CC: Mrs. Lester brings her 24-month old son Richard for an initial appointment. The family just moved to your area from Ohio. She is concerned that “something’s wrong.”
HPI: Her concerns began around 14 to 15 months. Mrs. Lester reports that Richard had poor eye contact even with familiar caregivers. He used "ma" rather indiscriminately to mean anything, did not point to objects and did not wave bye-bye. She brought these issues to the attention of her pediatrician while living in Ohio. However, the doctor thought this was normal for a boy his age. At the time of this first visit with you, his mother reports that his speech is limited to 3 words: “ma,” “ba,” and “da.” He mixes them up and they don’t seem to mean anything specific. You ask his mother, “How does he let you know what he wants?” She tells you he stands near the desired object and simply screams. He rarely plays with his toys; mostly, he wanders aimlessly around the house. Sometimes, however, he seems to get interested in objects in the lower cupboard. He plays with these items by taking them out of the cupboard and then putting them back in again. He might repeat this action for 45 minutes. He likes to build blocks, but seems to have a very clear idea of how to do this, so that if his dad builds a different way, he “pitches a fit” until it is done the way he wants it.
His mother has enrolled him a playgroup. He doesn’t seem to mind going there, but he mostly plays by himself. He still does not make good eye contact.
Developmental History: Richard smiled at 2 months and sat at 10 months. At the 12-month visit, he had not crawled or pulled to stand. He began walking at 15 months, although Mrs. Lester thinks he is clumsy.
Social History: His mother is 31 years old and his father is 37 years old. Mr. Lester is an electrical engineer at a robotics company. Mrs. Lester works part-time as a graphic designer. He has no siblings at present. Mrs. Lester reports that she and her husband are managing thanks to the support of the extended family.
Past Medical History: Richard had surgery for undescended right testis and inguinal hernia at 5 months of age. He passed all the neonatal screens, including hearing.
Family History: There is maternal cousin with mental retardation. Mr. Lester had a stuttering problem as a child.
Print