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Jason is 2 years and 4 months old. His mother has been concerned for the last6 months or more as he is saying very little. As a baby, he did not babble. He will point to things he wants or screams. Recently he has said ‘gone’ and ‘bye-bye’ and he can understand simple commands.
He does go to family members, but avoids cuddles and will often just ignore other people. He enjoys books for a short while and will turn several pages at a time. He also enjoys lining up toy cars in a row, but there are no other obsessive behaviours and he apparently copes with change. He does not sleep well, waking often in the night. His mother goes in and gives him a dummy and holds his hand. Observing Jason, he was very difficult to engage and no words were heard. A high pitched squeal was apparent when he became frustrated, which was frequent. He built a tower of 9 cubes and enjoyed playing with the toy cars and form boards.
- What diagnosis should be considered?
- What would you do if you saw this child?
- Which professionals should be involved?
- Are any investigations indicated?
- Are there any other issues that need to be discussed?
Case discussion: Autistic spectrum
Jason will probably be classified as atypical autism, which occurs in about 3 in 1000 children. (Classical autism, with normal intelligence, is much rarer, about 3 per 10 000). The features in Jason are severe language delay, impaired social development and observation of some repetitive play and resistance to change. Jason, therefore, has evidence of the three main features of autism and also onset, or rather a recognition, before the age of 3 years. At this stage, an assessment by a paediatrician or psychiatrist would be appropriate. Referral to speech therapy and also to the portage service would follow. One investigation worth doing would he fragile X, although this history is not typical, all such children are investigated.
The other issue worth discussing is the poor sleep pattern, which may have a significant impact on the family. A simple behavioural approach could be tried and the health visitor would be best placed to help with this. Jason may be more resistant to such methods than many other children.