POPULATIONS AT RISK

Course 4997: Intgv. Seminar

Part 1 of 3: Populations at Risk
15 February 2015
Oliviah Marshall

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ABSTRACT
This paper is one of three that will identify and analyze a client in an at-risk
population setting. The following information will discuss in depth, the at-risk population of
Autism (ASD). Autism will be analyzed as to why it is identified with being at risk, and
information to support it will be through findings in peer-reviewed articles as well as in citations
throughout the paper. The documented information will also provide an analysis of effects of
membership in the oppressed group, and discuss ethical dilemmas a social worker is presented
with while working with the selected group. To conclude the analysis of the population at risk
assessment, both positive and negative impacts of relationships, and or other seen behaviors will
be addressed, as well as how they relate to the NASW code of Ethics in Social Work.

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Since we have started courses the fall of 2014, I have interned my social work
field placement at the Judson Center, where their mission is To provide expert, comprehensive
services in southeastern Michigan that strengthen children, adults and families impacted by
abuse and neglect, autism, developmental disabilities, and mental health challenges so they are
successful in their communities. Though Judson Center is an agency that services many
populations, I am placed within the Autism Connections sector. Judson Center: Autism
Connections offers a plethora of services for individuals and families diagnosed with Autism
Spectrum Disorder (ASD). As in intern, I observe applied behavior analysis, shadow and lead
individual and group therapies, and have a role in case management.
Having the opportunity to work directly with Autism, I experience how and why ASD is
an at risk population. Estimated by the Center for Disease Control and Prevention (CDC), in
2014, 1 in 68 children were diagnosed with ASD (CDC, 2014). This number is significantly
increasing, and already about a 30 percent increase from the estimated 1 in 88 of year 2012. The
data continue to show that ASD is almost five times more common among boys than girls: 1 in
42 boys versus 1 in 189 girls. White children are more likely to be identified as having ASD than
are black or Hispanic children (CDC, 2014). However, signs and symptoms vary greatly, as well
as intellectual ability, physical and emotional traits or characteristics. With that being said,
Autism Spectrum Disorder is often remembered to as an umbrella diagnosis, having under it,
diagnosis of: Autistic Disorder, Aspergers Disorder, Childhood Disintegrative Disorder, Retts
Disorder, and Persuasive Development Disorder-not otherwise specified.

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Since the release of the fifth addition of Diagnostic and Statistical Manual (DSM), there
has been much debate of the revised section regarding Autism Spectrum Disorder. Instead of
classifying individuals into smaller sub-categories under the ASD umbrella, the DSM-V has
removed all other classification diagnosis except for the single diagnosis of Autism Spectrum
Disorder. The reasoning behind the change was to provide a descriptive and more detailed
diagnosis of the individual instead of labeling them in such a broad spectrum. In doing this, the
DSM-5 has simplified communication and social skills pattern into one and a created a stricter
guideline checklist to meet criteria of restricted repetitive behaviors (RRB). This theory is
hypothesized to produce a more individualized diagnosis and possibly even a different diagnosis
all together. However, the DSM-5 allows room to classify an individual as low, moderate or high
functioning ASD. The new change has created tremendous amounts of debates of opinion and
analysis into the manual. Many believe it will create a loss of identity to individuals who had
been diagnosed with previous statistical manuals. Some say the DSM-5 creates vague
descriptions to a diagnosis that is already extremely broad and ever changing.
The National Response Framework (NRF) describes an at risk population as
Populations whose members may have additional needs before, during, and after an incident
in functional areas, including but not limited to: maintaining independence, communication,
transportation, supervision, and medical care. Individuals in need of additional response
assistance may include those who have disabilities; who live in institutionalized settings; who are
elderly; who are children; who are from diverse cultures; who have limited English proficiency
or are non-English speaking; or who are transportation disadvantaged. Along with having the
diagnosis of Autism Spectrum Disorder, comorbidity is to be expecteddirectly or indirectly, at
a much higher rate than a typical population. A recent study identified that 70 percent of

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individuals diagnosed with ASD had at least one comorbid disorder, and 41 percent had two or
more. Of the comorbid assessments, the most common was found to be social anxiety disorder,
attention deficit/hyperactive disorder and oppositional defiant disorder. (Simonoff, 2008). The
dual diagnosis in an individual can prove for even more reasoning of an at risk classification.
Bow Soardie (pseudonym) is an eleven year old Caucasian male with a possible
diagnosis of Autism Spectrum Disorder. He completes weekly individual and or family therapy
with the LMSW at Judson Center: Autism Connections. Bow Soardie has been having a difficult
time with social relationships and maintaining friendships. The school social worker often
observes attention seeking behavior and acts of hopelessness from Bow. She explained a time in
the lunch room when Bow threw up on himself, but continued to sit and carry on with activity,
as if nothing happened, while remaining covered in his own vomit. Bow often falls behind in
school coursework, and sometimes does not even attempt to complete the assignment. While
establishing rapport in individual therapy, it was observed that Bow was fidgety with a hyper
affect. He appeared to struggle with remembering whose turn it was while playing a game, and
often would change conversations while in the middle of discussing something else. In April of
this year, Bow will undergo a psychiatric evaluation for correct diagnosis of his present
behaviors. His parents believe him to have Autism Spectrum Disorder, while the LMSW feels
Bow exhibits more behaviors of anxiety and depression. Should Bow be diagnosed with ASD, it
is very likely that he will also have a comorbid diagnosis of anxiety, ADHD and or depression. In
therapy, Bow is working towards completion goals such as independent thinking, improving
school performance and reduction of anxiety.

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The presented signs and symptoms relating to Bows diagnosis place him as a consumer
apart of an at risk population of being a child with disabilities. Severe delays, specific to the
Theory of Mind domain, are found to persist through middle childhood and adolescence in some
groups of children with sensory, motor or developmental disabilities, including those with
Autism. (Paynter, Peterson & Slaughter, 2007). Having a delay in any of these areas will present
lingering issues. Due to Bows inability to achieve typical theory of mind for his age group, he
could struggle with making or sustaining friendships. This could be an additional cause to Bows
current depression, and create low self-esteem or self-worth. Additionally, should Bow begin to
fall behind in school, his depression could also increase from that. Bows parents are trying to
work with the school social worker to put an Individualized Education Plan (IEP) or 504 in place
for Bow. With the added support in place for Bow, the hope is to provide additional assistance in
school, so he does not fall too far behind due to the diagnostic symptoms. Each of these factors
play a crucial part as to why Bow is considered at risk. In therapy, to address the presented
issues, mindfulness, CBT, DBT, and other therapeutic techniques are used.
Since Bow does not have many friends, his social development is crucially behind. He
spends many hours of each day playing video games, and being by himself. His homework and
health and grooming habits are becoming concern, as they do not get attention from him either.
In therapy, it is observed that Bow is reserved, however speaks fast and tries to interact with a lot
of conversation. This is believed to be of the comfort in established rapport between the therapist
and client. Bow feels appears to enjoy the attention on him, as to why he opens up and engages
so positively. However, while speaking, Bow fidgets with his hands and feet excessively. It has
been assessed that Bow walks on the back of his shoes as well. The LMSW believes it to
correlation of depression, and lack of self-care or ADHD and forgetting/loosing track of putting

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them on correctly. Youth with an ASD had the lowest rates of participation in employment and
the highest rates of no participation compared with youth in other disability categoriesYouth
with an ASD have poor postsecondary employment and education outcomes, especially in the
first 2 years after high school (Cooper, Narendorf, Shattuck, Sterzing, Taylor, Wagner. 2013). In
Michigan, post-secondary education can benefit an individual with disabilities (such as ASD)
until the age of 26 years old. With this, the individual has the opportunity to learn basic life skills
they will need to become independent adults. Programs such as budgeting, cleaning, cooking and
additional school curriculums and or college are available for the individual. Agencies such as
the Judson Center: Autism Connections provide post-secondary education, and should Bow be
diagnosed with ASD, this could be a future plan for him to use.
Currently, Bow is not prescribed any medication related to his present atypical behaviors.
His parents have expressed their concern with medicinal treatment, and appear very strong with
their beliefs. The use of medicine to treat disorders can be a very ethical debate. While some
believe in the impact of success with prescribed drugs, others do not want their children taking
them. In the field of social work, I have already observed many opinions and beliefs of various
treatment types. Only Risperidone has Food and Drug Administration approval for the
pharmacologic management of autism in children. However, health care providers may prescribe
other drugs used off-label to assist autistic children and their families with the core deficits and
associated behaviors of this condition (Brunssen, Waldrop, West, 2009). Risperidone is the most
widely researched drug for behavior modification in children with autism. In October 2006, the
FDA approved risperidone for the treatment of irritable, aggressive, and self-injurious behaviors
in children with autism, and currently it is the only drug approved for the treatment of autism
(FDA, 2006). Risperidone is a dopamine and serotonin receptor antagonist that has a high

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affinity for serotonin receptors (Taketomo, Hodding, & Kraus, 2003). Since 2006, the FDA has
further approved the medication of Abilify, which has similar treatment outcomes as
Risperidone. Researching medical information, and witnessing differing behaviors in children
with ASD, I can begin to understand understand how individuals (such as Bows parents)
believe it is ethically irresponsible to provide young children with medicinal treatment. Though
many medicines may appear to help experienced behaviors in presenting diagnoses such as
Autism Spectrum Disorder, case studies have yet to find additional, approved medications.
Questions such as why do autistic children with the same symptoms respond to medications
differently or why do some drugs improve behaviors but decrease other wanted behaviors are
a major factors as to why it is difficult to prescribe medications to Autistic individuals. Many
believe this is why a cure for Autism is so elusive. Prescribing medications to treat Autism can
also be ethically wrong due to how a medication is chosen. It must be done cautiously, due to the
fact that Autistic children have increased sensitivity and intensity of adverse effects than typical
children do. (Brunssen, 2009). Also, one must take into consideration that if a medication
produces negative effects for the diagnosed individual, immediate withdrawal can also pose for
additional problems.
At Judson Center, there are many children taking medication for their presenting
symptoms. As a social worker, I would be ethically wrong and going against NASW code of
conduct should I provide my bias opinion to a client regarding their medication intake. To act as
a professional social worker, I would become competent in what the medication is, and why they
are taking it. I would understand their dosage, ask about side effects etc. The Autism
Speaks/Autism Treats Network has created a tool-kit for parents and individuals deciding
whether to use medicinal treatment with their diagnosis. As a competent social worker, I would

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become familiar with this guide and discuss it with clients. The tool kit can be used at any point
in treatment, and even can be used to assess the medications a client is already using. (ATN/AIRP Medication Decision Aid).

CONCLUSION
This paper assessed the diagnosis of Autism Spectrum Disorder and comorbidity in
individuals. The DSM-V change related to ASD was addressed and how it impacts individuals
differently depending on how and they were diagnosed. A definition of at risk population was
discussed, as well as why Autism falls under that category. The presented client, Bow Soardie
has been introduced, as he is related to the Judson Center: Autism Connections. The at risk
population, of having a disability, in this case, ASD was analyzed and assessed. Present
behaviors of communication, socialization, repetitive (including negative as related to a typical
peer population) as Bow experiences were explained. Also, the ethical dilemma of children
prescribed medication for ASD was expressed. Solutions to the ethical dilemma and
considerations have been addressed.

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REFERENCE
Autism Speaks/Autism Treatment Network. ATN/AIR-P Medication Decision Aid.
(2015).
http://www.autismspeaks.org/science/resources-programs/autism-treatmentnetwork/tools-you-can-use/medication-guide
Baird, Gillian; Chandler, Susie PhD; Charman, Tony; Loucas, Tom PhD; Pickles, Andrew PhD;
Simonoff, Emily M.D. Journal of the American Academy of Child and Adolescent
Psychiatry. Psychiatric Disorders in Children With Autism Spectrum Disorders:
Prevalence, Comorbidity, and Associated Factors in a Population-Derived Sample. Vol
47: 8. PP 921-929. August 2008.
http://www.jaacap.com/article/S0890-8567(08)60059-3/pdf

Centers for Disease Control and Prevention. 2014.

http://www.cdc.gov/media/releases/2014/p0327-autism-spectrum-disorder.html

Cooper, Benjamin, Narendorf, Sarah Carter MSW; Shattuck, Paul T. PhD; Sterzing, Paul R

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MSSW. American Academy of Pediatrics. Postsecondary Education and Employment

Among Youth With an Autism Spectrum Disorder. Doi: 10.1542/peds/ 2011-2864.
2012.
http://pediatrics.aappublications.org/content/early/2012/05/09/peds.2011-2864.short

Judson Center: Helping those in need succeed. Autism Connections, Autism 101. 2015

http://www.judsoncenter.org/autism-connections/autism-101

Kanne, Stephen. PhD. Autism Speaks: 10 Years of Progress. A Lifetime of Hope. The DSM-5, A
Clinicians Perspective. [Blog] 2015.

http://www.autismspeaks.org/blog/2013/05/28/dsm-5-clinicians-perspective

Minnesota Department of Health. Defining At Risk Populations. July 2010.

http://www.health.state.mn.us/oep/responsesystems/atriskdef.html

Paynter, Jessica, Peterson, Candida C., Slaughter, Virginia P. , Journal of Child Psychology and
Psychiatry. Social Maturity and Thory of mind in typically developing children and those
on the autism spectrum. University of Queensland, Australia. Vol 48:12. Pp 1243-1250.

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(2007).
http://www.readcube.com/articles/10.1111%2Fj.1469-7610.2007.01810.x?
r3_referer=wol&tracking_action=preview_click&show_checkout=1

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