Final Week

In many ways, life has become easier for Thomas.  At 60 years old, Thomas feels like he has learned the best way to deal with his emotions, and he is more confident to handle his day-to-day living.  A month ago, Thomas’ mother, Molly, passed away from heart complications.  Working with the psychologist and learning coping techniques following the heartbreaking loss of Thomas’ father, Thomas knew that he was at a better stage to deal with the death of his mother.

          Before Molly’s death, Thomas was given the deed for the house that they currently live in, and a lawyer was assigned to help watch over Thomas and Rosie’s finances.  Thomas and Rosie continue to have a solid relationship, enjoying each other’s company and conveying their emotions and hardships to one another.  Together, they continue to volunteer at the Boys and Girls Club, which they feel is a wonderful way to make an impact on society.  David, the young boy that Thomas had been mentoring, is now 33 years old, and he remains an important part of both Thomas and Rosie’s life.  David continues to live in Harrisonburg, VA, and Rosie and Thomas meet with David at least once a week to do some type of social activity, whether it be playing bingo or going to see a movie.

          Thomas continues to use Art Therapy, which remains a great outlet for him to relax and express himself. Unfortunately, Thomas has developed some arthritis in his right hand from the continuous drawing motions, but he currently takes medication to help with some of the pain.  The doctor has informed Thomas that he needs to limit his drawing time to 2-3 hours per week. Thomas found this a little difficult to deal with at first, but was able to pull from some of those coping strategies that he was taught in those many psychologist sessions he had attended.

          At 70, Thomas is starting to deal with the process of growing old. He is still able to somewhat take care of himself and Rosie is a little bit of help, but they are starting to struggle keeping the house in good condition. The lawyer that was assigned to Thomas and Rosie to look over finances and the estate suggests that Thomas and Rosie either hire someone to come weekly to help with upkeep of the house and grounds or to sell the house and move into an assisted living community.

Thomas struggled with the decision making process and sought the advice of the staff at the Arc. With their help, Thomas decided that it was best for someone else to live in the house instead of Rosie and himself. Molly had left money in her will for Thomas, and subsequently Rosie, for when they were no longer able to take care of the estate. With this money Thomas and Rosie found a nice one bedroom house that was just bigger than an apartment. This way Thomas and Rosie had less space to take care of and were close to things like the hospital and the Walmart in town.

Sadly at the age of 80, Thomas passed away from complications with his condition. However, Thomas and Rosie were able to spend a happy ten years together in the house that they bought. Now Rosie must go on alone living in the house but passes soon after Thomas. Both Thomas and Rosie had nice ceremonies put on my members of the community that embraced their contribution to the town.

Week Thirteen

Thomas has just celebrated his 28th birthday! He is still living at home full time and was granted minimal SSI benefits because of this. He has attempted many different jobs but still has not found one that suits him or that can effectively deal with his behavior and social issues. Thomas is still fascinated with video games and spends a majority of his time playing them on the computer, television, and anything else he can get his hands on. The virtual world gives Thomas an opportunity to interact with other people and he feels like he can be a “normal” person in these games without any judgment from people who do not understand his disability.

A few weeks later while out running errands, Molly drove past a video game store with a “help wanted” sign in the window. On a whim, she stopped in and began talking to the manager about Thomas, his love of video games, and his disability. The manager was more than understanding and offered Thomas the job of a part-time sales person on the spot. Molly and Ian were overjoyed upon hearing this and Thomas was looking forward to it as well. Since the store was about a ten minute drive away, Thomas was motivated enough to take a drivers education course and obtain his driver’s license before beginning the job.

At 30 years old, Thomas is doing better than ever. He has been promoted to work at the video game store full time and his boss says he is one of the best employees they have. Thomas knows all there is to know about the video games, is enthusiastic about them, and gives helpful advice to customers. This not only has helped greatly with his social interactions, but has also broadened his friend group. He enjoys hanging out with his fellow coworkers outside of the workplace, and has even attempted to go out with them on the weekends. There have been a few times where Thomas has been overwhelmed while out at a bar with the sheer amount of conversations going on around him and the loud music. He knows that in order to deal with a situation like this, he needs to remove himself from the situation and either steps outside for some fresh air or excuses himself and goes home. Thomas’ new friends are very understanding and supportive which has helped Thomas with this transition.

Thomas is 35 years old and attends The Arc of Harrisonburg and Rockingham County where he has become very involved with The Op Shop.  Thomas works on crafts with other individuals with disabilities, whom he has grown very close to.  He also attends the Canteens every month which he looks forward to and loves.  Canteens are supervised social activities for individuals with disabilities 14 and up.  There are usually two canteens a month and this month The Arc had an Easter Dance and a BBQ.  Thomas has been able to gain great friendships through this network and it helps him improve his social and communication skills.

Through his work, he has attended three video-game conferences in Washington, DC.  This was a big leap for Thomas because it was the first time Thomas has been away from his parents for several days.  The first time attending the conference, it was very difficult and Thomas threw a tantrum because he was scared.  Thomas took a train from Staunton and was overwhelmed by the rattling sensation and close proximity to people.  However, each trip got easier with the help of peers and his support group.  Once he got used to the different feelings, he was able to calm himself down and was able to enjoy the trip.  These trips have definitely been a milestone in Thomas’ life as well as his parents.

When Thomas was 33 years old, he attended the video game convention for the second year.  He met a 30 year old woman named Rosie and they hit it off right from the beginning.  For the first time, Thomas felt at ease talking to someone.  She was interested in all of the same video games and activities that he was interested in. They have been dating on and off for a couple of years now and he has grown attached to her.  Thomas introduced her to his parents and Ian and Molly have grown to care for her.  Ian and Molly both think that this relationship has benefited Thomas in many ways though they believe that she may also have a mild form of Autism or Asperger’s syndrome.  However, Rosie has never been assessed or diagnosed for either.

Thomas is now 40 years old.  Rosie and Thomas have been dating long-distance for five solid years now.  They have agreed to have Rosie move from her home in Richmond, VA to an apartment in Rockingham County about 15 minutes away from Molly and Ian’s home.  Thomas was able to deal with this very well because Rosie has been able to relate to Thomas and help him make the transition.  They are very happy in their apartment and Rosie enjoys being able to call this apartment her “own home”.  Molly and Ian visit at least 2-3 times a week and they all have dinner together at least once a week.

Earlier in her adult life, Rosie attended J. Sargeant Reynolds Community College and got her Associate’s Degree to become a dental assistant.   Rosie got a job working at Kool Smiles in Richmond, VA after she completed her degree.  Gary, her boss at Kool Smiles enjoyed Rosie and considered her one of his most efficient workers.  Gary helped her tremendously in getting a job in Harrisonburg, VA at Brown & Sutt Dentistry when she moved.  Although Thomas’ SSI/ disability benefits help, the rent for the apartment is largely maintained by Rosie’s salary which is $42,000/ year. Thomas has learned how to cook for himself and maintain his own home while Rosie is at work.

When Thomas turned 42, he decided to sign up to be a volunteer at the Boys and Girls Club of Harrisonburg.  Throughout his first couple of weeks helping out here and there, he became especially fond of a fifteen year old boy named David.  Thomas felt that David was like him in some way but he couldn’t quite place his finger on it.  Thomas’ supervisor felt that it would be beneficial for Thomas to become his mentor. The young David and Thomas bonded over action figures and video game equipment.  Rosie began to notice how much David has influenced Thomas to come out of shell even more so than he has over the past five years.  At age 45 Thomas and Rosie got married in a very small and personal ceremony in Molly and Ian’s backyard.  Those who attended were close family and a few friends they had made together over the past years.  Shortly after they got married, Ian suffered a dramatic and severe fatal heart attack.  The news quickly spread and Thomas was devastated as any child who lost a parent would be.  Thomas and Ian were very close in their later adult lives and this took a toll on Thomas.  Rosie and Thomas’s finances were more than they could handle at this time in their life to due pay cuts at work; so, to lessen this financial burden they moved back into Thomas’s childhood home with Molly.  Molly’s needs have increased with her age and she is thankful to have Thomas by her side and Rosie to help her with small daily living tasks.

Thomas is now 50, and although the past couple of years have been very difficult for him without Ian, he has managed to pull through. Thomas felt empty after his father’s passing, therefore he met with a psychologist every two weeks, for six months, after his father’s death. (The psychologist had experience in working with children and adults with Autism).  The psychologist showed Thomas some new ways for Thomas to express himself when he feels upset over losing his dad, or any other feeling that he is not comfortable discussing out loud.  Art Therapy is one coping technique that has helped Thomas work through some of his more difficult feelings.  Thomas enjoys drawing sketches of potential video game scenarios as well as making collages that demonstrate his sometimes hidden feelings. Art therapy was not offered when Thomas was in school, but Thomas is bringing awareness to it now, and Art Therapy programs are now being integrated into the local school systems.  Thomas’ art has been displayed at the local Boys and Girls Club, and Rosie is planning a exhibition in the near future that will display some art from children in the local school systems.  Thomas and Rosie are more financially stable than ever before and are very happy in their marriage. They continue to live with Molly (who enjoys having the two around), and they have also decided not to have children. Rosie and Thomas have formed a great partnership with the local Boys and Girls Club, and spend much of their free time there because they have each begun to mentor more children in addition to David.  Currently, Thomas’ art accomplishments have given him confidence to submit some of his video game scenario pieces into a contest where the winner will get to work alongside video game designers and contribute to the creation of the new video game.

Week Twelve

Thomas Mahoney is now 25 years of age. As someone with Autism, Thomas' options have been limited with regard to his functioning outside of the home. Thomas stayed enrolled at his public school until he was 21, and he met some of his transition goals. Still, it was sometimes easier for everyone if Thomas just stayed home.

Thomas has continued to live with Molly and Ian and spends much of his time playing video games. Last year, just after he turned 24, he had a job for a short time at a local convenience store. It didn't work out for him, however, as he got confused easily and didn't like it when he had to be guided in what to do. He was able to express that he wanted to feel grown up but didn't really know how. He left the job after only a few weeks.  

Thomas is relatively happy most of the time, and he is fond of talking about his latest video game adventures when Molly and Ian return home from work. Ian and Thomas have become close - Thomas likes to try to make jokes, and his dad is always able to understand his strange and idiosyncratic sense of humor. Thomas has come to understand his dad's inability to walk and offers to help his dad around the house. It has become a way in which the two have been able to bond.


* Is Thomas eligible for public assistance? (SSI, disability)

* Locally in Harrisonburg, what is Friendship Industries? Are there people at Friendship who have Autism? What other kinds of supported employment options (if any) are available?

* If Thomas were unable to live at home, where would he go?

* Given Thomas' disability, what considerations ought Molly and Ian make if they were to become somehow incapacitated or if they died?

* Are there any other community-based options for Thomas? Check into Summit House in Harrisonburg. If Thomas lived in the Harrisonburg area, would he be able to attend?

DECISION POINT ::: In what other activities does Thomas become involved?

Week Eleven

Molly and Ian have worked hard over the last several years to support and help Thomas, and now 16 years of age, Thomas is doing well in high school. He currently attends the local public high school and is mostly in a self-contained class for children with Autism. The only mainstream class he has is PE, and this has proven to be the most difficult time of the day but still relatively manageable.  

Middle school, however, was another story. Thomas had managed to develop some friendly relationships with other children, although his limitations meant that, rather than coming to understand social cues in an intuitive manner, he had to very specifically be taught and coached as to what to say with friends and when. He entered middle school having had some positive experiences with two other kids at the Mathews Center, but Molly and Ian had to stop sending him there as the cost became prohibitive. It was shortly after ending with the Mathews Center that Thomas entered middle school. The first year went OK, but there were little signs that Thomas might have a rough time in middle school: even though the 5^th grade team at the elementary school had prepared teachers and administrators for Thomas and his specific needs, a new assistant principal had not been prepared for him and was not as understanding of Thomas’ disability as others in the school system had been. Thomas became frustrated at one point in the middle of his sixth grade year and ran out of his classroom. When he did, he was unable to avoid running into another student who was in the hallway at the time. The student fell and bumped her head. The assistant principal, who was in charge of discipline at the school, felt like Thomas’ behavior was intentional. Most everyone else involved, particularly the classroom teacher, knew Thomas and felt differently. Although Molly and Ian had been seeing a small change in Thomas’ behavior at home, they knew that he was not the kind of child who would intentionally hurt a peer. Still, the assistant principal held firm and suspended Thomas for 10 days.  

A manifestation determination was held, and, after a heated discussion, it was decided that Thomas’ behavior was a result of his disability. After 10 days, Thomas was able to return to school, but his attitude was quite different. This was the beginning of ongoing behavioral difficulties at the school that were a marked shift for Thomas in his experience of school. Finally, toward the end of his eighth grade year, the psychiatrist tried another type of medication which seemed to be effective for Thomas, and he was more able to manage himself throughout the school day. It wasn’t until moving to the high school, however, that Thomas finally felt safe and comfortable again in a school.

Now at age 16, Thomas is doing well on his IEP goals and is on track to graduate with an IEP diploma.

* Using Brofenbrenner’s ecological systems model, with what influences did Thomas have to contend in middle school?

* In your group’s opinion, what circumstances led to Molly and Ian’s resilience in the face of the challenges Thomas has presented as a child with ASD? Describe the factors that likely led to such resilience – be sure to consider what you can ascertain of Molly and Ian’s general level of functioning including what you perceive to be their overall psychological well-being.

* From the standpoint of the school and the IEP, what is transition? Describe at least 3 transition goals for Thomas. When would the IEP team have started to consider and include these?

* What is a manifestation determination meeting? Why does it occur? What are the possible ramifications of the meeting?

* What domain of development was likely a factor in Thomas’ differing experience in 7^th and 8^th grade? In other words, what was going on for Thomas that perhaps led to a change in the effectiveness of his medication?

* What happens when Thomas turns 18? For which services will he still be eligible? What kind of public assistance can he receive? How will he support himself? Be sure to look into SSI and disability – is he eligible when he turns 18? Is he eligible now, at 16?   

Week Ten

Week Ten is courtesy of the Wendy Marianna group!

When Thomas was around 9 years old, he began recognizing his strength and acting out in increasingly violent ways. Ian and Molly decided to take him to see a child psychiatrist in the area.  The goals listed in Thomas’s IEP were harder to achieve than originally expected; by bringing him to a psychiatrist Molly and Ian hoped to gain another professional opinion of what to do. The child psychiatrist recommended various behavioral intervention strategies and put Thomas on Olanzapine, an antipsychotic medication used to treat children with Autism.  

Thomas is now 12 years old. Over the past three years, Molly and Ian have watched Thomas grow in many areas, especially the more challenging areas such as expressive language and stress management. One of Thomas’s original goals was to use verbal communication to express his desires. At age 12 he has begun regularly using phrases such as, “Thomas needs the bathroom,” or, “Thomas wants noodles (or other food he is requesting).”

Ian and Molly began working longer hours during the week to earn some extra income. Although they were originally apprehensive about what to do with Thomas, a parent in their support group set them up with the Matthew’s Center. Thomas was able to receive after school care until 6 pm. Another area that Thomas has grown in is with his social world.  Thomas has made two friends at the Matthew’s Center, Primrose and Katniss, two girls with Asperger Syndrome. The trio has helped each other use more verbal communication and imaginary play, but work still needs to be done.  Ian and Molly have recently attended Thomas’s IEP meeting to update his goals.  The most significant progress the team hopes to see in Thomas is in the social area because middle school focuses more on group projects, athletics, programs, and other opportunities for young children to work together. If Thomas is able to participate more easily in any of these realms he will have achieved the goal for this year and will be better prepared to enter high school in the future.

Week Nine

Thomas is now 7 years of age, and the last few years seem to have gone by quickly for Molly and Ian. Thomas has shown some improvement in his language skills, but he is still far from typical in terms of his development. At home, he uses the PECS system which seems to help to keep him from becoming frustrated in communicating his needs.

In spite of considering a visit to a child psychiatrist, Molly and Ian have not taken Thomas to see anyone of this sort. Thomas continues his occupational therapy with a community-based provider, something that is helpful given the kind of therapy he receives during the school day. Molly and Ian continue to be concerned about Thomas' behaviors in the home, and they are considering requesting assistance through a local community agency. They have both been participating in couples counseling for the last year, something that has helped them to deal with the stresses of raising a child like Thomas and to ensure that their relationship stays strong. The stress has been overwhelming at times, particularly as Thomas has gotten bigger and is harder to contain when he tantrums. Molly is worried about what will happen as Thomas grows - will she be able to handle his outbursts?

* How often is Thomas likely to receive OT services in a typical public school system in Virginia? What about speech/language services? 

* Write 3 goals that are likely in Thomas' IEP at age 7. Include 3-4 objectives for each of the goals.

* What kinds of community-based services exist for children like Thomas? What kind of insurance would Thomas need to have in order to receive such services?