Video Cases Title

Ryan: 23 year-old patient
Ryan is a 23 year-old patient. Since he appears more social and verbal than what some people believe about autism, he did not receive an early diagnosis. Even his mother, who is a nurse, did not initially think he fit what she had been taught about autism.

Perhaps the most misguiding factor is that Ryan’s speech can appear engaging and he seems to make reasonable eye contact. However, upon closer examination, his conversations can become decidedly one-sided. He often does not respond to interjections by the other person in a conversation, and his responses can become long and “rambling” without any context to the other person’s interests. Social purpose and reciprocity appear to be missing in both his conversation and eye contact.

This video clip points out:

The experience of a parent (nurse) whose child was diagnosed with an autism spectrum disorder after the age of three.

People with autism spectrum disorders can appear engaging in their conversations.

In this patient case note:

He appears very personable and makes good eye contact.

His conversations initially sound very engaging, but if he is given the time, his speech can ramble and just “spits out a ton of information.”

His verbal interactions can be very one-sided with little reciprocity with another person. For example, when the interviewer makes a comment or asks a question, the patient often just continues his previous discussion without response to the other person.

He can focus on specific and enormous detail on his favorite subjects.

His facial affect is flat and does not show many emotions even when talking about being very frustrated or tells of a time when he cried.

Clinical suggestions:

1) Avoid the clinical myth that patients with autism spectrum disorders do not make eye contact.

2) Although patients may have verbal skills, they may lack the usual social reciprocity that is present in an engaging conversation.

3) Allow time for patients to speaks and present their usual speech patterns. Avoid over directing an interview by asking too many short, close-ended questions. If you are testing for social reciprocity then you also have to demonstrate that to your patient.

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