HoNOS-LD case study written vignette - Stevie

Stevie is a 26-year-old male. He is the only child of parents who are very involved in his care. He has profound mental retardation and has Autism with behavioural problems. He has no spontaneous or meaning full speech but does make grunting noises. He has very poor social interactions and remains solitary. He is unable to recognize the emotions of others. He can understand very simple verbal instructions. From the age of 10 years old, he has been seen by a local psychiatric service for his behavioural problems and has been attending the Manaaki centre for a number of years for day care. He has had nine admissions to the district hospital.

Stevie was admitted two weeks ago following an incident at home where he became violent, biting his parents and banging his head. His behaviour has included hitting walls, tables and breaking glass. He has spat at staff previously and inappropriately urinated on people. These behavioural problems have resulted in much conflict with others and were seen as the reason that he was unable to return to the Manaaki centre. In the past two weeks, he has been constantly rubbing his eyes to the point that they are swollen and red.

Currently he is restless - jumping and hopping around. He has poor concentration and attention and is easily distracted. He is orientated and knows where he is. He has limited ability to undertake activities of daily living. He has been waking early in the morning and will not go back to bed or asleep. This has been very disruptive to his parents.

He has a limited ability to communicate - either to understand instructions or express his needs. There is no evidence of hallucinations or delusions.

Stevie is currently living with his parents and has been attending the Manaaki centre regularly where he is isolated from others because of his behaviour. This includes punching, biting, pushing, twisting the arms of others, yelling, scratching, climbing and jumping. Staff describe him as solitary. He has very limited ability to engage in the activities of the Manaaki centre and is unable to attend to simple occupational activities outside the home.

He had a convulsion a number of years ago but there has been no evidence of seizures recently. He has had recurrent episodes of weight loss and anaemia and has chronic gastritis. In recent weeks, he has been vomiting and has been indicating abdominal pain.

His parents are anxious and over protective and there is some concern that their behaviour may be provoking Stevie. They wash and dress him which limits his ability to do these things for himself. Although he is capable of these activities, he is easily frustrated and his parents intervene to speed up the process. His parents ensure he has an adequate diet. He is able to eat unassisted.

He has been trialled on a variety of psychotropic medications and is currently managed on Quetiapine XR, clonazepam and Epilim CR. Modification of medications, individual training.