An 11-month-old boy is brought to the office by his mother for a well-child visit. The mother reports that he has been crying and screaming when other people approach him. She is concerned that it has been occurring for the past few months and that it seems to be worsening. She says, "He used to love being held by everyone but now wants to be with only me. He won't even let his grandma hold him anymore." The patient is crawling and can stand only with assistance. He babbles but does not say any clear words and uses hand gestures to communicate. Growth curves are tracking adequately. On physical examination, the patient clings to his mother and begins crying, turning his head away from the physician when he attempts to interact with him. Which of the following is the most likely explanation for this patient's behavior?

Question

An 11-month-old boy is brought to the office by his mother for a well-child visit.  The mother reports that he has been crying and screaming when other people approach him.  She is concerned that it has been occurring for the past few months and that it seems to be worsening.  She says, "He used to love being held by everyone but now wants to be with only me.  He won't even let his grandma hold him anymore."  The patient is crawling and can stand only with assistance.  He babbles but does not say any clear words and uses hand gestures to communicate.  Growth curves are tracking adequately.  On physical examination, the patient clings to his mother and begins crying, turning his head away from the physician when he attempts to interact with him.  Which of the following is the most likely explanation for this patient's behavior?

Quizplus · Accepted Answer

This patient's distress at interacting with unfamiliar people is typical of stranger anxiety, a normal part of development that begins around age 6 months. It is characterized by distress (expressed by crying, screaming, clinging) when unfamiliar people approach and occurs even in the presence of the caregiver. The development of stranger anxiety at this age indicates that the infant has made a specific attachment to the primary caregiver (mother) and is able to distinguish her from a strange or less familiar individual. Stranger anxiety typically peaks around age 9 months and resolves on its own by 2 years of age. Adjustment disorders are diagnosed when the response to a stressor is greater than would be expected and associated with impairment (Choice A). Stranger anxiety is a normal and expected developmental milestone. (Choice B) It is normal for an 11-month-old infant to avoid contact with a stranger if distressed. If an infant persistently shows poor eye contact, lacks joint attention, and has no response to being called by name at age 12-15 months, these may represent early signs of an autism spectrum disorder and should be evaluated further. (Choice D) Reactive attachment disorder occurs in children exposed to neglect and abuse and is characterized by decreased emotional responsiveness and lack of response to adult comfort. This infant appears to be appropriately attached to his mother. (Choice E) Separation anxiety disorder is diagnosed in children who exhibit persistent and disabling anxiety about losing attachment figures at separation. It usually develops in childhood rather than infancy, typically in association with starting school. Stranger anxiety, in contrast to separation anxiety, occurs even when the caregiver is present. Educational objective: Stranger anxiety, which presents as crying or screaming when unfamiliar people approach, is a normal and expected part of childhood development. It typically begins around age 6 months and resolves by 2 years of age.

An 11-Month-Old Boy Is Brought to the Office by His