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Difficulty: MediumChildhood and Neurodevelopmental Disorders

A 4-year-old boy is brought to the pediatric clinic by his foster parents due to behavioral challenges at his preschool. His teacher notes that he frequently wanders the room during group storytime, flaps his hands repeatedly when excited, and avoids interacting with peers. At home, he meticulously sorts his blocks by shape and becomes inconsolable if the arrangement is disrupted. His foster parents report that he uses only two-word phrases to express his needs and rarely makes eye contact. On physical examination, the child successfully hops on one foot and copies a cross on a piece of paper. Which of the following statements regarding this patient are correct? (Select all that apply)

  1. The patient's impaired social interaction and restricted, repetitive behaviors fulfill core diagnostic domains for autism spectrum disorder.Answer
  2. Early intensive behavioral and educational interventions are the most appropriate primary management strategy.Answer
  3. C
    The patient's ability to hop on one foot and copy a cross indicates a significant delay in motor development.
  4. D
    His expressive language capability of using two-word phrases is considered an age-appropriate milestone.
  5. E
    The social withdrawal and abnormal behaviors meet the timeline criteria for a primary psychotic disorder such as schizophreniform disorder.

Answer

The correct statements recognize that the patient's presentation fulfills core diagnostic domains for autism spectrum disorder, and that early intensive behavioral and educational interventions are the primary management strategy.
This patient presents with classic features of autism spectrum disorder, which is characterized clinically by deficits in social communication and interaction, alongside restricted, repetitive patterns of behavior. Because these core deficits significantly impact functioning in multiple environments (school and home), early intensive behavioral interventions provide the most effective means to improve the patient's long-term social and communicative outcomes.

Step-by-Step Solution

1
Evaluate the patient's developmental milestones based on his chronological age of 4 years.
The patient's motor skills (hopping on one foot, copying a cross) are age-appropriate. His language skills (two-word phrases) are delayed, as a 4-year-old should typically be speaking in full sentences.
Establishing a developmental baseline differentiates normal development or global delays from specific neurodevelopmental disorders.
2
Analyze the behavioral symptoms presented in multiple settings (home and preschool).
The patient displays distinct deficits in social communication (poor eye contact, avoiding peers) and exhibits restricted, repetitive behaviors (hand-flapping, inflexible routines).
These two distinct domains form the required core diagnostic criteria for autism spectrum disorder.
3
Determine the most appropriate management plan for the identified condition.
Early intensive behavioral and educational intervention is indicated.
Behavioral therapies, such as applied behavior analysis, are the gold standard for improving adaptive functioning and communication in young children with this condition.

Key Concept

Autism spectrum disorder diagnosis and evaluation of pediatric developmental milestones
Estimated Time:1m 30s
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Topics

Childhood and Neurodevelopmental Disorders

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