11-08-2008, 11:50 PM
A 3-year-old boy is brought to the clinic by his parents who are concerned about the child's behavior.
He seems not to respond when they call him, even though he may be in another room playing. He does
not show any emotion, if any of them hold him in their arms. Most of the time he stays in one place
alone playing with a wind up train he has. He says a few words, but not all of them are clear and he
does not seem to complete his sentences. He was born after a normal pregnancy without
complications and his development so far has been unremarkable. He is well nourished and otherwise
healthy, but the parents describe that he has not engaged in playing with other kids. In your office he
establishes poor eye contact, but notices a box of crayons. He grabs them and keeps arranging them
and throwing them around. He gets extremely upset when his mother tries to take the box away from
him. At this time, the most appropriate next step in management is to
A. order a brain CT
B. refer him for a hearing exam
C. refer him for speech therapy
D. refer him to a child psychiatrist immediately
E. order serum thyroid stimulating hormone
He seems not to respond when they call him, even though he may be in another room playing. He does
not show any emotion, if any of them hold him in their arms. Most of the time he stays in one place
alone playing with a wind up train he has. He says a few words, but not all of them are clear and he
does not seem to complete his sentences. He was born after a normal pregnancy without
complications and his development so far has been unremarkable. He is well nourished and otherwise
healthy, but the parents describe that he has not engaged in playing with other kids. In your office he
establishes poor eye contact, but notices a box of crayons. He grabs them and keeps arranging them
and throwing them around. He gets extremely upset when his mother tries to take the box away from
him. At this time, the most appropriate next step in management is to
A. order a brain CT
B. refer him for a hearing exam
C. refer him for speech therapy
D. refer him to a child psychiatrist immediately
E. order serum thyroid stimulating hormone