Autism Spectrum Disorders: Model Clinical Case and Viva QnA

Clinical Case of Autism Spectrum Disorder

Clinical Case: 4-year-old girl with Autism Spectrum Disorder

Patient: Sophia, a 4-year-old girl

Presenting Complaints:

• Limited verbal communication
• Difficulty interacting with peers
• Repetitive behaviors and restricted interests
• Sensory sensitivities

History:

Sophia's parents report that she has always been a quiet child. They became concerned when she didn't start speaking by age 2. Sophia rarely responds to her name and makes little eye contact. She prefers to play alone and becomes upset when her routines are disrupted. She shows an intense interest in spinning objects and lining up toys.

Developmental History:

• Motor milestones were reached on time
• Language delay: only a few single words at age 3
• Limited joint attention and pointing
• No pretend play observed

Clinical Observations:

• Limited eye contact during the examination
• Repetitive hand-flapping when excited
• Echolalia present (repeating phrases from cartoons)
• Becomes distressed with certain sounds (covers ears)
• Difficulty engaging in back-and-forth conversation

Assessment:

Based on the clinical presentation, developmental history, and observations, Sophia meets the DSM-5 criteria for Autism Spectrum Disorder. Further evaluations are recommended to assess her cognitive abilities, language skills, and adaptive functioning.

Management Plan:

1. Refer for comprehensive multidisciplinary assessment (speech and language therapy, occupational therapy, psychology)
2. Initiate early intensive behavioral intervention focusing on communication and social skills
3. Provide parent training in ASD-specific strategies
4. Consider sensory integration therapy to address sensory sensitivities
5. Develop an individualized education plan (IEP) for preschool
6. Regular follow-up to monitor progress and adjust interventions as needed

Click to read ASD criteria and management and learn MCHAT-R

Clinical Presentations of Autism Spectrum Disorders

Varieties of Clinical Presentations of Autism Spectrum Disorders

1. Classic Autistic Disorder (Kanner's Autism):

   • Significant language delays or absence of speech
   • Minimal social interaction and eye contact
   • Repetitive behaviors and restricted interests
   • Sensory sensitivities
   • Intellectual disability may be present

2. High-Functioning Autism:

   • Average to above-average intelligence
   • Well-developed language skills but difficulties with pragmatic language
   • Social challenges, especially with peers
   • Narrow, intense interests
   • May have motor clumsiness

3. Asperger's Syndrome (as previously defined):

   • No clinically significant language delay
   • Average to high IQ
   • Difficulties with social interaction and non-verbal communication
   • Intense, focused interests
   • Pedantic speech patterns

4. PDD-NOS (Pervasive Developmental Disorder - Not Otherwise Specified):

   • Milder symptoms that don't fully meet criteria for autistic disorder
   • May have better social skills or fewer repetitive behaviors
   • Variable language development
   • Often diagnosed in younger children or those with late onset of symptoms

5. Regressive Autism:

   • Normal early development followed by loss of previously acquired skills
   • Typically occurs between 15-30 months of age
   • Loss of language, social skills, and/or play skills
   • May be accompanied by increased anxiety or irritability

6. Autism with Savant Skills:

   • Exceptional abilities in specific areas (e.g., music, art, calculations)
   • Stark contrast between general functioning and specific talents
   • May have significant impairments in other areas of functioning

7. Nonverbal Autism:

   • Minimal or no spoken language
   • May use alternative forms of communication (e.g., gestures, picture exchange)
   • Often accompanied by intellectual disability
   • Significant challenges in social interaction and adaptive functioning

8. Autism with Prominent ADHD Symptoms:

   • Significant attention difficulties and hyperactivity
   • Impulsivity may exacerbate social challenges
   • May have difficulty following routines despite preference for sameness
   • Often requires management of both ASD and ADHD symptoms

Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

Question 1 of 30

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.