ASD questions

All of the following are early signs (red flags) of autism spectrum disorder (ASD) except A.Lack of response to name B.Reduced pointing and other gestures C.Severe tantrums D.Reduced imitation

C

The estimated lifetime risk of seizures in individuals with ASD is A.5% B.10% C.30% D.75%

C

A pediatrician is invited to come and speak at a conference for teachers about autism spectrum disorder (ASD). One of the teachers inquires why it seems like more white children are diagnosed with ASD than people of other races or ethnicities. The pediatrician refers the teacher to the most recent Centers for Disease Control and Prevention (CDC) report on ASD which states that: A. ASD is under-identified in Hispanic and black children. B.There are more genetic causes for ASD linked to children who are white. C.Vaccination rates are higher in white children. D.This must reflect the school demographics because rates of ASD are the same in all races and ethnicities.

A

An 18-month-old is seeing his pediatrician for a well child visit. The child has 25 words and has passed a hearing screen. His mother reports he enjoys playing "chase" with other children in the neighborhood. The pediatrician calls his name and he does not turn around to look. The pediatrician notices that he is lining up the toy cars in a row and turning the cars upside down and spinning the wheels rather than playing with them. The child's mother is not concerned. As a next step, the pediatrician should A.Administer a screen for Autism Spectrum Disorder. B.Order genetic testing. C.See him back in 3 months. D.See him back at the next scheduled well visit (24 months).

A

An autism spectrum disorder (ASD) is diagnosed in a 3-year-old patient in your practice who has been receiving speech therapy services for language delay but remains minimally verbal and does not yet point. You recommend additional evidence-based intervention and the parents would like you to write a letter of justification for their insurance company. Of the following, what will you include in your letter of justification? A.Early Intense Behavioral Intervention (EIBI) uses Applied Behavior Analysis (ABA) to improve language and adaptive skills. B.Sensory integration therapy uses evidence-based approaches to improve language and interaction. C.Play based therapy uses ABA to improve attention and cognitive flexibility. D.Developmental therapy uses play to improve compliance and appropriate behavioral responses.

A

The office manager at your pediatric practice inserted milestone checklists in every examination room to help guide the surveillance process. These checklists help remind parents and providers of particular milestones that a child should have reached by a certain age. The Centers for Disease Control and Prevention developed these checklists using an informal process that involved consensus opinion among expert workgroups. You recently read an article that the American Academy of Pediatrics recommends general developmental screening at the 9-, 18-, and 30-month well child visits. The checklists in your examination rooms are considered A.Surveillance tools but not screening tests B.Screening tests but not surveillance tools C.Both surveillance tools and screening tests D.Neither surveillance tools or screening tests

A

The parents of a nonverbal 3-year-old child recently diagnosed with ASD come in to discuss beginning the gluten free and casein free diet. They explain to you that they would like to decrease inflammation in his intestines to both diminish constipation and promote language development. You counsel them how to interpret the studies regarding this intervention. You listen to their rationale for pursuing a trial of dietary therapy in addition to the recommended preschool services. You agree on how to monitor the effect of the added dietary intervention. The effect of using this approach to address decisions related to care is which of the following? A.Increased patient satisfaction and engagement in care B.Adherence to the interventions recommended by the clinician C.Use of primarily evidence-based interventions D.Acquiescence to consumer selected therapy choic

A

Which of the following is considered a "red flag" for underlying neurologic or metabolic disorder in a child with ASD? A.Atypical pattern of regression B.Picky eating C.Failure to develop speech by age 5 D.Severe constipation

A

You are seeing a 16-year old patient named DY with ASD, who is main-streamed in high school, is doing well academically, but does not have many friends. The parents confide that as DY's ASD is "mild" they have not told him that he has an ASD diagnosis, but they are worried now that it appears that he needs more support socially that this will hold him back. What next steps would be appropriate? A.Discuss with the family that it is in DY's best interests to educate him about his ASD and what treatments might help. B.As DY has done well so far, and he appears to have adequate cognitive skills for success, encourage the family to not tell DY about his ASD diagnosis. C.Refer DY and his family back to the school to develop a plan for the rest of high school and possible college enrollment. D.Tell the family what a mistake it was to not tell DY about his ASD diagnosis when he was much younger and refer to psychiatry.

A

You are seeing a 2-year old only child (AB) in your office for an initial visit (family just moved from another state). AB was a full-term baby who has been healthy. However, her parents report that the childcare worker tells them that AB does not interact with any of the other children and her parents have concerns about her lack of words. You screen her with the M-CHAT, and she scores at risk. When you let the family know she is at risk for a diagnosis of autism spectrum disorder (ASD), they are surprised and say they don't believe she has ASD as she does not flap her hands. Of the following, the BEST next steps in partnering with AB's parents would be to A.Talk about the range of symptoms that children with ASD have, solicit input from her parents about any other developmental concerns, and share information about resources. B.Refer them for a diagnostic evaluation with a psychologist C.Provide them with resources about what ASD is (e.g., Autism Speaks) D.Tell them about the accuracy of screening tools such as the M-CHAT

A

You are seeing a child with ASD whose parents are concerned about worsening irritability and aggression. He takes risperidone which was previously effective in addressing these symptoms. In taking history you find out that he is also having difficulty getting to sleep and staying asleep. His parents also report that he has been laying over furniture, rubbing his abdomen and eating less. He has always been a selective eater, preferring processed foods over fruits and vegetables. You ask about stooling and they inform you that he is straining at hard stool and having new "accidents" consisting of "toothpaste" consistency stool in his underwear multiple times per day. His exam shows a soft abdomen that is slightly distended with scattered hard masses in the lower abdomen. You are unable to perform a rectal exam due to his anxiety and agitation. The BEST next step is A.Empiric trial of PEG 3350 for disimpaction and maintenance B.Increase his dosage of risperidone to address irritability and aggression. C.Referral to gastroenterology for further work-up D.Obtain abdominal radiographs

A

A 24-month old female who was born at-term and does not have history of developmental or medical problems comes into your office for a well-child visit. Her mother reports that the child is developing well in all areas other than language. Upon examination, you notice that the child can follow simple instructions and relies on eye contact and gestures rather than words to communicate. Her mother reports that this is typical of the child's communication preferences at home, and that she says "mama" and "dada" but no other words. The most likely cause of the patient's symptoms is A.Autism spectrum disorder B.Developmental delay C.Developmental disability D.Intellectual disability

B

AB is doing well in EI (therapists are coming to their home 3 times per week). AB's parents are still questioning whether she has a diagnosis of ASD. They state they do not know of other families of children with ASD. What should be the pediatric clinician's next steps? A.Give the parents some links to sites on the internet. B.Make a referral to a specialist to convince AB's parents of the ASD diagnosis. C.Make a list of characteristics that AB has that are consistent with ASD. D.Sit down with the family, solicit their thoughts about what a diagnosis of ASD is, and discuss what they have learned.

D

The parents of a 3-year-old child in your practice who was diagnosed with ASD after loss of language milestones and social withdrawal at around 18 months, come in for the first visit with a newborn younger sibling. They are hesitant about vaccinating the baby and refused Hep B in the hospital because of concerns about the potential for vaccines to increase risk for ASD. Of the following, the counseling you would provide would include A.Telling them that vaccines in the US are completely safe and there are never associated events. B.Reviewing the scientific evidence that does not support an association of vaccination and regression or ASD. C.Counseling them that the recurrence risk for ASD is very low and not to worry. D.Letting them know it is alright to defer vaccination until after 2 years of age because herd immunity can be counted on to offer protection

B

You are seeing a 9-year old boy with ASD whose parents are concerned with his declining academic performance. His parents and teachers report that he is easily distracted and has difficulty completing homework and other tasks. He tends to be up out of his seat frequently and seems to be constantly on the go. Regarding the evaluation, diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD) in children with ASD, which of the following statements is true? A.Medications that used for treatment are different from those used in children without ASD. B.The evaluation of a child for possible co-occurring ADHD should also include a consideration of co-occurring anxiety. C.Rating scales are not validated in children with ASD, so they are not useful in monitoring treatment. D.The Diagnostic and Statistical Manual (DSM-5) does not allow for the diagnosis of co-occurring ADHD in children with ASD.

B

Your next patient is a 13-year-old with ASD. You ask the patient's parents what their plans are for when the patient starts high school. The parents do not have an answer. Of the following, the BEST next step in working with the patient's parents would be to A.Send them to the social security office. B.Discuss that this is the beginning of their child's transition to adulthood and give the family a handout about the transition steps. C.Refer the family to the high school guidance counselor for more information. D.Refer the family to an adolescent medicine clinic.

B

A 10-year-old patient has ASD. His tested intelligence quotient (IQ), educational, and language scores are all in the average range. You are treating him with methylphenidate for his inattention. His parents are concerned that he have proper accommodations for learning at school and the school team has formalized a plan for provision of extra time for tests and a study hall to work on organizational study skills. The parents are most likely to tell you which of the following was the outcome of their meeting with school personnel? A.He will have an Individualized Educational Plan (IEP) because of the ASD diagnosis. B.He will have response to intervention to address his needs in the class setting. C.He will have a Section 504 plan to work with his attention and organization deficits. D.He will have enrichment periods in addition to his regular classes.

C

Autism spectrum disorder (ASD) affects both social communication and restrictive/repetitive behaviors. Which combination of behaviors below would meet the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria for ASD? A. Deficits in social communication and interaction including social-emotional reciprocity and nonverbal communicative behavior as well as having repetitive speech, movements, or use of objects. B. Deficits in social communication and interaction including social-emotional reciprocity, nonverbal communicative behavior, as well as having repetitive speech, movements, or use of objects and excessive adherence to routines. C. Deficits in social communication and interaction including social-emotional reciprocity and nonverbal communicative behavior, and developing and maintaining relationships as well as two restricted, repetitive behavior/interests.

C

The parents of a 4-year-old with ASD in your practice come in for a consultation with concerns about their child's progress with speech therapy. He makes few sounds and does not babble. He seems to understand what they say and will follow some instructions. He can point to pictures they label. He is the only child with ASD in his preschool program, and his speech pathologist is focusing on sound imitation. His parents note he does not imitate well. The parents are looking for guidance as to how his team might promote communication. Of the following, what might you advise them to discuss with the Committee on Preschool Special Education regarding his speech therapy? A.Plan to continue working on imitating sounds both with the therapist and in front of a mirror. B.Ordering a voice output tablet-based system as a first step for use at home to complement the speech therapy at school C.Consider implementing a simple picture system, starting with choice then building to picture exchange. D.Continue reinforcing verbal imitation since visual systems prevent learning spoken language.

C

The parents of a 6-year old with ASD and insomnia are seeing you for a follow-up visit. At the initial visit you did not identify any medical conditions that could contribute to insomnia and encouraged the family to limit screen time before bed and to work on establishing a predictable bedtime routine. The family was able to make the changes you suggested but they report it still takes him over 2 hours to fall asleep after his bedtime routine is complete. Once he falls asleep the family reports no night awakenings. He sleeps without restlessness or snoring, has good daytime energy and does not nap. The BEST next step in the management is A.Order polysomnography. B.Initiate a trial of clonidine prior to bedtime. C.Initiate a trial of melatonin prior to bedtime. D.Initiate a trial of diphenhydramine prior to bedtime

C

The pediatrician is seeing a 4-year old male child for the first time for a well-child check. The pediatrician is concerned because the child is non-verbal. Because of this, the pediatrician refers the child to be evaluated for an autism spectrum disorder (ASD). To feel more definite that the child has ASD the pediatrician asks the child's mother more questions. Which of the following helps guide the pediatrician to thinking the child has ASD? A.The child's Intelligence Quotient (IQ) is below 60. B.The child's hearing is normal. C.The child is fixated on cars, and enjoys spinning their wheels over and over again for long periods of time. D.The child had a febrile seizure at 18 months.

C

You are seeing an 8-year old boy with ASD whose parents are concerned about sleep. In taking a history, you find out that he has difficulty falling asleep and has frequent night awakenings. His parents report that they have a consistent bedtime routine and have followed your previous advice about limiting screen time before bed. After being put to bed he will make frequent "curtain calls", emerging from his room with complaints of leg pains. He frequently wakes up at night and is described as a very restless sleeper. The BEST next step in management is A.Empiric trial of melatonin B.A referral to sleep medicine for consideration of polysomnography C.Laboratory evaluation of ferritin and other indicators of iron insufficiency D.A behavioral intervention in order to reward him for staying in his room

C

You decide to bring back AB for a follow-up visit in a month, after she has been seen in early intervention (EI). The next area of discussion with AB's parents should be A.Discuss what evidence-based treatments are available. B.Talk about the different causes of ASD. C.Ask what happened at the EI evaluation and the results of the evaluation. D.Discuss what treatments might be dangerous and should not be tried by AB's parents.

C

A 15-month old male who was born at-term and does not have history of developmental or medical problems comes to your office for a well-child visit. His mother denies any concerns with behavior or development and notes that he is a sweet and independent child. Previous screening results did not indicate concerns in any area of development. However, during this visit you noticed that the child made little eye contact, repeated words and phrases, and flapped his hands when excited. You probe his mother but she continues to report typical developmental progress and no concerns at home or preschool. What is your next course of action? A.Consult a milestone checklist to see if all milestones are being met. B.Wait and see if behaviors are still present at the next well-child visit. C.Administer a general developmental screening test. D.Administer and autism-specific screening test.

D

In checking your schedule for the day, you notice that a 7-year old boy with autism spectrum disorder (ASD) is coming in whose parents are concerned about seizures. You decide to review the most recent literature about seizures in children with ASD prior to the visit. Among the following, which statement is true? A.Children with ASD and co-occurring intellectual disability are less likely to have seizures. B.Screening EEGs are recommended in asymptomatic children with ASD. C.Most first seizures in children with ASD occur before adolescence. D.Children with ASD and seizures are more likely to have behavioral challenges.

D

When it comes to an ASD diagnosis, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) requires that A.A diagnosis of ASD cannot be given in the setting of a known genetic disorder. B.A diagnosis of ASD precludes a co-occurring diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD). C.Cognitive delay must be present. D.Social communication and restrictive repetitive behaviors/interests must impair everyday function.

D

Which of the following statements is not true about the estimated prevalence of autism spectrum disorder (ASD)? A.The prevalence has been increasing in part due to changes in the diagnostic criteria over time and increased awareness of ASD among clinicians and parents. B.Boys, compared to girls, are approximately 4 times more likely to be diagnosed with ASD. C.Most children with ASD are diagnosed after 4 years of age but ASD can be diagnosed as early as 18 months of age. D.Black and Hispanic children, compared to white children, have a higher prevalence of ASD.

D

While you are seeing a 6-year old boy for his well child visit, you observe the child to have a strong desire to speak at length about sea animals. He has a vast fund of knowledge on the subject and engages in sharing his information as a monologue in a monotone voice. He makes poor eye contact and does not heed your efforts to get him to move on to another topic. When you inquire about how things are going for the child in first grade, mother shares that he is doing very well academically, is an excellent reader and great at math. The only problems that have come up relate to making friends. The teacher has told the mother that the child does not have friends and spends recess alone. The other children find his constant talk about whales annoying, and they think that he is weird. According to DSM 5, which of the following statements is true? A.This child should be evaluated for a possible diagnosis of Asperger's Disorder. B.This child should be evaluated for a possible diagnosis of Autistic Disorder. C.This child should be evaluated for a possible diagnosis of Pervasive Developmental Disorder not otherwise specified (PDD-nos). D.This child should be evaluated for a possible diagnosis of Autism Spectrum Disorder.

D

You are seeing a 2-year old toddler boy for his well child visit. The mother reports that the little boy is not yet speaking but she thinks that he understands. She sees him as very independent and notes that he can play on his own for hours. You have a hard time getting the little boy's attention by either calling his name or other means. He shows no interest in the toys in your office, preferring instead to turn over his stroller and spin the wheels. In considering your next steps, which of the following do you recommend to the mom? A.Discuss a referral to the Early Intervention program as your first step in order to get the child speech therapy. B.Discuss scheduling a hearing test as a first step and hold off on other plans until the results are available. C.Reassure the mom that because the child is understanding, he will begin to speak shortly. D.Discuss a plan of action that would involve scheduling a hearing test as soon as possible, a referral to Early Intervention, and then a plan for mom to come in thereafter to discuss the results and determine whether other medical specialists should be involved in the child's care to clarify the problem. Mention your concern about the possibility of ASD.

D

You work in a very busy practice within a large organization. The Medical Director just provided you with your clinic's ASD screening completion rate among well-child visits of children aged 18/24 months. The screening rate is low. You discuss with your medical staff barriers they are encountering with providing ASD screening. Staff reported a number of barriers. Which barrier below includes inaccurate information? A.There is not enough time in a visit. B.In a given day, there are many different types of visits, and it is hard to track which visits are for 18/24 month old children. C.I don't feel comfortable communicating to a parent a positive screen. D.We can't get reimbursed for conducting a screening.

D