This autism analysis case takes place in Wisconsin and involves a teenager with a past medical history of autism, disruptive behavior disorder, hypogammaglobulinemia, intractable seizures from a very young age, and overall intellectual disability with an IQ of 50-60. The patient’s medications include Kineret injections, Privigen infusions, Keppra, Risperdal and Zithromax. The patient is dependent on his parents and a home nurse for assistance with virtually every task involved in daily living, and will remain so for the rest of his natural life. His parents have joint physical custody but are divorcing, and as a result they require a life care planner to evaluate the costs of their child’s future care.
Question(s) For Expert Witness
- 1.) Could you review this patient's medical records on the autism spectrum and evaluate the costs of her ongoing care?
Expert Witness Response E-000286
Yes. Pending access to current records, caregivers, treating team, IEP if available, and onsite assessment, off-the-top-of-my-head initial recommendations would include, but would not be limited to, periodic (to be determined) medical follow-up: primary care, neurology, immunology, infectious disease, neuropsychology, a dentist who specializes in this population, nutritional, physical/occupational/speech-language for communication/recreational or play/behavioral therapy; possibly sensory integration therapy, music therapy, or others depending on evaluations of current status; associated diagnostic testing and periodic reevaluations for goals/maintenance for the above disciplines or for changes in condition, CT scans for encephalomalacia or hydrocephaly, EEG, sleep studies; possible referrals for new therapies, vagal nerve stimulation for seizure control; medications and associated diagnostics for side effects (Note: seizures typically increase during adolescence with changing hormonal levels and anatomical brain changes, and it may take some time to regain equilibrium); supplies and equipment replacement intervals/maintenance, vendors.
If the child will travel between parental homes, it may be necessary to have increased levels of home health care depending on geography. If child will move to different home(s), architectural modifications for safety, bathroom access, and more will be needed. The noncustodial parent may need a modified vehicle for transport. Home health might include an awake overnight caregiver, case manager, and RN oversight for LPN or HHA providers, as well as respite care for the custodial parent. Considerations associated with aging may include: Guardianship when parent(s) are not able to continue as the primary care provider, transition to an external care facility, as well as increased physical needs associated with aging and the included evaluations and care. There may be further considerations depending on additional case details that are not yet available to me.