Case Study
Patient Demographic: Client Age: 18 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: University Counseling Center Type of Counseling: Individual and Group Presenting Problem: Interpersonal relationships Diagnosis: Autism Spectrum Disorder. 299.00 (F84.0)
Mental Status Exam: Mental Status Exam: The client is sloppily dressed and appears his stated age. He exhibits pressured speech at times; otherwise, he speaks in a monotonous tone. The client becomes irritable when discussing the incident with campus police, and brightens when expressing his passion for snakes. He displays poor eye contact and there is difficulty with normal back-and-forth conversation. The client denies suicidal or homicidal ideation. He lives on campus in sober student housing and denies drug or alcohol use. History of th
Presenting Problem: You are a counselor a university counseling center. The university has a program providing limited assistance to students diagnosed with Autism Spectrum Disorder (ASD). The ASD program director has referred an 18-year-old white male enrolled in the program. She is concerned over his recent run-in with campus police. The client arrives to his scheduled counseling session today and explained that he has a girlfriend who “now apparently wants nothing to do with me.” Campus security has been involved due to the client showing up at his girlfriend’s dorm, yelling and creating a disturbance. The client explains that his peers told him he would have sex in college once he got a girlfriend. When his girlfriend refused to have sex, he said he didn’t understand and only wanted to talk. The client continues to express a desire to have sex now that he is in college by stating matter-of-factly, “I haven’t had much luck, but I’m going to keep trying.” When asked about interests, the client spoke at length about his love for snakes and knowledge of all 300 worldwide species.
Other Contexts:    e  The client provides written consent for you to speak to his mother. His mother explains that the client was originally diagnosed with Asperger’s disorder and ADHD in early childhood. She acknowledges that the client has difficulty tolerating frustration, primarily when encountering changes in routine. She further explains that she worries “constantly” about him having clean clothes, staying organized, and waking up for class on time. She states she calls the client at 8:00 am every morning to help him wake up and stay on track. The mother also says the client finds noise in the cafeteria overstimulating, so he often skips meals. Family and Work History The client is a first-year student majoring in architectural engineering with a 3.6 GPA. He held a part-time job at a local grocery store while in high school. The client’s parents have been married for 15 years, and he has one younger sibling living at home. The mother takes an SSRI for depression and anxiety. The client’s father struggled with similar issues as the client growing up, but he was never formally diagnosed. His family’s home is 45 minutes from campus, and the client’s mother visits most weekends to check on the client and help him clean his room. Relationships: The mother states the client has always had difficulty with peer relationships. She explains that he has always wanted a girlfriend, but he could never find someone who appreciated his differences. However, the client did have a small group of friends in high school who all played Dungeons and Dragons together. She thanks you for calling and states she will encourage the client to return to you for counseling services

Question: What information provided by the client and his mother is required for the diagnosis of autism spectrum disorder?
(A): Sleep-wake disturbances
(B): Sensory hyper-reactivity
(C): Extreme mood lability
(D): Impulsive outbursts

Correct Answer: Sensory hyper-reactivity
Explanation: Researchers indicate over three-quarters of those diagnosed with ASD show hypo or hyper-reactivity to sensory stimuli. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-5-TR) sensory processing difficulties as one of four types of restricted, repetitive patterns representative of the diagnosis of ASD. The client’s difficulty tolerating cafeteria noise is an example of sensory hyper-reactivity. It is common for individuals with ASD to have difficulties with sleep-wake disturbances, including insomnia, narcolepsy, and restless leg syndrome. However, the DSM-5-TR does not list sleep disturbance as a criterion for ASD. Mood lability is a comorbid symptom of ASD rather than a diagnostic criterion. For individuals with ASD, mood lability is often the result of sensory over-stimulation, difficulty tolerating a change in routine, or difficulty reading social cues. Impulsive outbursts are also commonly associated with ASD; however, the DSM-5-TR does not require this to diagnose ASD. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis