Autism Case Training:
A Developmental-Behavioral Pediatrics Curriculum
3
Early Warning Signs of Autism Spectrum Disorder
Why is This Case Important?
Evidence-based educational and interventional strategies can help children learn and build
competency in areas of need. Many of these strategies are most effective when introduced
early. It is important to be proactive regarding developmental concerns, and it is imperative
pediatricians be able to detect early warning signs of developmental delays. In the United
States, autism spectrum disorder (ASD) is usually diagnosed in children between 3 and 7 years
of age. However, studies have shown that parents usually have concerns about their child’s
development, especially social development, at or before 18 months of age.
The risk factors for receiving a later diagnosis of an ASD include:
• Having many primary care providers rather than seeing one consistent provider
• Living in a rural area compared with an urban setting
• Living in a near-poor household versus a wealthy household
Children who have severe language decits and/or display the symptoms of hand apping or toe
walking are more likely to be diagnosed earlier.
Introduce the
session goal
and format of
the case study
Slide 1-2
Cultural Competence
It is important for clinicians to understand how different childrearing practices and cultural
norms may inuence key decisions that parents make regarding their child including obtaining
evaluations and treatment, future planning, and acceptance of the child’s diagnosis. Clinicians
can approach parents openly and honestly by asking them about their unique style of
parenting and how the information or recommendations provided are received.
See the curriculum introduction for additional information on cultural competence and potential
discussion questions.
This case does not take
place in a clinical setting.
This unique setting and
the role of the physician
in addressing family
medical concerns may
provide an interesting
line of discussion.
Getting Started
This case is designed to be an interactive discussion of a scenario residents may encounter in their practices.
Participation and discussion are essential to a complete learning experience. This Facilitator’s Guide provides
potential prompts, suggestions for directing the discussion, and ideas for incorporating the optional teaching tools.
It is not designed as a lecture.
Case study icons:
Call-out: step-by-step teaching instructions
Note: tips and clarication
Slide: optional slide, if using PowerPoint
Filmstrip: optional slide contains an embedded video
Paper: potential place to distribute an optional handout
:3 0
Digital clock: tips if you only have ‘30 Minutes to Teach’
Autism Case Training:
A Developmental-Behavioral Pediatrics Curriculum
4
Early Warning Signs of Autism Spectrum Disorders
Case Study Part I
You are attending a family reunion and during a quiet moment, your cousin Elizabeth
takes you aside and asks you what you think about the development of her son, Mark.
She tears up as she tells you how worried she is about him. Mark will be 2 years old next
month, and he seems so different from the other children on the playground. Although he
is an affectionate and happy little boy, his behaviors can be so unpredictable. He is very
shy and has terrible temper tantrums. It is usually impossible to reason with him. Small
changes in his routine throw Mark off, and Elizabeth is worried that he won’t be able to
handle the crowd at this family gathering without causing a scene. You ask her what her
pediatrician thinks.
Elizabeth tells you that Mark has been seen by his pediatrician, and she has expressed
her concerns about his temper tantrums on a few visits. Mark enjoys going to the
doctor’s ofce because they have a large tropical sh tank, and he has generally been
calm in that setting. Mark’s doctors have all been very reassuring, and think he has a
bad case of the “terrible twos.” The doctor has told her to “give him some time; he is still
young and will likely grow out of this phase.”
You have been preoccupied by your relatives, and you honestly haven’t been paying
too much attention to Mark. You know that your cousin is a doting and caring mother.
Elizabeth and her husband, Sam, had fertility struggles, and she was thrilled to give birth
to Mark after a grueling course of in-vitro fertilization treatments. You know that Mark was
born full term without any complications. You heard that he was a fussy baby, but that he
was otherwise healthy.
Distribute “Case
Study Part I”
Slide 3
Slide 4
:3 0
Follow up with
student responses
to encourage more
discussion:
• What in the case
supports that?
• Why do you
think that?
• What makes you
say that?
Case Study Part I: Discussion Question
After reading the case, ask participants, “What stands out to you about the
mother’s concerns?”
Case Study Part I: Potential Prompts
1.1 What are some key developmental milestones for ages 6 months to 4 years?
1.2 It is evident that Elizabeth is concerned about Mark’s “shy” manner. What are typical
social skills that most children obtain by 12 months? By 18 months? By 24 months?
1.3 How can you determine the difference between a child with a shy temperament and a
child with an autism spectrum disorder?
1.4 As you begin to ask Elizabeth about her son, what other developmental milestones
do you want to consider?
1.5 How could you address Elizabeth’s concern about Mark’s temper tantrums?
1.6 What are the strengths of this child and family?