Case Study 2

The following case study illustrates culture and language issues in screening for autism. The case study provides a question for viewers to consider and reflect on.

Case Study 2: Screening for autism (Vietnamese)

(Adapted from Massachusetts Act Early (MA Act Early), (2017)).

Mrs Buivan arrives for an appointment with her three year-old Tran. Tran’s mother speaks only Vietnamese so you call the telephone interpretation line because you were not aware that an interpreter would be required. Through the interpreter, Mrs Buivan reports that she is worried because Tran only uses three to four words and has “bad” behaviour, such as temper tantrums and not listening. He also sleeps poorly and is a picky eater.

Mrs Buivan shares that she has been concerned about Tran since before he turned two. He is very different from his two older sisters. She shared her concerns with the Plunket Nurse at Tran’s 24-month well-child visit, but was told that boys often talk later than girls, he was hearing both Vietnamese and English at home (through television and his sisters), and she needed to be more consistent with discipline.

Tran, his sisters, and mother live with her parents who also believe that as Tran is a boy, he will talk later, especially because he has two sisters who are more than willing to speak for him. His mother feels there is something more going on and has decided to seek help from the local Child Health Service (who subsequently referred to CAMHs), after her friend told her that they had helped them find a special education classroom for their pre-schooler with a developmental delay.

You observe Tran and are concerned that he does not use any words and wanders around the clinic room without purpose. You want to complete an M-CHAT with the family but do not have a Vietnamese copy. You then remember it is available online and download a copy that his mother completes (http://mchatscreen.com/wp-content/uploads/2015/10/M-CHAT-R_F_Vietnamese_v4.pdf).

Mrs Buivan endorses three critical items and you review these with the telephone interpreter who confirms that these are accurate responses. You revisit Mrs Buivan’s concerns and support her sense that Tran needs a more detailed evaluation which she requests you help arrange at a follow up appointment. You also encourage her to enrol Tran at a pre-school since at age three, he is eligible for subsidised pre-school education.