Autism Spectrum Disorder - Most Likely Explanation for a Child's Behavior

Oct 10, 2026

A 10-year-old girl presents after transferring to a new school, with persistent difficulty making friends, anxiety and limited eye contact, and perseveration on horses. Her social communication problems, fixed interests, and restricted, repetitive behavior are evident, including repeatedly touching a blood pressure cuff while it inflates. With normal developmental milestones and grades, delayed recognition occurs when social demands increase. The scenario contrasts ASD features with adjustment and obsessive-compulsive disorder and emphasizes sensory-related behaviors.

LanguageEnglish

CategoryExam

FormatPDF

Pages100

Reading Time4 h 12 min

AccessFree to download

Clinical Vignette

Question and Options

Key Autism Spectrum Disorder Features

Differential Diagnosis

●●● AA Item 1 of 40 Question Id:15827Mark PreviousNextFull ScreenTutorialLab ValuesNotesCalculatorReverse ColorText Zoom A 10-year-old girl is brought to the office by her mother due to concerns about her adjustment to a new school.The mother says,"We werehomeschooling her before but enrolled her at a private school 3 months ago so that she could spend more time with kids her own age.Her gradeshave always been fine,but she's had a really hard time making friends—probably because all she wants to do is talk about horses.She's alwaysbeen a shy kid."The patient has had a strong interest in horses for years and enjoys reading and watching videos about them.She collectshorse figurines and arranges them next to her bed each night.The patient was born at full term,and developmental milestones were withinnormal range.During the interview,she appears anxious and does not make eye contact.She intermittently interrupts the interview by changingtopics and mentioning facts about animals.When her vital signs are checked,she touches the blood pressure cuff repeatedly while it inflates.Physical examination is unremarkable.Which of the following is the most likely explanation for this patient's behavior? ○ A.Adjustment disorder○ B.Age-appropriate development○ C.Autism spectrum disorder○ D.Obsessive-compulsive disorder○ E.Social anxiety disorderO F.Social communication disorder Submit Settings [] Item 1 of 40Question Id:15827 Mark D□□0 Previous Full Screen Tutorial Next Lab Values Notes Reverse ColorText Zoom Calculator Settings | Autism spectrum disorder | | | --- | --- | | Clinical
features | ·Deficits in social communication &interactions with onset in early development
o Sharing of emotions or interests
o Nonverbal communication
o Developing &understanding relationships
● Restricted,repetitive patterns of behavior
o Repetitive movements or speech
o Insistence on sameness/routines
o Intense,fixated interests
o Adverse responses to sensory input
·May occur with or without language &intellectual impairment | This patient's social interactions,fixed interest (horses),difficulty adjusting to change,and excessive sensory interest (repetitive touching of theblood pressure cuff)are suggestive of autism spectrum disorder(ASD).In more severe cases of ASD,where language and intellectualdevelopment are affected,children are typically diagnosed at earlier ages given the obvious deficits. However,there is a wide range of presentations in ASD.Patients without obvious early language,cognitive,and developmental impairments(often reported by parents as being within normal ranges)may come to clinical attention only later when social demands overwhelm the child'ssocial-emotional limitations(eg,moving from homeschool to a more socially demanding private school)and reveal impairments in functioningbeyond those expected in peers of the same age (Choice B).Struggles with reciprocal interactions such as conversations perseverating onspecial/fixed interests(eg,"all she wants to do is talk about horses"),inappropriately mentioning facts about animals,and atypical eye contactoften result in a "hard time making friends"at school. In addition,restricted,repetitive patterns as a core feature of ASD often lead to an inflexible preference for consistent routines and predictablestruggles during transitions or adjustments in daily schedules(eg,concerns with "adjustment to a new school")(Choice A).Patients also mayhave unusual reactions to sensory input,which can be demonstrated as either extreme aversions(eg,refusing foods with a particular texture)orexcessive interests in sensory experiences (eg,excessive touching or smelling of objects). (Choice D)Repetitive behaviors or speech in obsessive-compulsive disorder are distressingly performed to relieve the anxiety of unwantedintrusive obsessional thoughts.However,repetitive behaviors or speech (eg,hand flapping,lining u

FAQs

Why does the child seem to struggle with making friends at school?

Her social communication deficits include limited eye contact and conversations dominated by a fixed interest (horses), with inappropriately mentioning animal facts, making reciprocal interaction difficult.

What restricted or repetitive behaviors are described in the vignette?

She shows restricted, repetitive patterns such as intensely fixating on horses and repeatedly touching the blood pressure cuff as it inflates.

How can autism spectrum disorder present despite normal early milestones?

ASD can be recognized later when social demands increase, especially when early language and cognitive development are reported as within normal ranges but overwhelm the child's social-emotional limitations.

Oct 10, 2026

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