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A 27-year-old male is pleasant, emotionally warm, and happy. He lives with his parents, works in a sheltered workshop, did not complete high school and talks in 3 word sentences. Which of the following is the most likely diagnosis?
A. Autistic disorder
B. Childhood disintegrative disorder
C. Mental retardation
D. Mixed receptive-expressive language disorder
E. Rett's syndrome
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The correct answer is C. This young man is displaying simple mental retardation. He is affable, interacts well with others to the point that he can work in a sheltered workshop, could not complete high school and talks in three word sentences.
Autistic disorder (choice A) is not correct because persons with this diagnosis are rarely able to interact with others to the point of holding a job, and they characteristically do not use language for purposes of communication.
Childhood disintegrative disorder (choice B) is characterized by the clinically significant loss of previously acquired skills. This does not allow them to function well even in sheltered workshops.
Mixed receptive-expressive language disorder (choice D) is a neurologic condition and affects language skills. This man does have both receptive and expressive language skills, which he can use to the point of being productively employed.
Rett's syndrome (choice E) is associated with severe impairment, including loss of social engagement and previously acquired (before the age of 30 months) skills, and characteristic hand wringing movements. This condition is confined to females. Very recent evidence suggests a genetic etiology for Rett's syndrome.
