ASD — MRCPsych Paper B MCQ

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EasyChild & Adolescent PsychiatryASDMRCPsych Paper B

A 13-year-old boy has had persistent difficulties with reciprocal peer relationships since early childhood, occurring across home and school. He makes limited use of eye contact during conversation, has an intense interest in train timetables and becomes markedly distressed by changes to his daily routines. These difficulties impair his social and school functioning. His spoken-language development was not delayed, and his IQ is average. Which is the most likely diagnosis?

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Correct answer: D — Autism spectrum disorder

D. Autism spectrum disorder is the best answer. The vignette demonstrates both core dimensions: persistent differences in social communication and interaction, shown by impaired reciprocal peer relationships and limited integration of eye contact, and restricted or repetitive patterns, shown by a highly specific interest and marked distress when routines change. The developmental onset, occurrence across settings and functional impairment further support ASD. Normal spoken-language development and average intelligence do not exclude the diagnosis. ADHD would require prominent inattention and/or hyperactivity-impulsivity. Social anxiety is driven by fear of negative evaluation and does not explain restricted interests or rigidity. OCD involves intrusive, unwanted obsessions and neutralising compulsions rather than preferred circumscribed interests. Selective mutism involves failure to speak in particular social settings, which is not described.

Reference: National Institute for Health and Care Excellence. CG128: Autism spectrum disorder in under 19s: recognition, referral and diagnosis, Context and Appendix: Features suggesting possible autism. Published 2011; updated 2017. https://www.nice.org.uk/guidance/cg128