ASD Presentation — MRCPsych Paper B MCQ

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EasyChild & Adolescent PsychiatryASD PresentationMRCPsych Paper B

An 8-year-old boy is assessed because of longstanding difficulties evident both at home and at school. Since early childhood, he has had limited reciprocal conversation and reduced social use of eye contact. He has unusually intense restricted interests and becomes markedly distressed when familiar routines change. His general intellectual ability is age-appropriate. Which is the most likely diagnosis?

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Correct answer: D — Autism spectrum disorder

The most likely diagnosis is autism spectrum disorder. The child has longstanding difficulties in reciprocal social communication, including limited back-and-forth conversation and reduced social use of eye contact, together with restricted interests and inflexible adherence to routines. These represent the two core domains of autism. Age-appropriate intellectual ability does not exclude the diagnosis. ADHD would require prominent inattention and/or hyperactivity-impulsivity. Conduct disorder involves persistent violation of others’ rights or major rules, whereas oppositional defiant disorder is characterised by angry, argumentative or defiant behaviour; neither explains this combination of social-communication differences and restricted, repetitive behaviour. Separation anxiety disorder centres on excessive distress concerning separation from attachment figures. Formal diagnosis requires a comprehensive autism assessment.

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