Case study – assessing a boy with Autistic Spectrum Condition (ASC) initially diagnosed with ADHD

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Less common mental health conditions include autism spectrum disorders (ASD), eating disorders, tic disorders, and a number of very low prevalence conditions.


About one in fifty (2.1%) 5 to 19year olds were identified with one or more of these other types of disorder. 1.2% with ASD,0.4% with an eating disorder, and 0.8% with tics or another less common disorder.

Original diagnosis and new assessments leading to sandplay therapy

Tom was excluded from his primary school and then following reintegration he was excluded again in the last term of Year 7. Tom was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) during his primary years. When Tom arrived at the secondary pupil referral unit, he was extremely unhappy and downhearted. Following observation and consultation completed by myself as Educational Psychologist, and a number of social and emotional assessments conducted by the pastoral wellbeing staff, we decided that Tom would be offered the opportunity to complete some individual sandplay therapy sessions. This would be conducted by myself, Educational Psychologist and Sandplay Practitioner, over a period of eight to twelve weeks. Sandplay therapy is based on Jungian Psychology and Eastern Philosophy.

The nature of the approach was explained to Tom. He was able to ask questions and consider whether he would be willing to engage in this work. Tom was interested in the non-verbal nature of the sandplay therapy approach. Tom took some time to think about things and then agreed that he would like to give this a try. Tom engaged well for the initial eight sessions and then a further four. During this time, I got to know Tom very well. I believed that Tom’s mental health was at risk due to an undiagnosed Autistic Spectrum Condition (ASC). I questioned whether the behaviour originally recognised as evidence supporting a diagnosis of ADHD was due to social anxiety or whether an ASC was also present.

Observations and further assessment of intelligence

Tom made very good use of the therapeutic space and alliance and progressed well during the time. There were obvious benefits to his mental health. However, there were still underlying difficulties that remained. I supported Tom to attend a multi-professional assessment. As well as evidence from our therapeutic work, my part in this assessment involved consultation and observation of Tom in lessons and completion of a standardised assessment. The assessment was an important part of collating information on Tom’s cognitive processing. I used the Wechsler Intelligence Scale for Children – Fifth UK Edition (WISC-V UK) due to the familiarity of health professionals with the Wechsler tests.

Outcomes and new diagnosis

The outcomes of the assessment served as a shared language amongst professionals. On this occasion, the Psychiatrist and Clinical Psychologist were involved in the mental health evaluation of Tom. I remained his advocate on this occasion due to the therapeutic alliance we had established previously. Following intensive assessment over a period of time, Tom was diagnosed with an ASC.

My role following this involved working with Tom and his family to

understand the ASC diagnosis and how this has been affecting his mental health. Over the next few months, it was evident to see Tom’s progress in the area of emotional development. An Education Health and Care Plan assessment was completed simultaneously. As a consequence of the difficulties Tom experienced with his mental health and emotional wellbeing prior to diagnosis, the family visited a specialist school for young people with an Autistic Spectrum (AS). Family and professionals have seen how the school can support Tom’s complex needs across all areas. Tom has now been attending the school successfully for four years.

About the author

Dr Melanie Adkins is a Senior Educational Psychologist and Play Therapist in a local authority (LA) and runs her own company, Colour Me Happy Ltd. Melanie trained as an Educational Psychologist at the Tavistock Centre in 2005/6 and has been working in the same LA since this time. She completed her Doctorate in Educational Psychology at UCL, between 2008 and 2014, whilst working and starting her family.