unit 1 clinical presentation asperger’s syndrome presenter: dr. susana mwanza & dr. jonathan...

Unit 1 Clinical PresentationAsperger’s Syndrome

Presenter: Dr. Susana mwanza & Dr. Jonathan NcheengamwaModerator: Dr. Mpabalwani

24/11/2011

• L.F.• Female/6 yr old• Of Chilanga• Referred to UTH for Neurological Assessment• Presented to UTH on 13/10/2011 at• 09.00hrs

c/o

• Regression of speech• Inappropriate behaviour 4 6/12• Inappropriate communication • Difficulties in concentration• Hyperactivity 12/12• Not able to construct sentences

However able to read and write single words

Hx P/C

• Well till age 2• First noted change was loss of speech

developmental mile stone previously appropriately developed

PMHx

• RVT-NR• No other illneses

Birth Hx

• 1st born• Term• SVD• 3.6kg• Cried spontaneously• Pregnancy and labour uncomplicated

Feeding and <5 hx

• Breast fed in under 2hrs after birth• Weaning at 4 months• Received all vaccinations according to MOH

protocol

FHx

• Negative• No TB contact• No hx of Psychiatric disease

Socio-economic Hx

• Mother-House wife• Father-planner

examination

• Temp 35.3 deg. Celsius• Wt-22kg• Ht 123cm• Fully conscious• Afebile• Exhibiting inappropriate behaviour with• Occasional screeming

Examination

• RS• CVS Normal• P/A

Problem

• Delayed neuro-psycho-social development

Plan

• Consult neurologist and Child psychiatrist• Follow up in clinic 2 under Unit 1

Clinic 2 review (26/10/11)

• Delayed speech• Hyperactivity• Neonatal period-No jaundice• Sat by 6/12• Stood at 9/12• Able to feed self• Able to toilet self

Social Hx

• Moody• Plays alone 9even when in a group of children)• Hardly ever hugs with mum-hits her

sometimes• Sometimes hits self• Can use computer on his own and captures

new words easily• Says a word at a time

examination

• Alert• Hyperactive• Inappropriate behaviour-moving all over

examination room• No dysmorphism• Systemic exam normal• Normal testis

Problems

• Hyperactivity• Speech delay• Autistic behaviour

Review (same day0

• Noted hx of using computer beyond neurologic age

• Tends to learn things on his own• Mum says unable to sustain conversations• But, able to read

O/E

• Alert• In his own world• Not hyperactive

Diagnosis

• Asperger’s syndrome

Plan

• To UNZA School of Education for psycosocial assessment

• Review in 3/52 in clinic 2

Highlights of UNZA assessment

• Hyperactive tendencies• Not able to sit in one place• Always making sounds and statements• Did not make eye contact when being talked

to• Unable to take formal assessment• Instead, Special Needs Assessment profile

(SNAP) was administered

Diagnosis

• Autistic spectrum Disorders-Asperger’s Syndrome

Review (9/11/2011)

• Based on recommendations made at UNZA, mum was counselled

• To have child enrolled to special school (Baobab or UTH)