DR PARKER: Austin is an 8-year-old boy diagnosed
as having autism at age 2½ years. He has improved substantially in
cognition and speech but still struggles with social interactions. This is
his first year in a public school with his peers, and his parents wonder what
the future holds. They live in a suburb of Boston, and Austin's medical care
is covered by managed care insurance.
Austin weighed 8 lb 10 oz at birth, after a normal pregnancy and delivery.
He appeared alert and normal in all respects. The parents noted normal early
development, but at 12 months Austin began to box his ears at loud noises
and cry for no apparent reason. Friends and family told the parents not to
worry. At 18 months, Austin spoke only a few words (eg, "Mama, Daddy, juice"),
yet these few words soon disappeared from his speech. The pediatrician reassured
the concerned parents and advised them not to compare Austin with his older
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