Autism Spectrum Evaluation

Voiceover: Welcome to NP Certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Expert Fitzgerald faculty clinicians share their knowledge and experience to help you dissect the anatomy of a test question so you can better understand how to arrive at the correct test answer. So, if you're ready, let's jump right in.

Sally Miller: A three-year-old child is being seen because the daycare facility staff have suggested to the parents that the child is having difficulty interacting with other children. Additionally, the staff have observed that when the child seems to become anxious or upset, he always becomes fixated on stacking building blocks one on top of the other to the extent that he will not acknowledge anyone or anything else. When the parents ask if their child has autism spectrum disorder, the psychiatric mental health nurse practitioner advises the parents that:

A. The repetitive and predictable nature of stacking blocks is calming in children with autism spectrum disorder.

B. Stacking blocks is a very typical activity in children at this developmental stage and is not suggestive of ASD.

C. The child should be tested for ASD, but in any event, he should be discouraged from using building blocks as a coping mechanism

D. While the social dysfunction at this age may suggest ASD, the building block activity is not an abnormal finding in a three-year-old.

This is a great example of one of those questions where you think you may think you'd have the correct answer and then you look at the answer choices and you don't like any of them. or let me rephrase that. You do know the correct answer and you look at the four available answer choices and you don't like any of them. But you have to pick one because that's the nature of your certification exam.

So when you don't love any answer or of course conversely when you do love every answer choice and you have to pick it really is important to make sure that you number one answer exactly what is being asked of you as best you can and two that that everything in that answer choice is a correct statement. even if you don't necessarily think it's perfectly responsive to the question, it has to be a correct statement.

So, as we as I look through these answer choices, because frankly, I don't love every one of them. I don't think any one of them is a perfect answer. The bottom line here is the parents are bringing in their three-year-old. The daycare staff say that number one, the child is having difficulty interacting with others. And when he gets upset or anxious, he like zooms in on stacking blocks to the exclusion of other stimuli. He won't acknowledge anyone else or you know anything. So, you advise the parents that. Well, let's see. A says the repetitive and predictable nature of stacking blocks is calming in children with ASD. That's a true statement. I don't know that it actually answers the question directly, but it is a true statement.

B says stacking blocks is very typical in the children in children at this developmental stage and is not suggestive of ASD. Ask yourself if this is a true statement. Recall the child in this question stacks blocks when he's upset and becomes so fixated that he doesn't acknowledge anything or anyone else. Do you think that's uh normal at that developmental stage? I don't.

Then C says the child should be tested for ASD, but in any event, he should be discouraged from using building blocks as a coping mechanism. Well, he probably should be evaluated for ASD. However, he should not be discouraged from using blocks as a coping mechanism. If in fact the child is on the spectrum, those building blocks are a coping mechanism that helps manage anxiety and so shouldn't be discouraged. So, you know, C is not a good choice here because half of it's just flatout not true. Whether he's got ASD or not, we're not going to discourage him from using a coping mechanism that is calming and um soothing and doesn't hurt anybody.

And then D says, "While the social dysfunction at this age may suggest ASD, remember he's not interacting with other kids, the building block activity is not an abnormal finding." And again, we come back to this business of that activity at 3 years old is not a normal finding. Three-year-olds don't typically become so fixated on stacking blocks that to the exclusion of everything else around them. And so while we may not love every one of these answer choices, A is the correct answer because it's the best answer of those provided, it is a well acknowledged fact that the repetitive and predictable nature of stacking blocks one on top of the other or lining them up side by side. You know, you get the idea of the activity. This repetitive predictable nature really does reduce anxiety and provides like a sense of relief. It's it provides a sensory input and a sense of control in children with ASD. And they often turn to that as a it's a positive or desirable way for them to develop some control and relieve their anxiety. It's true.

B is just it's not correct. The hyperfixated activity to the exclusion of other stimuli is not typical developmental display at three years old. C is not correct. Like I said, while the child should have a full evaluation, he should not be discouraged from using the blocks. Whether he has autism spectrum disorder or not, he should not be discouraged from using the blocks. And D is not correct because autism spectrum disorder does require both a social dysfunction as well as restrictive repetitive patterns. I mean, uh, you're not expected to be able to recite every single diagnostic criteria for autism spectrum disorder for your boards, but you are expected generally to know that autism spectrum disorder is a disorder that most often becomes evident in those early childhood years. You know, some kids as early as 12 months old, but somewhere between two and three or two and four is the most common time that it becomes evident. And it is characterized by a persistent deficit in some sort of social phenomenon, social interaction, social phenomenon, and demonstrated uh restricted repetitive patterns of behavior or attention. You know, particular itemizations of each one. You don't need to regurgitate all of that for your boards, but you do want to know that a diagnosis of ASD is characterized minimally by persistent deficits in social function and restricted repetitive patterns of behavior.

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