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Abstract
Purpose: we present a case report on a boy with autism spectrum disorder (ASD) to illustrate the differential diagnostic questions that can emerge when working with such subjects.
 Case report: ASD is defined with qualitative deficits in social interactions, communications, and interests and activities. In the subject of this report these symptoms are influenced by a doubly disadvantage background. First, the boy belongs to an ethnicity known for its reservedness in communication – not only with strangers but also within their own families. Second, he was further disadvantaged by his specific microfamily environment.
 Conclusion: a doubly disadvantaged background appears to have interfered with the subject's development; consideration of this background was crucial for understanding his condition
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