AccessMedicine's Case of the Week: Autism Spectrum Disorder

From: Case Files: Psychiatry 5e

Go to the profile of Julie Grishaw, ACNP
Apr 01, 2019
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Case:

A 2½-year-old boy is brought to a pediatrician by his parents for his regular yearly examination. He is the couple's only child. The parents relate a normal medical history with a single episode of otitis media. They recently placed their son in day care for 2 half-days a week. However, he has not adjusted well, crying and having tantrums during the first hour of school. Then he usually quiets down, but he does not interact with the rest of the children. The teacher cannot seem to make him follow directions and notes that he does not look at her when she is near him and attempting to interact with him.

On further discussion with the parents, the pediatrician finds that the patient has only a limited vocabulary of perhaps 10 words. He does not use these words in any greater length than two words in a row and often uses them inappropriately. He did not speak his first clear word until 6 to 9 months. The patient does not interact well with other children but does not seem upset by them. His favorite toys are often used inappropriately-he performs single, repetitive movements with them for what seems like hours on end. The pediatrician picks the child up to help him onto the examination table and notices that he seems quite stiff, pushing himself away from the examiner with his hands. Although his hearing and eyesight appear to be intact, the child does not respond to requests by the pediatrician and does not make eye contact. All other gross neurologic and physical features are within normal limits.

Questions:

1: What is the most likely diagnosis?

2: What is the most likely prognosis for this condition?


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Go to the profile of Julie Grishaw, ACNP

Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education

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