or a child who was hearing impaired to listen to a lecture without an aide. It is no different for children with ASD who need additional social reinforcement and instruction to behave 'normally.'

Entry 4

One useful technique in helping children with autism avoid the tendency to engage in repetitive and ritualistic play is to encourage social modeling. Whenever I saw children using toys in a mechanical fashion without the typical imaginative or interactive play characteristic of other children, I would try to walk over to the child and mimic this type of play myself: for example, showing two dolls talking to one another or sliding cars down a ramp vs. lining them up. Sometimes the child ignored me but other children eventually did model my behavior. One or two children experienced distress, however, given that I was apparently messing up the order they were creating with the toys. None of the children experienced the eagerness sometimes children will exhibit when an adult joins in their play.

Children with autism seem less likely to laugh or engage in creative, silly play like talking in funny voices, singing, or moving in a loose and naturalistic way. If they do, it is often in a way that mimics the behavior of others rather than seems to arise from a natural place of genuine feeling or a desire to share and interact with others. Sometimes the difference can be quite obvious, other times it can be quite subtle.

Over these sessions, I have become to appreciate more and more the difficulty of trying to teach children how to engage in what is considered 'normal' social behavior. So much of the social scripts that we observe on a… [END OF PREVIEW]

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