A 3-year-old child lacks joint attention, does not point to share interest, has no meaningful two-word phrases, plays with toys repetitively (spinning wheels), and does not engage in pretend play. He reacts intensely to changes in routine. What is the most likely diagnosis and the key first-line evidence-based intervention?
- A Autism spectrum disorder — Applied Behaviour Analysis (ABA) therapy ✓
- B Global developmental delay — speech therapy alone
- C Intellectual disability — special education
- D ADHD — methylphenidate
Explanation
The presentation fulfils DSM-5 criteria for autism spectrum disorder (ASD): persistent deficits in social communication (no joint attention, no pointing, no two-word phrases) and restricted repetitive behaviours (stereotyped toy use, insistence on sameness). Early intensive Applied Behaviour Analysis (ABA) is the highest-quality, evidence-based intervention with demonstrated gains in language, cognition, and adaptive behaviour when started before age 5. Global developmental delay implies impairment across all domains; speech therapy alone is insufficient for ASD. ADHD does not account for repetitive behaviours or social communication deficits.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.