A 2-year-old boy has no words, no pointing, and no social smiling. He does not respond to his name, engages in repetitive spinning of objects for hours, and resists change in routine. Which is the MOST appropriate first-line therapy?

• A Applied Behavior Analysis (ABA) therapy ✓
• B Risperidone to reduce stereotypies
• C Play therapy with parental observation
• D Methylphenidate for attention difficulties

Explanation

This clinical picture is consistent with Autism Spectrum Disorder (ASD): absent language, absent joint attention (pointing), absent response to name, repetitive behaviors, and restricted interests. The most evidence-based first-line therapy for ASD is Applied Behavior Analysis (ABA), which uses operant conditioning principles to reinforce desired behaviors and reduce maladaptive ones. Early intensive ABA (20–40 hours/week in young children) has the strongest evidence for improving communication, social skills, and adaptive behavior. Risperidone is FDA-approved for irritability and aggression associated with ASD but not for core ASD features and is not first-line. Methylphenidate targets ADHD, not ASD. Play therapy lacks evidence as a standalone intervention in ASD.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.