Social Work Case Study

Sean is an active nonverbal 25-year-old man with a diagnosis of autism, OCD, seizure disorder and obesity. He currently is in an out of state residential placement due to a history of high intensity challenging behavior for the last 2 years and 3 months. He has received ABA services school and program as well as home based and residential programs. Sean is from a high metropolitan area due to his history of eloping from buildings it was deemed necessary that he live in a campus setting. Sean attends day program all on the campus where he continues to receive 1:1 staffing 24 hours a day. Sean does not have a formal mode of communication, currently the way that he communicates with others is by grabbing others by their hand or arms and leading

them to what he wants. He will also bring an item that he needs help with and put it in his staff’s hands. He enjoys going to van rides, walks around campus, and his favorite thing is to swing on the swings and to go swimming. While he is the residence, he enjoys watching Mary Poppins, play on his kindle and complete his puzzles and matching tasks.
Sean is the oldest of two boys, his brother is 20 years old and also has autism and high intensity challenging behaviors. Sean’s parents who are divorced, highly educated and financially stable, and who both are very involved and active in Sean’s life. His mother FaceTime’s with him in the morning and his father in the evening, if for some reason they are unable to FaceTime they ask for Sean to call the other parent. They alternate weekends so that every weekend they drive 3 hours one way to spend the weekend with him, while the other stays home with his brother. His brother is currently receiving home based services, from his school district. Sean lived in the campus setting residential communities since he was 19 years old.
Diagnoses
It is reported that Sean’s mother had an unremarkable pregnancy with no concerns during the pregnancy. Sean was referred to specialists due to the delay in language development. Sean’s parents reported that he usually preferred to be alone and did not make social connections with others around him. Sean began receiving ABA home based services at the age of 3 ½ . At the age of 13 Sean started to engage in the higher level challenging behavior and as admitted into a Neurobehavioral unit for less than a year. His parents reported that while on the unit continued to deteriorate and his parents had him discharged. Sean returned to the home services until the age of 19, when he moved to a residential placement due the concerns if Sean darting into the streets repeatedly.
Behavioral Characteristics
In Sean’s behavior repertoire that is currently tracked by his behavior team he engages in aggression, self-injurious behavior (SIB), property destruction, dropping and food stealing. When Sean engages in high and low intensity aggression, the low intensity looks like scratching, pinching and swatting. The high intensity is hitting with an open or closed hand, biting, head butting and hair pulling. The SIB is less intense but occurring at a much higher rate, Sean will bang the back of his hands to the wall, tables, or the inside of his thighs, he also will bang his heels on the floor. The property destruction is when Sean bangs on the wall, window and tables. When Sean engages in dropping behavior he drops to the ground usually to gain access to something, and the food stealing is when he steals food from the cabinets that has not been offered to him. Other behaviors that Sean engages in frequently but is not tracked be his behavior team, he makes loud vocalizations that sounds like moaning that are usually a precursor to the lower level challenging behavior. Sean also will cover his ears if he is in a louder environment typically he will engage in both the vocalizations and the ear covering together. Sometimes when Sean is using his Kindle he will have staff cover his ears so that way he can manipulate the Kindle with both hands. Sean also has a history of darting and eloping out of the buildings. Though this behavior does not occur frequently.
For the first year and a half Sean had physical management procedures in his behavior plan for the high intensity challenging behavior, but in the last few months the physical management procedures (PMPs) have been removed from his plan due to not needed to implement a PMP in the last 6 months.

Due to the high rate of occurrence of SIB in Sean’s program room his desk, chair and the wall surrounding him is padded with gym mats. His desk and chair are weighted so that they are not easily moveable. Sean has a history of high intensity aggression directed toward his peers and staff, he will quickly dart around his desk and engage in aggression and peer aggression. Sean does not like loud environments or if someone if the environment coughs or sneezes and will engage sudden and intense challenging behavior. Staff are quick to responds and redirect him back to his desk or away from the individual who coughed. Due to the history of unsafe behavior that Sean engages in he is intensively staff 24 hours a day as a 1:1, when he is common areas or transition from one location to another staff walk in close contact with him, the staff walk with their hands shadowing Sean’s arms as he is walking around. He is walking outside and there are no other vulnerable peers around he will usually run slightly ahead of the staff because he enjoys running

quickly.
Treatment Strategies