Case Study Overview
Joe is a 5 year old boy. While he excels academically and is far beyond his peers in terms of academics and vocabulary, his parents and kindergarten teachers have noticed that he seems to struggle with developing, maintaining and understanding relationships, especially with his peers.
Joe also has highly fixated interests and insists on sameness.
What DSM diagnosis best fits Joe?
Autism Spectrum Disorder (ASD)
(American Psychiatric Association, 2013)
What is the abbreviation for Autism?
Autism Spectrum Disorder (ASD).
Joe expresses discomfort with clothing tags and seams. He doesn't like loud noises and frequently covers his ears. He loves a weighted blanket as it helps him feel calm and regulated.
These are examples of:
Sensory processing differences.
These are often prominent in the life of people with ASD like Joe. "Hyper- or hyporeactivity to sensory input or unusual interest" in sensory aspects is commonly associated with ASD (American Psychiatric Association, 2013).
Joe does not make eye contact.
Is this considered typical or atypical for a 5 year old?
Atypical.
A lack of eye contact is often associated with ASD. Eye contact is included on early developmental screeners and is expected of even toddlers.
Some research suggests that "eye avoidance may be used to reduce amygdala-related hyperarousal" among folks on the autism spectrum (Stuart et al., 2023).
Many parents experience isolation and stress after diagnosis. This form of support can help mitigate that by offering shared understanding, emotional validation, and connection through shared lived experience (Lee, Terol, Yoon, & Meadan, 2024).
Peer Support Groups
For example, a Parent 2 Parent Model. The research indicates that these types of model can provide emotional support, advocacy, and knowledge, including practical advice (Lee, Terol, Yoon, & Meadan, 2024).
A local example of peer support can be found in the "Autism Family Meetups" hosted by Strides Toronto.
Joe seldom makes eye contact and often does not respond when spoken to, especially by unfamiliar people.
He has limited reciprocal (back and forth) communication with peers and often relies on social scripting or repetitive conversations.
What criteria best fits this?
"Persistent deficits in social communication and social interaction across multiple contexts."
(American Psychiatric Association, 2013)
__________ is a neurodevelopmental disorder characterized by persistent impairments in social communication and social interaction across multiple contexts, alongside restricted, repetitive patterns of behavior, interests, or activities. These symptoms appear early in development, vary in severity across individuals, and cause clinically significant challenges in social, occupational, or other areas of functioning (Johns Hopkins Medicine, 2025).
Autism Spectrum Disorder.
Joe may exhibit a preference for routines and experience distress when they are disrupted.
What does this refer to?
Insistence on sameness.
The language of "insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior" can be found in the DSM.
Joe is obsessed with Mulan. His last 3 birthday parties have been Mulan themed. Most of his conversations with his parents and classmates tend to focus on Mulan.
Joe has also memorized all of the Mulan movies and loves to tell others obscure facts about the films and content related to this franchise.
Is this considered typical or atypical for a 5 year old?
Atypical.
While children of this age often love characters, Joe's love for Mulan is intense beyond what is typical and Mulan seems to dominate his day to day life. This is consistent with ASD.
Provincial program in Ontario that offers resources and supports including financial support, children and youth family services, early year programs, and access to clinical therapies.
The Ontario Autism Program (OAP).
Eligibility Criteria:
(Ontario, 2024).
With an official diagnosis parents/caregivers can register for this program and receive support, although waitlists are often long.
Joe does better in structured and predictable settings, especially when supported by familiar adults.
However, in unfamiliar, overstimulating, or noisy environments, he appears to struggle with processing verbal input and sometimes exhibits signs of anxiety, withdrawal, or distress.
Name 3 avenues adults could take to support Joe?
Examples include:
- Provide structure and predictability (ex. consistent routines, clear expectations)
- Minimize overstimulation (ex. reduce noise, provide headphones, reduce bright lights, or crowded spaces when possible)
- Advance notice of changes, prepare Joe for new activities or environments.
- Encourage calming and regulation strategies (ex. quiet breaks, breathing, fidget tools.
- Validate feelings and celebrate successes (acknowledge difficulty and anxiety, offer reassurance, support building of confidence)
A key component of an autism diagnosis is that symptoms must appear in ____ childhood.
Early childhood (American Psychiatric Association, 2013).
He may engage in repetitive movements such as hand-flapping, spinning, or rocking when excited or upset.
What are these movements called?
Stimming behaviours or "stimming" (University of South Dakota, Center for Disabilities, 2006).
Joe struggles with some skills such as zippering his jacket for recess.
Is this typical or atypical for his age?
This is typical.
Many kids cannot do this skill at this age. Something as simple for adults as zipping a jacket is a complex task that comprises many skills include fine motor strength, bilateral coordination, hand-eye coordination, sequencing, concentration, and having frustration tolerance (CanChild Centre for Childhood Onset Disability Research, n.d.).
Motor skills can occur alongside ASD but are not diagnostic on their own.
This play-based intervention uses building bricks to help children with autism. This could assist Joe with improving social skills, communication, and teamwork.
Lego Therapy
This is a structured, play-based social skills intervention using LEGO to support operation, turn taking and joint attention.
(Owens, Granader, Humphrey, & Baron-Cohen, 2008; Narzisi et al., 2021)
Joe's play is often solitary or parallel, instead of with others.
While he can participate in assigned classroom activities, he prefers to do his own thing.
He can be rigid and loves to play the same games over and over again, or script out how scenarios should go.
What criteria best fits this?
"Restricted, repetitive patterns of behaviour, interests, or activities" (American Psychiatric Association, 2013).
Autism is commonly described as a ____ disorder noting that the severity and combination of symptoms vary widely between individuals.
Autism is described as a "spectrum" disorder. Some folks with ASD may have significant challenges with communication or behaviour, while others may have exceptional skills or only subtle differences in social interaction. The term emphasizes that no two autistic experiences are exactly alike.
This type of skill, like following multi-step instructions or switching between activities, may be challenging for a child like Joe.
Executive functioning.
Studies have found that people with ASD often have trouble with skills like memory, planning, and flexible thinking, which might be an important part of how the disorder affects the brain and behaviour (Demetriou, DeMayo, & Guastella, 2019).
Joe rarely points or brings objects to share with his peers or adults.
Is this typical or atypical?
This is atypical and commonly associated with ASD. These behaviours are a key part of what is termed "joint attention" or meaning the ability to coordinate attention with another person around an object or event (Hopkins, 2019).
By age 5, most children can do this naturally to share interest, communicate, or engage socially. When a child rarely does this, it can indicate markers of difficulty with social communication consistent with ASD.
In Canada, the parents or guardians of a child with ASD can qualify for several tax credits and benefits designed to alleviate the financial burdens of disability.
Name 1 of these benefits.
Examples include:
The Canada Child Disability Benefit, the Canada Caregiver Credit, and the Home Accessibility Tax Credit (Canada Revenue Agency, 2025).
The Canada Child Disability Benefit can give tax-free payments to ease daily costs, the Canada Caregiver Credit reduces income tax for those caring for a dependent with a disability, and the Home Accessibility Tax Credit offers tax relief for modifications that make someone's home safer and more accessible.
The DSM includes 3 ASD levels of "severity".
Which best fits Joe?
Level 1 autism "requiring support"
Joe has complex sentence structures and can understand some social cues. However, without adequate supports in place, his challenges can be impairing to his social life. Joe has difficulty initiating social interactions, and shows clear examples of atypical responses. However, many of the supports that may serve him are general in nature and he does not need ongoing adult scaffolding and monitoring (Autism Speaks, n.d.).
The DSM Diagnostic Criteria contains 5 key criteria, what does this include?
A. Persistent deficits in social communication and social interaction across multiple contexts,
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (see text for examples)
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual developmental disorder (intellectual disability) or global developmental delay.
(American Psychiatric Association, 2013)
Sometimes subtle, this characteristic can make Joe's autism less obvious, as he has strong abilities in terms of speech and memory.
"High functioning"
Researchers such as Sturrock et al. (2023) support that language and communication differences in these children can be subtle and often not immediately apparent to those unfamiliar with the child and may not show up clearly in all settings, making their traits of autism "less obvious".
Joe thrives on daily schedules, such as snack time, story time, and circle time, and may feel upset if they are skipped or happen at a different time.
Is this typical or atypical for a 5 year old?
This is typical.
Although insistence on sameness can be a trait of autism, it is typical for children at this age to thrive in such environments as they promote learning and the child feeling secure.
"Typical" children expect routines but can tolerate minor changes without intense anxiety or disruption.
This therapy is often described as “evidence-informed”, yet it has received a great deal of criticism, especially from autistic advocates who argue that it can harm mental health, erase autistic identity, and encourage masking of natural behaviours (Mathur et al., 2024).
Applied behaviour analysis (ABA)
Facets of this approach may support Joe in building skills related to communication and social skills.