Autism Spectrum Disorder

Case Study #2: Korean Child diagnosed with Autism Spectrum Disorder Background David Lee (pseudonym), age five years ten months, was diagnosed recently with Autism Spectrum Disorder. His parents, Lisa and Adam Lee followed the recommendation of their pediatrician, Dr. Su, to have David evaluated by the Child Study Team at Children’s Hospital four months after his fifth birthday. Dr. Su was concerned about David’s lack of interactive communication skills and his preoccupation with cars. The Lees believed that David’s lack of age-appropriate socialization was due to being an only child who was cared for by Mr. Lee’s mother on a daily basis. Mrs. Soon Young Lee (pseudonym), a widow, immigrated to the US from Korea three years ago to help care for her grandson while her son and daughter-in-law completed their doctoral and post-doctoral programs in chemical engineering at a local university. Adam Lee, the eldest child, and only son in his family was born in Korea and came to the US for his undergraduate education at age 19, where he met and married Lisa seven years ago. Adam has no interest in returning to Korea to live and is presently negotiating a research and development position for a chemical company in the US. Lisa was born in the US shortly after her parents emigrated from Korea. Lisa is not fluent in Korean. Lisa’s parents now reside in California and visit several times per year but cannot provide daily help to Adam and Lisa. Both parents are 30 years old, and Mrs. Lee is pregnant with their second child. The Lees are practicing Christians, and Mr. Lee’s mother is a Buddhist. David received a complete neurological, cognitive, and communicative evaluation at Children’s Hospital several months ago. Results indicated that David verbally interacted only when spoken to and that he had difficulty with turn-taking and coherence in conversations. Although David used complete sentences and a sophisticated vocabulary about his favorite topic of cars, his speech lacked inflection and sounded “robot-like.” David responded to his name inconsistently and showed little interest in play activities offered to him by either the clinicians or his parents. His use of nonverbal communication, such as gaze and gestures, was also inappropriate for a child his age. The Lees stated that they believed that David’s communication style in Korean is similar to what he exhibited on the day of the evaluation. David demonstrated some repetitive routines, such as stacking and restacking papers and books. David has a special interest in cars and can identify cars by maker and year with precision. He brought several books on cars with him to the Child Study Team evaluation and focused on them even when his parents tried to engage him in conversation. The Lees also commented that David had advanced ability in mathematics and performed at a 5th-grade level. David is expected to enroll in kindergarten this fall, where he can receive speech-language therapy on a daily basis if the parents agree to the recommendations provided by the Child Study Team. He has not attended preschool and has few socialization opportunities with peers other than when he attends church activities. The Lees are concerned about their son’s lack of interaction skills and his recent diagnosis of Autism Spectrum Disorder. They are also concerned because Adam’s mother, who provides most of David’s daily care, denies that there is any type of problem. Mrs. Soon Young Lee, a former middle school mathematics teacher in Seoul, speaks Korean to her grandson and 2 believes that he is a gifted child, not one with a communication difficulty. She encourages David’s interest in both mathematics and cars and praises his precociousness to family in Korea. She told her son and daughter-in-law that they should be glad that their child is “quiet and smart; he does not talk back to adults, and that is good.” She admonished them for “even thinking” that there was something wrong with their first son. Adam also indicated that there is friction with his mother because of his conversion to Christianity and what she considers his “disrespect” for her as the elder in the family. The Lees are dependent on Mrs. Soon Young Lee for financial aid, help in the home, and child care. Mrs. Soon Young Lee has recently lent her son money for a down payment on a home. They are also concerned that Mrs. Soon Young Lee’s criticism of and unwillingness to participate in therapy programs for their son will be detrimental. She has indicated that David should be placed in a school for gifted children and not labeled with Autism Spectrum Disorder or receive any therapies. Mr. Lee states that he wants to do the best for his son but that his mother’s influence in his home is great and that disregarding her wishes will cause greater tension within the family. Mrs. Soon Young Lee has no plans to return to Korea in the near future, as she will provide childcare for the new baby and David.

Discussion Questions 1. What problems might a multi-generational and multi-cultural family such as this have in understanding Autism Spectrum Disorder?

2. Why do you think the grandmother is so averse to her grandson being labeled with Autism Spectrum Disorder and receiving therapy? How much of her perception is cultural? Related to her personality?

3. Suppose you were the clinician working with this child in kindergarten in a public school; how important would it be to work with the grandmother regarding the nature of and treatment for Autism Spectrum Disorder? What are the advantages and disadvantages of enlisting her help or providing information to her?

4. What other issues other than cultural differences toward disability emerge in this case?