Making a Diagnosis of Autism Spectrum Disorder - Case Study Part IV

A little boy smiling

Six months later, you review the results of the evaluation with Billy’s mother.His hearing evaluation, consisting of behavioral audiometry and tympanogram testing, was normal. Billy’s comprehensive evaluation included assessments by a developmental-behavioral pediatrician, a psychologist, a speech-language pathologist, and an occupational therapist.

The report from the developmental-behavioral pediatrician details Billy’s medical history, developmental history, current behavior, and family history, as well as findings on physical and neurological examination. According to the report, Billy meets the DSM-5 criteria for the diagnosis of ASD. He has persistent deficits in social communication and social interaction across contexts, and he has two or more repetitive and restrictive behaviors, interests, or activities. He has a severity level of 2 for social communication and interactions and a severity level of 3 for restricted and repetitive behavior, interests, and activities.


A little boy making a silly face

The report also mentions that blood for a microarray was drawn at that visit, but the results are still pending as Billy only saw the specialist last week. The psychologist’s report reviewed Billy’s performance on cognitive testing and revealed below-age-level skills in all areas, with most pronounced weakness in the language domain.On formal language testing, Billy’s receptive and expressive skills were at the 15- to 18-month level.

The occupational therapist’s report described Billy’s strengths and weaknesses in fine motor skills and adaptive functioning, and detailed some of his sensory issues that impacted his day-to-day life.

All of the clinicians who evaluated Billy thoroughly described their observations of Billy’s social interactions and behaviors during their sessions.


A little boy running with his tongue out

As part of the comprehensive evaluation, Billy also underwent ADOS-2 (Autism Diagnostic Observation Schedule-2) testing, which supported the diagnosis of ASD. Observations included Billy wanting to play with a windup toy; he threw himself on the ground when the examiner tried to take the toy away. One clinician also mentioned that when his name was called, he did not answer.

Billy’s mother informs you she took a copy of the reports to Billy’s school. A meeting has been scheduled to re-assess Billy’s educational plan. She has also been reading some information on ASD and is looking into a parent support group located in her community. Billy’s mother tells you two other families she knows have sons with ASD. She asks why there seem to be so many more children diagnosed now than in the past.


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