The following case study is connected to the questions below: Please assist me in using the correct DSM Diagnosis and rationale (including code), approach to treating Disorder (including assessment techniques or tools) and treatment plan with at least three goals with measurable objectives), anticipated discharge criteria, and if more information about the client is required to better understand the client?

Jameer was born into a middle-class young suburban family in a small town outside Fayetteville, Arkansas. His parents, both Black and from rural Arkansas, were Janelle, aged 23, and Antoine, aged 34. Janelle's pregnancy was full-term, the delivery was normal, and the baby weighed 8 pounds, 2 ounces. Janelle and Antoine also had another child, Jaquon, who was 6 years older than Jameer. Jameer was handsome, with brown hair, brown eyes, and a beautiful smile. The parents looked forward to an exciting future, filled with the dreams that having two children can inspire.

Jameer's development over the first year of his life was normal. He was able to sit without support by 7 months, crawl at 10 months, and stand alone by 12 months. He took his first independent step at 15 months and was walking everywhere within a week. All visits to the pediatrician went well, and immunizations were given at the appropriate times.

Jameer: A Toddler with Troubles

After Jameer's first birthday party, to which several young children were invited, Janelle began to pay attention to some characteristics of her son's personality that just didn't seem to match those of the other children his age. Unlike the other toddlers, or even his brother when he had been a year old, Jameer was not babbling or forming any specific word sounds. Janelle thought that her son should have mastered at least a few words by then, especially after hearing other 1-year-olds say "mama" and "dada" and "cookie." Jameer could only produce a few noises, which he would utter randomly throughout the day. Janelle also noticed that these sounds were rarely directed toward anyone or anything. The child made no attempt to label people or objects; he would just make those noises.

At first, Janelle and Antoine attributed Jameer's language delay to the fact that he had an older brother who would speak for him and fulfill many of his needs without Jameer ever having to ask. But they soon became suspicious that a language delay was only part of the problem. At the birthday party and in other situations, Jameer seemed uninterested in playing with other children or even being around them socially. He seemed to enjoy everyone singing "Happy Birthday" to him, but he made no attempt to blow out the candles on the cake, even after others modeled this tradition for him. He was only a year old, but his indifference to the party bothered Janelle and Antoine.

Upon closer examination, his parents also noticed that Jameer had very few interests. He would seek out only one toy, even though his parents had purchased many for him, and his older brother had his as well. They shared a bedroom, so it was odd that Jameer never showed any interest in Jaquon's toys. If pushed to play with something new, he would sometimes throw intense, inconsolable tantrums. Often, he would take his favorite toy, a plastic dog, and stare it for a long time. His parents bought another one, then two more, so that he had four of these dogs. Sure enough, Jameer would play only with these toys, lining them up in a row, in the same order, and would not allow them to be removed until he decided he was finished with them. If someone attempted to rearrange or clear away the toys, he would again have a tantrum.

As her concern grew, Janelle decided to monitor her son's play habits more closely. She was both frightened and amazed at the meticulous way in which he manipulated the toys. On a few occasions, she realized that the order in which he aligned them matched the order in which they had been purchased. They were clean and free of any blemishes, and Jameer would take painstaking care in looking at all of their surface area each time he took them out.

He also had a marked preference for being with his mother. He had less of an interest in Antoine, Jaquon, or other people. In fact, Jameer might cry for hours if Janelle had to leave without him. Upon her return, he would stop crying but would not necessarily want to be with her. He would feel content knowing that she was home and go back to playing with his toys by himself. In addition, when called by either parent, Jameer often failed to respond to his name. And he displayed odd food preferences: He could not seem to get enough of some foods, and he simply could not tolerate the textures of others.

As the months went by and he remained unable to express his wants and needs, Jameer's tantrums became more frequent. If his mother did not understand his noises and gestures, he would grow angry at not being understood. The intensity of these episodes was also growing; Jameer was even beginning to hit his ears with his hands and cry for longer and longer periods. One of the most frightening aspects of this for Janelle was the fact that her misinterpretations of the episodes might sometimes endanger Jameer's health; she had no way of knowing if he had an upset stomach, a headache, or some other ailment.

Finally, when Jameer was 19 months old, Janelle took him to his pediatrician for some answers. The doctor agreed that there were some significant "delays" in Jameer's development, and he referred the child to a neurologist for a complete evaluation. The recommendation of a neurologist greatly upset Janelle and Antoine. They were now forced to confront their deepest fears. They found it extremely difficult to wait for the neurological evaluation, repeatedly dwelling on the terrible scenarios that the word delay evoked.

Prior to the appointment with the neurologist, the parents also followed up on the pediatrician's recommendation that they have Jameer's hearing formally tested. His hearing was found to be within normal range, and this news caused a mixed reaction in his parents. On one hand, they were happy that serious hearing deficits could be ruled out; on the other hand, where did that leave them? The results left many questions in their minds. Also prior to the neurological evaluation, Janelle and Antoine began to research the term developmental delays on the Internet; there, for the first time, they saw the word disability. When the time for Jameer's appointment with the neurologist finally arrived, they were extremely frightened, but they also still held out hope that Jameer's skills were just a little late in coming.

The neurologist was pleasant and very thorough. She reviewed the case history from pregnancy through birth, and then assessed Jameer's milestone achievements. She also completed physical, neurological, and motor examinations. Finally, she addressed his language delays and maladaptive behaviors by observing his lack of speech and his limited play skills. For all the weeks of waiting for this examination, it seemed to pass very quickly almost too quickly, the parents believed, for the doctor really to get to know Jameer. In fact, she was able to gather a great deal of information, and she told Janelle and Antoine that Jameer seemed to have autism spectrum disorder.

Autism spectrum disorder is a neurodevelopmental disorder with a range of symptoms that can occur at various levels of severity. The neurologist cited several factors that led to her tentative diagnosis of autism spectrum disorder in Jameer: his deficits in social communication, including his nonverbal communication; his severely delayed receptive and expressive language skills; his lack of imaginative play with toys; and his history of repeated and rigid behaviors. In short, all of the things Janelle, Antoine, and several other family members had noticed were symptoms of this disorder.

A diagnosis of autism spectrum disorder had been his parents' worst fear, after having read so much about its different forms during their research. From the information they had gathered, they had formed a mental image of an aggressive or self-injurious child, locked in his own world and unable to communicate. Antoine began to tune out as the doctor described the typical features of the disorder. Too many questions were pounding inside his head: Should they get a second opinion? Could it possibly be as bad as she was describing? Whose fault was it? Why hadn't the pediatrician said something sooner? How would Janelle handle this? What would the rest of the family say? What was the cure?

By the time Antoine was able to focus again, the visit was over, and the neurologist was talking about her forthcoming report and discussing her recommendations. He heard her explain that, with appropriate early interventions and services, the disorder was "workable," and that because Jameer was starting treatment at such a young age, he had a great deal of potential for progress. Antoine couldn't imagine how this devastating problem might be workable. He knew that on the long car ride home he would have to be filled in on the missing pieces of the doctor's conversation with Janelle.

Janelle took charge and played a more active role than Antoine in following up on the recommendations of the neurologist. In part this was because she stayed at home with the boys, while Antoine worked full-time at the county courthouse as a security officer. However, it was also because she felt she needed to stay busy to keep negative thoughts and mounting questions out of her mind. Antoine, who was feeling overwhelmed by the weight of the diagnosis, simply followed his wife's lead.

The first course of action was to have Jameer more fully and precisely evaluated and to have him begin early intervention services. And it was important that these services be provided by clinicians who specialized in the field of autism spectrum disorder. After consulting an advocacy group for individuals with developmental disabilities, Janelle learned of an early intervention center affiliated with the university. She scheduled an evaluation. Six weeks after seeing the neurologist, Jameer received a comprehensive evaluation and began treatment at the Kreutzman Child Development Center.

From this point forward, the family's lifestyle became a whirlwind of doctors' visits and a variety of therapies. The initial diagnostic evaluation itself was completed in 90 minutes. One clinician interviewed the parents, while a second took Jameer to a separate room for an individual assessment. They explained diagnostic and rating scales to the parents, including the DSM-5-TR criteria, the Modified Checklist for Autism in Toddlers Revised, and the Childhood Autism Rating Scale. All of Jameer's delays and behaviors were specifically categorized and totaled to arrive at a detailed clinical picture and diagnosis.

Consistent with the DSM-5-TR criteria for autism spectrum disorder, Jameer showed impairment in social communication and social interaction, including marked impairment in the use of nonverbal behaviors such as eye-to-eye gaze; failure to develop peer relationships typical of his developmental level; and lack of social or emotional reciprocity. He also showed restricted and repetitive patterns of behavior, interests, and activities, including stereotyped motor movements (for example, lining up toys); abnormal preoccupations and inflexible adherence to specific, nonfunctional routines or rituals; a strong attachment or preoccupation with unusual objects; and either hyperreactivity or hyporeactivity to sensory input or unusual interest in the sensory aspects of the environment (APA, 2022, 2013). His symptoms were present in early childhood, caused impairment in his life, and could not be accounted for by any other disorder.

Based on the Childhood Autism Rating Scale assessment, Jameer's autism spectrum disorder was rated between Level 1 ("requiring support") and Level 2 ("requiring substantial support"), in terms of social communication and restricted, repetitive behaviors. It was also specified in his diagnosis that Jameer's autism spectrum disorder was with accompanying intellectual impairment and with accompanying language impairment. He displayed a number of symptoms from the rating scale's 15 areas of assessment, including relating to people, imitation, emotional response, object use, visual and listening response, adaptation to change, verbal and nonverbal communication, and intellectual response. Slowly, these terms were starting to have more meaning to Janelle and Antoine. The diagnostic team at the center concluded that early intervention was certainly the treatment of choice at this point, and they helped the parents set up a variety of therapies for their son.

A diagnosis of autism spectrum disorder can feature a range of neurodevelopmental disturbances. Thus to help clarify an individual's particular pattern of the disorder, DSM-5-TR lists various specifiers specific features of that individual's disorder that are to be cited as part of the diagnosis.

Jameer was enrolled in the center's early intervention program, which provided 3 hours of behavioral therapy each week: 2 hours at the center itself and 1 hour at home. The goal of these behavioral sessions was to help the child develop learning readiness skills basic skills that one needs in order to be able to learn and acquire broader knowledge, behaviors, or skills. Jameer would be taught skills such as focusing his attention where directed, and following simple instructions. Again and again, in trial after trial, he would be rewarded whenever he performed these target behaviors or some approximation of them, and not rewarded if he failed to perform them. It was expected that through such efforts, the child would become increasingly able and willing to perform the behaviors across a wide range of situations and, in turn, be more ready to learn broader behaviors and skills.

These sessions were to follow the principles of the applied behavior analysis model a strict behavioral strategy that, according to research, helps many persons with autism spectrum disorder and other neurodevelopmental disorders. Jameer was also signed up for speech therapy 2 days a week and for occupational therapy 1 day a week. Ultimately, the three therapies all sought to increase his ability to engage new people. Janelle and Antoine felt incredibly grateful for their ability to access these services. In the rural town where they grew up, there were no such clinics or specialists. Antoine's job with the state government brought them to Fayetteville, where there were so many more resources to help them than they had back home. They were relieved, too, because his work enabled them to have high-quality health insurance, something they both knew was a privilege, having been raised on food stamps and enrolled in Medicaid as children.

The child's life was turned upside down by the early intervention program. Strangers were now being thrown into his world on a rotating basis, and these people were placing demands on him and changing his routines. He was also being separated from his mother in a strange place for the first time ever. During the first few therapy sessions, Janelle wanted to run from the observation room into the treatment room to "rescue" him from the therapist. Jameer cried and threw tantrums throughout those sessions. The therapist continually had to reassure Janelle that the child would become less resistant as long as the sessions were carried out consistently. Otherwise, the distraught mother would have withdrawn him from the program and tried teaching him herself.

Slowly, Jameer's tears and tantrums lessened as his therapy sessions became a regular part of his weekly schedule. Janelle and Antoine began to notice, after 2 months, a slight increase in his eye contact and less resistance when they asked him to complete specific tasks within the home, such as clearing away his figurines after he was finished playing. Nevertheless, his progress felt unbearably slow to them, and they noticed no developments in the area of language, despite the speech therapist's positive reports. Jameer also remained unreceptive to all new toys, and his play skills continued to be very limited.

Janelle and Antoine decided to supplement the center's early intervention sessions by hiring therapists on a private basis to provide more learning trials at home, as well as scheduling additional speech therapy sessions. In fact, it was the speech therapy that was of most interest to the couple. They believed that if they could just help their son talk, they could better understand what he was feeling and, in turn, could more effectively resolve his other issues.

In order to help children with autism spectrum disorder to speak, teachers often supplement their speech therapy with another form of communication, including sign language and simultaneous communication, a method that combines sign language and speech.