A 13-year-old girl is brought to the office by her mother due to concerns about her adjustment to a new school. Her mother says, "She has always been shy and somewhat awkward. I was hoping that her new school's emphasis on group projects would help her to be more social, but instead it has made her extremely anxious. She is pleading with me to consider home schooling so she can work by herself." The patient is bright but has always been an underachiever at school and has few friends. She has an obsessive interest in horses. The patient was born at full term, and developmental milestones were within normal range. During the interview, the girl appears anxious and makes poor eye contact. She interrupts the physician's questions by changing topics and mentioning facts about different horse breeds. When her vital signs are checked, she touches the blood pressure cuff repeatedly. Physical examination is unremarkable. Which of the following is the most likely explanation for this patient's behavior?

Question

A 13-year-old girl is brought to the office by her mother due to concerns about her adjustment to a new school.  Her mother says, "She has always been shy and somewhat awkward.  I was hoping that her new school's emphasis on group projects would help her to be more social, but instead it has made her extremely anxious.  She is pleading with me to consider home schooling so she can work by herself."  The patient is bright but has always been an underachiever at school and has few friends.  She has an obsessive interest in horses.  The patient was born at full term, and developmental milestones were within normal range.  During the interview, the girl appears anxious and makes poor eye contact.  She interrupts the physician's questions by changing topics and mentioning facts about different horse breeds.  When her vital signs are checked, she touches the blood pressure cuff repeatedly.  Physical examination is unremarkable.  Which of the following is the most likely explanation for this patient's behavior?

Quizplus · Accepted Answer

11ec25c8_d79d_9b72_bc81_95e4d5e78269_MD0003_00 This patient's social awkwardness, intense interest in and restricted focus on a single topic (horses), and unusual sensory interest (repetitive touching of the blood pressure cuff) are suggestive of a mild form of autism spectrum disorder (ASD). In cases of severe autism, where language and intellectual development are affected, children are typically diagnosed by age 5. However, in high functioning autism, where language and intellectual development may be normal, patients come to attention only later when social demands reveal the child's social-emotional deficits. Other features suggestive of ASD include the lack of initiation or response to interaction with others, awkward body language, reduced range of affect or emotional sharing, difficulty understanding the needs of others, and lack of flexibility. Patients may have sensory aversions (eg, dislike of sounds/textures) or excessive interest in sensory experiences (eg, touching, smelling, fascination with movement). (Choice B) Patients with obsessive-compulsive disorder may have compulsions such as the repetitive touching of objects. However, these compulsions are a response to, and are aimed at relieving, intrusive obsessional thoughts (eg, touching an object a certain number of times to prevent something bad from happening). (Choice C) In obsessive-compulsive personality disorder, there is a desire for orderliness at the expense of flexibility. It is not characterized by fixated interests or sensory anomalies. (Choices D and E) Both schizoid personality disorder and schizotypal personality disorder are characterized by deficits in social interaction. Schizotypal personality disorder is also characterized by odd or eccentric behaviors (eg, magical thinking, paranoia, idiosyncratic speech patterns). However, neither of these disorders is characterized by fixated interests. In addition, personality disorders are not diagnosed in children because their personalities are still developing. (Choice F) Deficits in social communication that are seen in ASD can lead to social anxiety. However, a separate diagnosis of social anxiety disorder is not given when symptoms are better explained by an ASD. Educational objective: High functioning autism in children may come to attention only when social demands reveal their social-emotional deficits during school-age years. Features include social awkwardness, fixated interests, and unusual responses to sensory experiences. References: Differentiating high-functioning autism and social phobia. (http://www.ncbi.nlm.nih.gov/pubmed/22038291) Autism. (http://www.ncbi.nlm.nih.gov/pubmed/24074734) Parent-reported early symptoms of autism spectrum disorder in children without intellectual disability who were diagnosed at school age. (http://www.ncbi.nlm.nih.gov/pubmed/29852752)

A 13-Year-Old Girl Is Brought to the Office by Her