|NIMH: Autism Spectrum Disorders|
|CDC: Prevalence of Autism|
|Ryan, Age 23|
|Adam, Age 8|
|CME Speaker Kit (ppt)|
Richard: 54 year-old patient
Richard is a 54 year-old patient. Earlier in his life, he has been diagnosed with a number of different mental disorders other than autism. Autism may not have been diagnosed, because Richard’s clinical presentation breaks many old stereotypes of the disorder.
He is able to hold an engaging and lengthy conversation. However, while the verbal output can be high, the conceptual depth and level of social reciprocity in his conversation can be lacking. Beyond an initial conversation, a clinician may note that this patient’s verbal interactions can be repetitive and “scripted.” Dialogue that seems spontaneous are actually patterns of speech and thought that can be elicited repeatedly with the same question.
This video clip points out:
People with autism spectrum disorders can present with verbal abilities.
People with autism spectrum disorders can be engaging in their conversations.
In this patient case note:
His verbal interactions are often “scripted.” In these scripts, he repeats the same verbal patterns repetitively. These verbal scripts can be triggered by certain questions at different times, yet the verbal dialogue is very similar each time.
He can talk extensively about abstract ideas without insight or understanding of the concepts.
He has a very restricted scope of interests.
His facial affect is flat.
1) Be careful of how questions are asked during a clinical interview. For example, a close-ended, overly simple question like “Do you hear voices” can result in an erroneous “Yes” response.
2) Putting aside DSM-IV criteria for a moment, there are some clinical red flags in this case that can increase diagnostic consideration of autism:
The patient may seem odd or strange to you.
Facial expressions may be limited or flat.
The patient may exhibit very special interests or obsessions.
The patient may overly focus on details.
The patient may have a strong preference for predictability.
Return to other Video Cases