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Clinical Crossroads |

An 8-Year-Old Boy With Autism

Isabelle Rapin, MD, Discussant
JAMA. 2001;285(13):1749-1757. doi:10.1001/jama.285.13.1749.
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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 sibling.

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Figure. Algorithm for the Detection and Evaluation of Autism
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Adapted with permission from Filipek et al.72 Copyright 1999, Kluwer Academic/Plenum Publishers.
PEDS indicates Parents' Evaluations of Developmental Status; ASQ, Ages and Stages Questionnaire; CDIs, Child Development Inventories; CHAT, Checklist for Autism in Toddlers; and PDDST, Pervasive Developmental Disorders Screening Test. Educational and skill assessment materials authored by Albert H. Brigance are published and distributed by Curriculum Associates Inc (Maryville, Tenn) as the BRIGANCE System.

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