Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
Department of Neurodevelopmental Pediatrics, Child Development & Rehabilitation Center, Center for Global Health, University of Virginia Children's Hospital, Charlottesville, VA.
J Dev Behav Pediatr. 2020 Aug;41(6):496-498. doi: 10.1097/DBP.0000000000000814.
Zahid is a 10-year-old boy who moved to the United States 18 months ago with his parents and 3 younger siblings. He and his family are refugees from Syria. Zahid was born in Syria after an uncomplicated pregnancy and delivery. Zahid's parents first became concerned about Zahid's development when he was 9 months old because he had not started cooing or babbling and did not respond to his name. At 3 years, a doctor in Syria expressed concern that Zahid may have autism spectrum disorder; however, his parents did not know what symptoms triggered the concern and believed his behavior was because of his ongoing exposure to trauma.Zahid underwent a full evaluation 1 year ago in the United States and was found to meet the criteria for autism spectrum disorder. Coaching was provided to his parents in obtaining appropriate educational support for their son, and a referral was placed for applied behavior analysis (ABA) to be provided by an organization in the community. After several meetings between the parents and school administration, an Individualized Education Program was initiated. Despite acceptance into a community-based ABA program, Zahid has not begun the intervention because of transportation difficulties. In-home ABA was offered but was refused by the family.The family is under significant stress. Zahid is nonverbal and has displayed behaviors affecting safety, including wandering/eloping and turning on kitchen appliances resulting in a kitchen fire. Zahid's mother completed high school, and his father completed sixth grade. Both parents speak limited English, and neither is employed. The family receives financial support through the government, but this will be ending soon. Zahid's father is concerned that employment outside of the home will further limit his ability to transport Zahid to necessary appointments. Zahid's mother does not drive. Zahid's father requests that the physician provide a letter requesting exemption from requirements to participate in work or training programs because of Zahid's needs. How would you respond to this overwhelmed father?
扎希德是一个 10 岁的男孩，他和他的父母以及 3 个年幼的兄弟姐妹在 18 个月前搬到了美国。他们一家是来自叙利亚的难民。扎希德在叙利亚出生，孕期和分娩过程都很顺利。他的父母在他 9 个月大的时候开始注意到他的发育问题，因为他还不会咿呀学语，也不会对自己的名字做出反应。3 岁时，一位叙利亚医生担心扎希德可能患有自闭症谱系障碍，但他的父母不知道是什么症状引起了医生的关注，他们认为孩子的行为是因为持续受到创伤。一年前，扎希德在美国接受了全面评估，被诊断为自闭症谱系障碍。医生向他的父母提供了辅导，以帮助他们的儿子获得适当的教育支持，并向社区的一个组织转介了应用行为分析（ABA）。在父母和学校管理部门进行了几次会议后，启动了个别化教育计划。尽管扎希德已经被社区的 ABA 项目接受，但由于交通困难，他尚未开始干预。家庭提供了上门 ABA，但被拒绝了。这个家庭承受着巨大的压力。扎希德无法说话，并且表现出影响安全的行为，包括游荡/逃跑以及打开厨房电器导致厨房起火。扎希德的母亲完成了高中学业，父亲完成了六年级学业。父母双方都只会说有限的英语，而且都没有工作。这个家庭通过政府获得经济支持，但这种支持即将结束。扎希德的父亲担心外出工作会进一步限制他带扎希德去必要的预约的能力。扎希德的母亲不会开车。扎希德的父亲请求医生出具一封信，要求豁免参加工作或培训计划的要求，因为扎希德有这方面的需求。你会如何回应这位不知所措的父亲？
