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An 8-year-old boy with moderate intellectual disability and suspected autism spectrum disorder arrives for a new patient appointment. He is reported to have had routine medical care up until this point, which included normal hearing screens. Which medical workup is expected for all such patients?

A. Sleep study

B. Genetic workup

C. Metabolic workup

D. Electroencephalography (EEG)

E. Audiology referral

Answer: B

It is recommended that all children with autism spectrum disorder undergo chromosomal microarray analysis and testing for fragile X syndrome in the effort to determine the etiology for their autism spectrum disorder.

The other medical studies included are indicated based on clinical findings. Audiology evaluations are important to perform if the child has never had his hearing tested; hearing impairment can result in symptoms similar to those of autism spectrum disorder. Many patients with autism have sleep disturbances. As a result, a sleep study can be helpful in ruling out conditions such as obstructive sleep apnea, which can result in behavioral dysregulation. Metabolic workup is usually reserved for situations in which physiologic symptoms are manifested. For children whose neurodevelopmental disorders are thought to be causing seizures, an EEG is indicated. However, in this vignette, there was no mention of concern for seizures.

A 14-year-old girl is brought into her pediatrician’s office because her mother has become concerned about her increased “clinginess” for the past 2 months, ever since the mother had to be hospitalized after a car accident. The mother stated that the girl has recently started refusing to return to school, stating that she has a variety of physical complaints, such as headache, stomach ache, or fatigue. The mother also stated that the girl is having more trouble falling asleep at night. She will either come into her parents’ room to sleep with them or demand that her mother stay with her until she is asleep. The girl is reported to have had similar behaviors when she was 3 years old, but these behaviors resolved by the time she was 5 years old. What is the most likely diagnosis?

A. Post-traumatic stress disorder (PTSD)

B. Generalized anxiety disorder

C. Social anxiety disorder

D. Major depressive disorder

E. Separation anxiety disorder

Answer: E

Although more often associated with younger ...

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