Case history
Case history #1
A 3-year-old boy presents because his parents have concerns about his language development. He started using single words at age 18 months but still doesn't use 2 words together. He stopped using words he had previously learned between 18 and 24 months, but has now regained most of these words. He also seems uninterested in engaging with other children. He occasionally engages with his parents but less than they think he should. He doesn't tend to look at them much and he has difficulty maintaining eye contact with them. When he wants something he pulls them to where the object is and screams; he doesn't point like other children. His parents have also noticed that he doesn't play in the same way as other children of his age; he tends to line toys up, or plays with certain aspects of them, such as the car doors. He doesn't use the toys in the imaginative way that other children do. When his toys are moved he becomes very upset. He tends to become distressed when he thinks there is change around the house. In contrast, he is not concerned when either of his parents leaves the house. He tends to flap his hands at times and his parents report him staring at the ceiling lights for 10 to 20 minutes at a time. He is a fussy eater and hates being messy.
Case history #2
A 24-year-old filing clerk at the local library is referred for assessment as a result of increasing tearfulness. He has recently graduated in computer science at college and was offered this job as he knows the librarians well, having spent most weekends at the library throughout his life. He reports never having made friends throughout school or college and describes feeling lonely as a consequence. At assessment he presents as reasonably well-kempt but dressed in a somewhat old-fashioned and quirky manner, and uses eye contact only fleetingly. His speech is monotone with rapid explosive bursts making it difficult to understand what he is saying. Throughout the assessment he fails to elaborate on anything without prompting. He only becomes animated when talking about artificial intelligence in computer technology, not recognizing that his assessor does not understand and is not particularly interested in this topic.
Other presentations
Children with ASD have a wide range of clinical presentations (see diagnostic approach). Patterns of difficulties and behaviors vary with age but language delay is a common parental concern. A detailed neurodevelopmental and current functioning history is required, with emphasis also placed on possible coexisting conditions (e.g., sleep difficulties or difficulties with challenging behavior) and medical comorbidities, such as epilepsy, which can be of early onset and can impact presentation. Babies may be either unusually placid or irritable; feeding difficulties are common. During the toddler years, impairments in speech, communication, play, and social functioning become more obvious. There may be regression of previously learned language skills; regression of motor skills alone (or regression of language skills after the age of 3 years) should make clinicians think of other possible diagnoses, and children should be appropriately investigated.[12] Feeding difficulties are common, with particular rigidities around certain foodstuffs and the environment when eating. There may also be sensory-related difficulties such as a negative, and sometimes idiosyncratic, reaction to certain textures, sounds, and other sensory stimuli.[13] By contrast, some children are interested in particular sensory environments or activities. Children may show motor mannerisms, such as hand flapping or spinning. Repetitive behaviors can be very challenging to manage.
People with ASD can be diagnosed from early childhood into late adulthood. Many young people and adults have mental health diagnoses, such as anxiety disorder, or depression. Mental health conditions can be a presenting feature in young or older adults. There is an increased likelihood of other neurodevelopmental conditions, such as attention deficit hyperactivity disorder (ADHD).[14][15][16][17]
Adults with symptoms suggestive of ASD may or may not seek a diagnosis, depending on the extent to which their difficulties are affecting their daily life. When identified in adulthood, ASD is often identified as the cause of difficulties at home, in social relationships or those with a partner, or in the workplace.
Some adults seek a diagnosis for the first time following a diagnosis of ASD in one of their children, or in another family member.
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