Case Study
Patient Demographic: Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through
Presenting Problem: You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.
Other Contexts: book. Family History: The client reports that his parents are supportive of his issues that are a result of autism. The client says that his 8-year-old brother gets frustrated sometimes because his parents often support the client and focus on him more due to his autism. The client reports that he does not have any friends.  The client appears uninterested in the session

Question: The client appears uninterested in the session. Based on what you see, which of the following would be the most appropriate clinical intervention based on the client’s diagnosis and presentation?
(A): You encourage the client to participate so that he can feel better.
(B): You talk with the client about the video game book he is reading.
(C): You attempt to process with the client about why he is not engaging.
(D): You continue talking with the parents because they are providing helpful information and you know that building rapport with the client will be a long process.

Correct Answer: You talk with the client about the video game book he is reading.
Explanation: You engage with the client about what he is reading because you want to create a connection and this is a very simple one to make. Encouraging the client to participate might work, but it does not create a connection with the client. You have learned a lot about the client from his parents, but you also need to engage him in building a therapeutic relationship. Processing with the client regarding his lack of participation may be helpful, but considering his diagnosis and age, it would be more helpful to talk with him about the video game book. Therefore, the correct answer is (B)
Competency: counseling skills and interventions