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Autism Spectrum Disorder

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Testing Sensory and Multisensory Function in Children with Autism Spectrum Disorder

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Challenging Case: New-Onset Hallucinations and Developmental Regression in a Child with Autism Spectrum Disorder.

Aanchal Sharma¹, Demetra Pappas¹, Joseph Gonzalez-Heydrich²

¹Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Brookline, MA.

Journal of Developmental and Behavioral Pediatrics : JDBP

|April 11, 2024

Summary

A 5-year-old boy with autism spectrum disorder developed psychosis with hallucinations, leading to language decline. Medical evaluations revealed specific abnormalities, prompting a search for advanced interventions.

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Area of Science:

Neurodevelopmental Disorders
Pediatric Psychiatry
Behavioral Science

Background:

A 5-year-old boy diagnosed with autism spectrum disorder (ASD) initially responded well to applied behavioral analysis (ABA) therapy.
He later developed psychosis, experiencing hallucinations and a significant decline in expressive language and social interaction.
Despite trials of various medications and therapies, his challenging behaviors and symptoms persisted.

Purpose of the Study:

To present a complex case of a child with autism spectrum disorder and comorbid psychosis.
To detail the diagnostic process, including extensive medical evaluations.
To explore potential interventions and the expected developmental trajectory for such cases.

Main Methods:

Case report detailing a 5-year-old boy's clinical presentation, diagnosis, and treatment history.
Review of extensive medical evaluations including MRI, urine organic acids, and antibody testing.
Description of current educational and therapeutic interventions, including ABA, speech, occupational, and music therapy.

Main Results:

Medical evaluation revealed dilated perivascular spaces, ketosis, increased lactic acid, minimally positive antinuclear antibody, and elevated Vitamin B12.
Other extensive studies, including genetic testing and EEG, were normal.
The child continues to exhibit significant behavioral challenges, including head-banging, hyperactivity, aggression, and self-care deficits, alongside persistent response to internal stimuli.

Conclusions:

This case highlights the complexity of managing autism spectrum disorder with comorbid psychotic symptoms in a child.
The identified medical findings warrant further investigation for potential underlying conditions or treatment targets.
Multidisciplinary intervention and ongoing assessment are crucial for managing developmental and behavioral challenges and planning for future trajectory.