Understanding Roman's Developmental Concerns

Dr Jumoke Ojo CT3 RCH Aberdeen Dr Murray Smith Consultant Psychiatrist, RCH Aberdeen Autism

Presentation Mrs Caroline is here to speak with you regarding concerns about her son Roman's speech. Roman is 5 years, but she has noticed that he isn't developing like his 8 year old sister Siobhan or his 10 year old brother Kendall Roy. Roman's vocabulary is limited to 3 or 4 words, and he doesn t like to play with other children, sits on his own. His hearing and vision have been tested and found to be fine. The GP has referred her to be reviewed for possible Autistic spectrum condition. You are to take a focused history, looking out for possible signs/symptoms of Autism

What would you like to know about Roman'sspeech/Communication

Roman said his first word at the age of 4, and his first word was pen. His vocabulary is limited to 4 words: Pen, wheel, food and car. Answers He hardly communicates, and usually points to something if he needs it. He sometimes gets frustrated when he wants something and throws a tantrum sometimes He is yet to say mummy or daddy which worries Mrs Roy.

What do you want to know about his social interaction

Social interaction/play Roman Plays alone, leaves if anyone tries to come and join him to play He goes to nursery, teachers have noticed he doesnt play with anyone, wants to be alone, doesn t join in circle time Does not like to hug anyone, wants to stay on his own Avoids eye contact,

What do you want to know about his interests?

Answers Roman likes to play with pens. He gathers pens and has a whole dresser full on pens in his room. He likes to line them up in very curvy lines and can sit and do this for hours. Roman gets upset if his pen arrangement is scattered or moved in the slightest way. He is preoccupied with the pens, he is also very preoccupied with the washing machine, and would watch It spin for hours . He doesn t like change or surprises. For example, he gets upset if they have to end play time a bit early. He likes to rock back and forth repeatedly

What would you like to know in terms of developmental /Family history?

Answers Roman's pregnancy was planned. Pregnancy went very smooth with no complications Not on any medication while pregnant No drinking or smoking while pregnant He smiled at 4 months, crawled at 9 months, walked at 1 year, but didn t talk as mentioned previously till he turned 4 No physical health problems His father Logan Roy has a diagnosis of ADHD/problems with anger management His cousin, 'Cousin Greg' has a diagnosis of Autism

What comorbidities do you want tofindout about?

Roman's mood is fine, he sleeps and eats well. He is able to keep up with his interests There has been no psychotic symptoms Answers Roman can sit still especially when looking at the washing machine. He has very good concentration and doesn t like to be disturbed when concentrating on his favorite activity.

What else do you want to find out from his mom? Hint: Risk

Answers No worries about Roman's safety Thankfully no self injurious behaviour They try to manage his tantrums calmly when they happen. No physical abuse from Logan Roy (father), however he has recently left his wife to be with another woman in Newyork :)!

For more Reading: 1. Nice guidelines on Autism: https://www.nice.org.uk/guidance/cg128 2. Video from National Autistic society from the eyes of people with autism: https://www.youtube.com/watch?v=xTLUYda-0O8 3. ICD-11 Criteria for diagnosis of Autism:https://icd.who.int/browse11/l- m/en#/http%253a%252f%252fid.who.int%252ficd%252fentity%252f437815624