Maria is 19. She has mild ASD, average intellectual ability, and challenges in the pragmatic use of language. She also has type I Diabetes Mellitus that she has managed well in the past. She lives in a group home and works part time as an assistant in a shop. The group home manager reminds her to take her medications but has noted that Maria has lost weight and become less and less willing to check her blood sugar and take her insulin. She helps Maria make an appointment with her family nurse practitioner.

A Little More about Maria

Maria has always had a strong, “black-and-white” focus on morality. As an adult, she has developed a dislike of government entitlement programs such as Medicaid. When asked about her reluctance to take her insulin, she says that because it is paid for by Medicaid, it goes against her moral code, so she should therefore not take it anymore. When you speak with her, you notice some flatness of affect, although that may be part of her ASD. The caregiver who accompanies her says that she has seemed wary and untrustful lately and gives some examples. Her employer has also mentioned to the caregiver that Maria seems less motivated at work than before.