Key Insight 2
Treating the Child Not Just Their Diagnosis
Being able to meet people where they are and provide compassionate, quality care or support has always informed my extracurricular and educational experiences. When I originally decided to pursue a graduate degree in speech-language pathology, I was concerned that my degree being in English and having a minor in Education would not expose me to all the science or psychology related skillsets that I may need in order to be serve the patient/client population I may exposed to in this field. So, this past semester I registered for Psych 410: Behavioral and Mental Disorders. The opportunity to learn about behavioral and intellectual disorders was an incredible in-class supplement to the clients that I would observe and engage with working as on Observation Intern at Prisma Richland's Pediatric Physical and Specialty Therapy Facility. It is through these experiences that I strengthened my aptitude for understanding others' needs, specifically those of a child who carry a large part of their identity through their diagnosis.
BTC-Supplemental Artifact
Photo of me with entire SLP team
WTC Artifact (Primary) PSYCH 410 Final Paper- Download
In PSYCH 410: Behavioral and Mental Disorders, our final was formatted as a case study essay analysis (linked to the left) where we reviewed a patient’s history and then presented a primary diagnosis, two differential diagnoses and assessment type. The case study I chose to examine was the one that resonated with me the most and offered the best opportunity for me to analyze autism spectrum disorder and differential diagnoses as well. The study presented a 6-year-old boy who presented with all the qualifiers to be diagnosed with ASD: repetitive behaviors, difficulty communicating or understanding social cues, and aversion to changes in routine or preferences. All children with autism present these symptoms to be diagnosed, it is just a range of severity depending on the individual which is why it can be challenging to diagnose certain cases. The differential diagnoses I examined were Social Pragmatic Communication Disorder and Intermittent Explosive Disorder (IED).
The ability to rule out the two came from the missing components within each. For social pragmatic communication disorder, the clear differentiator is that the disordered behavior lies only in their communication skills and understanding of how to use pragmatic language skills, but they do not have the features of repetitive behaviors or difficulty during transitions. For IED, the outbursts the child was experiencing were a result of his age and difficulty working through his frustrations associated with ASD. The transitions, or lack of consistency in routine, were what typically caused the outbursts. This differs from IED due to the “trigger” that causes an outburst. With IED there is a component of uncontrollable anger, often unwarranted, whereas with ASD it is a response associated with their diagnoses. This case study is just one example that displays the importance of not generalizing an individual based on certain symptoms they may present with in order to reach a diagnosis. While the boy in the study may present signs of having ASD, social pragmatic communication disorder, and IED, only an ASD diagnosis qualifies and would offer the best course of therapy for this client. Medical history, familial background, interests, hobbies, and social abilities are all crucial pieces of information when treating an individual but you can only obtain this information by taking the time to know the individual before assuming a diagnosis.
My work at Prisma Richland’s Pediatric Physical and Specialty Therapy Clinic has been more than just educational: it has been tremendously rewarding. I have had the opportunity to work with 5 speech-language pathologists (SLP) all of whom have introduced me to a variety of techniques and patient populations. While working at Prisma, I immediately took note of how there was a large portion of our patient population who had received a primary diagnosis of autism spectrum disorder (ASD). Through my experiences working with these pediatric clients, I was truly able to capture the concept that ASD is certainly a spectrum that affects every patient differently. There were patients who were completely nonverbal and were being introduced to Augmentative Alternative Communication (AAC) devices, those in Applied Behavior Analysis (ABA) Therapy, those in feeding therapy for sensory aversion, or those seeking speech therapy for articulation or pragmatic language disorders. Every day can look completely different for a child with autism spectrum disorder depending on their sleep the night before, routine being followed or altered before therapy, what they have been eating, if they are under the weather, and many other factors. This can be seen through my detailed observation notes, (linked to the right) how every child who had a primary diagnosis of ASD required different types of care, and even those with similar needs varied greatly as well. I learned very quickly since working at Prisma, that it is crucial to be adaptable to the child’s needs for that day. This really goes for any client, but especially clients with ASD. Using alternative methods to engage and aid pediatric patients who have autism spectrum disorder is essential for not only overall success during a given progress period but also the ability to effectively complete tasks during a session.
BTC Artifact-Prisma Notes (Primary)
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WTC Artifact-Supplementary-PSYCH Notes on ASD/IDD/ADHD (Download)
This beyond the classroom internship opportunity, coupled with my in-class curriculum, offered me far greater insight into the importance of accurate diagnosing of disordered behaviors and how to engage and cater to individuals who may have an ASD diagnosis. The importance of ensuring that there is an accurate evaluation of their needs along with corresponding with psychologists or developmental pediatric physicians in speech therapy is crucial. Taking PSYCH 410 gave me the opportunity to reflect on how I was able to aid in the progress planning for a client who was being seen for a language delay. The SLP I was working with asked me if I had taken a class that went over echolalia, a speech condition where the individual simply repeats back to you what you had just said without being instructed to do so, which I had been able to cover both in PSCYH 410 and in Intro to Speech Language Pathology and Audiology (COMD 500). We then discussed that the child we were working with had been evaluate several times by developmental pediatrics, but had yet to receive an ASD diagnosis. She continued to discuss with me how he does not have all the identifiers but based on observation in session and her previous notes it was clear that he struggled interacting with kids his own age and even adults. I offered the suggestion of social pragmatic communication disorder. The SLP agreed with me that he met all the criteria. While as an SLP, she could not make the formal diagnosis, it allowed her to better cater each session to fit his needs. There have been other cases where I was able to observe and aid in note taking during sessions with children with behavioral needs associated with an ASD diagnosis. I felt immensely more prepared in doing so thanks to both the PSYCH 410 and my professor due to his background working in Family and Child Therapy and the COMD 500 Introduction to Speech Language Pathology and Audiology class I took.
Through these experiences, I have found the true importance in the continuation of education in any profession that requires active field experience and the value of understanding a diagnosis well enough to be able to accommodate everyone's differences. While I hope to continue to grow in this knowledge to become a well-informed SLP, this classroom and internship experience has taught me the value behind both education and the ability to be adaptive to patients’ needs. Treating the individual as a child first and while still bearing in mind their diagnosis builds a sense of trust and confidence between both the child and the SLP. Although it is especially important when working with individuals with ASD to be adaptable, this is an important quality no matter what workplace someone is in. Feeling seen, heard, and understood is a universal desire. In order to serve my community and profession effectively, I plan to carry these attributes over into my professional career and community.