A 2-year-old boy is brought to the clinic by his mother, who is concerned about his language development. She says, "I know that children speak at different ages and he is still young, but I am concerned that his speech isn't progressing and that he needs to interact with other children more. His day care teacher says that he is shy and sits in a corner playing with his favorite truck. We have also been busy with a recent move and have not given him as much attention, which doesn't help." The patient's birth history, medical history, and audiology screening are unremarkable. His mother is 6 months pregnant with her second child, and the family moved to a new home 3 months ago. In the examination room, the patient sits in a corner, avoiding eye contact with the doctor and repeatedly spinning the wheels of a toy truck. He does not respond to his name. He makes occasional grunting sounds but says no fully formed words. When his mother tries to take his truck away, he begins screaming and pulls it back. Which of the following is the most likely diagnosis in this patient?

Question

A 2-year-old boy is brought to the clinic by his mother, who is concerned about his language development.  She says, "I know that children speak at different ages and he is still young, but I am concerned that his speech isn't progressing and that he needs to interact with other children more.  His day care teacher says that he is shy and sits in a corner playing with his favorite truck.  We have also been busy with a recent move and have not given him as much attention, which doesn't help."  The patient's birth history, medical history, and audiology screening are unremarkable.  His mother is 6 months pregnant with her second child, and the family moved to a new home 3 months ago.  In the examination room, the patient sits in a corner, avoiding eye contact with the doctor and repeatedly spinning the wheels of a toy truck.  He does not respond to his name.  He makes occasional grunting sounds but says no fully formed words.  When his mother tries to take his truck away, he begins screaming and pulls it back.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

11ec160b_3605_bdc7_9249_6305b7162047_MD0001_00 This child's lack of social engagement, speech delay, and repetitive play are consistent with autism spectrum disorder (ASD). ASD is more common in boys. Deficits often become apparent by the second year of life, with the diagnosis typically made before age 5. In higher-functioning cases, ASD may be diagnosed later, when social expectations increase and deficits become more noticeable. ASD can occur with varying degrees of language and intellectual impairment. Language deficits can range from odd, stilted speech to delayed or complete lack of intelligible speech. Other features of ASD include impaired joint attention (eg, lack of pointing or bringing objects to others), motor stereotypies (eg, hand flapping, spinning), and hyperreactivity or hyporeactivity to sensory input (eg, extreme responses to sounds or textures, indifference to pain). (Choice A) Adjustment disorders are diagnosed when symptoms develop within 3 months of an identifiable stressor. Although the mother's pregnancy and family's move to a new home may be stressful for the boy, it would not explain his lack of language acquisition, poor social interaction, and repetitive play. (Choice C) Language impairment frequently accompanies ASD. However, an isolated language disorder would not explain this child's lack of social interaction and restricted interests. (Choice D) At age 2, children should be saying 2- or 3-word phrases, engaging in parallel play using a variety of toys, making eye contact, and responding to their names. (Choice E) Selective mutism involves a failure to speak in specific situations (eg, school) despite speaking in other settings. This boy's language impairment in all settings, deficits in social reciprocity, and restricted and repetitive behaviors are characteristic of ASD. (Choice F) In social anxiety disorder, children may have difficulty engaging with others due to anxiety in new social circumstances but otherwise have normal communication skills. This child's deficits are evident in multiple domains (home, school, office). (Choice G) Social (pragmatic) communication disorder is characterized by deficits in verbal and nonverbal communication for the purposes of social interaction. If these deficits are accompanied by restricted patterns of behavior, such as in this child, the appropriate diagnosis is ASD. Educational objective: Autism spectrum disorder is characterized by impaired social communication/interactions and restricted, repetitive interests or behaviors. It can occur with or without language and intellectual impairment. __________ References: Autism spectrum disorders. (http://www.ncbi.nlm.nih.gov/pubmed/23300017) Social (pragmatic) communication disorders and autism spectrum disorder. (http://www.ncbi.nlm.nih.gov/pubmed/26699538) Autistic spectrum disorders: a review of clinical features, theories and diagnosis. (http://www.ncbi.nlm.nih.gov/pubmed/25862937)

A 2-Year-Old Boy Is Brought to the Clinic by His