Preschool children who have atypical patterns of development.

Abstract

1. Mark D. Simms, MD, MPH* 2. Robert L. Schum, PhD† 1. 2. *Editorial Board. 3. 4. †Pediatric Psychologist, Child Development Center, Children’s Hospital of Wisconsin; Associate Professor of Pediatrics, Medical College of Wisconsin, Milwaukee, WI. After completing this article, readers should be able to: 1. Describe the probability of identifying a specific etiology for mental retardation. 2. Delineate the strongest influences on young children’s language development. 3. Explain how autism can be distinguished from other disorders. 4. Describe the evaluation of preschool children who have atypical patterns of development. At 42 months of age, CG, a sturdy appearing Caucasian male, was unable to communicate clearly because of speech and language difficulties. His parents reported that he spoke “90% gibberish and 10% words” and often answered questions irrelevantly by reciting the alphabet or a nursery rhyme. Although very affectionate, he did not interact much with peers. His behavior was mostly self-directed, and he had difficulty maintaining attention to therapist-directed tasks. He was easily overstimulated and often flapped his arms with excitement. He also was observed to shake his head repetitively, stare at objects, and arrange his toys in straight lines. He became very upset if his toys were moved by someone else. His father, a computer software engineer, was reported to have started talking “late” and had had difficulty with reading in elementary school. Nonverbal cognitive testing found CG’s intelligence to be within the average range, but his language abilities were at the level of a 26-month-old. His articulation errors varied, depending on the length of his utterance, and he had a disorder of syntax (grammar) and semantic (word meaning) language . Children who have atypical patterns of development are a diagnostic challenge in the preschool years. Delayed or inappropriate use of language often is the most prominent symptom, and it frequently is accompanied by unusual social interaction patterns, odd behaviors, or limited play skills. Atypical behaviors include those considered to be uncommon, such as perseveration on specific activities, adherence to strict daily rituals, aloofness, and echolalia (repeating words, phrases, …