Autism Spectrum Disorder

Adam’s Story

Adam, a 12-year-old boy, was brought in by his mother for psychiatric evaluation. He had temper tantrums that were causing problems for him at school. She said that school had always been stressful for Adam and that it had become worse after he entered middle school.

Adam’s sixth-grade teachers reported that he could do classroom work, but that he had a hard time making friends. He seemed to mistrust the motives of classmates who were sincere and nice to him. Instead, he believed others who laughed and faked interest in the toy cars and trucks that he brought to school. The teachers noted that he often cried and rarely spoke in class.

When interviewed one-on-one, Adam mumbled when asked questions about school, classmates and his family. When asked if he like toy cars, however, Adam lit up. He pulled out several cars, trucks and airplanes from his backpack. He did not make good eye contact but talked at length about the vehicles, using their correct names, such as front-end loader, B-52 and Jaguar.

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Adam spoke his first word at age 11 months and began to use short sentences by age 3. He had always been very focused on trucks, cars and trains. His mother said that he had always been “very shy” and had never had a best friend. He struggled with childhood jokes and banter because “he takes things so literally.” Adam’s mother had always seen this behavior as “a little odd.” She added that this behavior was like that of Adam’s father, a successful lawyer, who had the same focus in his interests. Both of them were “sticklers for routine” who “lacked a sense of humor.”

During the exam, Adam was shy and made below-average eye contact. The doctor diagnosed him with autism spectrum disorder without intellectual impairment. Adam has trouble interacting with classmates and holding a conversation — both symptoms of social communication problems. Adam also has fixed interests — he is interested in cars and trains and little else. Perhaps because his autism spectrum symptoms were like his father’s behavior, his mother viewed Adam as “a little odd” but did not seek an evaluation and diagnosis.