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Review Question - QID 210020

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QID 210020 (Type "210020" in App Search)
A 3-year-old boy is brought to your pediatrics office by his parents for a well-child checkup. The parents are Amish and this is the first time their child has seen a doctor. His medical history is unknown, and he was born at 39 weeks gestation. His temperature is 98.3°F (36.8°C), blood pressure is 97/58 mmHg, pulse is 90/min, respirations are 23/min, and oxygen saturation is 98% on room air. The child is in the corner stacking blocks. He does not look the physician in the eye nor answer your questions. He continually tries to return to the blocks and becomes very upset when you move the blocks back to their storage space. The parents state that the child has not begun to speak and often exhibits similar behaviors with toy blocks he has at home. On occasion, they have observed him biting his elbows. Which of the following is the best next step in management?

Educating the parents about autism spectrum disorder

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Fluoxetine

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Hearing exam

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Restructuring of the home environment

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Risperidone

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This patient is presenting with behaviors concerning for autism spectrum disorder but first should have a hearing disorder ruled out.

Autism spectrum disorder presents with social-emotional reciprocity deficits, non-verbal communicative behaviors, and trouble with developing, maintaining, and understanding relationships. These patients often exhibit repetitive motor movements, insistence on sameness, and have fixated interests. Prior to making this diagnosis, it is important to rule out other organic causes that may cause these symptoms such as hearing dysfunction.

Incorrect Answers:
Answer 1: Educating the parents about autism spectrum disorder would be a premature step to take. Though this patient is exhibiting many behaviors suggestive of autism spectrum disorder, he needs to be further worked up for other possible organic etiologies.

Answer 2: Fluoxetine is an appropriate treatment for autism spectrum disorder once the diagnosis has been established and other causes ruled out.

Answer 4: Restructuring of the home environment would be the appropriate management of autism spectrum disorder once other diagnoses have been ruled out.

Answer 5: Risperidone is another appropriate drug for autism spectrum disorder especially when aggressive behavior or repetitive motor symptoms are present.

Bullet Summary:
Prior to making the diagnosis of autism spectrum disorder, other organic etiologies must be ruled out such as hearing dysfunction.

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